6 Simple Steps to Keep Your Heart Healthy

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Article Link: http://www.webmd.com/diet/features/6-simple-steps-to-keep-your-heart-healthy?src=RSS_PUBLIC

A healthy heart — and a healthier you — starts today with these quick tips from the experts.
By Wendy C. Fries
WebMD Feature

Keeping your heart healthy is so simple it can be put into catchy, two-word phrases: Eat right. Get exercise. Don’t smoke.

Putting those heart-healthy catch phrases into action, of course, isn’t so simple.  Which matter most? How can you put them into daily practice?

Here are practical heart health hints you can use every day.

Get Exercise: Time to Play

Adults need at least 30 minutes of exercise five or more days a week for heart health. But improving cardiovascular and overall health isn’t only about sweating on a treadmill or climbing stairs, say the pros. Getting out to play is exercise too, and improving heart health is just as easily about kickball with your kids, walking the dog, or shooting hoops with colleagues during your lunch break.

Heart-Healthy Keys to Exercise

Get a total of at least 30 minutes of exercise daily — and you don’t have to do it all at once. Aim for a 10-minute morning walk perhaps, a short workout with hand weights at lunch, and some digging in the garden before dinner, and you’ve met your goals.

To get the full benefits of aerobic exercise “folks should get their heart rate up so they’re somewhat breathless, but can still carry on a conversation,” says Susan Moores, RD, MS, a registered dietitian and American Dietetic Association spokeswoman. She adds that all kinds of exercises are important, from strength training and aerobics, to flexibility and stretching exercises.

Routine Exams: Get Checked

“Nobody’s going to keep an eye on your medical health other than you,” says Elaine Magee, MPH, RD, author of Food Synergy, and WebMD’s “Recipe Doctor.” “You are in charge.”

That’s an easy thing to forget, especially when talking about the ho-hum pragmatism of routine health exams. Yet getting regular blood pressure, blood sugar, and cholesterol checks, as well as physical exams are important steps in maintaining heart health.

“Anything you can find out about what’s going on inside your body the better,” says Magee. Especially true when you consider that heart-threatening conditions like high blood pressure and high cholesterol are “silent” — meaning there’s almost no way to know you have them unless you get tested.

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Healthy Oils, Healthy Fats: The ‘New’ Truth

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By Peter Jaret
WebMD Feature

New research has overturned some long-held ideas about good fats and bad fats. It used to be gospel truth: Saturated fat is bad. New studies suggest that, while no one would call saturated fats “good,” in moderation they may not be so hard on your heart after all. What’s more, replacing saturated fats with the wrong kinds of foods — such as the highly refined carbohydrates in white bread, white rice, pastries, and sugary candies or desserts — may actually increase your heart disease danger.

How can the average person make sense of the new research? Rather than banish saturated fat, many experts say it’s more important to eat plenty of vegetables, grains, and fish, as well as a variety of fats in moderate amounts. Here are 5 tips to remember when you’re trying to fit fats and oils into your heart-healthy diet.

1. Don’t Obsess Over Saturated Fat

Health experts began recommending cutting back on saturated fat when they discovered that it raises LDL, the “bad” cholesterol. That advice made perfect sense. High LDL is linked to heart disease.

The focus on slashing saturated fat may have been misguided. “Recommendations to focus on saturated fat were based on a single biomarker, LDL cholesterol,” says Dariush Mozaffarian, MD, an associate professor of medicine and epidemiology at the Harvard School of Public Health. “But we now know there are many other important biomarkers for heart disease risk.”

When you look at all of the biomarkers together, he says, the effects of saturated fat aren’t as bad as once thought. Indeed, reviewing the evidence, Mozaffarian and his colleague Renata Micha found that levels of saturated fat have very little impact on cardiovascular risk.

Americans currently consume about 11.5% of calories from saturated fat. If we cut that roughly in half, to 6.5%, we might lower our risk of heart disease by only about 10%, says Mozaffarian.

Unfortunately, during the low-fat craze, many people replaced saturated fat with fat-free products made of highly-refined carbohydrates and often too much salt. Studies show that substituting refined carbohydrates for saturated fat may end up increasing our heart disease risk.

