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Phosphorus is important not only for maintaining healthy bone metabolism but also for many other biological functions such as cell membrane integrity and cellular energy systems. In patients with end-stage renal disease, decreased renal excretion of phosphorus results in hyperphosphatemia, which causes secondary hyperparathyroidism and/or an increase in the serum calcium x phosphorus product. A high serum calcium x phosphorus product accelerates vascular calcification, 1 which is reported to be independently associated with mortality in patients on hemodialysis. 2,3 Hyperphosphatemia also is an independent risk factor for mortality in these patients. 2-4 For example, the relative mortality risk at a serum phosphate concentration greater than 6.5 mg/dL is more than twice (2.02; CI 1.10 to 3.73) that of a normal serum phosphate concentration (3.0-5.0 mg/dL), after adjusting for several factors. 5 A serum phosphate concentration greater than 5.0 mg/dL is independently associated with an increased risk of death in hemodialysis patients. 4 MINORI SATOH, AKIKO KOIZUMI, SATOSHI IZUMI, YASUHIRO KUGOH, ERIKOKIRIYAMA, EMIKO OGUMA, TAKU FURUKUBO, CHIHARU MATSUNAGA, TOMOYUKI YAMAKAWA, DAISUKE KADOWAKI, AND SUMIO HIRATA Background: Patient adherence to a phosphate binder treatment regimen is crucial in the management of hyperphosphatemia. Nonadherence may be due to a lack of patient knowledge of the nature and treatment of the illness.Objective: To investigate the effectiveness of pharmacist-provided education regarding phosphate binders and hyperphosphatemia on serum phosphate concentration and calcium x phosphorous product in hemodialysis patients. Methods:A total of 398 hemodialysis patients who were prescribed phosphate binders participated in a pharmacist-run, education-based intervention session regarding phosphate binders and hyperphosphatemia. Each session was individualized on the basis of patient knowledge, assessed via a questionnaire. Particular attention was given to correcting patient misconceptions. Patients with elevated serum phosphate received additional education. Mean serum concentrations of phosphate and calcium, averaged from 4 measurements obtained at both baseline and postintervention, were compared to evaluate the efficacy of the intervention.Results: Postintervention, patients with the highest baseline serum phosphate concentrations (≥7.0 mg/dL) showed a significant decrease in mean ± SD serum concentrations of phosphate and calcium-phosphate product (7.4 ± 0.4 mg/dL and 72.6 ± 6.4 mg 2 /dL 2 to 6.5 ± 0.8 mg/dL and 63.1 ± 8.4 mg 2 /dL 2 , respectively; p < 0.001). Likewise, patients with serum phosphate concentrations ranging from 6.0-6.9 mg/dL showed a significant decrease in both parameters after educational intervention (p < 0.05 and p < 0.005, respectively).Conclusions: An education session regarding phosphate binders and hyperphosphatemia, provided by pharmacists for hemodialysis patients, appeared effective in reducing serum phosphate concentrations and calcium x phosphorus product, thus contri...

The purpose of this study is to analyze the value of an investment in power generation assets that do not emit CO 2 , by using a real option model. This study evaluates the effects of future uncertainty on investment decision-making, by focusing on the uncertainty of CO 2 emission credits [yen/t-CO 2 ] in the fairly near future in Japan. Electric utilities are required to keep plans to prepare for various future uncertainties such as the price of CO 2 emission credits. The real option approach can evaluate the option value of decision-making under uncertainty. This study examined the option value of a power plant [yen/KW] to evaluate the effects of an externality under uncertainty. The results showed that nuclear power would have the most value under the forthcoming CO 2 emission limitations. In order to secure the effectiveness of measures against global warming, we should reconsider the roles of nuclear power plants in Japan. Finally, the real option model is shown to be an effective candidate for a decision-making support tool to deal with problems in energy environmental policy.

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