Alameda Hospital

OBJECTIVES: This study evaluated the production of dry fermented salami associated with an outbreak of Escherichia coli O157.H7 infection in Washington State and California. METHODS: Facility inspections, review of plant monitoring data, food handler interviews, and microbiological testing of salami products were conducted. RESULTS: Production methods complied with federal requirements and industry-developed good manufacturing practices. No evidence suggested that postprocessing contamination occurred. Calculations suggested that the infectious dose was smaller than 50 E. coli O157:H7 bacteria. CONCLUSIONS: Dry fermented salami can serve as a vehicle of transmission for O157:H7 strains. Our investigation and prior laboratory studies suggest that E. coli O157:H7 can survive currently accepted processing methods.

Epidemiology and candidate gene studies indicate a shared genetic basis for celiac disease (CD) and rheumatoid arthritis (RA), but the extent of this sharing has not been systematically explored. Previous studies demonstrate that 6 of the established non-HLA CD and RA risk loci (out of 26 loci for each disease) are shared between both diseases. We hypothesized that there are additional shared risk alleles and that combining genome-wide association study (GWAS) data from each disease would increase power to identify these shared risk alleles. We performed a meta-analysis of two published GWAS on CD (4,533 cases and 10,750 controls) and RA (5,539 cases and 17,231 controls). After genotyping the top associated SNPs in 2,169 CD cases and 2,255 controls, and 2,845 RA cases and 4,944 controls, 8 additional SNPs demonstrated P<5 × 10(-8) in a combined analysis of all 50,266 samples, including four SNPs that have not been previously confirmed in either disease: rs10892279 near the DDX6 gene (P(combined) = 1.2 × 10(-12)), rs864537 near CD247 (P(combined) = 2.2 × 10(-11)), rs2298428 near UBE2L3 (P(combined) = 2.5 × 10(-10)), and rs11203203 near UBASH3A (P(combined) = 1.1 × 10(-8)). We also confirmed that 4 gene loci previously established in either CD or RA are associated with the other autoimmune disease at combined P<5 × 10(-8) (SH2B3, 8q24, STAT4, and TRAF1-C5). From the 14 shared gene loci, 7 SNPs showed a genome-wide significant effect on expression of one or more transcripts in the linkage disequilibrium (LD) block around the SNP. These associations implicate antigen presentation and T-cell activation as a shared mechanism of disease pathogenesis and underscore the utility of cross-disease meta-analysis for identification of genetic risk factors with pleiotropic effects between two clinically distinct diseases.

Sixteen copy characteristics or advertising approaches that appear to either increase or decrease irritation emerge from a study of 524 television commercials. The results also show how irritation levels vary by product class and by socioeconomic level.

OBJECTIVE: To describe the surgical technique, early results and complications of tibial tuberosity advancement (TTA) for treatment for cranial cruciate ligament (CrCL)-deficient stifle joints in dogs. STUDY DESIGN: Retrospective clinical study. ANIMALS: Dogs (n=101) with CrCL-deficient stifles (114). METHODS: Medical records of 101 dogs that had TTA were reviewed. Complications were recorded and separated into either major or minor complications based on the need for additional surgery. In-hospital re-evaluation of limb function and time to radiographic healing were reviewed. Further follow-up was obtained by telephone interview of owners. RESULTS: Complications occurred in 31.5% of the dogs (12.3% major, 19.3% minor). Major complications included subsequent meniscal tear, tibial fracture, implant failure, infection, lick granuloma, incisional trauma, and medial patellar luxation; all major complications were treated with successful outcomes. All but 2 minor complications resolved. The mean time to documented radiographic healing was 11.3 weeks. Final in-hospital re-evaluation of limb function (mean, 13.5 weeks), was recorded for 93 dogs with lameness categorized as none (74.5%), mild (23.5%), moderate (2%), and severe (1%). All but 2 owners interviewed were satisfied with outcome and 83.1% reported a marked improvement or a return to pre-injury status. CONCLUSIONS: TTA is a procedure comparable with alternate methods of CrCL repair with expected good to excellent functional outcome. CLINICAL RELEVANCE: TTA procedure can be successfully used to obtain the dynamic stability of a CrCL-deficient stifle joint in dogs.