Does this mean you can eat as much butter and cheese as you like? No. The American Heart Association still recommends limiting saturated fat to no more than 7% of total calories. Fats of all kinds are high in calories, so it’s wise not to overindulge. The new findings simply reinforce the idea that it’s also important to be wary of buying foods that claim to be fat-free or low-fat. Check the label to see if they are high in salt and refined carbohydrates, such white flour and sugar.

2. Choose Heart Healthy Plant-Based Oils

Most experts still agree that it’s smart to replace some saturated fats with unsaturated fats. Plant-based oils like olive oil or canola oil are a healthier choice than butter, for instance.

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Pediatricians Promote Benefits of Recess

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little girl playing on jungle gym

Dec. 31, 2012 — The American Academy of Pediatrics has two New Year’s resolutions for schools: Keep the school nurse and don’t drop recess.

The recommendations are part of two new policy statements published in Pediatrics.

The American Academy of Pediatrics (AAP) says there’s a growing trend in schools to take away recess and use the time to teach subjects.

“There is pressure on schools to increase performance on standardized testing, and a lot of times teachers are using withdrawal of recess as a punishment for children,” says Robert Murray, MD, a co-author of the recess policy statement and a professor at the Ohio State University in Columbus.

“Recess is an important part of the school day that should not be cast off without thinking,” he says.

It is not a reward, he says. Recess is necessary and important to help children learn and grow.

“No matter what kind of recess, whether indoors or outdoors, structured or unstructured, kids need a safe place to play,” Murray says. “And the equipment should be good and people who supervise should be well-trained.”

Health Benefits of Recess

The benefits of recess are many. “The child who gets regular breaks in the day performs better cognitively in the classroom and gets a lot of social and emotional benefits,” he says. “Recess provides kids with the chance to be creative and play with others just for the fun of it.”

It doesn’t have to be a full hour or half-hour either, he says. Recess can come in shorter bursts of play time sprinkled throughout the school day. “We need to carve out time that belongs to a child.”

Recess is not the same as physical education or gym either, says the policy statement’s co-author Catherine Ramstetter, PhD. She is a health educator at the Christ College of Nursing and Health Sciences in Cincinnati.

“Recess promotes a healthy learning environment. Importantly, recess should be used as a complement to physical education classes, not a substitute,” she says. “It would be ideal if every school had deep pockets to build huge, amazing playgrounds. But every kid will play differently anyway, and every school doesn’t have the resources. We need to protect recess as it benefits the whole child.”

Key Role for School Doctor

A second AAP policy statement wants schools to assign important roles for a school doctor and school nurse.

School doctors serve school districts as advisors, consultants, volunteers, team doctors, or school district doctors.

But there’s no single set of rules for states and school districts about what a school doctor should do. The new policy statement wants all school districts to have a doctor to oversee health services.

What’s more, school doctors should help coordinate policy and practice plans for kids with chronic health conditions, such as diabetes and asthma. The AAP policy statement says kids spend about seven hours a day,180  days a year, in school. During that time they may only see their doctor once a year.

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20-Minute Home ‘Clean-Ups’ for Better Family Health

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Daunted by the mess in your home? These quick and easy cleanups will tackle that mess while saving you time.
Reviewed by Melinda Ratini, DO, MS

Doing a thorough, deep clean of your whole home can take several hours — hours you don’t always have available. Make the most of your valuable time with faster, smarter solutions for getting at those places  where germs, dust, and allergens lurk.

20-Minute Bathroom Blitz

Once your children are old enough to sit safely in the tub and play for a bit, you can toss in a variety of bath toys and get the bathroom sanitary — if not sparkling — during 15 or 20 minutes of tub time. You’re still within arm’s reach should any water mishaps occur. All you need is some distilled white vinegar to clean and kill most bathroom germs without having to worry that the kids tub will be inhaling harsher chemicals.

  • The toilet. Toilets are where most of our bathroom germs come from — urine is actually sterile, but feces are decidedly not. Flushing can send all kinds of bacteria, germs, and fungus into the air. Pour about two cups of white vinegar or disinfectant into the bowl, and then use a spray bottle to spray more onto all the hard surfaces of the toilet (including the rim and handle). Let it sit about 10 minutes while you handle one of the other tasks. Then wipe down the outside and scrub the bowl with a toilet brush.
  • The sink. Spray your sink with vinegar and wipe thoroughly. Don’t forget the handles and faucet.
  • The shower. If you have a glass shower door, regularly spraying it with vinegar prevents residue from building up.

