AAPM Medical physics practice guideline 15.A: Peer review in clinical physics.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education, and professional practice of medical physics. The AAPM has more than 8000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. While must is the term to be used in the guidelines, if an entity that adopts the guideline has shall as the preferred term, the AAPM considers that must and shall have the same meaning. Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

Jasmonic acid and salicylic acid induced defensive response in wine grapes against Drosophila suzukii (Diptera: Drosophilidae).

To better understand the elicitor induced defense in wine grapes against Drosophila suzukii (Matsumura), two varieties, Pinot Noir and Chardonnay, were sprayed with jasmonic acid (JA) and salicylic acid (SA). Total phenols, total flavonoids, total tannins and total soluble sugars were quantified. Oviposition preference by D. suzukii in response to JA and SA applications were also studied. Behavioral response of D. suzukii to various sugars was recorded. The effect of flavonoids (gallic acid, catechin, quercetin at 100 and 500 ppm) on mortality of D. suzukii was also studied in CAFE assay. Our results showed that JA and SA application significantly affected phenol, flavonoid and tannin contents of grapes. Reduced injury was observed in treated plants; this reduction was more pronounced in Chardonnay than Pinot Noir. The number of eggs laid by D. suzukii females was lower in JA and SA-treated plants; this reduction was more pronounced under no-choice conditions than under choice conditions. In prandial behavior, sucrose solution (5%), glucose solution (5%), fructose solution (5%), sucrose (5%) + yeast (5%) solutions and yeast solutions (5%) showed higher attraction of D. suzukii females compared to control treatments. Among flavonoids, catechin (100 ppm) showed higher mortality of D. suzukii than rest of the treatments. The results of this study can be used for developing management strategies of D. suzukii in wine grapes and related crops.

Dendrochronology reveals different effects among host tree species from feeding by Lycorma delicatula (White).

The spotted lanternfly, Lycorma delicatula (White) (Hemiptera: Fulgoridae), was first detected in the United States in Berks County, Pennsylvania, in 2014. Native to China, this phloem-feeding planthopper threatens agricultural, ornamental, nursery, and timber industries in its invaded range through quarantine restrictions on shipments, as well as impacts on plants themselves. The long-term impacts of L. delicatula feeding on tree species have not been well studied in North America. Using standard dendrochronological methods on cores taken from trees with differing levels of L. delicatula infestation and systemic insecticidal control, we quantified the impact of L. delicatula feeding on the annual growth of four tree species in Pennsylvania: Ailanthus altissima, Juglans nigra, Liriodendron tulipifera, and Acer rubrum. The results suggest that L. delicatula feeding is associated with the diminished growth of A. altissima, but no change was observed in any other tree species tested. The results also suggest that systemic insecticides mitigate the impact of L. delicatula feeding on A. altissima growth.

Development of rearing methodology for the invasive Spotted Lanternfly, Lycorma delicatula (Hemiptera: Fulgoridae).

Lycorma delicatula, White (Hemiptera: Fulgoridae), spotted lanternfly, is a univoltine, phloem-feeding, polyphagous and invasive insect in the USA. Although a primary host for this species is Ailanthus altissima, tree of heaven, L. delicatula also feeds on a wide range of hosts important to the USA including cultivated grapevines. Due to the need for classical or augmentative biological control programs to reduce impacts of L. delicatula across invaded areas, we developed a laboratory-based rearing protocol for this invasive species. Here, we evaluated the use of A. altissima apical meristems, epicormic shoots, and fresh foliage cut from A. altissima as a food source for rearing newly hatched L. delicatula. On these sources of plant material <20% of L. delicatula developed into adults and no oviposition occurred. However, when young, potted A. altissima trees were used as a food source, >50% of L. delicatula nymphs developed to the adult stage under natural daylengths and temperatures ranging from 20-25°C. The addition of wild grapevine, Vitis riparia, did not increase survivorship or reduce development time. To elicit mating and oviposition, adults were provided with A. altissima logs as an oviposition substrate and maintained under shortened daylengths and reduced nighttime temperatures (12L:12D and 24°C:13°C). This resulted in 2.12 egg masses deposited per female, which was 4× more than when adults were maintained in standard rearing conditions (16L:8D and 25°C). Based on these experiments, we present a protocol for reliably rearing L. delicatula under laboratory and/or greenhouse conditions.

