artery-hardening condition are no. 1 killer worldwide
Doctorsâ€™ efforts to battle the dangerous atherosclerotic plaques that build
up in our arteries and cause heart attacks and strokes are built on several
false beliefs about the fundamental composition and formation of the
plaques, new research from the University of Virginia School of Medicine
shows. These new discoveries will force researchers to reassess their
approaches to developing treatments and discard some of their basic
assumptions about atherosclerosis, commonly known as hardening of the
â€śThe leading cause of death worldwide is complications of atherosclerosis,
and the most common end-stage disease is when an atherosclerotic plaque
ruptures. If this occurs in one of your large coronary arteries, itâ€™s a
catastrophic event,â€ť said Gary K. Owens, PhD, of UVAâ€™s Robert M. Berne
Cardiovascular Research Center. â€śOnce a plaque ruptures, it can induce
formation of a large clot that can block blood flow to the downstream
regions. This is what causes most heart attacks. The clot can also dislodge
and cause a stroke if it lodges in a blood vessel in the brain. As such,
understanding what controls the stability of plaques is extremely
Until now, doctors have believed that smooth muscle cells â€“ the cells that
help blood vessels contract and dilate â€“ were the good guys in the bodyâ€™s
battle against atherosclerotic plaque. They were thought to migrate from
their normal location in the blood vessel wall into the developing
atherosclerotic plaque, where they would attempt to wall off the
accumulating fats, dying cells and other nasty components of the plaque. The
dogma has been that the more smooth muscle cells there are in that wall,
particularly in the innermost layer referred to as the â€śfibrous capâ€ť, the
more stable the plaque is and the less danger it poses.
UVAâ€™s research reveals those notions are woefully incomplete at best.
Scientists have grossly misjudged the number of smooth muscle cells inside
the plaques, the work shows, suggesting the cells are not just involved in
forming a barrier so much as contributing to the plaque itself. â€śWe
suspected there was a small number of smooth muscle cells we were failing to
identify using the typical immunostaining detection methods. It wasnâ€™t a
small number. It was 82 percent,â€ť Owens said.
Suddenly, the role of smooth muscle cells is much more complex, much less
black-and-white. Are they good or bad? Should treatments try to encourage
more? Itâ€™s no longer that simple, and the problem is made all the more
complicated by the fact that some smooth muscle cells were being
misidentified as immune cells called macrophages, while some
macrophage-derived cells were masquerading as smooth muscle cells.
Researcher Laura S. Shankman, a PhD student in the Owens lab, was able to
overcome the limitations of the traditional methods for detecting smooth
muscle cells in the plaque. Further, Shankman identified a key gene, Klf4,
that appears to regulate these transitions of smooth muscle cells.
Remarkably, when she genetically knocked out Klf4 selectively in smooth
muscle cells, the atherosclerotic plaques shrank dramatically and exhibited
features indicating they were more stable, the ideal therapeutic goal for
treating the disease in people. Of major interest, loss of Klf4 in smooth
muscle cells did not reduce the number of these cells in lesions but
resulted in them undergoing transitions in their functional properties that
appear to be beneficial in disease pathogenesis. That is, it switched them
from being â€śbadâ€ť guys to â€śgoodâ€ť guys.
The discoveries have been
outlined in a paper published online by the journal Nature Medicine.
CMS and AMA
announce efforts to help providers get ready for ICD-10
With less than three months remaining until the nation switches from ICD-9
to ICD-10 coding for medical diagnoses and inpatient hospital procedures,
The Centers for Medicare & Medicaid Services (CMS) and the American Medical
Association (AMA) are announcing efforts to continue to help physicians get
ready ahead of the October 1 deadline. In response to requests from the
provider community, CMS is releasing additional guidance that will allow for
flexibility in the claims auditing and quality reporting process as the
medical community gains experience using the new ICD- 10 code set.