Medication errors and adverse events caused by them are common during and after a hospitalization. The impact of these events on patient welfare and the financial burden, both to the patient and the healthcare system, are significant. In 2005, The Joint Commission put forth medication reconciliation as National Patient Safety Goal (NPSG) No. 8 in an effort to minimize adverse events caused during these types of care transitions. However, the meaningful and systematic implementation of medication reconciliation, as expressed through NPSG No. 8, proved to be extraordinarily difficult for healthcare institutions around the country. Given the importance of accurate and complete medication reconciliation for patient safety occurring across the continuum of care, the Society of Hospital Medicine convened a stakeholder conference in 2009 to begin to identify and address: (1) barriers to implementation; (2) opportunities to identify best practices surrounding medication reconciliation; (3) the role of partnerships among traditional healthcare sites and nonclinical and other community-based organizations; and (4) metrics for measuring the processes involved in medication reconciliation and their impact on preventing harm to patients. The focus of the conference was oriented toward medication reconciliation for a hospitalized patient population; however, many of the themes and concepts derived would also apply to other care settings. This paper highlights the key domains needing to be addressed and suggests first steps toward doing so. An overarching principle derived at the conference is that medication reconciliation should not be viewed as an accreditation function. It must, first and foremost, be recognized as an important element of patient safety. From this principle, the participants identified ten key areas requiring further attention in order to move medication reconciliation toward this focus. 1 There is need for a uniformly acceptable and accepted definition of what constitutes a medication and what processes are encompassed by reconciliation. Clarifying these terms is critical to ensuring more uniform impact of medication reconciliation. 2 The varying roles of the multidisciplinary participants in the reconciliation process must be clearly defined. These role definitions should include those of the patient and family/caregiver and must occur locally, taking into account the need for flexibility in design given the varying structures and resources at healthcare sites. 3 Measures of the reconciliation processes must be clinically meaningful (i.e., of defined benefit to the patient) and derived through consultation with stakeholder groups. Those measures to be reported for national benchmarking and accreditation should be limited in number and clinically meaningful. 4 While a comprehensive reconciliation system is needed across the continuum of care, a phased approach to implementation, allowing it to start slowly and be tailored to local organizational structures and work flows, will increase the chances of successful organizational uptake. 5 Developing mechanisms for prospectively and proactively identifying patients at risk for medication-related adverse events and failed reconciliation is needed. Such an alert system would help maintain vigilance toward these patient safety issues and help focus additional resources on high risk patients. 6 Given the diversity in medication reconciliation practices, research aimed at identifying effective processes is important and should be funded with national resources. Funding should include varying sites of care (e.g., urban and rural, academic and nonacademic, etc.). 7 Strategies for medication reconciliation-both successes and key lessons learned from unsuccessful efforts-should be widely disseminated. 8 A personal health record that is integrated and easily transferable between sites of care is needed to facilitate successful medication reconciliation. 9 Partnerships between healthcare organizations and community-based organizations create opportunities to reinforce medication safety principles outside the traditional clinician-patient relationship. Leveraging the influence of these organizations and other social networking platforms may augment population-based understanding of their importance and role in medication safety. 10 Aligning healthcare payment structures with medication safety goals is critical to ensure allocation of adequate resources to design and implement effective medication reconciliation processes. Medication reconciliation is complex and made more complicated by the disjointed nature of the American healthcare system. Addressing these ten points with an overarching goal of focusing on patient safety rather than accreditation should result in improvements in medication reconciliation and the health of patients.