The IAEA remote and automated quality control methodology for radiography and mammography.

Radiography remains the most widely used imaging modality throughout the world. Additionally, while it has been demonstrated that a quality control (QC) program, especially in mammography, improves image quality, weekly technologist QC testing might be lacking even where there is clinical qualified medical physicist (CQMP) support. Therefore, the International Atomic Energy Agency (IAEA) developed simple QC phantoms that can easily be used on a regular basis (daily/weekly) for radiography and mammography. These are simple in design and use materials that are easily accessible in most parts of the world. A software application is also developed that automatically analyzes images and Digital Imaging and Communications in Medicine (DICOM) header information. It exports data to a comma-separated values (CSV) file that is read by a Microsoft Excel® spreadsheet for documentation and graphical analysis. The phantom and the software were tested in four institutions (in Costa Rica and the United States of America) both on computed radiography and direct digital mammography and radiography systems. Data were collected over a 3-year period. No corrective actions were taken on the data, but service was performed on two of the units. Results demonstrated noise that could be attributed to suboptimal placement of the phantom and incorrect data being put into the DICOM header. Preliminary evaluation of the IAEA methodology has demonstrated that it can provide meaningful QC data that are sensitive to changes in the imaging systems. Care must be taken at implementation to properly train personnel and ensure that the image data, including the DICOM header, are being correctly transmitted. The methodology gives the opportunity for a single CQMP to provide QC services even to remote sites where travel is prohibitive, and it is feasible and easy to implement.

Phenology of Lycorma delicatula (Hemiptera: Fulgoridae) in Virginia, USA.

The spotted lanternfly, Lycorma delicatula (White), is an invasive planthopper that was first discovered in North America in Berks County, Pennsylvania in 2014. Currently, L. delicatula has spread to eight additional states and threatens agricultural, ornamental, and timber commodities throughout the United States. The timing of insect life events is very important in the development of pest management tools and strategies. In 2019 and 2020, L. delicatula phenology was successfully documented in Winchester, Virginia using weekly 5-min observational surveys at established monitoring plots. Each year, L. delicatula were active in the environment from May to November with initial detections of first, second, third, fourth, and adults occurring in May, May, June, June, and July, respectively. Cumulative average growing degree days were also calculated for the onset of each L. delicatula life stage using local weather data and a lower developmental threshold of 10°C. First-instar L. delicatula were initially observed at 135 and 111.5, adults at 835 and 887, and egg masses at 1673.5 and 1611.5 in 2019 and 2020, respectively. Combined, these data can be used by growers and land managers to facilitate timing of effective pest management strategies.

AAPM medical physics practice guideline 3.b.: Levels of supervision for medical physicists in clinical training.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: (1) Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. (2) Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

Spatio-Temporal Model for Predicting Spring Hatch of the Spotted Lanternfly (Hemiptera: Fulgoridae).

The effect of temperature on the rate of spotted lanternfly, Lycorma delicatula (White) (Hemiptera: Fulgoridae), egg development was investigated for a population in Pennsylvania. Mean developmental duration (days ± SE) for egg hatch was evaluated at five constant temperatures of 19.9, 24.2, 25.1, 26.7, and 30°C using egg masses laid during the fall of 2018 and collected in 2019 from Berks Co., Pennsylvania. Base temperature thresholds for egg development were estimated using intercept and slope parameters by fitting a linear relationship between average temperature and developmental rate for the Pennsylvania study, two Korean studies, and the combined data sets. The base threshold estimates were then used to calculate seasonal accumulated degree-days (ADD) and construct logistic equations for predicting cumulative proportion of hatch in the spring. The fitted logistic prediction equations were then graphed against the egg hatch observations from field sites in Pennsylvania (2017) and Virginia (2019). When base temperature estimates from the three studies and combined studies were used to calculate ADD, the logistic models predicted similar timing for seasonal egg hatch. Because the slopes and intercepts for these four data sets were not statistically different, a base temperature threshold of 10.4°C derived from the combined model is a good estimate for computing ADD to predict spotted lanternfly spring emergence across a spatio-temporal scale. The combined model was linked with open source weather database and mapping programs to provide spatiotemporal prediction maps to aid pest surveillance and management efforts for spotted lanternfly.

Development of Behaviorally Based Monitoring and Biosurveillance Tools for the Invasive Spotted Lanternfly (Hemiptera: Fulgoridae).

