Reducing Patient Care Delays in Radiation Oncology via Optimization of Insurance Pre-Authorization

PURPOSE/OBJECTIVE(S)

Difficulties and delays in insurance pre-authorization (pre-auth) can negatively impact patient care, resulting in postponing, modifying, or even cancelling radiation therapy for patients. Unfortunately, pre-auth delays are not uncommon. The purpose of our project was to perform a root cause analysis of reasons for pre-auth delays, and implement solutions to optimize our workflow to better serve our patients. Our primary objectives were to decrease the mean time for clinical treatment plan (CTP) completion, and for number of cases delayed/denied, by 50% each.

MATERIALS/METHODS

We performed a root cause analysis of reasons for pre-auth delays and used the PDSA & A3 quality improvement methods. We sampled ∼2 cases per disease site (total 19 cases from July - Aug 2022) to determine the "current state," pre-interventions. Countermeasures included: 1) customizing our CTP templates for each disease site to contain the specific clinical information required by each insurer, 2) formalizing earlier completion of CTPs through task automation at time of scheduling CT simulation in our Care Path, and 3) continuously refining our countermeasures based on monthly status updates and department meetings. We tracked various physician, authorization, and outcome-metrics between October 2022 and January 2023, including mean time for CTP completion, % usage of our Care Path, % usage of revised CTP templates, mean time until pre-auth initiated & completed, % of cases requiring peer-to-peer phone calls, and % of cases denied/delayed.

RESULTS

There were 417 patients from a variety of disease sites who had a CT simulation at our institution between October 1, 2022, and January 31, 2023. Mean time for CTP completion (from the time of CT simulation request) improved from 16 days at baseline to 7 days by the end of the project. In the beginning, only 5% of CTPs were completed within 2 days of scheduling the CT simulation, and this improved to 42-56% during the project period. Percent usage of the Care Path improved dramatically from 16% to 91%, as did % usage of our revised CTP templates, from 0% to 96%. Despite initial lag in pre-authorization team workflow changes, the % of pre-authorizations initiated by day 3 from CT request improved from 32% at baseline to 48% by month 4. Mean time to complete insurance pre-authorizations improved from 16 days at baseline to 10 days. The percent of cases requiring peer to peer or were denied was reduced significantly from 32% at baseline to 4-11%.

CONCLUSION

Improvingtimeliness and details of CTP documentation by using our Care Path and revising CTP templates improved efficiency of insurance pre-auth completion, and reduced the number of cases delayed/denied.

Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care

OBJECTIVE

The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis.

METHODS

We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded.

RESULTS

We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers.

CONCLUSION

In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.

Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry

BACKGROUND

Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months.

METHODS

We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed.

RESULTS

We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05).

CONCLUSION

While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.

Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis

BACKGROUND

Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry.

METHODS

In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months.

RESULTS

One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability.

CONCLUSION

High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.

Screening two biodegradable polymers in enhanced efficiency fertiliser formulations reveals the need to prioritise performance goals

Enhanced efficiency fertilisers (EEF) may reduce nitrogen (N) losses and improve uptake efficiency through synchronising N release with in-season plant requirements. We hypothesised that EEF formed via matrix encapsulation in biodegradable polymers will improve N use efficiency when compared to conventional urea fertiliser. This hypothesis was investigated for two biodegradable polymer matrices: polyhydroxyalkanoate (PHA), containing 11.6% urea (by mass), and polybutylene-adipate-co-terephthalate (PBAT), containing either 19.4 or 32.7% urea; and two contrasting soil types: sand and clay. Nitrogen availability and form was investigated under leaching conditions (water) with a growth accelerator pot experiment involving a horticultural crop and novel non-destructive three-dimensional scanning to measure in-season biomass development. The PBAT 32.7% formulation enabled greater above ground biomass production at both 50 and 100 kg N ha^-1 equivalent application rates compared to conventional urea. For the sandy soil, plant scanning indicated that improved uptake performance with PBAT 32.7% was probably the result of greater N availability after 25 days than for conventional urea. Two of the encapsulated formulations (PHA and PBAT 19.4%) tended to decrease nitrogen leaching losses relative to urea (P < 0.05 for the red clay soil). However, decreased N leaching loss was accompanied by poorer N uptake performance, indicative of N being less available in these biopolymer formulations. A snapshot of nitrous oxide emissions collected during peak nitrate concentration (prior to planting and leaching) suggested that the biopolymers promoted N loss via gaseous emission relative to urea in the sandy soil (P < 0.05), and carbon dioxide emissions data suggested that biopolymer-carbon increased microbial activity (P < 0.1). Controlled testing of N release in water was a poor predictor of biomass production and leaching losses. The diverse behaviours of the tested formulations present the potential to optimise biopolymers and their N loadings by taking into account soil and environmental factors that influence the efficient delivery of N to target crops. The greater N uptake efficiency demonstrated for the PBAT 32.7% formulation confirms our hypothesis that matrix encapsulation can enable better synchronisation of N release with crop requirements and decrease leaching losses.

An investigation of radiographers' and radiologists' perceptions and attitudes in Kuwait towards extending radiographers' role in mammography

INTRODUCTION

Kuwait has a shortage of radiologists, especially in mammography, resulting in increased workload and longer waiting times for women receiving imaging investigations. This study looked at how radiographers and radiologists perceived radiographers' role extension (RE) in mammography, and whether this could reduce radiologist workload, thereby improving patient service and waiting times.

METHODS

A single case study design with 10 radiographers (mammographers) and 10 radiologists was undertaken across multiple sites: hospitals, screening clinics and specialist centres in Kuwait. Data included individual semi-structured interviews, documentary analysis and field notes. Perceptions were examined under a theoretical framework, Abbotts' System of Professions.

RESULTS

Two main themes were identified, firstly in examining the current role of radiographers in mammography and areas of interest for extending role, this highlighted insufficient knowledge of the concept. The second focused on in-depth understanding of drivers and barriers to RE in mammography, both groups opposed radiographers performing extended tasks without radiologist supervision.