UNLABELLED: In a recent study, a single nucleotide polymorphism (SNP) of the Toll-like receptor 4 (TLR4) gene (c.1196C>T [rs4986791, p.T399I]) emerged as conferring protection from fibrosis progression compared to a major, wild-type (WT) CC allele (p.T399). The present study examined the functional linkage of this SNP, along with another common, highly cosegregated TLR4 SNP (c.896A>G [rs4986790, p.D299G]), to hepatic stellate cell (HSC) responses. Both HSCs from TLR4(-/-) mice and a human HSC line (LX-2) reconstituted with either TLR4 D299G and/or T399I complementary DNAs were hyporesponsive to lipopolysaccharide (LPS) stimulation compared to those expressing WT TLR4, as assessed by the expression and secretion of LPS-induced inflammatory and chemotactic cytokines (i.e., monocyte chemoattractant protein-1, interleukin-6), down-regulation of bone morphogenic protein and the activin membrane-bound inhibitor expression (an inhibitory transforming growth factor beta pseudoreceptor), and activation of a nuclear factor kappaB (NF-kappaB)-responsive luciferase reporter. In addition, spontaneous apoptosis, as well as apoptosis induced by pathway inhibitors of NF-kappaB, extracellular signal-regulated kinase (ERK), and phosphatidylinositol 3-kinase were greatly increased in HSCs from either TLR4(-/-) or myeloid differentiation factor 88(-/-) (a TLR adaptor protein) mice, as well as in murine HSCs expressing D299G and/or T399I SNPs; increased apoptosis in these lines was accompanied by decreased phospho-ERK and Bcl-2. CONCLUSION: TLR4 D299G and T399I SNPs that are associated with protection from hepatic fibrosis reduce TLR4-mediated inflammatory and fibrogenic signaling and lower the apoptotic threshold of activated HSCs. These findings provide a mechanistic link that explains how specific TLR4 SNPs may regulate the risk of fibrosis progression.

Psoriasis is a common inflammatory skin disease with complex genetics and different degrees of prevalence across ethnic populations. Here we present the largest trans-ethnic genome-wide meta-analysis (GWMA) of psoriasis in 15,369 cases and 19,517 controls of Caucasian and Chinese ancestries. We identify four novel associations at LOC144817, COG6, RUNX1 and TP63, as well as three novel secondary associations within IFIH1 and IL12B. Fine-mapping analysis of MHC region demonstrates an important role for all three HLA class I genes and a complex and heterogeneous pattern of HLA associations between Caucasian and Chinese populations. Further, trans-ethnic comparison suggests population-specific effect or allelic heterogeneity for 11 loci. These population-specific effects contribute significantly to the ethnic diversity of psoriasis prevalence. This study not only provides novel biological insights into the involvement of immune and keratinocyte development mechanism, but also demonstrates a complex and heterogeneous genetic architecture of psoriasis susceptibility across ethnic populations.