The spotted lanternfly, Lycorma delicatula White, is an invasive planthopper (Hemiptera: Fulgoridae) that was first detected in the United States in Berks County, PA, in 2014, and has since spread in the mid-Atlantic region. This phloem-feeding pest has a broad host range, including economically important crops such as grape where their feeding causes dieback of infested plants. Monitoring the presence and abundance of L. delicatula is of utmost importance to develop pest management approaches. Current monitoring practices include sticky bands deployed on tree trunks, sometimes paired with commercially available methyl salicylate lures. A drawback associated with sticky bands is the high numbers of nontarget captures. Here, we developed traps for L. delicatula based on a circle trap originally designed for weevils. These traps are comprised of a screen funnel that wraps around the trunk of a tree and guides individuals walking up the trunk into a collection device. In 2018 and 2019, we compared circle trap designs with sticky bands in Pennsylvania and Virginia. In both years, circle trap designs yielded captures that were equivalent to or exceeded captures of L. delicatula on sticky bands. Nontarget captures were significantly lower for circle traps compared with sticky bands. Presence of a methyl salicylate lure in association with traps deployed on host trees or vertical tree-mimicking posts did not increase L. delicatula captures compared with unbaited traps. Circle traps, modified using vinyl screen and a larger collection device, present an alternative to the current approach with reduced nontarget capture for monitoring L. delicatula.

AAPM medical physics practice guideline 7.a.: Supervision of medical physicist assistants.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances. Approved by AAPM's Executive Committee May 28, 2019.

Effects of Interspecific Larval Competition on Developmental Parameters in Nutrient Sources Between Drosophila suzukii (Diptera: Drosophilidae) and Zaprionus indianus.

Two invasive drosophilids, Drosophila suzukii (Matsumura) (Diptera: Drosophilidae) and Zaprionus indianus (Gupta) (Diptera: Drosophilidae) are expanding their geographic distribution and cohabiting grape production in the Mid-Atlantic. The ecological and economic impact of these two species within vineyards is currently unknown. Zaprionus indianus was presumably not capable of ovipositing directly into grapes because they lack a serrated ovipositor and may use D. suzukii oviposition punctures for depositing their own eggs. Therefore, an interspecific larval competition assay was performed at varying larval densities using commercial medium and four commonly grown wine grapes in Virginia to investigate the impact Z. indianus larvae may have on the mortality and developmental parameters of D. suzukii larvae. Zaprionus indianus did not affect D. suzukii mortality or development parameters even at high interspecific densities when reared in commercial medium, but it did cause higher D. suzukii mortality within grapes. Mortality was also influenced by the variety of grape in which the larvae were reared, with smaller grapes having the highest D. suzukii mortality. Presence of Z. indianus also increased development time to pupariation and adult emergence for most interspecific competition levels compared with the intraspecific D. suzukii controls. Pupal volume was marginally affected at the highest interspecific larval densities. This laboratory study suggests that competition from Z. indianus and grape variety can limit D. suzukii numbers, and the implications on D. suzukii pest management be further verified in the field.

Brown Rice Vinegar as an Olfactory Field Attractant for Drosophila suzukii (Matsumura) and Zaprionus indianus Gupta (Diptera: Drosophilidae) in Cherimoya in Maui, Hawaii, with Implications for Attractant Specificity between Species and Estimation of Relative Abundance.

Drosophila suzukii (Matsumura) is an agricultural pest that has been observed co-infesting soft-skinned fruits with Zaprionus indianus Gupta. The characterization of olfactory preferences by species is a necessary step towards the development of species-specific attractants. Five olfactory attractants were used to survey the populations of two invasive drosophilids in cherimoya in Maui, Hawaii. The attractants used were apple cider vinegar (ACV), brown rice vinegar (BRV), red wine (RW), apple cider vinegar and red wine (ACV+RW; 60/40), and brown rice vinegar and red wine (BRV+RW; 60/40). For D. suzukii, BRV+RW resulted in more captures than BRV, ACV, and RW, while ACV+RW resulted in more captures than ACV. No differences were observed between BRV+RW and ACV+RW. BRV had greater specificity in attracting D. suzukii compared to ACV, ACV+RW, and RW. For Z. indianus, no significant differences were observed in either the mean captures or specificity for any attractant used. Collectively, these findings demonstrate that (1) BRV and BRV+RW are effective field attractants and (2) D. suzukii has unique olfactory preferences compared to non-target drosophilids, while (3) Z. indianus' preferences do not appear to vary from non-target drosophilids, and (4) the accuracy of relative abundance is impacted by the specificity of the attractants.

