ACAD10 is not required for metformin's metabolic actions or for maintenance of whole-body metabolism in C57BL/6J mice.

AIM: Acyl-coenzyme A dehydrogenase family member 10 (ACAD10) is a mitochondrial protein purported to be involved in the fatty acid oxidation pathway. Metformin is the most prescribed therapy for type 2 diabetes; however, its precise mechanisms of action(s) are still being uncovered. Upregulation of ACAD10 is a requirement for metformin's ability to inhibit growth in cancer cells and extend lifespan in Caenorhabditis elegans. However, it is unknown whether ACAD10 plays a role in metformin's metabolic actions. MATERIALS AND METHODS: We assessed the role for ACAD10 on whole-body metabolism and metformin action by generating ACAD10KO mice on a C57BL/6J background via CRISPR-Cas9 technology. In-depth metabolic phenotyping was conducted in both sexes on a normal chow and high fat-high sucrose diet. RESULTS: Compared with wildtype mice, we detected no difference in body composition, energy expenditure or glucose tolerance in male or female ACAD10KO mice, on a chow diet or high-fat, high-sucrose diet (p ≥ .05). Hepatic mitochondrial function and insulin signalling was not different between genotypes under basal or insulin-stimulated conditions (p ≥ .05). Glucose excursions following acute administration of metformin before a glucose tolerance test were not different between genotypes nor was body composition or energy expenditure altered after 4 weeks of daily metformin treatment (p ≥ .05). Despite the lack of a metabolic phenotype, liver lipidomic analysis suggests ACAD10 depletion influences the abundance of specific ceramide species containing very long chain fatty acids, while metformin treatment altered clusters of cholesterol ester, plasmalogen, phosphatidylcholine and ceramide species. CONCLUSIONS: Loss of ACAD10 does not alter whole-body metabolism or impact the acute or chronic metabolic actions of metformin in this model.

Responsiveness of sphingosine phosphate lyase insufficiency syndrome to vitamin B6 cofactor supplementation.

Sphingosine-1-phosphate (S1P) lyase is a vitamin B6-dependent enzyme that degrades sphingosine-1-phosphate in the final step of sphingolipid metabolism. In 2017, a new inherited disorder was described caused by mutations in SGPL1, which encodes sphingosine phosphate lyase (SPL). This condition is referred to as SPL insufficiency syndrome (SPLIS) or alternatively as nephrotic syndrome type 14 (NPHS14). Patients with SPLIS exhibit lymphopenia, nephrosis, adrenal insufficiency, and/or neurological defects. No targeted therapy for SPLIS has been reported. Vitamin B6 supplementation has therapeutic activity in some genetic diseases involving B6-dependent enzymes, a finding ascribed largely to the vitamin's chaperone function. We investigated whether B6 supplementation might have activity in SPLIS patients. We retrospectively monitored responses of disease biomarkers in patients supplemented with B6 and measured SPL activity and sphingolipids in B6-treated patient-derived fibroblasts. In two patients, disease biomarkers responded to B6 supplementation. S1P abundance and activity levels increased and sphingolipids decreased in response to B6. One responsive patient is homozygous for an SPL R222Q variant present in almost 30% of SPLIS patients. Molecular modeling suggests the variant distorts the dimer interface which could be overcome by cofactor supplementation. We demonstrate the first potential targeted therapy for SPLIS and suggest that 30% of SPLIS patients might respond to cofactor supplementation.

Integration of a nurse practitioner and physician associate leadership structure within an academic cancer center.

BACKGROUND: Nurse practitioners and physician associates are an essential part of the multidisciplinary cancer care team with expanding and evolving roles within cancer specialties. LOCAL PROBLEM: As these clinicians flourish, a parallel need for leadership rises to optimize scope of practice, mentor, and retain this crucial workforce. The purpose of this quality improvement project was to development a nurse practitioner and physician associate leadership structure within an academic cancer center. METHODS: Development of this nurse practitioner and physician associate leadership structure was guided by transformational leadership theory. In collaboration with nursing, business, and physician leadership, a quad structure was supported. INTERVENTIONS: Implementation of a leadership structure included the establishment of eight team leaders and two managers. These leaders identified multiple opportunities for improvement including improved communications, offload of nonbillable work, development of incentive programs, provision of equipment, specialty practice alignment, hematology/oncology fellowship, and professional development. RESULTS: Overall, a nurse practitioner and physician associate leadership structure allowed for representation across the cancer center. Such inclusion supported multiple quality improvement projects developed in partnership with nursing, business, and physician leaders. Cumulatively, these interventions yielded efficient workflows and expansion of services. Consistent with reported evidence, these efforts contributed to nurse practitioner and physician associate retention as well as improved job satisfaction. CONCLUSIONS: Advanced practice leadership is essential to recruiting, developing, supporting, and retaining nurse practitioner and physician assistant colleagues in cancer care.