Many of the recent, widespread declines and disappearances of amphibian populations have taken place in seemingly undisturbed, montane habitats. The question of whether the observed patterns differ from those expected from natural population dynamics is the subject of an ongoing controversy with important implications for conservation. We examined this issue for the Monteverde region of Costa Rica’s Cordillera de Tilarán, where a multi‐species population crash in 1987 led to the disappearance of the endemic golden toad ( Bufo periglenes) and many other species. Focusing on long‐term studies of other amphibian assemblages, we developed probabilistic null models for the number of disappearances. Tests of these models at Monteverde suggest that the patterns observed there are highly improbable in the context of normal demographic variability. Twenty species of frogs and toads (40% of the anuran fauna) were missing throughout our 1990–1994 surveys of a 30‐km 2 area. Not all organisms in this area had declined accordingly: the relative frequency of absences was much greater for anurans than for breeding birds. Nevertheless, anuran habitats, most of which are protected within the Monteverde Cloud Forest Preserve, seemed unchanged, and none of the breeding‐bird species known to be sensitive to deforestation was missing. Thus, only factors other than direct, obvious human impacts can explain the amphibian declines. Consistent with our tests of null models, analyses of recent population trends do not support the hypothesis that the 1987 crash was an extreme fluctuation from which populations are recovering. Surviving species for which baseline data are available—stream‐breeding glass frogs ( Hyalinobatrachium fleischmanni and Centrolenella prosoblepon) and a pond‐breeding treefrog ( Hyla pseudopuma)—remained far less abundant than they were before the crash and showed no increase during 1990‐1994. We documented an increase only for one terrestrial‐breeding rain frog ( Eleutherodactylus diastema). Pruebas de Modelos Nulos para Disminuciones de Anfibios en una Montaña Tropical Muchas de las disminuciones y desapariciones recientes de poblaciones de anfibios en varias partes del mundo se han producido en hábitats que aparentemente no han sido alterados. La pregunta de si los patrones observados difieren de lo que es predicho por la dinámica natural de poblaciones es el tema de una controversia actual que tiene consecuencias importantes para la conservación. Se examinó esta pregunta para la región de Monteverde en la Cordillera de Tilarán, Costa Rica, donde un colapso de poblaciones en 1987 produjo la desaparición del endémico sapo dorado ( Bufo periglenes) y muchas otras especies. Centrándose en estudios a largo plazo sobre anfibios de otras regiones, se desarrollaron modelos nulos probabilísticos con respecto al número de desapariciones. Al probarse estos modelos para Monteverde se sugiere que los patrones observados son poco probables dentro de los parámetros normales de la variabilidad demográfica. Durante 1990‐1994 en un área de 30‐km 2 , veinte especies de ranas y sapos (el 40% de los anuros de la región) estuvieron ausentes. No todos los organismos del área disminuyeron de la misma forma: por ejemplo, la frecuencia relativa de especies ausentes fue mucho mayor para los anuros que para las aves que se reproducen en el área de estudio. Sin embargo, la mayoría de los hábitats de anuros están protegidos dentro de la Reserva Biológica Bosque Nuboso de Monteverde, y no parecía que habían cambiado. Además, ninguna de las especies de aves que son afectadas de manera negativa por la deforestación estuvo ausente. Por lo tanto, las disminuciones de anfibios sólo pueden ser explicadas por factores que no son los impactos obvios y directos causados por los seres humanos. De acuerdo con nuestras pruebas de modelos nulos, los análisis de tendencias recientes de abundancia no apoyan la hipótesis de que el colapso de 1987 fuera una fluctuación extrema de la cual las poblaciones están recuperándose. Las especies sobrevivientes de las que existen datos demográficos anteriores al colapso—ranas de vidrio ( Hyalinobatrachium fleischmanni y Centrolenella prosoblepon), que se reproducen en quebradas, y una rana arborícola ( Hyla pseudopuma) que pone huevos en lagunas y pozos—eran mucho menos abundantes durante 1990–1994 de lo que fueron antes de este evento y no se encontró evidencias de aumento. Se documentó un incremento solo en las poblaciones de Eleutherodactylus diastema, que se reproduce en hábitats terrestres.

