The majority of adults with outpatient visits to a large urban health care system did not use the patient portal, and initiation of use was lower for racial and ethnic minorities, persons of lower socioeconomic status, and those without neighborhood broadband internet access. These results suggest the emergence of a digital divide in patient portal use. Given the scale of investment in patient portals and other internet-dependent health information technologies, efforts are urgently needed to address this growing inequality.

Perilipin A coats the lipid storage droplets in adipocytes and is polyphosphorylated by protein kinase A (PKA); the fact that PKA activates lipolysis in adipocytes suggests a role for perilipins in this process. To assess whether perilipins participate directly in PKAmediated lipolysis, we have expressed constructs coding for native and mutated forms of the two major splice variants of the perilipin gene, perilipins A and B, in Chinese hamster ovary fibroblasts. Perilipins localize to lipid droplet surfaces and displace the adipose differentiation-related protein that normally coats the droplets in these cells. Perilipin A inhibits triacylglycerol hydrolysis by 87% when PKA is quiescent, but activation of PKA and phosphorylation of perilipin A engenders a 7-fold lipolytic activation. Mutation of PKA sites within the N-terminal region of perilipin abrogates the PKAmediated lipolytic response. In contrast, perilipin B exerts only minimal protection against lipolysis and is unresponsive to PKA activation. Since Chinese hamster ovary cells contain no PKA-activated lipase, we conclude that the expression of perilipin A alone is sufficient to confer PKA-mediated lipolysis in these cells. Moreover, the data indicate that the unique C-terminal portion of perilipin A is responsible for its protection against lipolysis and that phosphorylation at the N-terminal PKA sites attenuates this protective effect.Acute mobilization of adipose triacylglyerol stores for energy is regulated primarily by the activation state of cAMP-dependent protein kinase (PKA) 1 (1). Historically, this stimulation has been attributed to phosphorylation and activation of hormonesensitive lipase (HSL), but as noted previously (2, 3), the meager doubling of HSL activity upon phosphorylation in vitro falls far short of explaining the 30 -100-fold activation of cellular lipolysis upon elevation of PKA activity in isolated primary adipocytes. Although some the of differences between the magnitude of the in vitro and in vivo responses may be attributed to the PKA-induced translocation of HSL from the cytosol to the lipid storage droplets within adipocytes (4), it is likely that additional factors, notably the perilipins, contribute to the cellular response.The perilipins are a class of proteins found exclusively at the limiting surface of lipid storage droplets, i.e. at the lipid/aqueous interface, in adipocytes and in steroidogenic cells (5-7). These proteins are the most abundant PKA substrates in adipocytes (5), and both their subcellular location and polyphosphorylation by PKA suggest a role for the perilipins in PKAmediated lipolysis. In adipocytes, alternative mRNA splicing gives rise to perilipins A and B, the former at much higher levels than the latter (8). Thus far, functional studies point to a role for the perilipins in protecting stored TAG from hydrolysis by cellular lipases. Ectopic expression of perilipin A in 3T3-L1 adipoblasts results in perilipin A-coated lipid droplets and increases the half-life of stored TAG deposits by a factor of 4...

Maintenance immunosuppression after kidney allograft failure was associated with a greater incidence of infection, while weaning of immunosuppression commonly resulted in symptomatic rejection with fever mimicking infection on presentation. Management of the failed allograft should include planning to avoid both infection and sensitizing events.