During the past decade, column flotation cells have become widely accepted for the upgrading of fine coal streams. this popularity can be largely attributed to the ability of columns to remove high-ash clays from the froth product via the addition of wash water to a relatively deep froth. while there are numerous successful column installations, discussions with both end-users and engineering firms have identified certain design criteria that can make these installations challenging. the greatest of these challenges is the overall size of the cells and the associated foundation loads. to address this problem, a new high-intensity flotation system known as the StackcellTM has been developed. this technology makes use of pre-aeration coupled with a high-shear feed canister. this arrangement provides efficient bubbleparticle contacting, thereby substantially shortening the residence time required for coal collection and virtually eliminating most of the column height. this article reviews the design features of this innovative technology and presents recent data obtained from fullscale installations.

Obesity prevalence and average body composition vary by US race and gender. Asian Americans have the lowest prevalence of obesity. Relying on body-mass index (BMI) to estimate obesity prevalence may misclassify subgroups that appear normally weighted but have excess body fat. We evaluated percentage body fat (PBF) and BMI to determine whether BMI reflects PBF consistently across different races. 940 college students were recruited from a local public university over four consecutive years. We measured PBF by bioelectrical impedance analysis (BIA), weight by physicians' scales, and height with stadiometers. Our sample comprised Asians (49%), Caucasians (23%), Hispanics (7%), and Other (21%). Participants averaged 21.4 years old; BMI was 22.9 kg/m2; PBF was 24.8%. BMI and PBF varied significantly by race and gender (P value = 0.002 and 0.005 for men; 0.0009 and 0.0008 for women). Asian-American women had the lowest BMI (21.5 kg/m2) but the second highest PBF (27.8%). Linear association between BMI and PBF was the weakest (r 2 = 0.09) among Asian-American women and BMI had the poorest sensitivity (37%) to detect PBF. The high PBF with low BMI pattern exhibited by Asian-American women suggests that they could escape detection for obesity-related disease if BMI is the sole measure that estimates body composition.

Purpose:To evaluate the impact of age, glaucoma-specific diagnosis, and history of prior glaucoma surgery on outcomes in pediatric patients treated with latanoprost monotherapy.Patients and Methods:Prospective, randomized, double-masked 12-week, multicenter study included individuals 18 years or younger with glaucoma. Subjects stratified by age (0 to <3, 3 to <12, 12 to 18 y), diagnosis [primary congenital glaucoma (PCG) vs. non-PCG], and baseline intraocular pressure (IOP; 22 to <27, 27 to 31, >31 mm Hg), and randomized (1:1) to latanoprost vehicle (8 am) and latanoprost 0.005% (8 pm) or timolol 0.5% (or 0.25% for those less than 3 y old; 8 am/8 pm). IOP and safety assessments performed and adverse events recorded at baseline, weeks 1, 4, 12. Post hoc analyses in age-specific and diagnosis-specific groups of latanoprost-treated subjects were conducted (intent-to-treat population).Results:Sixty-eight subjects were treated with latanoprost (0 to <3, n=17; 3 to <12, n=26; 12 to 18, n=25); 82%, 42%, and 24%, respectively, had a primary diagnosis of PCG. Among Non-PCG subjects, 0% (0/3), 47% (7/15), and 63% (12/19) had a primary diagnosis of juvenile open-angle glaucoma in the 0 to <3, 3 to <12, and 12 to 18 year cohorts, respectively. Mean percent IOP reductions from baseline at week 12 were 22%, 24%, and 30% in the youngest through oldest age groups, respectively (P=0.3600). At week 12, a higher responder rate (15% IOP reduction) was observed in the non-PCG than in the PCG group (70% vs. 45%, respectively; P=0.0361). Latanoprost was well tolerated.Conclusion:All age and diagnosis subgroups showed clinically relevant (>20%) mean IOP reduction at week 12 with latanoprost monotherapy.