BACKGROUND: Neutralizing antibodies (NAB) to interferon beta (IFNbeta) occur in about one-third of MS patients treated with IFNbeta-1b and there is an association with a loss of clinical and MRI efficacy. However, there are no data regarding the bioavailability of IFNbeta-1b in patients with and without NAB. METHODS: The authors measured MxA in whole blood by ELISA, and serum-binding antibodies (SBA) by Western blot and ELISA in 134 samples of MS patients on IFNbeta-1b and 54 control subjects, and correlated the MxA levels and SBA titers with the NAB titer. RESULTS: In the IFNbeta group 84 samples were NAB negative, 21 were NAB positive (i.e., titer of > or =20), and 29 had detectable NAB (i.e., titer between 10 and 20). The median MxA concentration in NAB-negative patients was 4.09 ng/10(5) peripheral blood leukocytes (PBL), 2.37 ng/10(5) PBL in samples with detectable NAB, 0.36 ng/10(5) PBL in NAB-positive samples, and 0.27 ng/10(5) PBL in control subjects. There was no significant difference between NAB-positive samples and control subjects, otherwise the groups differed significantly from each other. SBA occurred in 49% of NAB-negative samples, in 79% of samples with detectable NAB, and in all NAB-positive samples. With regard to the SBA titer, all groups differed significantly from each other. In none of the control samples were SBA detected. CONCLUSION: The conversion of SBA into NAB depends to some degree on the SBA titer, but other mechanisms may be involved. Once NAB have developed, the bioavailability of IFNbeta as measured by MxA is completely inhibited.

In order to investigate the potential for Borrelia burgdorferi infection before the recognition of Lyme disease as a clinical entity, the polymerase chain reaction (PCR) was used to examine museum specimens of Ixodes dammini (deer ticks) for the presence of spirochete-specific DNA sequences. One hundred and thirty-six archival tick specimens were obtained representing various continental U.S. locations; DNA sequences characteristic of modern day isolates of B. burgdorferi were detected in 13 1940s specimens from Montauk Point and Hither Hills, Long Island, New York. Five archival specimens of Dermacentor variabilis (dog tick) from the same collection and 118 Ixodes specimens from other endemic and nonendemic sites were negative. These data suggest that the appearance of the Lyme disease spirochete in suitable arthropod vectors preceded, by at least a generation, the formal recognition of this disease as a clinical entity in the United States.

UNLABELLED: Only 20% of patients with chronic hepatitis C (CHC) will develop cirrhosis, and fibrosis progression remains highly unpredictable. A recent genome-wide association study identified a genetic variant in the patatin-like phospholipase-3 (PNPLA3) gene (rs738409 C>G) associated with steatosis that was further demonstrated to influence severity of fibrosis in nonalcoholic fatty liver disease. The aim of this study was to assess the impact of this polymorphism on histological liver damage and response to antiviral therapy in CHC. We recruited 537 Caucasian CHC patients from three European centers (Brussels, Belgium [n = 229]; Hannover, Germany [n = 171]; Lyon, France [n = 137]); these patients were centrally genotyped for the PNPLA3 (rs738409 C>G) polymorphism. We studied the influence of rs738409 and other variants in the PNPLA3 region on steatosis and fibrosis assessed both in a cross-sectional and longitudinal manner. Seven other variants previously associated with fibrosis progression were included. Finally, we explored the impact of rs738409 on response to standard antiviral therapy using the interferon lambda 3 (IL28B) [rs12979860 C>T] variant both as a comparator and as a positive control. After adjustment for age, sex, body mass index, alcohol consumption, and diabetes, rs738409 mutant G allele homozygote carriers remained at higher risk for steatosis (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.08-6.03, P = 0.034), fibrosis (OR 3.13, 95% CI 1.50-6.51, P = 0.002), and fibrosis progression (OR 2.64, 95% CI 1.22-5.67, P = 0.013). Conversely, rs738409 was not independently associated with treatment failure (OR 1.07, 95% CI 0.46-2.49, P = 0.875) and did not influence clinical or biological variables. CONCLUSION: The PNPLA3 (rs738409 C>G) polymorphism favors steatosis and fibrosis progression in CHC. This polymorphism may represent a valuable genetic predictor and a potential therapeutic target in CHC liver damage.

