The basics of EDI (electronic data interchange): a pathway to the information highway

With EDI, patients such as Jane Russo can focus not on the time-consuming and often confusing business of benefit coordination, but on getting well. Similarly, the registration clerk's job is simplified thanks to a single electronic link that provides the information needed to perform his or her job accurately and efficiently. The health information management department can use EDI to maintain authority over the release of information and make the process of transferring patient information more expeditious. As EDI further evolves into the clinical arena, it will enhance care providers' access to longitudinal patient clinical records. In addition, the information highway will provide access to better information for quality assessment, outcomes management, and the development of clinical guidelines. With access to the information highway, healthcare providers, payers, and employers can take an evolutionary leap in their efforts toward coordinating truly patient-centered, high-quality care.     

Culture,Ethnicity, and Level of Education in Alzheimer’s Disease

Alzheimer’s disease (AD) is the most frequent cause of dementia, where the abnormal accumulation of beta-amyloid (Aβ) and tau lead to neurodegeneration as well as loss of cognitive, behavioral, and functional abilities. The present review analyzes AD from a cross-cultural neuropsychological perspective, looking at differences in culture-associated variables, neuropsychological test performance and biomarkers across ethnic and racial groups. Studies have found significant effects of culture, preferred language, country of origin, race, and ethnicity on cognitive test performance, although the definition of those grouping terms varies across studies. Together, with the substantial underrepresentation of minority groups in research, the inconsistent classification might conduce to an inaccuratte diagnosis that often results from biases in testing procedures that favor the group to which test developers belong. These biases persist even after adjusting for variables related to disadvantageous societal conditions, such as low level of education, unfavorable socioeconomic status, health care access, or psychological stressors. All too frequently, educational level is confounded with culture. Minorities often have lower educational attainment and lower quality of education, causing differences in test results that are then attributed to culture. Higher levels of education are also associated with increased cognitive reserve, a protective factor against cognitive decline in the presence of neurodegeneration. Biomarker research suggests there might be significant differences in specific biomarker profiles for each ethnicity/race in need of accurate cultural definitions to adequately predict risk and disease progression across ethnic/racial groups. Overall, this review highlights the need for diversity in all domains of AD research that lack inclusion and the collection of relevant information from these groups.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13311-022-01193-z.     

Acute toxicant exposure and cardiac autonomic dysfunction from smoking a single narghile waterpipe with tobacco and with a “healthy” tobacco-free alternative

Tobacco smoking using a waterpipe (narghile, hookah, shisha) has become a global epidemic. Unlike cigarette smoking, little is known about the health effects of waterpipe use. One acute effect of cigarette smoke inhalation is dysfunction in autonomic regulation of the cardiac cycle, as indicated by reduction in heart rate variability (HRV). Reduced HRV is implicated in adverse cardiovascular health outcomes, and is associated with inhalation exposure-induced oxidative stress. Using a 32 participant cross-over study design, we investigated toxicant exposure and effects of waterpipe smoking on heart rate variability when, under controlled conditions, participants smoked a tobacco-based and a tobacco-free waterpipe product promoted as an alternative for “health-conscious” users. Outcome measures included HRV, exhaled breath carbon monoxide (CO), plasma nicotine, and puff topography, which were measured at times prior to, during, and after smoking. We found that waterpipe use acutely decreased HRV (p < 0.01 for all measures), independent of product smoked. Plasma nicotine, blood pressure, and heart rate increased only with the tobacco-based product (p < 0.01), while CO increased with both products (p < 0.01). More smoke was inhaled during tobacco-free product use, potentially reflecting attempted regulation of nicotine intake. The data thus indicate that waterpipe smoking acutely compromises cardiac autonomic function, and does so through exposure to smoke constituents other than nicotine.     

Sunlight exposure and vitamin D deficiency in Turkish women

Vitamin D is an essential steroid involved in bone metabolism, cell growth, differentiation, and regulation of the minerals in the body. The main sources of this vital vitamin are adequate diet and photosynthesis in the skin. The aim of this study was to investigate the efficiency of vitamin D synthesis in 48 premenopausal women (14-44 years) in relation to three different types of dressing in summer. Women in the first group (Group I) dressed in a style which exposed the usual areas of the skin to sunlight; women in the second group (Group II wore traditional clothing with the skin of the hands and face uncovered, while the third group (Group III) dressed in traditional Islamic style, covering the whole body including hands and face. Serum 25OHD levels of Group I, Group II, and Group III were 56+/-41.3 nmol/l, 31.9+/-24.4 nmol/l, 9+/-5.7 nmol/l, respectively (Group I vs Group III, p<0.001; Group II vs Group III, p<0,03; Group I vs Group II, p>0.05). Vitamin D levels were low in 44 percent of the Group I and 60% of the Group II, which suggested that sun exposure of skin areas of hands and face may partially provide vitamin D synthesis, but may not be enough to eliminate vitamin D deficiency. All the patients in group III had vitamin D levels below normal. This study emphasizes the necessity of vitamin D fortification of food even in a sunny country where some people may not be exposed to sunlight because of inappropriate clothing or an indoor-life.     

A closed-loop control "playback" smoking machine for generating mainstream smoke aerosols.

