Treatment of secondary hyperparathyroidism in kidney disease: what we know and do not know about use of calcimimetics and vitamin D analogs

There is a growing understanding of the pathophysiology of secondary hyperparathyroidism (SHPT) and a recent emergence of new agents for SHPT treatment in patients with advanced kidney disease. At the same time, appreciation that mineral metabolic derangements promote vascular calcification and contribute to excess mortality, along with recognition of potentially important “non-classical” actions of vitamin D, have prompted the nephrology community to reexamine the use of various SHPT treatments, such as activated vitamin D sterols, phosphate binders, and calcimimetics. In this review, the evidence for treatment of SHPT with calcimimetics and vitamin D analogs is evaluated, with particular consideration given to recent clinical trials that have reported encouraging findings with cinacalcet use. Additionally, several controversies in the pathogenesis and treatment of SHPT are explored. The proposition that calcitriol deficiency is a true pathological state is challenged, the relative importance of the vitamin D receptor and the calcium sensing receptor in parathyroid gland function is summarized, and the potential relevance of non-classical actions of vitamin D for patients with advanced renal disease is examined. Taken collectively, the balance of evidence now supports a treatment paradigm in which calcimimetics are the most appropriate primary treatment for SHPT in the majority of end stage renal disease patients, but which nevertheless acknowledges an important role for modest doses of activated vitamin D sterols

Translocating Common Nighthawks at McConnell Air Force Base, Kansas to Reduce Aircraft Strikes

McConnell Air Force Base (MAFB) experiences a unique bird/aircraft hazard problem with migrating common nighthawks (Chordeiles minor) from August-October. Nighthawks are the most commonly struck species at MAFB, representing about 38% of total reported bird/aircraft strikes and 82% of the strikes from August-October. Factors that contribute to an over abundance of nighthawks on MAFB are: abundant foraging opportunities in close proximity to the airfield, available roosting habitat for nighthawks on and around the airfield, the lack of a Bird Aircraft Strike Hazard program to address nighthawks, and the location of MAFB on a nighthawk migration route. Approaches for managing nighthawks on and around airfields are limited because of their nocturnal behavior, logistics, and an incomplete understanding of nighthawk behavior. At MAFB, we determined the number of nighthawks using the airfield; their foraging, loafing and roosting areas; and their feeding habits. Based on this information, we developed a management strategy to reduce the nighthawk hazard to aircraft. From August-October in 1999 and 2000, we recorded 540 and 920 observations, respectively, of nighthawks using the airfield. The number of individuals increased rapidly during August and September, reaching a peak between 9-14 September in 1999 and 27-30 September in 2000. During one 2-hour survey period each in 1999 and 2000, 37 and 59 nighthawks, respectively, were flushed from the airfield. Most nighthawk foraging activity at the airfield occurred between 1800-2200. Nighthawks started roosting on the airfield about 1800 with a peak between 2200-0200. Thirty-seven nighthawks collected during the study period consumed a variety of insects, consisting mostly of corn earworm moths (Noctuidae—47% of stomach contents) and beetles (Scarabaeidae). Insect sweeps of the airfield indicated a low density of these species of insects, suggesting that most nighthawks foraging activity occurred away from the airfield. Management of nighthawks on MAFB has been difficult because commonly used hazing techniques seem to be ineffective. Furthermore, nighthawks have a behavior of returning to the same roosting location after being flushed which can present an even greater risk to aircraft. We developed and evaluated a unique live-capture technique for nighthawks using the airfield for the purpose of evaluating nighthawk relocation. During 1999 and 2000, 215 nighthawks were captured and relocated to sites 44 km north and 88 km south from MAFB. Only one nighthawk returned to MAFB after being relocated 44 km north. The nighthawk returned after 11 days to within 100 m of its capture location. Relocation of nighthawks from MAFB in 1999 and 2000 reduced nighthawk/aircraft strikes from 9 in 1998 when no relocation was conducted to 0 in 1999 and 3 in 2000

Characterization, renovation, and utilization of water from slurry transport systems

The transportation of a number of commodities as water slurries in pipelines offers a number of advantages which will make this method of transport more popular in coming years. Among the formeost of these advantages are high reliability, low operating costs, minimum environmental disruption, and ability to operate with nonpetroleum energy resources. Although coal is the most frequently mentioned material that is a candidate for slurry transport, other commodities including minerals, wood chips, and even solid refuse may be moved in this manner. Water used as a slurry transport medium must be properly characterized, renovated, and used in order to make slurry transport environmentally and economically acceptable.Project # B-145-MO Agreement # 14-34-0001-121