AIMS: Lactate is produced by anaerobic metabolism and may reflect inadequate tissue perfusion in conditions such as acute heart failure (AHF). We evaluated the prevalence and clinical significance of elevated blood lactate on admission in patients with AHF. METHODS AND RESULTS: We enrolled 237 patients with AHF (mean age 67 ± 12 years; 70% men) presenting without overt clinical evidence of peripheral hypoperfusion ('warm haemodynamic profile'). Median (upper and lower quartiles) blood lactate on admission was 1.8 (1.5; 2.4) mmol/L; 103 (43%) patients had an elevated blood lactate (≥2 mmol/L). Patients with an elevated lactate had higher blood high-sensitivity troponin I [15.4 (8.5; 26.1) vs. 9.9 (4.3; 19.6) pg/mL], aspartate aminotransferase [28 (20; 44) vs 24 (19; 36) IU/L] and endothelin-1 (12.1 ± 6.2 vs. 9.3 ± 3.9 pg/mL) (all P < 0.05). In this group plasma concentration of neutrophil gelatinase-associated lipocalin increased during the first 48 h, whereas values fell for those with normal baseline lactate [1.9 (-3.2; 9.7) vs. -1.3 (-13.9; 5.6) μg/dL; P < 0.05). One-year mortality was higher amongst patients with an elevated blood lactate (36% vs. 21%; P < 0.05). After adjustment for other well-established prognostic variables, blood lactate on admission predicted poor outcome (hazard ratio 1.24, 95% confidence interval 1.08-1.41; P < 0.05). CONCLUSIONS: An elevated blood lactate on admission is common in AHF patients without overt clinical evidence of peripheral hypoperfusion and is associated with markers of organ dysfunction/damage and a worse prognosis.

Holmes, K. K., D. W. Johnson (Univ. of Oregon Medical School, Portland, Oregon 97201) and H. J. Trostle. An estimate of the risk of men acquiring gonorrhea by sexual contact with infected females. &lt;it&gt;Amer. J. Epid&lt;/it&gt;., 1970, 97: 170–174.— Among the crew from an aircraft carrier visiting the Philippines for 6 days, 2, 191 men admitted sexual contact with a group of females known to have a prevalence of 19.7% of &lt;it&gt;N. gonorrhoeae&lt;/it&gt; infection. The mean number of consorts visited by each man was 1.2. Seventy-seven % of the men did not use prophylaxis. Eighty-eight cases of gonorrhea were actually observed among the males in the shipboard population following the liberty period. With this information a risk estimate was developed and it appears that the risk of acquiring gonorrhea by contact with an infected female is about 22%.

Although there has been nearly complete agreement in the scientific community that Monte Carlo techniques represent a significant improvement in the exposure assessment process, virtually all state and federal risk assessments still rely on the traditional point estimate approach. One of the rate-determining steps to a timely implementation of Monte Carlo techniques to regulatory decision making is the development of "standard" data distributions that are considered applicable to any setting. For many exposure variables, there is no need to wait any longer to adopt Monte Carlo techniques into regulatory policy since there is a wealth of data from which a robust distribution can be developed and ample evidence to indicate that the variable is not significantly influenced by site-specific conditions. In this paper, we propose several distributions that can be considered standard and customary for most settings. Age-specific distributions for soil ingestion rates, inhalation rates, body weights, skin surface area, tapwater and fish consumption, residential occupancy and occupational tenure, and soil-on-skin adherence were developed. For each distribution offered in this paper, we discuss the adequacy of the database, derivation of the distribution, and applicability of the distribution to various settings and conditions.

Signalling pathway activation analysis is a powerful approach for extracting biologically relevant features from large-scale transcriptomic and proteomic data. However, modern pathway-based methods often fail to provide stable pathway signatures of a specific phenotype or reliable disease biomarkers. In the present study, we introduce the in silico Pathway Activation Network Decomposition Analysis (iPANDA) as a scalable robust method for biomarker identification using gene expression data. The iPANDA method combines precalculated gene coexpression data with gene importance factors based on the degree of differential gene expression and pathway topology decomposition for obtaining pathway activation scores. Using Microarray Analysis Quality Control (MAQC) data sets and pretreatment data on Taxol-based neoadjuvant breast cancer therapy from multiple sources, we demonstrate that iPANDA provides significant noise reduction in transcriptomic data and identifies highly robust sets of biologically relevant pathway signatures. We successfully apply iPANDA for stratifying breast cancer patients according to their sensitivity to neoadjuvant therapy.