20-Minute Kitchen Cleanup at Breakfast or Lunch

If you’re like most busy moms, your kids eat at least one meal in the kitchen sitting at the counter or island or in a breakfast nook or dining area nearby. During the 20 minutes it takes them to eat, you can tackle a fast kitchen clean-up that will leave everything more healthy and hygienic.

  • Spray all hard surfaces — countertops, sink, cupboard fronts, taps, and faucets — with a disinfectant cleaner (or distilled white vinegar) and let it sit for 10 minutes.
  • Do a fast purge of the refrigerator. Dump leftovers that are more than 2 days old and other foods that are past their expiration date. Check the crisper drawers and toss withering lettuce and moldy strawberries.
  • Replace old sponges.
  • Take out the trash. Before you put a new bag in the trash can, spray down the sides with cleaner and wipe. Bags often leak or overflow and bacteria can collect on the bin.

Ask the kids to put their dishes in the dishwasher when they are finished eating (or help them, if they’re little). Then spray the kitchen floor with disinfectant cleaner or distilled white vinegar and let them use dirty dish towels to wipe it clean. Toss the dishtowels in the next load of laundry.

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Breast Cancer Diagnosis Could Benefit Greatly From Spectroscopy

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Main Category: Breast Cancer
Also Included In: Medical Devices / Diagnostics;  Cancer / Oncology
Article Date: 31 Dec 2012 – 2:00 PST

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The analysis of small deposits of calcium in breast tissue can help differentiate cancerous and benign tumors, but it is sometimes not easy to make such a diagnosis. Now a team of researchers in the US believes a new method that uses a special type of spectroscopy to locate calcium deposits during a biopsy, could greatly improve the accuracy of diagnosis.
The team, from Massachusetts Institute of Technology (MIT) and Case Western Reserve University (CWRU), writes about the work that led them to this conclusion in a paper published online in Proceedings of the National Academy of Sciences on 24 December.

Calcium Deposits

Microcalcifications, or small deposits of calcium, form when calcium from the bloodstream deposits onto degraded proteins and fats left behind by injured and dying cells.
They can be a telltale sign of breast cancer, but most tumors that contain them are benign.
Microcalcifications are most often seen in breast tumors, but they can also occur, albeit rarely, in other types of cancer, says co-senior author Maryann Fitzmaurice, senior research associate and adjunct associate professor of pathology and oncology at CWRU, in a statement.
Calcification also plays a major role in atherosclerosis, or hardening of the arteries.

Biopsy Can Be Long and Arduous Procedure

When microcalcifications show on a mammogram, doctors do a follow-up biopsy of the suspect tissue to test for cancer.
Figures show that in around 1 in 10 cases with such microcalcifications, the tumor is cancerous, so the follow-up biopsy is critical.
During the procedure, the radiologist takes X-rays from three different angles to locate the tiny calcium deposits, then inserts a needle into the tissue and removes up to 10 tissue samples.
A pathologist then tests these samples to see if they contain microcalcifications.
But in 15 to 25% of cases, it is not easy to locate and take a tissue sample accurately, resulting in an inconclusive diagnosis. This means the patient has to have more X-rays and undergo more invasive surgery to retrieve further samples.
But, as Fitzmaurice explains, this second attempt is rarely successful:
“If they don’t get them on the first pass, they usually don’t get them at all.”
“It can become a very long and arduous procedure for the patient, with a lot of extra X-ray exposure, and in the end they still don’t get what they’re after, in one out of five patients,” she adds.

New Method Uses Special Type of Spectroscopy

Spectroscopy is a way of determining the composition of a material by studying how it absorbs or scatters radiation such as light. It is often used in physical and analytical chemistry, and there are many applications now in medicine too.

One of the challenges in applying the technique to medicine is cost and speed: often the equipment is very expensive and slow to deliver results in “real time”.

For the past several years, the MIT and CWRU team has been working on overcoming this challenge to help the radiologist determine, in a matter of seconds, if the tissue contains microcalcifications or not.