Recognizing that healthcare providers need help with the transition, CMS and
AMA are working to make sure physicians and other providers are ready ahead
of the transition to ICD-10 that will happen on October 1. Reaching out to
healthcare providers all across the country, CMS and AMA will in parallel be
educating providers through webinars, on-site training, educational articles
and national provider calls to help physicians and other healthcare
providers learn about the updated codes and prepare for the transition.
The International Classification of Diseases, or ICD, is used to standardize
codes for medical conditions and procedures. The medical codes America uses
for diagnosis and billing have not been updated in more than 35 years and
contain outdated, obsolete terms. The use of ICD-10 should advance public
health research and emergency response through detection of disease
outbreaks and adverse drug events, as well as support innovative payment
models that drive quality of care.
CMSâ€™ free help includes the
â€śRoad to 10â€ť aimed specifically at smaller physician practices with
primers for clinical documentation, clinical scenarios, and other
specialty-specific resources to help with implementation.
The AMA also has a broad range of materials available to help physicians
prepare for the October 1 deadline. To learn more and stay apprised on
visit AMA Wire.
In accordance with the coming transition, the Medicare claims processing
systems will not have the capability to accept ICD-9 codes for dates of
services after September 30, 2015, nor will they be able to accept claims
for both ICD-9 and ICD-10 codes.
Visit CMS for the release.
to nurses go unreported in Federal database
A nurse practitioner in Connecticut pleaded guilty in June to taking $83,000
in kickbacks from a drug company in exchange for prescribing its high-priced
drug to treat cancer pain. In some cases, she delivered promotional talks
attended only by herself and a company sales representative.
But when the federal government released data on payments by drug and device
companies to doctors and teaching hospitals, the payments to nurse
practitioner were nowhere to be found.
That's because the federal Physician Payment Sunshine Act doesn't require
companies to publicly report payments to nurse practitioners or physician
assistants, even though they are allowed to write prescriptions in most
Nurse practitioners and physician assistants are playing an ever-larger role
in the healthcare system. While registered and licensed practice nurses are
not authorized to write prescriptions, those with additional training and
advanced degrees often can.
A ProPublica analysis of prescribing patterns in Medicare's prescription
drug program, known as Part D, shows that these two groups of providers
wrote about 10 percent of the nearly 1.4 billion prescriptions in the
program in 2013. They wrote 15 percent of all prescriptions nationwide (not
only Medicare) in the first five months of the year, according to IMS
Health, a health information company.
For some drugs, including narcotic controlled substances, nurse
practitioners and physician assistants are among the top prescribers.
Asked whether payments to these providers should be reported, a spokesman
for the Centers for Medicare and Medicaid Services, which manages the
disclosure system, said: "Nurse practitioners and physician assistants are
currently not covered recipients under the statute for Open Payments."
Visit NPR for the story.
According to a new
study, we are taller and smarter than our ancestors
New studies of the global population have given a report that we are
apparently taller and even smarter than our ancestors. Even though part of
that statement might seem kind of obvious, the new studies of global
populations was analyzed by a team of researchers at the University of
Edinburgh and came to a conclusion that, indeed, we have picked up some
This collective study followed at least 100 total studies over many years,
discussing the details of 350,000 people from both rural and urban
Dr. Peter Joshi, who is from the University of Edinburghâ€™s Usher Institute
said in a statement that their research answered questions first posed by
Darwin as to the benefits of genetic diversity.
He goes on to say that their next step will be to hone in on the specific
parts of the genome that most benefit from diversity. He also added that
what they didnâ€™t measure is whatâ€™s happening in this generation. He said
factors that affected peopleâ€™s lives years ago are very different today.
This was after looking back over evolutionary times.
Joshi also said in a statement that if you inherit two identical defective
genes from the mother and father youâ€™re going to reduce brain size and
function. Why evolution has favored bigger brain size and higher cognitive
function they could not say. He also said there were several further avenues
they want to go down. They want to hone in on the genes genetic diversity
affects the most.
