REVIEW ON PHORBOL ESTER DEGRADATION OF JATROPHA SEED CAKE FOR ITS USE AS ANIMAL FEED

Jatropha curcas is an oil-seed plant with good adaptability to grow in unfavourable conditions like infertile soil with scanty rainfall. It had been exploited for the extraction of oil for bio-diesel. The compressed seed cake, after the oil extraction, is a rich source of protein with certain toxic and anti-nutritional factors. The major toxins in the seed cake are phorbol esters and trypsin inhibitors that lead to various health problems if ingested. Even though the application of the various extracts carries a lot of beneficial advantages, yet the toxicity in oil and the compressed cake does not allow the by-products and the oil to be used elsewhere. Various physicochemical and biological methods have been described for the detoxification of Jatropha seed cake and oil of which the chemical extraction with methanol and ethanol have shown promising results in reducing the toxin contents by 97-100% while UV-irradiation reduced the phorbol esters completely. Submerged fermentation by Bacillus sp. achieved complete detoxification of phorbol esters within a week. A new strain was found to degrade the phorbol esters to phorbol, myristic acid and acetic acid within 12 h of incubation in submerged fermentation process. The detoxified products, in future, can be used as animal feed and food supplement to help utilize the by-products as a healthy diet

The Variation of Chargemaster Price Listings for Urogynecologic Procedures

IMPORTANCE: A 2018 Executive Order calling for price transparency required hospitals to publicly provide chargemasters, which are detailed lists of standard price listings for billable medical procedures. OBJECTIVES: The objective of this study was to evaluate price listing variations in common urogynecology procedures. STUDY DESIGN: This was a cross-sectional study of chargemasters obtained between February and April 2020 from hospitals across 5 states chosen to reflect the diversity of health systems in the United States. Hospital characteristic and quality metric data were obtained from the Homeland Infrastructure Foundation, U.S. Department of Agriculture, and U.S. Centers for Medicare & Medicaid Services websites. Current Procedural Terminology codes and procedure names for 9 urogynecologic procedures were used to search each chargemaster and extract price listings. Price listings were compared with data on quality, population demographics, and hospital characteristics to determine if any significant relationships existed. RESULTS: Eight hundred thirty-four chargemasters were identified. Price listings for most procedures differed significantly across the 5 states, including colpocleisis, cystoscopy with chemodenervation, diagnostic cystoscopy, diverticulectomy, sacral neuromodulation, midurethral sling, and sacrospinous ligament fixation. Price listings were significantly higher in urban hospitals than rural hospitals for 6 procedures. No significant association was seen with price listing and quality measures for most procedures. CONCLUSIONS: Listed prices varied for several urogynecologic procedures. Some of this variation is associated with hospital characteristics such as urban setting. However, notably, price listing was not associated with quality. Further investigation of chargemaster price listings with hospital characteristics and quality metrics and with what is actually paid by patients is imperative for patients to navigate charges

Chargemaster Pricing Variation for Commonly Billed Procedures in Interventional Cardiology

OBJECTIVES: A chargemaster is a database of all of the billable items offered by a hospital with their base price listings. A 2018 executive order required all American hospitals to publish their chargemasters to increase price transparency and reduce healthcare expenditures. Chargemaster listings, however, demonstrate marked variability and inconsistency and have not been associated with consumer benefit. The objective of this study was to analyze chargemasters for commonly billed interventional cardiology procedures across five diverse states to explore relationships between price listings and hospital characteristics, ownership, location, and hospital quality. METHODS: Chargemasters were downloaded from hospitals in five states selected to represent the nation\u27s healthcare diversity. Price listings for five interventional cardiology procedures (percutaneous coronary angiography, coronary angiography, single-vessel angioplasty, single-vessel stent, and percutaneous coronary intervention of acute myocardial infarction) were extracted. Statistical analyses such as the Kruskal-Wallis test were performed to explore relationships between mean chargemaster price listings for each procedure and hospital characteristics, ownership, location, and quality ratings. RESULTS: The median mean chargemaster price of four of the five interventional cardiology procedures significantly differed across all states. Price listings were significantly higher in urban versus rural areas and in general acute care hospitals and state government-owned facilities. The highest prices were found with the highest hospital quality rating. CONCLUSIONS: Chargemaster price listings for common interventional cardiology procedures varied significantly across these five states. Urban and metropolitan hospital location, hospital type, and hospital ownership could be factors driving increased chargemaster procedure prices. Prices were highest at hospitals with the highest quality rating