PURPOSE To evaluate the safety and efficacy of three doses of PF-04523655, a 19-nucleotide methylated double stranded siRNA targeting the RTP801 gene, for the treatment of diabetic macular edema (DME) compared to focal/grid laser photocoagulation. METHODS This multicenter, prospective, masked, randomized, active-controlled, phase 2 interventional clinical trial enrolled 184 DME patients with best corrected visual acuity (BCVA) of 20/40 to 20/320 inclusive in the study eye. Patients were randomly assigned to 0.4-mg, 1-mg, 3-mg PF-04523655 intravitreal injections or laser. The main outcome measure was the change in BCVA from baseline to month 12. RESULTS All doses of PF-04523655 improved BCVA from baseline through month 12. At month 12, the PF-04523655 3-mg group showed a trend for greater improvement in BCVA from baseline than laser (respectively 5.77 vs. 2.39 letters; P = 0.08; 2-sided α = 0.10). The study was terminated early at month 12 based on predetermined futility criteria for efficacy and discontinuation rates. PF-04523655 was generally safe and well-tolerated, with few adverse events considered treatment-related. By month 12, the discontinuation rates in the PF-04523655 groups were higher than the laser group and were inversely related to dose levels. CONCLUSIONS PF-04523655 showed a dose-related tendency for improvement in BCVA in DME patients. Studies of higher doses are planned to determine the optimal efficacious dose of PF-04523655. PF-04523655 may offer a new mode of therapeutic action in the management of DME. (ClinicalTrials.gov number, NCT00701181.).

Obesity prevalence and average body composition measures vary according to U.S. gender and racial subgroups with Asian‐ American men and women having the lowest prevalence of obesity. However relying on body‐mass index (BMI) to estimate obesity prevalence may misclassify subgroups with normal weight sarcopenic obesity. Our objective was to evaluate percentage body fat and BMI to determine whether BMI reflects percent body fat consistently across different ethnic subgroups. We conducted a serial cross‐sectional study of 940 college students recruited from a public University in Southern California over four consecutive years. Percent body fat (PBF) was measured by bioelectrical impedance analysis (BIA) (Biodynamics, Inc, Seattle WA), weight measured by physicians’ scales, and heights with stadiometers. Our ethnic sample consisted of Asian (49%), Caucasian (23%), Hispanic (7%), and Other (21%). On average, participants were 21.4 years old, BMI was 22.9 kg/m2, and PBF averaged 24.8%. BMI and PBF varied significantly by race/ethnicity for men and women (p‐value = 0.002 and 0.005 for men; and 0.009 and 0.008 for women respectively). On average, Asian men had the lowest BMI (23.7 kg/m2), and the lowest percent body fat (18.9%) of the four racial/ethnic groups. Asian women had the lowest BMI (21.5 kg/m2) but the second highest percent body fat (27.8%), with Hispanic women having the highest PBF (29.9%) and the highest BMI (23.5 kg/m2). While our college‐aged study population was generally normal‐weighted, the high PBF with low BMI pattern exhibited by Asian American women suggests that this group could be at risk for obesity‐related disease and could escape detection if BMI is the sole measure used to estimate body composition. Funding was provided by the UCLA Department of Medicine.

Objective: To evaluate the efficacy of different dosing paradigms of PF-04523655 (PF) versus ranibizumab (comparator) in subjects with neovascular age-related macular degeneration (AMD).Design: Multicenter, open-label, prospective, randomized, comparator-controlled exploratory study.Participants: A total of 151 patients with subfoveal choroidal neovascularization (CNV) secondary to neovascular AMD who were naive to AMD therapy.Methods: In this phase 2 study, patients were randomized to 1 of 5 treatment groups with equal ratio. All groups received ranibizumab 0.5 mg at baseline and (a) PF 1 mg every 4 weeks (Q4W) from week 4 to week 12; (b) PF 3 mg Q4W from week 4 to week 12; (c) PF 3 mg every 2 weeks (Q2W) from week 4 to week 12; (d) PF 1 mg + ranibizumab (combination) Q4W from baseline to week 12; and (e) ranibizumab Q4W to week 12. All study treatments were given as intravitreal injections.Main Outcome Measures: The primary end point was the mean change in best-corrected visual acuity (BCVA) from baseline at week 16; secondary end points included the percentage of patients gaining >= 10 and >= 15 letters in BCVA and mean change in retinal central subfield thickness, lesion thickness, and CNV area.Results: At week 16, the PF 1 mg + ranibizumab combination group achieved numerically greater improvement in mean BCVA from baseline (9.5 letters) than the ranibizumab group (6.8 letters). The difference was not statistically significant. The BCVA improvement in the PF monotherapy groups was less than in the ranibizumab group. Similar trends were observed in the percentage of patients who gained >= 10 and >= 15 letters. From baseline to week 16 (last observed carried forward), the combination and ranibizumab groups had similar mean reductions in central subfield retinal thickness and total CNV area, which were greater than in all PF monotherapy groups. There were no clinically meaningful differences in reduction of lesion thickness among treatment groups.Conclusions: In this early, underpowered study evaluating treatments for neovascular AMD, the combination of PF with ranibizumab led to an average gain in BCVA that was more than with ranibizumab monotherapy. No safety concerns were identified.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. Ophthalmology 2012; 119: 1867-1873 (C) 2012 by the American Academy of Ophthalmology.