At first they tried a method based on Raman spectroscopy, which uses light to measure energy shifts in molecular vibrations, revealing precise molecular structures. The advantage of this method is that it is very accurate at identifying microcalcifications. But the disadvantage is the equipment is expensive and the analysis takes a long time.

In this latest study, the researchers describe how they turned to another method, called “diffuse reflectance spectroscopy”, and found it gave results just as accurately as Raman spectroscopy, but much faster and at less cost.

Co-lead author Narahara Chari Dingari, a postdoc at MIT, says:
“With our new method, we could obtain similar results with less time and less expense.”

97% Success Rate with Diffuse Reflectance Spectroscopy

Diffuse reflectance spectroscopy collects and analyzes light after it has interacted with the sample. This gives a unique “spectrographic signature”.
In their PNAS paper, the authors describe how they examined 203 tissue samples within minutes of their removal from 23 patients.
Each sample could be one of three types, each with its own spectrographic signature. It could be healthy, it could contain lesions with no microcalcifications, or it could contain lesions with microcalcifications.

By analyzing these patterns, the team produced a computer algorithm that showed a success rate of 97% in identifying tissue with microcalcifications.

Jaqueline Soares, another lead author and MIT postdoc, suggests the changes in the way the different tissues absorb light are probably due to altered levels of specific proteins (elastin, desmosine and isodesmosine) that are often cross-linked with calcium deposits in diseased tissue.

Simple Technology with High Accuracy Is a “Good First Step”

James Tunnell is an associate professor of biomedical engineering at the University of Texas and was not involved in the study. He describes the study as a “good first step” toward a system that could have a big impact on breast cancer diagnosis.
“This technology can be integrated into the system that is already used to take biopsies. It’s a very simple technology that can get the same amount of accuracy as more complicated systems.”
The team envisages their technique being used by radiologists to provide enhanced “real time” guidance to current biopsy procedures.

Because it provides the analysis results within seconds, the new technique could help the radiologist to move the needle to another spot before taking any samples.

The researchers are planning to carry out a new study to test the approach in “real time”: as biposies are being carried out in patients.

Funds from the National Institutes of Health, the National Institute of Biomedical Imaging and Bioengineering and the National Cancer Institute helped finance the study.

Written by Catharine Paddock PhD
Copyright: Medical News Today

Visit our breast cancer section for the latest news on this subject.
“Diagnostic power of diffuse reflectance spectroscopy for targeted detection of breast lesions with microcalcifications”; Jaqueline S. Soares, Ishan Barman, Narahara Chari Dingari, Zoya Volynskaya, Wendy Liu, Nina Klein, Donna Plecha, Ramachandra R. Dasari, and Maryann Fitzmaurice; PNAS, published ahead of print 24 December 2012; DOI:10.1073/pnas.1215473110; Link to Abstract.
Additional source: MIT News.
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n.p. (2012, December 31). “Breast Cancer Diagnosis Could Benefit Greatly From Spectroscopy.” . Retrieved fromhttp://www.medicalnewstoday.com/articles/254502.php.

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Breast cancer is a tumor that has become malignant – it has developed from the breast cells. A ‘malignant’ tumor can spread to other parts of the body – it may also invade surrounding tissue. When it spreads around the body, we call it ‘metastasis’. Read more…

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Scientists Home In On Cause Of Osteoarthritis Pain

Main Category: Arthritis / Rheumatology
Article Date: 31 Dec 2012 – 1:00 PST

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Scientists Home In On Cause Of Osteoarthritis Pain

Researchers at Rush University Medical Center, in collaboration with researchers at Northwestern University, have identified a molecular mechanism central to the development of osteoarthritis (OA) pain, a finding that could have major implications for future treatment of this often-debilitating condition.

“Clinically, scientists have focused on trying to understand how cartilage and joints degenerate in osteoarthritis. But no one knows why it hurts,” said Dr. Anne-Marie Malfait, associate professor of biochemistry and of internal medicine at Rush, who led the study. An article describing the research was published in the December 11 print version of the Proceedings of the National Academy of Sciences.

Joint pain associated with OA has unique clinical features that provide insight into the mechanisms that cause it. First, joint pain has a strong mechanical component: It is typically triggered by specific activities (for example, climbing stairs elicits knee pain) and is relieved by rest. As structural joint disease advances, pain may also occur in rest. Heightened sensitivity to pain, including mechanical allodynia (pain caused by a stimulus that does not normally evoke pain, such as lightly brushing the skin with a cotton swab), and reduced pain-pressure thresholds are features of OA.