Drosophila suzukii (Diptera: Drosophilidae) Oviposition and Adult Emergence in Six Wine Grape Varieties Grown in Virginia.

Drosophila suzukii (Matsumura) is a pest of small fruits and grapes in the United States and in its home range of Japan. Physiological and morphological laboratory testing was performed on six commonly grown wine grape varieties in Virginia. Skin thickness, penetration force, and ºBrix were analyzed to determine ovipositional preferences. Experiments were performed for three consecutive years from grapes collected at one Virginia vineyard. More eggs were laid in intact Viognier grapes than any other variety. Oviposition into intact grapes was not affected by skin thickness or ºBrix; however, oviposition increased when penetration force decreased. An ovipositional choice test determined no varietal preferences. Survivorship from egg to adulthood using uninjured and injured grapes was also assessed to determine varietal suitability as D. suzukii hosts, with more flies emerging from injured grapes than uninjured. However, D. suzukii adults did emerge from intact grapes and at higher percentages than previously recorded in other wine grape studies. All varieties had eggs oviposited into them when injured. Determining the time at which each grape variety became susceptible to oviposition was determined using a D. suzukii bioassay spanning 12 wk using grapes from the green pea stage until ripe. Susceptibility to D. suzukii oviposition was based upon ripening period and penetration force. Early ripening varieties may be more susceptible to D. suzukii oviposition in the field with later maturing, harder fleshed-varieties which may escape D. suzukii oviposition.

Ongoing quality control in digital radiography: Report of AAPM Imaging Physics Committee Task Group 151.

Quality control (QC) in medical imaging is an ongoing process and not just a series of infrequent evaluations of medical imaging equipment. The QC process involves designing and implementing a QC program, collecting and analyzing data, investigating results that are outside the acceptance levels for the QC program, and taking corrective action to bring these results back to an acceptable level. The QC process involves key personnel in the imaging department, including the radiologist, radiologic technologist, and the qualified medical physicist (QMP). The QMP performs detailed equipment evaluations and helps with oversight of the QC program, the radiologic technologist is responsible for the day-to-day operation of the QC program. The continued need for ongoing QC in digital radiography has been highlighted in the scientific literature. The charge of this task group was to recommend consistency tests designed to be performed by a medical physicist or a radiologic technologist under the direction of a medical physicist to identify problems with an imaging system that need further evaluation by a medical physicist, including a fault tree to define actions that need to be taken when certain fault conditions are identified. The focus of this final report is the ongoing QC process, including rejected image analysis, exposure analysis, and artifact identification. These QC tasks are vital for the optimal operation of a department performing digital radiography.

The iPLA(2)γ is identified as the membrane potential sensitive phospholipase in liver mitochondria.

Previous reports from our lab identified a mitochondrial calcium-independent phospholipase A2 activity that is activated when the mitochondrial membrane potential is decreased. This activity was demonstrated to influence occurrence of the permeability transition. Originally, this activity was ascribed to the iPLA2ß protein. Recently, both iPLA2ß and iPLA2γ knock out mice have been generated. It has been shown by others that the iPLA2γ plays a significant role in progression of the permeability transition. In this paper, using the iPLA2ß and iPLA2γ knock out mice we show that the membrane potential sensitive activity is the iPLA2γ.

AAPM Medical Physics Practice Guideline 3.a: Levels of supervision for medical physicists in clinical training.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States.The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner.Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized.The following terms are used in the AAPM practice guidelines:Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline.Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

The YhhN protein of Legionella pneumophila is a Lysoplasmalogenase.