EVALUATING SERUM PHOSPHOROUS ACROSS DIFFERING LEVELS OF RENAL FUNCTION WITHIN A LARGE ETHNICALLY DIVERSE POPULATION John J. Sim, Ning Smith, Joanie Chung, Eric Yan, Simran Bhandari, Scott Rasgon, Kam Kalantar-Zadeh Kaiser Permanente Los Angeles Medicial Center We sought to examine the relationship of serum phosphorous across declining levels of eGFR.Retrospective cohort study within KPSC of those with valid measurement of serum phosphorous 01/01/1998 05/31/2010. Comparisons of cohort characteristics among population based quartiles of phosphorous with ANOVA and chi-square tests. Generalized additive models with cubic smoothing splines were used to determine the relationship btwn phosphorous and eGFR. Subgroup analyses were performed stratified by age group, gender and race. Calcium, PTH, and vitamin D levels were also analyzed for their relationship with eGFR. A total 325,357 patients had a valid serum phosphorous measurement and 159,535 (49%) had concurrent eGFR. Average phosphorous began to increase at eGFR 50. This trend holds among different age groups, genders and races. We observed similar trend for PTH in relation to eGFR. But the average vitamin D and calcium levels seem to be independent of the eGFR values. Males, older age, and black race had lower phosphorous levels. While hyperphosphatemia is a manifestation of advanced renal failure, our observational cohort demonstrates rising serum phosphorous levels earlier in CKD at an eGFR of 50 mL/min/1.73 m which was consistent across different ages, gender, and races.

Objective: To compare the efficacy and safety of latanoprost versus timolol in pediatric patients with glaucoma.Design: Prospective, randomized, double-masked, 12-week, multicenter study.Participants: Individuals aged <= 18 years with glaucoma.Methods: Stratified by age, diagnosis, and intraocular pressure (IOP) level, subjects were randomized (1:1) to latanoprost vehicle at 8 AM and latanoprost 0.005% at 8 PM or timolol 0.5% (0.25% for those aged <3 years) twice daily (8 AM, 8 PM). At baseline and weeks 1, 4, and 12, IOP and ocular safety were assessed and adverse events were recorded. Therapy was switched to open-label latanoprost PM and timolol AM and PM for uncontrolled IOP.Main Outcome Measures: Mean IOP reduction from baseline to week 12. Latanoprost was considered noninferior to timolol if the lower limit of the 95% confidence interval (CI) of the difference was >-3 mmHg. A proportion of responders (subjects with >= 15% IOP reduction at weeks 4 and 12) were evaluated. Analyses were performed in diagnosis subgroups: primary congenital glaucoma (PCG) and non-PCG.Results: In total, 137 subjects were treated (safety population; 12-18 years, n=48; 3-<12 years, n=55; 0-<3 years, n=34). Mean age was 8.8 +/- 5.5 years, and mean baseline IOP was 27.7 +/- 6.17 mmHg; 125 subjects completed the study, and 107 subjects were in the per protocol population. Mean IOP reductions for latanoprost and timolol at week 12 were 7.2 and 5.7 mmHg, respectively, with a difference of 1.5 mmHg (95% CI, -0.8 to 3.7; P=0.21).Responder rates were 60% for latanoprost and 52% for timolol (P=0.33). Between-treatment differences in mean IOP reduction for PCG and non-PCG subgroups were 0.6 mmHg (95% CI, -2.3 to 3.4) and 2.6 mmHg (95% CI, -0.8 to 6.1), respectively. Responder rates for latanoprost versus timolol were 50% versus 46% for the PCG group and 72% versus 57% for the non-PCG group. Both therapies were well tolerated.Conclusions: Latanoprost 0.005% is not inferior (i.e., is either more or similarly effective) to timolol and produces clinically relevant IOP reductions across pediatric patients with and without PCG. Both latanoprost and timolol had favorable safety profiles over the duration of this 3-month trial.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. Ophthalmology 2011;118:2014-2021 (C) 2011 by the American Academy of Ophthalmology.