Malfait and her colleagues took a novel approach to unraveling molecular pathways of OA pain in a surgical mouse model exhibiting the slow, chronically progressive development of the disease. The study was conducted longitudinally, that is, the researchers were able to monitor development of both pain behaviors and molecular events in the sensory neurons of the knee and correlate the data from repeated observations over an extended period.

“This method essentially provides us with a longitudinal ‘read-out’ of the development of OA pain and pain-related behaviors, in a mouse model” Malfait said.

The researchers assessed development of pain-related behaviors and concomitant changes in dorsal root ganglia (DRG), nerves that carry signals from sensory organs toward the brain. They found that a chemokine known as monocyte chemoattractant protein (MCP)-1 (CCL2) and its receptor, chemokine receptor 2 (CCR2), are central to the development of pain associated with knee OA.

Monocyte chemoattractant protein-1 regulates migration and infiltration of monocytes into tissues where they replenish infection-fighting macrophages. Previous research has shown that MCP-1/CCR2 are central in pain development following nerve injury.
In the study, following surgery the laboratory mice developed mechanical allodynia that lasted 16 weeks. Levels of MCP-1, CCR2 mRNA and protein were temporarily elevated, and neuronal signaling activity increased in the DRG at eight weeks after surgery. This result correlated with the presentation of movement-provoked pain behaviors (for instance, mice with OA travelled less distance, when monitored overnight, and climbed less often on the lid of their cage — suggesting that they avoid movement that triggers pain) which were maintained up to 16 weeks.

Mice that lack Ccr2 (knockout mice) also developed mechanical allodynia, but this began to resolve from eight weeks onward. Despite having severe allodynia and structural knee joint damage equal to that in normal mice, Ccr2-knockout mice did not develop movement-provoked pain behaviors at eight weeks.
To confirm the key role of CCR2 signaling in development of the observed movement-provoked pain behavior after surgery, the researchers administered a CCR2 receptor-blocker to normal mice at nine weeks after surgery and found that this reversed the decrease in distance traveled, that is, movement-provoked pain behavior.

Interestingly, levels of MCP-1 and CCR2 returned to baseline or lower by 16 weeks in mice exhibiting movement-provoked pain behaviors. This finding may suggest that the MCP-1/CCR2 pathway is involved only in the initiation of changes in the DRG, but once macrophages are present, the process is no longer dependent on increased MCP-1/CCR2.

“Increased expression of both MCP-1 and its receptor CCR2 may mediate increased pain signaling through direct excitation of DRG neurons, as well as through attracting macrophages to the DRG,” the researchers said.

“This is an important contribution to the field of osteoarthritis research. Rather than looking at the cartilage breakdown pathway in osteoarthritis, Dr. Malfait and her colleagues are looking at the pain pathway, and this can take OA research in to a novel direction that can lead to new pain remedies in the future,” said Dr. Joshua Jacobs, professor and chairman of orthopedic surgery at Rush University Medical Center.

Treatment of OA in the United States costs almost $200 billion annually. According to the Centers for Disease Control and Prevention, it is expected that by 2030 nearly 70 million adults in the U.S. will have been diagnosed with some form of arthritis.
According to the Arthritis Foundation, an estimated 27 million Americans live with OA, but, despite the frequency of the disease, its cause is still not completely known and there is no cure. In fact, many different factors may play a role in whether or not you get OA, including age, obesity, injury or overuse and genetics.

Osteoarthritis (OA) is one of the oldest and most common forms of arthritis and is a chronic condition characterized by the breakdown of the joint’s cartilage. Cartilage is the part of the joint that cushions the ends of the bones and allows easy movement of joints. The breakdown of cartilage causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint.

Malfait’s co-researchers on this study were Rush scientists Rachel E. Miller. PhD, Phuoong B. Tran, PhD, Rosalina Das, and Nayereh Ghoreishi-Haack, and Dr. Richard J. Miller, PhD, and Dongjun Ren from Northwestern University.

Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number R01AR060364.