CONCLUSION

Radiologists and radiographers' attitudes were influenced by concepts of professional identity and professional identity formation. Insufficient professional knowledge negatively affected the radiographers' readiness to undertake RE in mammography. Radiologists are reluctant to blur boundaries, enabling them to maintain and control jurisdiction of their own profession and that of radiographers, thereby, as discussed in Abbott's theory, limiting impact on workload or waiting times.

IMPLICATIONS FOR PRACTICE

Whilst RE is limited, to improve workload and patient waiting times, setting up an educational programme for radiographers specialising in mammography would be an important step to extending the radiographers' role. The study highlighted a need to educate radiographers to undertake breast ultrasound and amend policy to introduce training programmes for radiographers. Radiographer rotation across the various radiographic modalities negatively affected radiographers' performance, placing well-trained radiographers permanently within the mammography department should improve experience and overall skills.

Use of Smartphones, Computers and Social Media Among People with SMI: Opportunity for Intervention

Mobile technology provides a unique opportunity to expand access to evidence-based interventions. The objective of this study was to provide an update regarding use of technology in people with serious mental illness (SMI). In 2017, 403 people in treatment for SMI were surveyed. Technology use was common: 65.8% used a smartphone, 53.6% used the Internet on a computer or tablet in the past 6 months, and over two thirds (67.9%) used social media. Rates of technology and Facebook use were similar to rates among low-income Americans. Approximately three quarters were willing to use a device to access interventions for stress, health and mental health. Younger adults were more likely to use most forms of technology and social media compared to older adults, but willingness to try technology-delivered interventions did not vary by age. This survey supports the rationale for ongoing development and testing of digital interventions for people with SMI.

Total intravenous anaesthesia with ketamine, medetomidine and guaifenesin compared with ketamine, medetomidine and midazolam in young horses anaesthetised for computerised tomography

BACKGROUND

There is no information directly comparing midazolam with guaifenesin when used in combination with an alpha-2 agonist and ketamine to maintain anaesthesia via i.v. infusion in horses.

OBJECTIVES

To compare ketamine-medetomidine-guaifenesin with ketamine-medetomidine-midazolam for total intravenous anaesthesia (TIVA) in young horses anaesthetised for computerised tomography.

STUDY DESIGN

Prospective, randomised, blinded, crossover trial.

METHODS

Fourteen weanlings received medetomidine 7 μg/kg bwt i.v. and anaesthesia was induced with ketamine 2.2 mg/kg bwt i.v. On two separate occasions horses each received infusions of ketamine 3 mg/kg bwt/h, medetomidine 5 μg/kg bwt/h, guaifenesin 100 mg/kg bwt/h (KMG) or ketamine 3 mg/kg bwt/h, medetomidine 5 μg/kg bwt/h, midazolam 0.1 mg/kg bwt/h (KMM) for 50 min. Cardiorespiratory variables and anaesthetic depth were assessed every 5-10 min. Recovery times after the infusions ceased were recorded and recovery quality was assessed using a composite score system (CSS), simple descriptive scale (SDS) and visual analogue scale (VAS). Multivariable models were used to generate mean recovery scores for each treatment and each recovery score system and provide P-values comparing treatment groups.

RESULTS

Anaesthesia was uneventful with no difference in additional anaesthetic requirements and little clinically relevant differences in cardiopulmonary variables between groups. All horses recovered without incident with no significant difference in recovery times. Quality of the anaesthetic recovery was significantly better for the KMM group compared with the KMG group using the CSS (P<0.001), SDS (P<0.001) and VAS (P<0.001).

MAIN LIMITATIONS

No surgical stimulus was applied and study animals may not represent general horse population.

CONCLUSION

Midazolam is a suitable alternative to guaifenesin when co-infused with ketamine and medetomidine for anaesthesia in young horses undergoing noninvasive procedures. Both infusions produce a clinically comparable quality of anaesthesia; however, recovery from anaesthesia is of a better quality following an infusion of ketamine-medetomidine-midazolam.

Anaerobic co-digestion of pig manure and algae: impact of intracellular algal products recovery on co-digestion performance

This paper investigates anaerobic co-digestion of pig manure and algae (Scenedesmus sp.) with and without extraction of intracellular algal co-products, with views towards the development of a biorefinery concept for lipid, protein and/or biogas production. Protein and/or lipids were extracted from Scenedesmus sp. using free nitrous acid pre-treatments and solvent-based Soxhlet extraction, respectively. Processing increased algae methane yield between 29% and 37% compared to raw algae (VS basis), but reduced the amount of algae available for digestion. Co-digestion experiments showed a synergy between pig manure and raw algae that increased raw algae methane yield from 0.163 to 0.245 m(3) CH4 kg(-1)VS. No such synergy was observed when algal residues were co-digested with pig manure. Finally, experimental results were used to develop a high-level concept for an integrated biorefinery processing pig manure and onsite cultivated algae, evaluating methane production and co-product recovery per mass of pig manure entering the refinery.

Enhanced biogas production using cow manure to stabilize co-digestion of whey and primary sludge

Increasing biogas production from municipal anaerobic digesters via additional loading with industrial/agricultural wastes offers a low-cost, sustainable energy generation option of significant untapped potential. In this work, bench-top reactors were used to mimic a full-scale primary sludge digester operating at an organic loading rate (OLR) of 2.4 kg COD/m3 d and a 20 d hydraulic retention time (HRT). Co-digestion of whey with primary sludge was sustained at a loading rate of 3.2 kg COD/m3 d (17 d HRT) and boosted gas production to 151% compared to primary sludge digestion alone. Addition of chemical alkalinity enabled co-digestion of whey with primary sludge to be maintained at an elevated OLR of 6.4 kg COD/m3 d (11 d HRT) with gas production increased to 208%. However, when the chemical addition was simply replaced by cow manure, stable operation was maintained at OLRs of 5.2-6.9 kg COD/m3 d (11-14 d HRT) with gas production boosted up to 268%.