Interventions to Improve Advanced Practitioner Work-Related Quality of Life and Patient Satisfaction.

Background: Across the United States, an incremental need for cancer care continues to emerge. Specialty nurse practitioners and physician assistant teams have helped in meeting this demand. However, there is a need for evidence-based recommendations to inform appropriate provider-patient staffing ratios that encompass complex cancer treatments and ensure optimal care. Methods: A literature review identified a gap in existing research with regard to recommended inpatient provider-patient ratios for hematology and oncology services. The conceptual framework of ICU nursing workload was utilized to ensure a comprehensive understanding of an inpatient specialty cancer provider's duties. Results: Within the unit, job, patient, and situation workload levels, there were multiple interventions implemented to streamline systems and improve workplace conditions for providers, as measured by the work-related quality of life (WRQoL) scale. Patient satisfaction scores improved an average of 4% across multiple criteria and exceeded benchmark rankings by 10.7% surrounding communication with nurses and physicians (a 6.3% increase). Discharge efficiency improved, with 6.1% more discharges occurring by 11:00 am, and length of stay was noted to be 8.8 days fewer than teaching services treating the same cancer diagnosis. Finally, additional shift pay was greatly reduced and turnover decreased by 17%. Conclusion: Application of the conceptual framework of ICU nursing workload provided a scientific assessment of specialty inpatient cancer services within one institution. Interventions resulted in improved working conditions, patient satisfaction, discharge efficiency, and reduced turnover, ultimately ensuring the provision of high-quality cancer care.

Influence of hydrogeochemical processes on zero-valent iron reactive barrier performance: a field investigation.

Geochemical and mineralogical changes were evaluated at a field Fe0-PRB at the Oak Ridge Y-12 site concerning operation performance during the treatment of U in high NO3- groundwater. In the 5-year study period, the Fe0 remained reactive as shown in pore-water monitoring data, where increases in pH and the removal of certain ionic species persisted. However, coring revealed varying degrees of cementation. After 3.8-year treatment, porosity reduction of up to 41.7% was obtained from mineralogical analysis on core samples collected at the upgradient gravel-Fe0 interface. Elsewhere, Fe0 filings were loose with some cementation. Fe0 corrosion and pore volume reduction at this site are more severe due to the presence of NO3- at a high level. Tracer tests indicate that hydraulic performance deteriorated: the flow distribution was heterogeneous and under the influence of interfacial cementation a large portion of water was diverted around the Fe0 and transported outside the PRB. Based on the equilibrium reductions of NO3- and SO4(2-) by Fe0 and mineral precipitation, geochemical modeling predicted a maximum of 49% porosity loss for 5 years of operation. Additionally, modeling showed a spatial distribution of mineral precipitate volumes, with the maximum advancing from the interface toward downgradient with time. This study suggests that water quality monitoring, coupled with hydraulic monitoring and geochemical modeling, can provide a low-cost method for assessing PRB performance.

Influence of hydrogeochemical processes on zero-valent iron reactive barrier performance: a field investigation.

Geochemical and mineralogical changes were evaluated at a field Fe0-PRB at the Oak Ridge Y-12 site concerning operation performance during the treatment of U in high NO3- groundwater. In the 5-yr study period, the Fe0 remained reactive as shown in pore water monitoring data, where increases in pH and the removal of certain ionic species persisted. However, coring revealed varying degrees of cementation. After 3.8-yr treatment, porosity reduction of up to 41.7% was obtained from mineralogical analysis on core samples collected at the upgradient gravel-Fe0 interface. Elsewhere, Fe0 filings were loose with some cementation. Fe0 corrosion and pore volume reduction at this site are more severe due to the presence of NO3- at a high level. Tracer tests indicate that hydraulic performance deteriorated: the flow distribution was heterogeneous and under the influence of interfacial cementation a large portion of water was diverted around the Fe0 and transported outside the PRB. Based on the equilibrium reductions of NO3- and SO4(2-) by Fe0 and mineral precipitation, geochemical modeling predicted a maximum of 49% porosity loss for 5 yr of operation. Additionally, modeling showed a spatial distribution of mineral precipitate volumes, with the maximum advancing from the interface toward downgradient with time. This study suggests that water quality monitoring, coupled with hydraulic monitoring and geochemical modeling, can provide a low-cost method for assessing PRB performance.