Population-Based Survey of Complementary and Alternative Medicine Usage, Patient Satisfaction, and Physician Involvement

Background. With an increasing proportion of Americans using complementary or alternative medicine (CAM), physicians need to know which patients are using CAM to effectively manage care. Methods. In this cross-sectional study, telephone interviews were conducted with 1,584 South Carolina adults (ages 18 and older); 66% responded to the survey of demographics, general health, frequency of CAM use, perceived CAM effectiveness, and physician knowledge of CAM use. Results. A total of 44% had used a CAM during the past year. Increasing age and higher education were significantly associated with CAM use. More than 60% perceived CAM therapy as very effective, and 89% said they would recommend CAM to others. Physicians were unaware of CAM use in 57% of their patients using CAM. Conclusion. Complementary or alternative medicine use in this rural Southern state is similar to national usage. Users view CAM as effective. Physicians are frequently unaware of patients\u27 CAM use. More research is needed to establish CAM effectiveness and how CAM affects medical care, training, and public health

Improving inferences in population studies of rare species that are detected imperfectly.

Abstract. For the vast majority of cases, it is highly unlikely that all the individuals of a population will be encountered during a study. Furthermore, it is unlikely that a constant fraction of the population is encountered over times, locations, or species to be compared. Hence, simple counts usually will not be good indices of population size. We recommend that detection probabilities (the probability of including an individual in a count) be estimated and incorporated into inference procedures. However, most techniques for estimating detection probability require moderate sample sizes, which may not be achievable when studying rare species. In order to improve the reliability of inferences from studies of rare species, we suggest two general approaches that researchers may wish to consider that incorporate the concept of imperfect detectability: (1) borrowing information about detectability or the other quantities of interest from other times, places, or species; and (2) using state variables other than abundance (e.g., species richness and occupancy). We illustrate these suggestions with examples and discuss the relative benefits and drawbacks of each approach

Measurement of the Condensation Coefficient of Water in the UMR Simulation Chamber

The UMR Cloud Simulation Facility is described. The facility is designed to provide a controlled environment simulating the conditions of natural atmospheric processes. It consists of two cooled-wall expansion cloud chambers and peripheral instrumentation for generation and characterization of aerosols used for cloud formation studies. Results of initial studies of the growth of warm cloud droplets and inferred measurements of the condensation coefficient are described

Measurement of the Condensation Coefficient of Water in the UMR Cloud Simulation Chamber

Measurements of the condensation coefficient of water under conditions closely approximating those in natural atmospheric cloud have been made in the cooled-wall UMR cloud simulation chamber. Current measurements disclose a value of condensation coefficient near unity at the outset of the experiment, generally decreasing to lower values (~ .01) as the experiment progresses. The significance of the magnitude of condensation coefficient in atmospheric cloud is briefly discussed

GG-Strands

A $G$-strand is a map $g(t,{s}):\,\mathbb{R}\times\mathbb{R}\to G$ for a Lie group $G$ that follows from Hamilton's principle for a certain class of $G$-invariant Lagrangians. The SO(3)-strand is the $G$-strand version of the rigid body equation and it may be regarded physically as a continuous spin chain. Here, $SO(3)_K$-strand dynamics for ellipsoidal rotations is derived as an Euler-Poincar\'e system for a certain class of variations and recast as a Lie-Poisson system for coadjoint flow with the same Hamiltonian structure as for a perfect complex fluid. For a special Hamiltonian, the $SO(3)_K$-strand is mapped into a completely integrable generalization of the classical chiral model for the SO(3)-strand. Analogous results are obtained for the $Sp(2)$-strand. The $Sp(2)$-strand is the $G$-strand version of the $Sp(2)$ Bloch-Iserles ordinary differential equation, whose solutions exhibit dynamical sorting. Numerical solutions show nonlinear interactions of coherent wave-like solutions in both cases. ${\rm Diff}(\mathbb{R})$-strand equations on the diffeomorphism group $G={\rm Diff}(\mathbb{R})$ are also introduced and shown to admit solutions with singular support (e.g., peakons).Comment: 35 pages, 5 figures, 3rd version. To appear in J Nonlin Sc