A first generation smoking machine capable of reading and replicating detailed puffing behavior from recorded smoking topography data is presented. Unlike standard smoking machines, which model human puffing behavior as a steady periodic waveform with a fixed puff frequency, volume, and duration, this novel machine generates a mainstream smoke aerosol by automatically "playing-back" puff topography recordings. Because combustion chemistry is highly non-linear, representing real smoking behavior with a smoothed periodic waveform may result in a tobacco smoke aerosol with a significantly different chemical composition and physical properties than that generated by a smoker. The machine presented here utilizes a rapid closed-loop control algorithm coded in Labview to generate smoke aerosols for toxicological assessment and inhalation studies. To illustrate its use, dry particulate matter and carbon monoxide yields generated using the playback and equivalent periodic puffing regimens are compared for a single smoking session by a 26-year-old male narghile water-pipe smoker. It was found that the periodic puffing regimen yielded 20% less carbon monoxide (CO) than the played-back smoking session, indicating that steady periodic smoking regimens, which are widely used in tobacco smoke research, may not produce realistic smoke aerosols.     

Thyrotropin binding to porcine thyroid plasma membranes: Kinetic and thermodynamic analyses

Evaluation of TSH binding to plasma membranes of porcine thyroid revealed unique sensitivity to pH and temperature. Analysis of apparent equilibrium binding yielded a linear Scatchard plot at the optimal pH of 6.0, indicating one class of binding sites. At physiological pH 7.4 a curvilinear Scatehard plot was obtained, resolved by computer analysis into two classes of binding sites of different affinities and capacities. Treatment of membranes with phospholipase C resulted in a 20% decrease in the number of high affinity sites, but no change occurred in binding affinity. In contrast, low affinity sites were not altered.To evaluate the significance of the curvilinear Scatchard plot, the kinetics of association were examined. The intrinsic K_d(k_d/k_a) was 0.20 nM, a value essentially equivalent to that of the high affinity binding component. The ‘negative cooperativity’ model of hormone binding was evaluated by examining the effect of excess unlabeled TSH on dissociation rate. Dissociation of bound ¹²⁵I-labeled TSH was biphasic, and was enhanced by unlabeled hormone, regardless of whether the membranes were prelabeled at pH 6.0 or 7.4. This effect was not correlated with curvilinear Scatchard plots, and therefore not proof of negative cooperativity.Binding sites for TSH were further distinguished by their sensitivity to temperature. A van't Hoff plot of temperature dependence of the apparent K_d of the high affinity site was linear from 4 to 37°C. In contrast, the apparent K_d of low affinity binding did not vary with respect to temperature. These results demonstrate that there are at least two independent binding sites for TSH on porcine thyroid plasma membranes, distinguishable by their equilibrium binding properties. thyrotropin receptor; thyroid; negative cooperativity; dissociation kinetics; curvilinear Scatchard plot; binding thermodynamics     

Carcinogenic PAH in waterpipe charcoal products

Because narghile waterpipe (shisha, hooka) smoking normally involves the use of burning charcoal, smoke inhaled by the user contains constituents originating from the charcoal in addition to those from the tobacco. We have previously found that charcoal accounts for most of the polyaromatic hydrocarbons (PAH) and carbon monoxide in the smoke of the waterpipe, both of which are present in alarming quantities. Because charcoal manufacturing conditions favor formation of PAH, it is reasonable to assume that charcoal sold off the shelf may be contaminated by PAH residues. These residues may constitute a significant fraction of the PAH inhaled by the waterpipe user and those in her/his vicinity. We measured PAH residues on three kinds of raw waterpipe charcoal sampled from Beirut stores and cafés. We found that PAH residues in raw charcoal can account for more than half of the total PAH emitted in the mainstream and sidestream smoke, and about one sixth of the carcinogenic 5- and 6-ring PAH compounds. Total PAH content of the three charcoal types varied systematically by a factor of six from the charcoal with the least to the greatest PAH residue. These findings indicate the possibility of regulating charcoal carcinogen content.     

Pesticide and toxicity reduction using an integrated vegetated treatment system

The California, USA, central coast is one of the most productive agricultural areas in the world, and numerous stakeholders are working there to implement conservation practices to reduce contaminated runoff. Practices include vegetated treatment systems (VTS) designed to promote contaminant reduction and breakdown. The current study evaluated the effectiveness of a vegetated drainage ditch incorporating a sedimentation basin, a vegetated section, and a Landguard organophosphate-A (OP-A) enzyme dosing system. The VTS was constructed on a working farm and was designed to remove organophosphate and pyrethroid pesticides, the primary pesticides causing toxicity in Salinas Valley watersheds. The present study was conducted during five separate irrigation events on tailwater runoff containing mixtures of pesticides and suspended sediments. Water samples were collected at four stations within the system, and these were subjected to chemical analyses and tested for toxicity to Ceriodaphnia dubia. All inflow samples were highly toxic to C. dubia, and this was largely because of diazinon. Treatment of diazinon-contaminated runoff was only partially effective using aquatic vegetation. All diazinon remaining after vegetated treatment was effectively removed after treatment with the Landguard OP-A enzyme. Chemical analysis of the VTS water samples showed that pyrethroid and organochlorine pesticide concentrations in water were greatly reduced in the sedimentation section of the ditch, and these pesticides were further reduced in the vegetated section of the ditch. The overall conclusion from these analyses is that the VTS was effective at reducing the more hydrophobic organochlorine and pyrethroid pesticides from water. The water-soluble pesticide diazinon was not sufficiently removed during the VTS residence times observed in this study; however, residual diazinon was effectively removed using Landguard OP-A.