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
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Super-Fine Sound Beam Could One Day Be An Invisible Scalpel

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Article Date: 29 Dec 2012 – 0:00 PST

Super-Fine Sound Beam Could One Day Be An Invisible Scalpel

A carbon-nanotube-coated lens that converts light to sound can focus high-pressure sound waves to finer points than ever before. The University of Michigan engineering researchers who developed the new therapeutic ultrasound approach say it could lead to an invisible knife for noninvasive surgery.

Today’s ultrasound technology enables far more than glimpses into the womb. Doctors routinely use focused sound waves to blast apart kidney stones and prostate tumors, for example. The tools work primarily by focusing sound waves tightly enough to generate heat, says Jay Guo, a professor of electrical engineering and computer science, mechanical engineering, and macromolecular science and engineering. Guo is a co-author of a paper on the new technique published in the current issue of Nature’s journal Scientific Reports.

The beams that today’s technology produces can be unwieldy, says Hyoung Won Baac, a research fellow at Harvard Medical School who worked on this project as a doctoral student in Guo’s lab.

“A major drawback of current strongly focused ultrasound technology is a bulky focal spot, which is on the order of several millimeters,” Baac said. “A few centimeters is typical. Therefore, it can be difficult to treat tissue objects in a high-precision manner, for targeting delicate vasculature, thin tissue layer and cellular texture. We can enhance the focal accuracy 100-fold.”

The team was able to concentrate high-amplitude sound waves to a speck just 75 by 400 micrometers (a micrometer is one-thousandth of a millimeter). Their beam can blast and cut with pressure, rather than heat. Guo speculates that it might be able to operate painlessly because its beam is so finely focused it could avoid nerve fibers. The device hasn’t been tested in animals or humans yet, though.

“We believe this could be used as an invisible knife for noninvasive surgery,” Guo said. “Nothing pokes into your body, just the ultrasound beam. And it is so tightly focused, you can disrupt individual cells.”
To achieve this superfine beam, Guo’s team took an optoacoustic approach that converts light from a pulsed laser to high-amplitude sound waves through a specially designed lens. The general technique has been around since Thomas Edison’s time. It has advanced over the centuries, but for medical applications today, the process doesn’t normally generate a sound signal strong enough to be useful.

The U-M researchers’ system is unique because it performs three functions: it converts the light to sound, focuses it to a tiny spot and amplifies the sound waves. To achieve the amplification, the researchers coated their lens with a layer of carbon nanotubes and a layer of a rubbery material called polydimethylsiloxane. The carbon nanotube layer absorbs the light and generates heat from it. Then the rubbery layer, which expands when exposed to heat, drastically boosts the signal by the rapid thermal expansion.

The resulting sound waves are 10,000 times higher frequency than humans can hear. They work in tissues by creating shockwaves and microbubbles that exert pressure toward the target, which Guo envisions could be tiny cancerous tumors, artery-clogging plaques or single cells to deliver drugs. The technique might also have applications in cosmetic surgery.

In experiments, the researchers demonstrated micro ultrasonic surgery, accurately detaching a single ovarian cancer cell and blasting a hole less than 150 micrometers in an artificial kidney stone in less than a minute.

“This is just the beginning,” Guo said. “This work opens a way to probe cells or tissues in much smaller scale.”

The researchers will present the work at the SPIE Photonics West meeting in San Francisco. The research was funded by the National Science Foundation and the National Institutes of Health.
University of Michigan
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Unexpanded Medicaid Programs Under The Affordable Care Act Will Cost Hospitals

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Article Date: 29 Dec 2012 – 0:00 PST

Unexpanded Medicaid Programs Under The Affordable Care Act Will Cost Hospitals
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The choice by many states not to increase Medicaid health insurance for the poor may produce unintentional cuts for hospitals that supply uncompensated care, according to a new study conducted by Vanderbilt University.
John Graves, Ph.D., a Vanderbilt policy expert in the Department of Preventive Medicine and his team used data collected from U.S. hospitals and insurance data in each state to determine reductions in Medicare and Medicaid disproportionate share (DSH) funds paid to approximately three-fourths of U.S. hospitals that attend low-income patients.
The findings, published in the New England Journal of Medicine, laid out numbers to show the influence of funding changes and estimate what the difference would be if Medicaid is or isn’t made larger in each state.
Graves explained:

“Expanded insurance through the exchanges alone will trigger lower DSH payments to hospitals. The problem comes in states where much of the uncompensated care provided will remain the same if Medicaid is not expanded, yet DSH cuts will still occur. Hospitals will need to recoup these DSH losses either by providing less uncompensated care, or by shifting the costs onto everyone else.”