Microaerophilic conditions support elevated mixed culture polyhydroxyalkanoate (PHA) yields, but result in decreased PHA production rates

For commercial polyhydroxyalkanoate (PHA) production the objective is to maximise the fraction of feedstock that ends up as polymer, and minimise biomass growth. In this paper, oxygen limitation was applied to achieve this. Intracellular PHA content in mixed cultures in batch systems operated with low and high DO was compared. It is shown that in microaerophilic conditions a higher fraction of substrate is accumulated as PHA in comparison to high DO conditions, evidenced by elevated intracellular PHA content: in the order of 50% higher in the early stages of accumulation. However, the accumulation capacity is not affected by DO. The PHA content in biomass in both the low and high DO systems reached approximately 35%. The time taken for the PHA content in the low DO system to reach capacity was three times longer than in the high DO system.

Microbial community analysis during continuous fermentation of thermally hydrolysed waste activated sludge

Acidogenic fermentation of thermally hydrolysed waste activated sludge was carried out at laboratory scale in two reactors operated under different hydraulic retention times (HRT). Process performance was assessed in terms of volatile fatty acid (VFA) composition and yield. The diversity of the microbial population was investigated by constructing a 16S rRNA gene library and subsequent phylogenetic analysis of clones. Fluorescence in situ hybridization (FISH) was used to assess the relative abundance of different bacterial groups. Bacteroidetes and Firmicutes were the dominant taxonomic groups representing 93% of the total sequences obtained in the reactor with 4 d HRT. A similar VFA yield (0.4-0.5 g VFA(COD) g SCOD(-1)) was obtained for the HRTs tested (1-4 d), indicating that extended retention times were not useful. Within Firmicutes, Clostridia was the major group detected in the clone sequences. These had close affiliation to Sporanaerobacter acetigenes, suggesting organisms of this group were important for hydrolysis of the protein fraction of the substrate. However, FISH analysis failed to detect the major portion of the bacteria, and this is most likely due to the lack of appropriate probes. This work emphasizes the diversity of fermentative communities, and indicates that more work is needed to identify and detect the important members.

Chemical techniques for pretreating and regenerating active slag filters for improved phosphorus removal

Active slag filters are an emerging technology for removing phosphorus (P) from wastewaters. Recent research revealed that adsorption onto Fe oxides/oxyhydroxides at near-neutral pH and oxidizing Eh is the key mechanism of P removal by melter slag filters. Currently, filter lifespan is limited by available adsorption sites. This study examined whether the performance and longevity of active filters could be improved via chemical treatment to create additional reactive sites as well as regenerate exhausted ones. Fresh original melter slag as well as slag from an exhausted full-scale filter was tested. Chemical reagents that could manipulate the pH/Eh of the slag granule surfaces and potentially activate them for further P removal were used, namely hydrochloric acid (HCI), sodium hydroxide (NaOH) and sodium dithionite (Na2S2O4). Waste stabilization pond effluent was then applied to the treated slag to assess the effectiveness of the treatments at improving P removal. Fresh slag treated with Na2S204 and HCl, respectively, retained 1.9 and 1.4 times more P from the effluent than the untreated fresh slag. These reagents were even more effective at regenerating the exhausted slag, increasing total retained P by a factor of 13 and six, respectively, compared with untreated slag. Sodium hydroxide was ineffective at increasing P removal. The higher P retention by the 'treated exhausted slag' compared with the 'treated fresh media' indicates that adsorption sites on melter slag filters become increasingly reactive with time. This research is the first study to provide evidence that P retention by active slag filters can be increased by both (1) chemical pre treatment and (2) chemical post-treatment once their P removal is exhausted, thereby potentially transforming them from a single use system to a more viable, reusable treatment technology.

Production of volatile fatty acids by fermentation of waste activated sludge pre-treated in full-scale thermal hydrolysis plants

This work focuses on fermentation of pre-treated waste activated sludge (WAS) to generate volatile fatty acids (VFAs). Pre-treatment by high-pressure thermal hydrolysis (HPTH) was shown to aid WAS fermentation. Compared to fermentation of raw WAS, pre-treatment enabled a 2-5x increase in VFA yield (gVFA(COD)gTCOD(-1)) and 4-6x increase in VFA production rate (gVFA(COD) L(-1) d(-1)). Three sludges, pre-treated in full-scale HPTH plants, were fermented. One was from a plant processing a mix of primary sludge and WAS and the other two from plants processing solely WAS. The HPTH plants solubilised suspended matter, evidenced by a 20-30% decrease in suspended solids and an increase of soluble COD : total COD from 0.04 to 0.4. Fermentation of the three sludges yielded similar VFA concentrations (15-20gVFA(COD) L(-1)). The yields were largely independent of retention time (1 d-6 d) and temperature (42°C, 55°C). Also, the product spectrum depended mostly on the composition of the sludge rather than on operating conditions.

Impact of operating history on mixed culture fermentation microbial ecology and product mixture

Mixed culture fermentation is an alternative to pure culture fermentation for production of biofuels and valuable products. A glucose-fed, continuous reactor was operated cyclically to a central pH of 5.5 from a number of precedent pHs, from 4.5 to 7.5. At each pH, stable chemical production was reached after 2 retention times and was held for least 2 further retention times prior to the next change. Bacterial groups were identified by phylogenetic analysis of 16S rRNA gene clones. Bacterial community dynamics were monitored by terminal-restriction fragment length polymorphism. More ethanol was produced at high pH, and more butyrate at lower pH. At pH 5.5, the product spectrum was not measurably influenced by precedent pH but showed seemingly random changes. The impact of precedent pH on community structure was more systematic, with clear indications that when the pH was returned to 5.5, the bacterial group that was dominant at the precedent pH remained at high abundance. This result is important, since it indicates a decoupling between microbial function (as indicated by product spectrum), and community structure. More work is needed to determine the longevity of this hysteresis effect. There was evidence that groups retained their ability to re-emerge even after times of low abundance.