Identification and quantification of mineral precipitation in Fe0 filings from a column study.

Thermogravimetric analysis (TGA) combined with X-ray diffraction (XRD) was used to identify mineral phases and determine corrosion rates of granular iron samples from a 2-yr field column study. Similar to other studies, goethite, magnetite, aragonite, and calcite were found to be the major precipitated minerals, with Fe2(OH)2CO3 and green rust as minor phases. Based on TGA-mass spectrometry (MS) analysis, Fe0 corrodes at rates of 0.5-6.1 mmol kg(-1) d(-1) in the high NO3- (up to 13.5 mM) groundwater; this rate is significantly higher than previously reported. Porosity reduction was 40.6%-45.1% for the inlet sand/Fe0 interface and 7.4%-25.6% for effluent samples of two test columns. Normalized for treatment volumes, porosity loss values are consistent with studies that use high levels of SO4(2-) but are higher than those using low levels of corrosive species. Aqueous mass balance calculations yield corrosion rates similar to the TGA-MS method, providing an alternative to coring and mineralogical analysis. A severely corroded iron sample from the column simulating a 17-yr treatment throughput showed >75% porosity loss. Extensive porosity loss due to high levels of corrosive species in groundwater will have significant impact on long-term performance of permeable reactive barriers.

CO2 hydrate composite for ocean carbon sequestration.

Rapid CO2 hydrate formation was investigated with the objective of producing a negatively buoyant CO2-seawater mixture under high-pressure and low-temperature conditions, simulating direct CO2 injection at intermediate ocean depths of 1.0-1.3 km. A coflow reactor was developed to maximize CO2 hydrate production by injecting water droplets (e.g., approximately 267 microm average diameter) from a capillary tube into liquid CO2. The droplets were injected in the mixing zone of the reactor where CO2 hydrate formed at the surface of the water droplets. The water-encased hydrate particles aggregated in the liquid CO2, producing a paste-like composite containing CO2 hydrate, liquid CO2, and water phases. This composite was extruded into ambient water from the coflow reactor as a coherent cylindrical mass, approximately 6 mm in diameter, which broke into pieces 5-10 cm long. Both modeling and experiments demonstrated that conversion from liquid CO2 to CO2 hydrate increased with water flow rate, ambient pressure, and residence time and decreased with CO2 flow rate. Increased mixing intensity, as expressed by the Reynolds number, enhanced the mass transfer and increased the conversion of liquid CO2 into CO2 hydrate. Using a plume model, we show that hydrate composite particles (for a CO2 loading of 1000 kg/s and 0.25 hydrate conversion) will dissolve and sink through a total depth of 350 m. This suggests significantly better CO2 dispersal and potentially reduced environmental impacts than would be possible by simply discharging positively buoyant liquid CO2 droplets. Further studies are needed to address hydrate conversion efficiency, scale-up criteria, sequestration longevity, and impact on the ocean biota before in-situ production of sinking CO2 hydrate composite can be applied to oceanic CO2 storage and sequestration.

Hydrate composite particles for ocean carbon sequestration: field verification.

This paper reports on the formation and dissolution of CO2/seawater/CO2 hydrate composite particles produced during field experiments in Monterey Bay, CA using a CO2 injector system previously developed in the laboratory. The injector consisted of a coflow reactor wherein water was introduced as a jet into liquid CO2, causing vigorous mixing of the two immiscible fluids to promote the formation of CO2 hydrate that is stable at ambient pressures and temperatures typical of ocean depths greater than approximately 500 m. Using flow rate ratios of water and CO2 of 1:1 and 5:1, particulate composites of CO2 hydrate/liquid CO2/seawater phases were produced in seawater at depths between 1100 and 1300 m. The resultant composite particles were tracked by a remotely operated vehicle system as they freely traveled in an imaging box that had no bottom or top walls. Results from the field experiments were consistent with laboratory experiments, which were conducted in a 70 L high-pressure vessel to simulate the conditions in the ocean at intermediate depths. The particle velocity and volume histories were monitored and used to calculate the conversion of CO2 into hydrate and its subsequent dissolution rate after release into the ocean. The dissolution rate of the composite particles was found to be higher than that reported for pure CO2 droplets. However, when the rate was corrected to correspond to pure CO2, the difference was very small. Results indicate that a higher conversion of liquid CO2 to CO2 hydrate is needed to form negatively buoyant particles in seawater when compared to freshwater, due primarily to the increased density of the liquid phase but also due to processes involving brine rejection during hydrate formation.