With the implementation of the Affordable Care Act (ACA), Medicare DSH reductions will start with a 75 percent complete decrease in 2014 as new insurance exchanges become active nationwide.
To limit the impact of the reductions, the government has created a formula to add some DSH funds back, figured by the number of citizens who are uninsured in each state. However, due to the ruling by the Supreme Court saying that states are not required to expand Medicaid, the number of citizens covered in each state will differ greatly from state to state.
It was found that a few states not increasing Medicaid will be instead proposing coverage to more people in their insurance exchanges, while still not covering the majority of low-income, uninsured people. DSH reductions will still occur in those states, making it extremely hard for hospitals that provide uncompensated care.
On the other hand, Graves also discovered that states that intend to expand Medicaid coverage may end up covering around 60 percent of their uninsured citizens, greatly improving the amount of hospital care covered by private and public insurance companies. This may counteract the cuts in DSH funds.
Texas, Louisiana, and Florida have already said they will not extend Medicaid coverage. These states and two others will undergo the most unplanned DSH reductions, Graves says.
A separate study done earlier this year stated that extending coverage to currently uninsured adults would raise the cost of the program, because those individuals are more likely to have expensive health issues than non-disabled patients who are currently covered under Medicaid.

Written by Kelly Fitzgerald
Copyright: Medical News Today

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“Medicaid Expansion Opt-Outs and Uncompensated Care”
John A. Graves, Ph.D.
New England Journal of Medicine, December 2012, DOI: 10.1056/NEJMp1209450
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Kids Use Kitchen Items for Risky Games and Highs

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Article Link: http://www.webmd.com/parenting/news/20121227/kids-kitchen-items-highs?src=RSS_PUBLIC

Dec. 28, 2012 — Common kitchen items like ground cinnamon and marshmallows are increasingly being used by kids for dangerous choking games and cheap, easy highs, a toxicologist warns.

“A lot of these spices and household products are around all year. But during the holidays, kids are out of school. So they have less structure and may spend more time on the Internet, where they can learn about choking games and other ways to get high,” says Christina Hantsch, MD, of Loyola University Health System in Maywood, Ill.

“There is always something new out there. So parents have to educate themselves and their children and have a relationship where they can talk about things they have heard of that may very well be risky.”

Dangerous Games

So just what are kids doing with these spices and products?

Hantsch says the emergency room at her hospital saw 12 preteen kids who took the “cinnamon challenge.” During this challenge, kids swallow cinnamon without any water. This results in a cough and burning sensation that can lead to breathing issues and choking.

Videos of the cinnamon challenge on the Internet have gone viral, which is why it is increasing in popularity. In 2011, poison centers in the U.S. received 51 calls about exposure to cinnamon among teens. In the first three months of 2012, they received 139 calls, she says.

The “chubby bunny” marshmallow challenge has similar risks. In this game, kids stuff as many marshmallows into their mouth as they can, and try to say “chubby bunny.” Two kids choked to death during this game.

“It is a little concerning that we are starting to see these things in younger children and preteens who are not aware of the serious consequences,” she says.

Getting High on Household Products

Other kitchen and household products are also risky. Ground nutmeg can be snorted, smoked, or eaten in large amounts to produce marijuana-like effects, Hantsch says. “We are talking about large quantities, not a little bit in your Chai tea.”

Kids are also using aerosol whipped cream and aerosol cooking spray to produce a laughing-gas effect.

Other risky behaviors include drinking hand sanitizer, which often has an alcohol base. “Even a mouthful can make someone feel inebriated,” she says. Some may sniff glue and magic markers to get high. “They may sniff them directly or have the product in a bag that they hold over their mouth and nose.”

The Role of Holiday Stress

Besides the free time and lack of structure, the holidays can be times of stress and emotional tumult for children and teens. “They may be more upset and anxious and more likely to explore or self-medicate,” says Scott Krakower, DO. He is the medical director of the Mineola Community Treatment Center at the North Shore-Long Island Jewish Health System in Mineola, N.Y.

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