Luxury uptake of phosphorus by microalgae in full-scale waste stabilisation ponds

Biological phosphorus removal was studied in two full-scale waste stabilisation ponds (WSP). Luxury uptake by microalgae was confirmed to occur and in one pond the biomass contained almost four times the phosphorus required by microalgae for normal metabolism. However, the phosphorus content within the biomass was variable. This finding means that assumptions made in prior publications on modelling of phosphorus removal in WSP are questionable. While fluctuations in microalgal growth causes variation in many water quality parameters, this further variation in luxury uptake explains the high degree of variability in phosphorus removal commonly reported in the literature. To achieve effective biological phosphorus removal high levels of both luxury uptake and microalgal concentration are needed. The findings of this work show that while high levels of these parameters did occur at times in the WSP monitored, they did not occur simultaneously. This is explained because accumulated phosphorus is subsequently consumed during rapid growth of biomass resulting in a high biomass concentration with a low phosphorus content. Previous laboratory research has allowed a number of key considerations to be proposed to optimise both luxury uptake and biomass concentration. Now that is has been shown that high levels of biomass concentration and luxury uptake can occur in the field it may be possible to redesign WSP to optimise these parameters.

Phosphate release from waste stabilisation pond sludge: significance and fate of polyphosphate

Net phosphorus removal from waste stabilisation pond (WSP) systems is governed by the rate of phosphorus incorporation into the sludge layer and the rate of phosphorus release from this sludge back to the overlying wastewater. Luxury uptake of phosphorus by microalgae has been shown to occur under WSP conditions in the laboratory; however, the significance of this mechanism and the fate of polyphosphate contained in the settled solids have not previously been investigated. In this work the analysis of sludge samples from three WSP showed that up to 71% of the total phosphorus in the sludge was in the form of polyphosphate. This indicates that polyphosphate accumulation could potentially be an important mechanism for phosphorus sequestration in WSP and challenges the common view that chemical precipitation is the predominant phosphorus removal mechanism in these systems. The release of phosphate from WSP sludge samples was monitored in the laboratory. The samples from two different pond systems had release rates in the order of 4.3 microgP/gTSS.d. However, the third sample which was collected during an algal bloom had a release rate of 12.4 microgP/gTSS.d. Phosphate release from fresh microalgal sludge grown under laboratory conditions was also studied and was shown to have a release rate of 160 microgP/gTSS.d. Analysis of polyphosphate during the experiments on laboratory grown microalgal sludge showed that polyphosphate was indeed degraded resulting in phosphate release. Interestingly, after the initial release phase phosphorus was assimilated by the biomass and some polyphosphate was reformed. It is likely that this is due to bacterial growth in the sludge.

Functional analyses of differentially expressed isoforms of the Arabidopsis inositol phosphorylceramide synthase

Sphingolipids are key components of eukaryotic plasma membranes that are involved in many functions, including the formation signal transduction complexes. In addition, these lipid species and their catabolites function as secondary signalling molecules in, amongst other processes, apoptosis. The biosynthetic pathway for the formation of sphingolipid is largely conserved. However, unlike mammalian cells, fungi, protozoa and plants synthesize inositol phosphorylceramide (IPC) as their primary phosphosphingolipid. This key step involves the transfer of the phosphorylinositol group from phosphatidylinositol (PI) to phytoceramide, a process catalysed by IPC synthase in plants and fungi. This enzyme activity is at least partly encoded by the AUR1 gene in the fungi, and recently the distantly related functional orthologue of this gene has been identified in the model plant Arabidopsis. Here we functionally analysed all three predicted Arabidopsis IPC synthases, confirming them as aureobasidin A resistant AUR1p orthologues. Expression profiling revealed that the genes encoding these orthologues are differentially expressed in various tissue types isolated from Arabidopsis.

Effects of redox potential and pH changes on phosphorus retention by melter slag filters treating wastewater

The release of phosphorus (P) and iron (Fe) from a melter slag filter in solutions of varying Eh and pH was examined. The filter had been removing P from waste stabilization pond effluent for several years. The study revealed that the highest P (95% of total P) and Fe (25% of total Fe) release from the slag occurred in the solution with the lowest Eh (-400 mV, relative to the standard hydrogen electrode, SHE) and lowest pH (4.9). Solutions with high pH (9.1) also proved favorable for P release (20 to 40% of total P) from the slag, at both reducing (-400 mV) and oxidizing (+300 mV) Eh. By contrast, solutions with pH 4.9 and 6.7 and oxidizing Eh (+300 mV) liberated the lowest P and Fe contents into the aqueous phase (<1% for both elements). The findings showed that Eh and pH are important parameters affecting P release from slag filters. At low Eh and low pH, P is released due to the dissolution of Fe oxides/oxyhydroxides, as supported by scanning electron microscopy (SEM)/energy dispersive spectrometry (EDS). At high pH, P is desorbed from negatively charged Fe oxide/oxyhydroxide surfaces. The results of this investigation are pertinentto the design and operation of melter slag filters that treat all forms of P-rich waters, such as wastewater, stormwater, and farm runoff. The study demonstrated that P retention by melter slag filters is optimal in water bodies characterized by near-neutral pH and oxidizing Eh because these conditions favor P adsorption onto Fe oxides/oxyhydroxides.

Synthesis and SAR study of acridine, 2-methylquinoline and 2-phenylquinazoline analogues as anti-prion agents

Transmissible spongiform encephalopathies (TSEs) are thought to arise from aggregation of a protease resistant protein denoted PrP(Sc), which is a misfolded isoform of the normal cellular prion protein PrP(C). Using virtual high-throughput screening we have selected structures analogous to acridine, 2-methyquinoline and 2-phenylquinazoline as potential therapeutic candidates for the treatment of TSEs. From the synthesis and screening of constructed libraries we have shown that an electron-rich aromatic ring attached through an amine linker to the position para to the ring nitrogen is beneficial to both binding to PrP(C) and the suppression of PrP(Sc) accumulation for acridine and 2-methylquinoline analogues. 2-Phenylquinazoline analogues appear to utilise a different mode of action by binding at a different location and/or pose. We report IC50s in the nanomolar range.

Modelling biological processes under anaerobic conditions through integrating titrimetric and off-gas measurements-applied to EBPR systems

An innovative method for modelling biological processes under anaerobic conditions is presented and discussed. The method is based on titrimetric and off-gas measurements. Titrimetric data is recorded as the addition rate of hydroxyl ions or protons that is required to maintain pH in a bioreactor at a constant level. An off-gas analysis arrangement measures, among other things, the transfer rate of carbon dioxide. The integration of these signals results in a continuous signal which is solely related to the biological reactions. When coupled with a mathematical model of the biological reactions, the signal allows a detailed characterisation of these reactions, which would otherwise be difficult to achieve. Two applications of the method to the enhanced biological phosphorus removal processes are presented and discussed to demonstrate the principle and effectiveness of the method.