Visit the Dispatch Times for the story.
HHS awards improve
healthcare, public health preparedness
Health departments across the country will receive more than $840 million in
cooperative agreements from the U.S. Department of Health and Human Services
to improve and sustain emergency preparedness of state and local public
health and healthcare systems.
The cooperative agreement funds are distributed through two federal
preparedness programs: the Hospital Preparedness Program (HPP) and the
Public Health Emergency Preparedness (PHEP) programs. Nationwide, HHS
awarded a total of $228.5 million for HPP and $611 million for PHEP in
fiscal year 2015.
These programs represent critical sources of funding and support for the
nationâ€™s health care and public health systems. The programs provide
resources needed to ensure that local communities can respond effectively to
infectious disease outbreaks, natural disasters, or chemical, biological, or
radiological nuclear events.
Approximately 24,000 organizations across the country form nearly 500
healthcare coalitions. Coalition members include hospitals, emergency
medical service providers, emergency management associations, long-term care
facilities, behavioral health organizations, public health agencies, and
other public and private sector partners.
Visit HHS for the release.
Is your supply
chain ready for the congestion crisis?
Longer commute times are just one sign that congestion is creeping into our
lives. Highways and bridges are in desperate need of repair, making travel
slowerâ€”and more dangerous. Our overburdened air-traffic-control system
struggles to deal with increasingly crowded skies. Port congestion is a
growing problem, exacerbated by the new super-size container ships that take
far longer to unload than older, smaller ships. â€śExpect delaysâ€ť has become
the recurring theme of our transportation system.
With growing congestion a global megatrend, companies have a choice. Either
accept it (and its higher costs and lower profits) or take control of your
fate with strategic, game-changing actions that cut time and costs from the
First, itâ€™s important to understand the magnitude of the coming congestion
crisis and its underlying drivers. These include the following:
Not enough port container capacity.
Until the summer of 2008, container ports on both the west and east coasts
of North America were nearing capacity as imports and exports soared. Then
the recession hit, and the problem receded as port traffic slowed. But now
the problem is back with a vengeance. Shipment volumes through North
American ports, which fell 20% in 2009 from a record peak in 2007, are now
higher than they were in 2007, and port-expansion plans from Vancouver to
Los Angeles/Long Beach are bogged down by political wrangling.
Railway systems are near capacity.
For instance, the average transit times to move containers from the ports of
Los Angeles and Long Beach to Chicago grew from 84 hours at the end of 2004
to 120 hours by early 2015.
Highways canâ€™t keep up with demand.
The highway systems in North America and Western Europe are also feeling the
strain. The United States greatly expanded â€ślane milesâ€ťâ€”one measure of
capacityâ€”in the 1950s, 1960s, and 1970s but not much since then. Meanwhile,
the load factor on the system has been doubling every 30 years. Today, the
load factor (total vehicle miles traveled divided by lane miles) is growing
more than 10 times faster than capacity is.
Air freight isnâ€™t the answer.
Airports in North America are slowed by outdated traffic-control systems,
limited runway capacity, and a shortage of fuel-efficient air freighters. In
the last 40 years, only three major new airports have been built in North
America: Dallas-Fort Worth, Montrealâ€™s Mirabel, and Denver International.
All of them replaced existing airports. Expansion of runway capacity in the
United States also has been limited. Since 1975, just 41 new runways were
planned, and only 25 were actually built, each with an average construction
time of about 11 years! Lobbying by special interest groups got in the way.
The shortage of transport capacity relative to demand will have a profound
effect on businesses. For instance, Procter & Gambleâ€™s logistics costs
already exceed such key value-adding costs as manufacturing, even though the
company mainly ships by land. Longer supply chains also increase inventory
levels and carrying costs related to financing and warehousing.