Objective Approximately, 50–60% of patients with sleep apnea have hypertension. To explore a mechanism of this relationship, we compared its prevalence in a hypertensive population with and without hyperaldosteronism. Methods Using the Kaiser Permanente Southern California database, hypertensive individuals who had plasma aldosterone and plasma renin activity measured between 1 January 2006 and 31 December 2007 were evaluated. Hyperaldosteronism was defined as an aldosterone : renin ratio more than 30 and plasma aldosterone more than 20 ng/dl or an aldosterone : renin ratio more than 50 (ng/dl : ng/ml per h). Hypertension was identified by International Classification of Disease, Ninth Revision (ICD-9) coding and sleep apnea was defined by ICD-9 coding or procedural coding for dispensation of positive airway devices. Results Of 3428 hypertensive patients, 575 (17%) had hyperaldosteronism. Sleep apnea was present in 18% (105) with hyperaldosteronism vs. 9% (251) without hyperaldosteronism (P < 0.001). Odds ratio for sleep apnea in patients with hyperaldosteronism was 1.8 (95% confidence interval 1.3–2.6) after controlling for other sleep apnea risk factors. No ethnic group was at greater risk for sleep apnea. Conclusion The prevalence of sleep apnea in a diverse hypertensive population is increased in patients with hyperaldosteronism, even when controlling for other sleep apnea risk factors.

The StackCell flotation technology offers significant metallurgical and design benefits that are a result of a superior rate of flotation when compared to conventional, mechanical cells. This improvement in flotation rate is the combined result of pre-aeration techniques, high-shear contacting, and a quiescent phase separation. In addition, high-grade products similar to that achieved in column flotation applications are also possible due to the addition of wash water that is distributed over a deep froth. Design considerations for this new technology are discussed relative to both lab- and pilot-scale test data.

There is concern that recommending protein-enriched meal replacements as part of a weight management program could lead to changes in biomarkers of liver or renal function and reductions in bone density. This study was designed as a placebo-controlled clinical trial utilizing two isocaloric meal plans utilizing either a high protein-enriched (HP) or a standard protein (SP) meal replacement in an outpatient weight loss program.

Since there has been concern over the use of high protein meal replacements for obesity due to potential effect on liver, renal function, and bone metabolism, the present double‐blind randomized controlled trial was conducted in 100 obese subjects who were randomly assigned to receive either standard protein (SP) (0.5 g per pound lean body mass) or high protein (HP) (1.0 g per pound lean body mass) with a diet plan designed to provide a 500 Calorie deficit per day. Subjects were instructed to mix a soy/whey protein powder (Performance Protein Powder, Herbalife) or a non‐protein isocaloric carbohydrate powder (control) with a standard meal replacement (Formula 1, Herbalife). Meal replacements were taken twice a day with one meal for 3 months and then one a day for 9 months. 75 subjects completed the 1 year study and subjects in both groups lost weight (HP ‐4.05 ± .83 kg vs. SP ‐4.42 ± 1.12 kg, p<0.05). There was no difference between groups in weight loss. Liver functions including AST, ALT, Bilirubin, Alkaline Phosphatase were in the normal range and did not change significantly. Similarly, 24 hour urine collections for creatinine, albumin, and calcium secretion did not change from baseline and were not different between groups. Bone mineral density by DEXA did not change in either group over one year. These studies demonstrate that protein‐enriched meal replacements are safe and effective for weight loss over one year.