'Active' filters for upgrading phosphorus removal from pond systems

This paper investigates limestone and iron slag filters as an upgrade option for phosphorus removal from wastewater treatment ponds. A review of 'active' filter technology and the results from laboratory and field research using packed columns of the different media is presented. It is shown that both limestone and iron slag can remove phosphorus but highlights that different types of limestone give markedly different performance. Filter performance appears to be improved by increasing temperature and by the presence of algae, presumably because of its tendency to elevate pH. Performance is related to hydraulic retention time (HRT), but this relationship is not linear, particularly at low HRTs. Importantly for future research, the results from field-testing with pond effluent show significant differences compared to those obtained when using a synthetic feed in the laboratory. For the iron slag filter, higher performance was observed in the field (72% in field vs. 27% in laboratory, at a 12 hour-HRT), while the opposite was observed for the limestone (64% in laboratory vs. 18% in field, at a 12-hour HRT).

Comparison of methods for the determination of K(L)aO2 for respirometric measurements

The mass transfer coefficient for oxygen in water (K(L)aO2) is an important parameter for respirometric studies. But determination of K(L)aO2 in process conditions is not straightforward, In this paper, two distinct procedures for determining K(L)aO2 in process conditions are outlined and tested. The off-gas method relies on a gas mass balance over a bioreactor while the non-steady state methods rely on analysing DO recovery after perturbation. Various means for inducing perturbation are tested and compared. K(L)aO2 values for a bioreactor are determined by the listed methods. It was found that the off-gas method resulted in the highest K(L)aO2 for the given reactor, while the non-steady state method, whereby perturbation is caused by exogenous activity on acetate, resulted in the lowest K(L)aO2. It is shown that the gas mass balancing technique is robust to unexpected exogenous activity (caused by for example, the oxidation of storage polymers formed or nitrite accumulated), while the non-steady state methods that involve inducing perturbations by exogenous activity appear susceptible to such continued exogenous activity in the DO recovery period.

Rate of nitrate production during a two-stage nitrification batch reaction

The two steps of nitrification, namely the oxidation of ammonia to nitrite and nitrite to nitrate, often need to be considered separately in process studies. It has been assumed that these two reactions can be described by single Monod models. In this paper, the suitability of the single Monod model for describing nitrite oxidation to nitrate is discussed. The measured rate of nitrate production during a batch reaction is presented. For the system studied it was found that nitrate production actually increased after the completion of ammonia oxidation. It is suggested that the reason for the increase was a combination of: (i) likely competition for oxygen when both substrates were present, and (ii) a decrease in ammonia inhibition of nitrite oxidisers with the removal of ammonia. The result is that a single Monod expression (based on nitrite as the substrate) could not be used to describe nitrate production. In these types of systems the consequence of oxygen limitation and substrate inhibition should also be considered.

Comparison of source images for protons, pi-'s, and lambda's in 6A GeV Au+Au collisions

Source images are extracted from two-particle correlations constructed from strange and nonstrange hadrons produced in 6A GeV Au+Au collisions. Very different source images result from pp vs p Lambda vs pi(-)pi(-) correlations. Scaling by transverse mass can describe the apparent source size ratio for p/pi(-) but not for Lambda/pi(-) or Lambda/p. These observations suggest important differences in the space-time emission histories for protons, pions, and neutral strange baryons produced in the same events.

Improving titrimetric techniques by modelling pH change in activated sludge systems

Existing titrimetric techniques rely on a well defined hydrogen ion production rate. In particular, they are only suitable in circumstances in which constant background pH influencing reactions take place. This is rarely the case due to the presence of the carbonate acid/base system. In this paper, a model, which describes the influence of the nitrification process on pH and accounts for the action of the carbonate system, is presented. The validity of the model is tested by comparison of model predictions for the important state variables with that of experimental data from a batch oxidation of ammonium nitrogen. The two cases studied are the responses of an endogenously respiring nitrifying sludge to: an ammonium chloride pulse and a pulse of both bicarbonate and ammonium chloride. The results are most encouraging as the dynamic HPR response is mirrored by the model simulation. Furthermore, using the model for data interpretation, the initial nitrogen substrate levels are recovered. It is shown that this could not have been achieved in either case using existing titrimetric techniques.

Event-by-event analysis of proton-induced nuclear multifragmentation: determination of the phase transition universality class in a system with extreme finite-size constraints

A percolation model of nuclear fragmentation is used to interpret 10.2 GeV/c p+197Au multifragmentation data. Emphasis is put on finding signatures of a continuous nuclear matter phase transition in finite nuclear systems. Based on model calculations, corrections accounting for physical constraints of the fragment detection and sequential decay processes are derived. Strong circumstantial evidence for a continuous phase transition is found, and the values of two critical exponents, sigma = 0.5+/-0.1 and tau = 2.35+/-0.05, are extracted from the data. A critical temperature of T(c) = 8.3+/-0.2 MeV is found.

Amino acids in the cytoplasmic C terminus of the parathyroid Ca2+-sensing receptor mediate efficient cell-surface expression and phospholipase C activation