These are just the first-order costs of congestion. The second-order costs
are even greater. Companies can easily match supply and demand if demand is
steady over time with no change in volume or mix. But as soon as demand
changes, supply levels at each step of the chain must adjust.
Given the lag time before changes in demand are actually felt by different
players along the chain, their effects are amplified when they hit, leading
to inventory shortages or pile-ups. Then, companies tend to overcompensate
by stopping or increasing production lines, and inventory levels can
fluctuate wildly. This is the â€śwhipsawâ€ť effect, and congestion can
The associated costs can be significant: Lost profits from a stockout equal
the gross margin of a productâ€”generally in the range of 20% to 50%. Product
overstocks result in discounted prices, which are usually about half to
two-thirds of the gross margin. Congestion-driven losses from stockouts and
overstocks are overwhelmingly greater than the direct costs of congestion
but often remain hidden because they may not be measured or called out.
The bottom line: Companies must redesign their supply chains or become
victims of the direct and indirect costs of increasing congestion.
The longer your supply chain is, the greater the risk of variability. But
much supply-chain variability is self-inflicted, the result of inadequately
informed planning and needless complexity in processes, products, and
portfolios. Companies should also look for ways to shorten and simplify
their supply chains by shifting away from high-volume, world-scale plants
that make just a few products to smaller plants that make a wider range of
products closer to local markets. Increases in unit-production costs are
often offset by lower logistics costs, faster replenishment cycles and fewer
stockouts and overstocks. The same logic can apply to distribution logistics
when global distribution centers are replaced by regional warehouses.
Visit Harvard Business Review for the report.
popular sunburn art can lead to cancer
There is a warning by dermatologists to the public against a new trend in
skin decoration known as sunburn art. Report from doctors says that this new
trend is dangerous because as a form of sunburn it increases the risk of
melanoma which is the most common kind of skin cancer in the United States.
This new sunburn art is created through the decorative use and placement of
sunscreen on the skin, this is to create a specific symbol or design while
exposing the rest of their skin to direct sunlight. They intentionally get
extreme sunburns in order to highlight the design or mark of choice.
According to physicians, this activity can increase the risk of melanoma by
as much as 50 percent. They also said that it causes the skin to prematurely
Reports from dermatologists states that extreme exposure to the sunâ€™s rays
can cause â€śfragmentation of collagenâ€ť. Collagen is what makes humans look
fresh and young. Ergo, if fragmentation occurs it can cause the skin to look
old and dull.
Recommendation from experts has it that before venturing out into the sun,
people should apply a sunblock with a minimum of SPF 30. They further
suggest that people reapply the sunblock once every three or four hours
according to the manufacturerâ€™s directions. They also note that people
should use cream rather than spray as spray does not cover the skin entirely
which renders it less effective.
Visit the Dispatch Times for the article.
The U.S. just
recorded its first confirmed measles death in 12 years
Health officials confirmed the country's first measles death since 2003, and
they believe the victim was most likely exposed to the virus in a health
facility in Washington state during an outbreak there.
The woman died in the spring; a later autopsy confirmed that she had an
undetected measles infection, the Washington State Department of Health said
in a statement. The official cause of death was announced as "pneumonia due
The woman was at a Clallam County health facility "at the same time as a
person who later developed a rash and was contagious for measles," the
health department statement read. "The woman had several other health
conditions and was on medications that contributed to a suppressed immune
system. She didnâ€™t have some of the common symptoms of measles such as a
rash, so the infection wasnâ€™t discovered until after her death."
According to the U.S. Centers for Disease Control and Prevention, 178 people
from 24 states and the District were reported to have measles from Jan. 1
through June 26 of this year. Two-thirds of the cases, the CDC noted, were
"part of a large multi-state outbreak linked to an amusement park in
This newly confirmed case marks Washington's 11th reported instance of
measles this year, and state health officials urged people to vaccinate
against the virus.
Visit the Washington Post for the article.