Epidermal growth factor receptor (EGFR) immunoreactivity was evaluated in 85 cases of invasive transitional cell carcinoma of the bladder. The impact of EGFR staining on patient survival was compared with tumor stage, histologic grade, immunoreactivity for c-erb B-2 and proliferating cell nuclear antigen, flow cytometrically determined S-phase fraction and DNA ploidy, abnormal expression of blood-group-related antigens, and patient blood type. Using a new monoclonal anti-EGFR antibody reactive in formalin-fixed tissue, the authors found a significant correlation between EGFR expression and high tumor stage, and between EGFR expression and poor patient outcome. However, EGFR expression as a predictor of prognosis was not independent of stage. An intriguing association between patient blood type and patient survival was noted. Other indices did not predict patient outcome after data were adjusted for stage.

We have examined the ability of recombinant adenoviral vectors to transduce human hematopoietic cells. Our findings indicate that adenovirus readily infects a large proportion of CD34+ cells. Using adenovirus vectors that transduce either a lacZ or an alkaline phosphatase reporter gene, we observed up to 45% of total CD34+ cells infected. Upon more detailed analysis, we observed comparable levels of transduction for CD34+/CD38- cells and for CD34+ cells in G(zero) phase of the cell cycle. Importantly, exposure to adenovirus resulted in negligible levels of toxicity as assayed by propidium iodide staining and colony-forming ability. Using adenovirus vectors, we also describe a model system for regulated gene expression in early hematopoietic tissues. CD34+ cells were simultaneously infected with two viruses, one carrying a TetR/VP16 transactivator (tTA) and the second carrying a tTA-dependent lacZ reporter gene. Using this approach, beta-gal expression was only observed upon coinfection with the transactivator vector. In addition, as shown previously (Gossen and Bujard, Proc Natl Acad Sci USA 89:5547, 1992), tetracycline was able to inhibit tTA mediated induction, thereby providing an effective means to regulate expression of the reporter gene. We conclude that recombinant adenovirus is an effective vehicle for transiently expressing genes in primitive human hematopoietic cells.

Murine CD4 and CD8 T cells express predominantly types 1 and 4 sphingosine 1-phosphate (S1P) G protein-coupled receptors (designated S1P1 and S1P4 or previously endothelial differentiation gene-encoded 1 and 6) for S1P, which has a normal plasma concentration of 0.1-1 microM. S1P now is shown to enhance chemotaxis of CD4 T cells to CCL-21 and CCL-5 by up to 2.5-fold at 10 nM to 0.1 microM, whereas 0.3-3 microM S1P inhibits this chemotaxis by up to 70%. Chemotaxis of S1P(1), but not S1P(4), transfectants to CXCL1 and CXCL4 was similarly affected by S1P. Activation of CD4 T cells, which decreases S1P receptor expression, suppressed effects of S1P on chemotaxis. Pretreatment of labeled CD4 T cells with S1P before reintroduction into mice inhibited by a maximum of 75% their migration into chemokine-challenged s.c. air pouches. The S1P-S1P(1) receptor axis thus controls recruitment of naive T cells by maintaining their response threshold to diverse lymphotactic factors.