The C-terminal tail of the calcium receptor (CaR) regulates the affinity of the receptor for ligand, desensitization, and membrane localization. To determine the role of specific amino acids in the bovine parathyroid CaR in mediating signal transduction and cell-surface expression, we transfected truncated and mutated CaR cDNAs into HEK-293 cells. The ability of high extracellular [Ca(2+)] ([Ca(2+)](o)) to increase total inositol phosphate (InsP) production, an index of phospholipase C (PLC) activation, was determined. Receptor expression was assessed by immunoblotting and immunocytochemistry. In cells transiently or stably expressing receptors with the C-terminal tail truncated after residue 895 (CaR-(1-895)) or 929 (CaR-(1-929)), raising [Ca(2+)](o) increased InsPs to levels comparable with those of cells expressing wild-type CaRs. There were no PLC responses to high [Ca(2+)](o) (up to 30 mm) in cells expressing CaRs with C-terminal tails of only 3 residues (CaR-(1-866)), even though these receptors were expressed in the membrane. We scanned the residues between Ser(866) and Val(895) using tandem-Ala and single-site mutagenesis. Two point mutants (His(880) --> Ala and Phe(882) --> Ala CaR) showed 50-70% reductions in high [Ca(2+)](o)-induced InsP production. The levels of expression and glycosylation of these mutants were comparable with wild-type CaRs, but both receptors were profoundly retained in intracellular organelles and co-localized with the endoplasmic reticulum marker BiP. This suggested that the signaling defects of these receptors were likely because of defective trafficking of receptors to the cell surface. Modeling of the C-terminal domain of the CaR indicated that His(880) and Phe(882) are situated in a putative alpha-helical structure of 15 amino acids between residues 877 and 891 in the C-terminal tail. Our studies support the idea that specific amino acids, and possibly a unique secondary structure in the C-terminal tail, are required for the efficient targeting of the CaR to the cell surface required for PLC activation.

Quality of life in schizophrenia: contributions of anxiety and depression

A number of studies have demonstrated a strong relationship between quality of life in schizophrenia and general psychopathology measures, and moreover, that the positive, negative, and disorganized symptoms are less related to quality of life. The current investigation examined the relationship between quality of life and symptomatology in 63 stabilized outpatients diagnosed with schizophrenia or schizoaffective disorder. Consistent with other findings, more severe depression, as rated on the Brief Psychiatric Rating Scale (BPRS) was associated with lower general life satisfaction and lower satisfaction with daily living, finances, health, and social life. In addition, higher anxiety ratings on the BPRS were associated with less satisfaction with global quality of life, daily activities, family, health and social relationship, even when controlling for positive symptoms, negative symptoms, or depression. No other symptoms of schizophrenia were as strongly associated with subjective quality of life. Anxiety was also significantly correlated with a number of positive and negative symptoms while depression was substantially less related. These findings, suggest that more precise analyses of general psychopathology, and anxiety in particular, may be necessary to further clarify the factors involved in quality of life in schizophrenia. In addition, these findings suggest future directions for theories of affect and treatment in schizophrenia.

Sugar transport regulation: comparative characterization of the effect of NADH CoQ reductase deficiency in two cell culture systems

In this report, we have characterized the upregulation of glucose transport in two different respiration-deficient fibroblast cell cultures. We have demonstrated that glucose transport increases in respiration-deficient cells as measured by 2 deoxy D-glucose transport and is readily observed in both the WG750 human and G14 Chinese hamster fibroblast respiration-deficient cell lines when compared with the MCH55 normal human and V79 parental Chinese hamster cell lines, respectively. Using subcellular fractionation techniques, the GLUT 1 glucose transporter was found located predominantly in the plasma membrane-enriched fraction of the human and hamster cell lines. In human cells, the expression of the GLUT 1 glucose transporter was elevated three-fold in the plasma membrane-enriched fraction of the WG750 respiration-deficient mutant cells. In the Chinese hamster cell lines, the respiration-deficient G14 cells exhibited no such GLUT 1 glucose transporter elevation in the plasma membrane-enriched fraction, yet expressed a >2-fold increase in glucose transport. Furthermore, the G14 cells had a similar content of GLUT 1 glucose transporter in the plasma membrane fraction when compared with the V79 parental cell line. Using Western blot analysis, the GLUT 1 glucose transporter in G14 cells exhibited a different mobility on a polyacrylamide gel when compared with the mobility of the GLUT 1 glucose transporter of the V79 cell line. This differential mobility of the glucose transporters in the hamster cells appeared to be related to glycosylation differences of the glucose transporters. Although normal human and hamster cell lines exhibited significant increases in insulin-stimulated sugar transport (P < 0.05), the two respective respiration-deficient cell lines exhibited no significant increases in insulin-stimulated sugar transport (P > 0.05). Additionally, the expression of the GLUT 1 mRNA in the human WG750 mutant cells was elevated when compared with GLUT 1 mRNA in normal cells. Insulin exposure significantly increased GLUT 1 mRNA in human cells (P < 0.05). No differences in the GLUT 1 mRNA were observed between both hamster cell lines. Thus, both respiration-deficient cell lines are insulin resistant (i.e., regarding their insulin-stimulated sugar transport). The respiration-deficient mutation results in an increased sugar transport in the human and hamster cells; however, the human cells adapt to the mutation by increasing their levels of GLUT 1 mRNA and eventually membrane-located glucose transporters. On the other hand, the hamster cells adapt by apparently modifying their glucose transporters' intrinsic activity via glycosylation. We feel that these cell systems can be effective models to study the multiple factors involved in sugar transport regulation in vertebrate cells.

Clocking hadronization in relativistic heavy-Ion collisions with balance functions

A novel state of matter has been hypothesized to exist during the early stage of relativistic heavy-ion collisions, with normal hadrons not appearing until several fm/c after the start of the reaction. To test this hypothesis, correlations between charges and their associated anticharges are evaluated with the use of balance functions. It is shown that late-stage hadronization is characterized by tightly correlated charge-anticharge pairs when measured as a function of relative rapidity.

Amino acids in the second and third intracellular loops of the parathyroid Ca2+-sensing receptor mediate efficient coupling to phospholipase C