Lysoplasmalogenase catalyzes hydrolytic cleavage of the vinyl-ether bond of lysoplasmalogen to yield fatty aldehyde and glycerophospho-ethanolamine or glycerophospho-choline. We recently purified lysoplasmalogenase from rat liver microsomes and identified the protein as TMEM86B, an integral membrane protein that is a member of the YhhN family found in numerous species of eukaryotes and bacteria. To test the hypothesis that bacterial YhhN proteins also function as lysoplasmalogenase enzymes, we cloned the Lpg1991 gene of Legionella pneumophila, which encodes a 216 amino acid YhhN protein (LpYhhN), and expressed it in Escherichia coli as a C-terminal-GFP-His8-fusion. Membranes were solubilized and the fusion protein was purified by nickel-affinity chromatography, cleaved with Tobacco Etch Virus protease, and subjected to a reverse nickel column to purify the un-tagged LpYhhN. Both the fusion protein and un-tagged LpYhhN exhibit robust lysoplasmalogenase activity, cleaving the vinyl-ether bond of lysoplasmalogen with a Vmax of 12 µmol/min/mg protein and a Km of 45 µM. LpYhhN has no activity on diradyl plasmalogen, 1-alkenyl-glycerol, and monoacylglycerophospho-ethanolamine or monoacylglycerophospho-choline; the pH optimum is 6.5-7.0. These properties are very similar to mammalian TMEM86B. Sequence analysis suggests that YhhN proteins contain eight transmembrane helices, an N-in/C-in topology, and about 5 highly conserved amino acid residues that may form an active site. This work is the first to demonstrate a function for a bacterial YhhN protein, as a vinyl ether bond hydrolase specific for lysoplasmalogen. Since L. pneumophila does not contain endogenous plasmalogens, we hypothesize that LpYhhN may serve to protect the bacterium from lysis by lysoplasmalogen derived from plasmalogens of the host.

Does oral supplementation of a fermented papaya preparation correct respiratory burst function of innate immune cells in type 2 diabetes mellitus patients?

Fermented papaya preparation (FPP) is a nutritional supplement reported to act as an antioxidant by scavenging reactive oxygen species (ROS) and removing "bad ROS," while inducing "respiratory burst" production of necessary "good ROS." We sought to investigate the safety of oral administration of FPP (9 g/day, 6 weeks) to T2D patients with regard to its effect on the hyperglycemia status of these patients. Peripheral blood was collected during a baseline visit, followed by subsequent collections both during and after supplementation. Induced "respiratory burst" ROS production was measured at each visit in addition to fasting blood glucose, lipid profile, glycated hemoglobin (HbA1c), and lipid/protein peroxidation. Oral FPP supplementation induced "respiratory burst" in peripheral blood mononuclear cells while not influencing other blood parameters studied. When human monocytic THP-1 cells were supplemented with sugar-based FPP, cellular ATP and NADPH concentrations were increased while matched glucose alone did not produce similar effects, suggesting a glucose-independent component of FPP to be responsible for increasing cellular energetics. THP-1 cells supplemented with FPP also exhibited higher mitochondrial membrane potential (Δψm) and oxygen consumption as compared with cells treated with glucose alone. Taken together, our observations lead to the hypothesis that FPP corrects inducible "respiratory burst" function in type 2 diabetes patients.

Mitochondrial uncoupling does not decrease reactive oxygen species production after ischemia-reperfusion.

Cardiac ischemia-reperfusion (IR) leads to myocardial dysfunction by increasing production of reactive oxygen species (ROS). Mitochondrial H(+) leak decreases ROS formation; it has been postulated that increasing H(+) leak may be a mechanism of decreasing ROS production after IR. Ischemic preconditioning (IPC) decreases ROS formation after IR, but the mechanism is unknown. We hypothesize that pharmacologically increasing mitochondrial H(+) leak would decrease ROS production after IR. We further hypothesize that IPC would be associated with an increase in the rate of H(+) leak. Isolated male Sprague-Dawley rat hearts were subjected to either control or IPC. Mitochondria were isolated at end equilibration, end ischemia, and end reperfusion. Mitochondrial membrane potential (mΔΨ) was measured using a tetraphenylphosphonium electrode. Mitochondrial uncoupling was achieved by adding increasing concentrations of FCCP. Mitochondrial ROS production was measured by fluorometry using Amplex-Red. Pyridine dinucleotide levels were measured using HPLC. Before IR, increasing H(+) leak decreased mitochondrial ROS production. After IR, ROS production was not affected by increasing H(+) leak. H(+) leak increased at end ischemia in control mitochondria. IPC mitochondria showed no change in the rate of H(+) leak throughout IR. NADPH levels decreased after IR in both IPC and control mitochondria while NADH increased. Pharmacologically, increasing H(+) leak is not a method of decreasing ROS production after IR. Replenishing the NADPH pool may be a means of scavenging the excess ROS thereby attenuating oxidative damage after IR.