Research Article| June 01 2002 Removal of 2-methylisoborneol and geosmin in surface water treatment plants in Arizona Darlene Bruce; Darlene Bruce 11960 East Alameda Drive, Tempe, AZ 85282 (480) 921-0887 E-mail: cjbruce@usa.net E-mail: cjbruce@usa.net Search for other works by this author on: This Site PubMed Google Scholar Paul Westerhoff; Paul Westerhoff 2Arizona State University, Department of Civil and Environmental Engineering, Tempe, AZ 85287-5306, USA (480) 965-8130 E-mail: p.westerhoff@asu.edu Search for other works by this author on: This Site PubMed Google Scholar Alice Brawley-Chesworth Alice Brawley-Chesworth 3City of Phoenix Water Services Department, 23rd Avenue Water Treatment Plant, Phoenix, Arizona (602) 534-6113 E-mail: abrawley@ci.phoenix.az.us Search for other works by this author on: This Site PubMed Google Scholar Journal of Water Supply: Research and Technology-Aqua (2002) 51 (4): 183–198. https://doi.org/10.2166/aqua.2002.0016 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Twitter LinkedIn Tools Icon Tools Cite Icon Cite Permissions Search Site Search nav search search input Search input auto suggest search filter All ContentAll JournalsThis Journal Search Advanced Search Citation Darlene Bruce, Paul Westerhoff, Alice Brawley-Chesworth; Removal of 2-methylisoborneol and geosmin in surface water treatment plants in Arizona. Journal of Water Supply: Research and Technology-Aqua 1 June 2002; 51 (4): 183–198. doi: https://doi.org/10.2166/aqua.2002.0016 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex Many utilities experience taste and odour episodes that affect the public's perception of the safety of drinking water. Two compounds responsible for earthy and musty taste and odours in drinking water supplies are geosmin and 2-methylisoborneol (MIB), which are produced by blue-green algae and actinomycetes. MIB and geosmin are typically removed in water treatment plants (WTPs) through the addition of powdered activated carbon (PAC) or strong oxidants. However, chemical addition can be costly and performance variable, depending on the water chemistry. Optimization of water treatment processes and chemical addition for removal of MIB and geosmin would be economically beneficial to utilities and provide a service to customers. Results from this research showed traditional water treatment processes (coagulation) could not be optimized for removal of MIB and geosmin. During ozonation, hydroxyl radicals accounted for a greater percentage of MIB or geosmin oxidation relative to molecular ozone oxidation. PAC adsorption experiments in Arizona drinking water showed that dissolved organic carbon competed with MIB and geosmin for PAC adsorption sites. Utilities should conduct taste and odour removal tests in local waters containing natural dissolved organic carbon and not rely on manufacturer data in ultra-pure water. Laboratory PAC experiments predicted full-scale PAC performance well. activated carbon, coagulation, geosmin, methylisoborneol, ozone This content is only available as a PDF. © IWA Publishing 2002 You do not currently have access to this content.

Abstract Aims The clinical significance of the measurement of urine sodium concentration (UNa+) in response to loop diuretic administration in patients with acute heart failure (AHF) is still unsettled. We studied the association of serial measurements of spot UNa+ during the first 48 h of AHF treatment with the indices of decongestion, renal function, and prognosis. Methods and results We enrolled 111 AHF patients, all of whom received intravenous furosemide on admission. The mean spot UNa+ significantly increased in the 6 h sample (P &amp;lt; 0.05 vs. baseline) and returned to baseline values in the 24 and 48 h samples. Based on the increase or decrease/no change of UNa+ in the 6 and 48 h samples vs. baseline, patients were divided into two groups at each time point, respectively. Patients did not differ in baseline clinical and laboratory characteristics. Patients with a decrease/no change of UNa+ in the 6 and 48 h samples had a lower weight loss during hospitalization. Patients with a decrease/no change of UNa+ in the 48 h sample had a poorer diuretic response and a significant increase in the urinary levels of the tubular biomarkers: kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin. Low UNa+ and decrease/no change in UNa+ in the 6 and 48 h samples were independent predictors of higher risk of all-cause mortality during 1-year follow-up (all P &amp;lt; 0.05). Conclusion In AHF, low spot UNa+ and lack to increase UNa+ in response to intravenous diuretics are associated with poor diuretic response, markers of tubular injury and high risk of 1-year mortality.