To determine the role of amino acids in the second and third intracellular (IC) loops of the Ca(2+)-sensing receptor (CaR) in phospholipase C (PLC) activation, we mutated residues in these loops either singly or in tandem to Ala and assessed PLC activity by measuring high extracellular [Ca(2+)] ([Ca(2+)](o))-induced inositol phosphate accumulation and protein expression by immunoblotting and immunocytochemistry in human embryonic kidney 293 cells. Two CaR constructs in the second IC loop, F707A CaR and to a lesser extent L704A CaR, demonstrated reduced activation of PLC, despite levels of protein expression comparable with the wild-type (wt) CaR. Substitution of Tyr or His for Phe-707, but not Leu, Val, Glu, or Trp, partially restored the ability of high [Ca(2+)](o) to activate PLC. Eight residues in the third IC loop were involved in PLC signaling. The responses to high [Ca(2+)](o) in cells expressing CaRs with Ala substitutions at these sites were <35% of the wt CaR. The L798A, F802A, and E804A CaRs were dramatically impaired in their responses to [Ca(2+)](o) even up to 30 mm. Substitutions of Leu-798 with other hydrophobic residues (Ile, Val, or Phe), but not with acidic, basic, or polar residues, produced reduced responses compared with wt. Phe-802 could be replaced with either Tyr or Trp with partial retention of the ability to activate PLC. Glu-804 could only be substituted with Asp or Gln and maintain its signaling capacity. Cell surface expression of the CaRs mutated at Leu-798 and Phe-802 appeared normal compared with wt CaR. Cell surface CaR expression was, however, reduced substantially in cells expressing several mutants at position Glu-804 by confocal microscopy. These studies strongly implicate specific hydrophobic and acidic residues in the second and third IC loops of the parathyroid CaR (and potentially larger stretches of the third loop) in mediating efficient high [Ca(2+)](o)-induced PLC activation and or CaR expression.

Adaptation to loudness and environmental stimuli in three newly fitted hearing aid users

Hearing aid fitting strategies can be categorized according to whether a loudness normalization or a loudness equalization rationale is employed. Regardless of the underlying rationale, the amount of patient participation in determining the initial hearing aid settings will vary when an audiologist-driven (AD) versus a patient-driven protocol is employed. When an AD protocol is used, few changes are made during the initial fitting session based on user feedback. It is assumed that the patient will adapt to the loudness and/or sound quality provided by the hearing aids if not immediately acceptable. The following three case reports document varying degrees of adaptation to hearing aid settings derived using an AD approach. Clinical implications will be discussed.

Canonical and microcanonical calculations for fermi systems

Recursion relations are presented that allow exact calculation of canonical and microcanonical partition functions of degenerate Fermi systems, assuming no explicit two-body interactions. Calculations of the level density, sorted by angular momentum, are presented for 56Ni. The issue of treating unbound states is also addressed.

Induction of ribosome methylation in MLS-resistant Streptococcus pneumoniae by macrolides and ketolides

One major mechanism for resistance to macrolide antibiotics in Streptococcus pneumoniae is MLS (macrolide, lincosamide, and streptogramin B) resistance, manifested when the 23S rRNA is methylated by the product of an erm gene. This modification results in the decreased binding of all known macrolide, lincosamide, and streptogramin B antibiotics to the ribosome. More than 30 ermAM-containing clinical isolates of S. pneumoniae were examined in our lab and showed high-level resistance (MIC > or =128 microg/ml) to erythromycin, azithromycin, tylosin, clindamycin, and ketolide (macrolides that lack the cladinose sugar) TE-802. We found that the new generation of ketolides A965 and A088 displayed variable activity against the same group of resistant S. pneumoniae strains. To understand the basis of variability of the minimal inhibitory concentration (MIC) values of A965 and A088, we examined the effects of a series of macrolides and ketolides on the level of 23S rRNA methylation in five ermAM-containing resistant S. pneumoniae isolates. We show here that the basal levels of ribosomal methylation vary from strain to strain. The level of rRNA methylation can be strongly induced by erythromycin, azithromycin, and TE-802, resulting in high-level of resistance to these compounds. Ketolide A965 and A088, however, are weak inducers at sub-MIC drug concentrations, therefore showing variable activities in strains with differential methylation levels.

Accumulation of carbon monoxide and carbon dioxide in stored canola

Production of carbon monoxide (CO) and carbon dioxide (CO(2)) from canola was studied in the laboratory and in commercial storage. Canola rapidly produced amounts of CO and CO(2) far exceeding those reported for dry cereal grain and dried peas and at levels dangerous to human health. In the laboratory, canola (5.8% m.c.) was stored in sealed flasks at 25, 35 and 45 degrees C for 12 weeks. Levels of CO, CO(2) and oxygen (O(2)) were then measured by gas chromatography. Average levels of CO and CO(2) increased with storage temperature. Levels of CO peaked at 6 weeks, exceeding 10,000 ppm v/v (1%) at 45 degrees C. CO(2) levels peaked at 11.9% after 10 weeks storage at 45 degrees C. In field measurements, CO levels in a steel bin (7000 tonne capacity) filled with canola ranged from 1100 to 800 ppm in the grain bulk before sealing, 1050-370 ppm in the grain bulk after sealing, and 290-440 ppm in the head space of the sealed bin. CO(2) concentrations were >3% in the grain bulk and averaged 1.5% in the headspace. CO production rate was estimated at 200 ng g(-1) day(-1). Canola storage poses a greater potential safety hazard than storage of cereals.

Protein kinase C activation blocks calcium receptor signaling in Xenopus laevis oocytes

We examined whether calcium receptor (CaR) signaling is affected by protein kinase C (PKC) activation by assessing the effects of phorbol-12-myristate-13-acetate (PMA) on 45Ca2+ efflux from Xenopus laevis oocytes expressing wild-type (WT) and mutant bovine parathyroid CaRs. Raising extracellular [Ca2+] ([Ca2+]0) from 0.5 to 5.5 mM increased 45Ca efflux (26 +/- 3-fold) in oocytes expressing full-length and C-terminally truncated receptor (amino acid 1-895). These increases in 45Ca efflux were blocked by 88 +/- 3% after PMA treatment for 20 min. Three consensus PKC phosphorylation sites (Thr-647, Ser-795, and Thr-889) were mutated in the context of the full-length and truncated CaR. PMA treatment inhibited high [Ca2+]0-induced responses in oocytes expressing the Ser795Ala CaR (1-895), Thr889Ala CaR (1-895), and Ser795Ala/Thr889Ala CaR (1-895) by 30-40% compared with untreated controls (P < 0.05). A triple mutant of the full-length CaR demonstrated similarly reduced susceptibility to inhibition of 45Ca efflux by PMA. Thus, these sites are important in mediating the effects of PKC activation on CaRs, but other residues and effector molecules are likely to participate in the effects of PKC on CaR-induced signal transduction in target cells.