BACKGROUND:Various adipose tissue factors have been implicated as biomarkers of the metabolic syndrome (MS). The objective of this study was to assess which specific adipose tissue factors would discriminate the presence of MS in a strictly obese population meeting waist circumference (WC) criteria for the MS.METHODS:This was a cross-sectional study of 148 subjects recruited from a university-based weight loss program prior to starting the program. Patients were eligible if they had a BMI more than 25 kg/m(2) and had WC more than 40 and 35 inches in males and females, respectively. Biomarkers measured included high sensitivity C-reactive protein (hs-CRP), leptin, adiponectin, and total insulin.RESULTS:Of the total population, 33.8% satisfied criteria for the MS. Insulin was the only biomarker to consistently differentiate between presence and absence of MS in this obese population (P = 0.0001 in males, P = 0.006 in females). All biomarkers measured with the exception of leptin had a statistically significant relationship with increasing criteria for the MS.CONCLUSIONS:In a population where an excess amount of adipose tissue exists, insulin is the only reliable biomarker to differentiate MS status. We surmise that differences in hs-CRP, leptin, and adiponectin are a reflection of their measurements in individuals with statistically different amounts of adipose tissue.

Background: While high protein diets have been shown to improve satiety and retention of lean body mass (LBM), this study was designed to determine effects of a protein-enriched meal replacement (MR) on weight loss and LBM retention by comparison to an isocaloric carbohydrate-enriched MR within customized diet plans utilizing MR to achieve high protein or standard protein intakes.Methods: Single blind, placebo-controlled, randomized outpatient weight loss trial in 100 obese men and women comparing two isocaloric meal plans utilizing a standard MR to which was added supplementary protein or carbohydrate powder. MR was used twice daily (one meal, one snack). One additional meal was included in the meal plan designed to achieve individualized protein intakes of either 1) 2.2 g protein/kg of LBM per day [high protein diet (HP)] or 2) 1.1 g protein/kg LBM/day standard protein diet (SP). LBM was determined using bioelectrical impedance analysis (BIA). Body weight, body composition, and lipid profiles were measured at baseline and 12 weeks.Results: Eighty-five subjects completed the study. Both HP and SP MR were well tolerated, with no adverse effects. There were no differences in weight loss at 12 weeks (-4.19 +/- 0.5 kg for HP group and 3.72 +/- 0.7 kg for SP group, p > 0.1). Subjects in the HP group lost significantly more fat weight than the SP group (HP = - 1.65 +/- 0.63 kg; SP = - 0.64 +/- 0.79 kg, P = 0.05) as estimated by BIA. There were no significant differences in lipids nor fasting blood glucose between groups, but within the HP group a significant decrease in cholesterol and LDL cholesterol was noted at 12 weeks. This was not seen in the SP group.Conclusion: Higher protein MR within a higher protein diet resulted in similar overall weight loss as the standard protein MR plan over 12 weeks. However, there was significantly more fat loss in the HP group but no significant difference in lean body mass. In this trial, subject compliance with both the standard and protein-enriched MR strategy for weight loss may have obscured any effect of increased protein on weight loss demonstrated in prior weight loss studies using whole food diets.

Background: Long-term results of Roux-en-Y gastric bypass (RYGB) are nonexistent in the veterans affairs (VA) population. We compare excess weight loss (EWL) success and medical comorbidity changes between the VA and non-VA population after RYGB.Methods: Retrospective review of consecutive subjects undergoing RYGB from 1997 to 2002 at the Los Angeles VA. Weight and comorbidity data were collected every 6 and 12 months, respectively.Results: Fifty-nine subjects were included; 54%, 58%,46.8%, and 44.1% Of Subjects achieved EWL > 50% at years 1 to 4. Hypertension resolved in 23%, 30%, and 32% at months 12 to 36. Obstructive sleep apnea resolved in 37%, 48%, 48%, 44%, and 60% at months 12 to 60. Diabetes mellitus resolved in 86%, 84%, 79%, and 80% at months 12 to 48. Improvements in the lipid panel were observed by month 12 and maintained thereafter.Conclusions: EWL and proportion of subjects with resolved hypertension and obstructive sleep apnea are inferior to the non-VA population. Nevertheless, improvements in measures of success are maintained in the VA population. (c) 2008 Excerpta Medica Inc. All rights reserved.