Subject(s)
Amino Acid Metabolism, Inborn Errors/chemically induced , Amino Acid Metabolism, Inborn Errors/diagnosis , Glutathione Synthase/deficiency , Acetaminophen/adverse effects , Amino Acid Metabolism, Inborn Errors/complications , Dyspnea/chemically induced , Dyspnea/complications , Dyspnea/diagnosis , Humans , Male , Middle AgedABSTRACT
BACKGROUND: Approximately 5% of preschool-age children suffer from amblyopia. Many of them have high or unequal hyperopia. Amblyogenic risk factors frequently can be detected by photoscreening. METHODS: Free photoscreening was offered to Alaskan children ages 1 to 5 from urban and rural screening hubs. Screened images were mailed to the Alaska Blind Child Discovery coordinating center for physician photoscreen interpretation, specifically seeking latent or anisometropic hyperopia. Parents and screeners then were mailed results and information about amblyopia. Follow-up examination data were tallied, and a cost-consequence analysis was developed for various vision screening paradigms and eye care. RESULTS: From 1996 through 2003, a total of 13,255 screenings were performed with a positive interpretation rate of 4.7%. Penetrance of screening was 22% in urban and 44% in rural communities. Positive predictive value was estimated to be more than 90%. Average cost to screen and inform an Alaskan preschooler was approximately 10.67 dollars, and cost to detect amblyogenic risk factors by photoscreening in an Alaskan was approximately 206 dollars. Compared to American Academy of Pediatrics (AAP) 1995 guidelines, implementing photoscreening added 9%, while mandating complete prekindergarten examination added 49% to overall eye care. CONCLUSIONS: MTI photoscreening achieved high community penetrance and high positive predictive value for latent hyperopia and other amblyogenic factors. When follow-up costs are considered, adding photoscreening to current AAP guidelines may add 112 dollars per child over 10 years, but probably would assist in the reduction of amblyopia. Penetrance of urban photoscreening likely will remain low unless pediatric vision screening guidelines and reimbursement are revised.
Subject(s)
Amblyopia/diagnosis , Health Care Costs , Hyperopia/diagnosis , Photography/economics , Vision Screening/economics , Vision Screening/methods , Alaska , Child, Preschool , Humans , Infant , Predictive Value of TestsABSTRACT
Different phosphoinositides are synthesized in cell membranes in order to perform a variety of functions. One of the most abundant of these lipids is phosphatidylinositol (PI) 4-phosphate (PI4P), which is formed in human eukaryotes by type II and type III phosphatidylinositol 4-kinase (PI4K II and III) activities. PI4K II activity occurs in many different subcellular membranes, although no detailed analysis of the distribution of this activity has been reported. Using density gradient ultracentrifugation, we have previously found that in A431 cells the predominant PI4K activity arises from a type II alpha enzyme that is localized to a buoyant membrane fraction of unknown origin [Waugh, Lawson, Tan and Hsuan (1998) J. Biol. Chem. 273, 17115-17121]. We show here that these buoyant membranes contain an activated form of PI4K II alpha that can be separated from the bulk of the PI4K II alpha protein in A431 and COS-7 cells. Proteomic analysis revealed that the buoyant membrane fraction contains numerous endoplasmic reticulum (ER)-marker proteins, although it was separated from the bulk of the ER, ER-Golgi intermediate compartment, transitional ER, Golgi and other major subcellular membranes. Furthermore, the majority of the cytoplasmic valosin-containing protein (VCP), an AAA+ATPase implicated in various ER, transitional ER, Golgi and nuclear functions, was almost completely localized to the same buoyant membrane fraction. Co-localization of VCP and PI4K activity was confirmed by co-immunoprecipitation. These results suggest the previously unsuspected existence of an ER-related domain in which the bulk of the cellular PI4P synthesis and VCP are localized.