Possible ancient oceans on Mars: evidence from Mars Orbiter Laser Altimeter data

High-resolution altimetric data define the detailed topography of the northern lowlands of Mars, and a range of data is consistent with the hypothesis that a lowland-encircling geologic contact represents the ancient shoreline of a large standing body of water present in middle Mars history. The contact altitude is close to an equipotential line, the topography is smoother at all scales below the contact than above it, the volume enclosed by this contact is within the range of estimates of available water on Mars, and a series of extensive terraces parallel the contact in many places.

Accuracy of hearing aid use time as reported by experienced hearing aid wearers

OBJECTIVE

The purpose of this study was to investigate the relationship between the amount of time that a person reports wearing his or her hearing aid and the actual time that the hearing aid is worn. Although use time data are used in the analysis and interpretation of investigations concerned with auditory perceptual learning and with user satisfaction, the accuracy of self-reported use time has not been fully investigated.

DESIGN

The experimental and control group were fit with a hearing aid that has the capability of storing use time data for later analysis. The experimental group was told that the self-reported use time would be verified with a computer analysis of the hearing aid that provides the actual use time. The control group was not informed of the use time validation procedure. The agreement between self-reported and actual use time was compared statistically between groups (knowledge of validation versus no knowledge of validation).

RESULTS

The experimental group provided accurate self-reported use time whereas the control group showed a significant difference between actual use time and self-reported use time.

CONCLUSIONS

The results may assist in the interpretation of results of previous investigations that have depended on self-reported use time and in the design of future investigations. For the clinician, the results indicate that relying on a patient's self-reported hearing aid use time for documentation of satisfaction or signal processing preference may be misleading.

Selectivity of the multidrug resistance modulator, LY335979, for P-glycoprotein and effect on cytochrome P-450 activities

Overexpression of ATP-dependent drug efflux pumps, P-glycoprotein (Pgp) or multidrug resistance-associated protein (MRP), confers multidrug resistance to tumor cells. Modulators of multidrug resistance block the action of these pumps, thereby sensitizing cells to oncolytics. A potent Pgp modulator is LY335979, which fully sensitizes Pgp-expressing cells at 0.1 microM in cytotoxicity assays and for which Pgp has an affinity of 59 nM. The present study examines its effect on MRP1-mediated drug resistance and cytochrome P-450 (CYP) activity and its ability to serve as a Pgp substrate. Drug resistance was examined with HL60/ADR and MRP1-transfected HeLa-T5 cells. Drug cytotoxicity was unaffected by 1 microM LY335979; leukotriene C4 uptake into HeLa-T5 membrane vesicles was unaffected. Because the substrate specificity of Pgp and CYP3A overlap, the effect of LY335979 on the 1'-hydroxylation of midazolam by CYP3A in human liver microsomes was examined. The apparent K(i) was 3.8 microM, approximately 60-fold higher than the affinity of Pgp for LY335979. The modulator's effect on Pgp was evaluated with Pgp-overexpressing CEM/vinblastine (VLB)(100) and parental CCRF-CEM cells. Both cell lines accumulated [(3)H]LY335979 equally well and did not efflux [(3)H]LY335979 during a 3-h incubation, indicating that it is not a substrate of Pgp. Equilibrium-binding studies with CEM/VLB(100) plasma membranes and [(3)H]LY335979 showed that Pgp had a K(d) of 73 nM, which is in good agreement with the previously determined K(i) value. Thus, LY335979 is an extremely potent Pgp, and not MRP1 or MRP2, modulator and has a significantly lower affinity for CYP3A than for Pgp.

Dietary prevention of age-related macular degeneration

BACKGROUND

Age-related macular degeneration (ARMD) is the leading cause of blindness in people over the age of 65, and the prevalence of ARMD is expected to increase as the population ages. Although the incidence of ARMD increases sharply with age, recent studies indicate that prevention measures and dietary changes, implemented early in life, can reduce an individual's risk of ARMD.

METHODS

Several dietary components have been proposed and studied with regard to their ability to protect against ARMD; these components include antioxidant vitamins and specific carotenoids. In particular, consumption of dark green, leafy vegetables has been shown in clinical studies to reduce the risk of ARMD.

RESULTS

Biochemical studies of such vegetables have found that they contain several nutrients that may account for this effect, including high concentrations of the related carotenoids lutein and zeaxanthin. Structural and clinical studies have shown that these carotenoids are concentrated in the retinal macular pigment and that such accumulation is dependent on dietary intake. Further studies have indicated that the density of the macular pigment is related to preservation of visual sensitivity and (possibly) protection from ARMD.

CONCLUSIONS

Large-scale clinical trials will be necessary to demonstrate that specific agents can reduce the incidence of ARMD. Nevertheless, specific dietary components--particularly, the carotenoids found in dark green, leafy vegetables--have shown great promise. While lifestyle modifications such as smoking cessation, reduction of alcohol consumption, and the wearing of sunglasses may reduce the risk of ARMD, it is likely that consumption of specific dietary components can reduce the risk further.

Regulation of extracellular calcium-activated cation currents by cAMP in parathyroid cells

Parathyroid cells express Ca2+-sensing receptors that couple changes in the extracellular Ca2+ concentration ([Ca2+]o) to increases in the intracellular free Ca2+ concentration ([Ca2+]i) and to the suppression of parathyroid hormone secretion. Using whole cell patch clamping, we previously identified voltage-independent Ca2+-conducting currents in bovine parathyroid cells that increased with rising [Ca2+]o and were blocked by Cd2+ and nifedipine. Because cAMP-dependent phosphorylation regulates dihydropyridine-sensitive Ca2+ channels in other systems, we tested whether cAMP modulates these currents. At 0.7 mM Ca2+, nonselective Ca2+-conducting currents were suppressed by 30-50% when the recording pipette was perfused with cAMP. High-[Ca2+]o-induced increases in membrane currents were also abrogated. The effects of cAMP were reversible and dose dependent (3 x 10(-9) to 3 x 10(-3) M) and required ATP in the pipette solution. Perfusion of the cell interior with the catalytic subunit of protein kinase A mimicked the effects of cAMP, as did perfusion of the bath with the adenylate cyclase activator forskolin. These findings support the idea that cAMP-dependent phosphorylation suppresses high-[Ca2+]o-induced cation currents and may play a role in regulating ion fluxes in parathyroid cells.