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Study Reveals "Unacceptable Delays" In Stroke Prevention Surgery
Only one in five UK patients have surgery to reduce their risk of stroke within the two week target time set by the National Institute for Health and Clinical Excellence (NICE), finds a study published on bmj.com today.

Health Affairs Study Finds No Link Between Cost, Quality Of Care
Quality of care is not linked to the cost of care, according to a study published last week on the Web site of the journal Health Affairs, CQ HealthBeat reports. For the study, researchers from Dartmouth College and Harvard University analyzed the health care bills of chronically ill Medicare beneficiaries in their last two years of life who received end-of-life care from 2,172 unidentified hospitals. The patients had one of three common conditions: heart attack, pneumonia or congestive heart failure. The study -- sponsored by the National Institute on Aging -- looked at common quality indicators at a hospital-by-hospital level instead of regional level (Norman, CQ HealthBeat, 5/22). Researchers compared the data with some of the quality measures reported on the HHS Hospital Compare Web site (Goldstein, "Health Blog," Wall Street Journal, 5/21). The study found that among the one-fifth of hospitals that spent the least, the cost of end-of-life care was $16,059 on average. In comparison, the cost of end-of-life care at the top 20% of highest-spending hospitals was $34,742 on average. The study also found no link -- or even evidence against a link -- between spending and the quality indicators. The researchers noted that the results might be skewed because the quality indicators they used might penalize hospitals that treat sicker patients. In addition, the study used process-of-care measures instead of patient outcomes. According to CQ HealthBeat, the findings of the study could have an effect on the debate over health care reform legislation because lawmakers and President Obama both have said that a reform plan must be able to control costs and expand access to high-quality, affordable health care (CQ HealthBeat, 5/22).
News of the day
Mixed Neurodegenerative Disorders Are Emerging From The Shadows
Many cases of age-related neurodegenerative disease fall into the gray zone between big, defined diseases - Alzheimer"s or Parkinson"s, for example. Their diagnostic accuracy is low, researchers agree. That"s a problem, because mixed disease is not only common, but also quite different in its course from pathologically "pure" disease. (Mixed disease is often worse.) But there"s also excitement and opportunity. The large overlap between established neurodegenerative diseases is ripe for scientific exploration, and recent advances at the genetic, clinico-pathologic, and molecular levels have turned it into a dynamic area of research. In particular, diseases such as Dementia with Lewy bodies and frontotemporal dementias are drawing intense interest as biomarker development branches out beyond Amyloid beta and tau, holding out a future where molecular-based diagnoses can define the pathogenic proteins that together drive a given person"s individual disease.
Diagnostics

Synchronized Swimming Of Algae May Have Significant Implications For Human Health And Disease

Using high-speed cinematography, scientists at Cambridge University have discovered that individual algal cells can regulate the beating of their flagella in and out of synchrony in a manner that controls their swimming trajectories. Their research was published on the 24th July in the journal Science. The researchers studied the unicellular organism Chlamydomonas reinhardtii, which has two hair-like appendages known as flagella. The beating of flagella propels Chlamydomonas through the fluid and simultaneously makes it spin about an axis. The researchers found that cells can beat their flagella in two fundamentally distinct modes: synchronised, with nearly identical frequencies and positions, and unsynchronised, with two rather different frequencies. Using a specialised apparatus to track the swimming trajectories of individual cells, the group showed that the periods of synchrony correspond to nearly straight-line motion, while sharp turns result from the asynchronous beating. Whereas previous studies had suggested that these modes were associated with different subpopulations of cells, the new work shows that the cells actually control the frequencies and thereby switch back and forth between the two modes. In essence, this suggests Chlamydomonas has two "gears". Moreover, the researchers have developed a mathematical analysis that describes the two beating flagella as "coupled oscillators," in a way similar to models of synchronised flashing of fireflies and the "Mexican wave" of people in a stadium. Analyzing terabytes of data on the patterns of synchronisation, they showed that the strength of the coupling was consistent with it arising from the fluid flows set up by the beating flagella. These observations constitute the first direct demonstration that hydrodynamic interactions are responsible for synchronisation, which has long been predicted to lead to such coordination. Professor Raymond E. Goldstein, the Schlumberger Professor of Complex Physical Systems in the Department of Applied Mathematics and Theoretical Physics (DAMTP) and lead author of the study, said: "These results indicate that flagellar synchronization is a much more complex problem than had been appreciated, and involves a delicate interplay of cellular regulation, hydrodynamics, and biochemical noise." Funded by the Biotechnology and Biological Sciences Research Council (BBSRC), the work is part of a larger effort to improve our knowledge of evolutionary transitions from single-cell organisms (like Chlamydomonas) to multicellular ones. In addition, the flagella of Chlamydomonas cells are nearly identical to the cilia in the human body. In many of life"s processes, from reproduction to respiration, coordinated action of cilia plays a crucial role. For this reason, insight into synchronization and its control may have significant implications for human health and disease. The group was led by Professor Goldstein and included postdoctoral researchers Dr. Marco Polin and Dr. Idan Tuval, Ph.D. student Knut Drescher, and Professor Jerry P. Gollub, a Leverhulme Visiting Professor at DAMTP from Haverford College. Notes: The article "Chlamydomonas swims with two `gears" in a eukaryotic version of run-and-tumble locomotion" was published Friday 24th July in the journal Science. Farzana Miah University of Cambridge


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