Pattern Formation in the Longevity-Related Expression of Heat Shock Protein-16.2 in Caenorhabditis elegans.

Aging in Caenorhabditis elegans is controlled, in part, by the insulin-like signaling and heat shock response pathways. Following thermal stress, expression levels of small heat shock protein-16.2 show a spatial patterning across the 20 intestinal cells that reside along the length of the worm. Here, we present a hypothesized mechanism that could lead to this patterned response and develop a mathematical model of this system to test our hypothesis. We propose that the patterned expression of heat shock protein is caused by a diffusion-driven instability within the pseudocoelom, or fluid-filled cavity, that borders the intestinal cells in C. elegans. This instability is due to the interactions between two classes of insulin-like peptides that serve antagonistic roles. We examine output from the developed model and compare it to experimental data on heat shock protein expression. Given biologically bounded parameters, the model presented is capable of producing patterns similar to what is observed experimentally and provides a first step in mathematically modeling aging-related mechanisms in C. elegans.

Evaluation of physician and patient compliance with the use of peak flow meters in commercial insurance and Oregon health plan asthmatic populations.

BACKGROUND: Home use of peak expiratory flow (PEF) meters is recommended by NIH management guidelines for patients with moderate to severe asthma. OBJECTIVE: To evaluate whether differences in physician PEF meter prescription patterns and patient compliance rates with PEF meter use exist between populations of commercially insured and Oregon Health Plan (OHP) patients. METHODS: A prospective, case-series study was conducted at the Bay Clinic Coos Bay, Oregon. Volunteers responded to a short survey. Patient asthma severity was evaluated by responses to the following questions: (1) frequency of shortness of breath per week, (2) daily and weekly frequency of albuterol rescue inhaler use, and (3) other prescription medications used. Additional questions included: (1) possession of a PEF meter, (2) physician instruction of meter use, (3) patient compliance with instructions, and (4) type of medical insurance. Using NIH asthma stratification guidelines, only respondents with moderate to severe asthma were included in this study. Respondents were age restricted to between 6 and 60 years. Incomplete surveys were not accepted. RESULTS: Ninety-six surveys were received and 54 accepted. Only 24 (44%) of the 54 respondents with moderate to severe asthma had a PEF meter. Nineteen (79%) used it according to physician instructions. Of the 29 patients reporting to have commercial insurance, 18 (62%) had a PEF meter and 15 (83%) used it as prescribed. Of the 21 asthmatic patients with OHP coverage, only 5 (24%) P = .007 had a peak flow meter and 4 (80%) used it as prescribed. CONCLUSIONS: We conclude physician prescription compliance of peak flow meters for asthma monitoring falls short of the NIH guidelines. When a PEF meter is prescribed, patients will likely use it regardless of their medical insurance. Significant differences exist in physician compliance with PEF meter prescription between populations of commercially insured and OHP patients. More study is necessary to further understand this divergence in care delivery.

Clinical psychopharmacy consultations: acceptance of recommendations on an adult inpatient psychiatric unit.

A retrospective chart review of consultations performed by a clinical pharmacist practicing in an adult psychiatric hospital was conducted. Data during the first 12 months of the service were collected from consultation reports, progress notes, physician's orders, laboratory data, and discharge summaries. Twenty-nine consultations were performed, resulting in a total of 135 recommendations. Of those, 125 were assessed and categorized. Of the recommendations, 113 (90.4%) were medication related and 12 (9.6%) were non-medication related. From the 125 recommendations, 99 (79.2%) were implemented and 26 (20.8%) were not. Particular categories of recommendations were also analyzed and had individual implementation rates ranging from 33.3% to 100%. Clinical pharmacists have previously documented their positive impact on patient care in a variety of settings, including psychopharmacy. The majority of recommendations made in this study were medication related with an overall implementation rate of 79%. This report illustrates the influence the clinical pharmacist has on the drug therapy of the psychiatric patient.