Overregulation of Health Care: Musings on Disruptive Innovation Theory

Disruptive innovation theory provides one lens through which to describe how regulations may stifle innovation and increase costs. Basing their discussion on this theory, Curtis and Schulman consider some of the effects that regulatory controls may have on innovation in the health sector

Overregulation of Health Care: Musings on Disruptive Innovation Theory

Disruptive innovation theory provides one lens through which to describe how regulations may stifle innovation and increase costs. Basing their discussion on this theory, Curtis and Schulman consider some of the effects that regulatory controls may have on innovation in the health sector

Enhancing human cognition with cocoa flavonoids

Enhancing cognitive abilities has become a fascinating scientific challenge, recently driven by the interest in preventing age-related cognitive decline and sustaining normal cogni-tive performance in response to cognitively demanding environments. In recent years, cocoa and cocoa-derived products, as a rich source of flavonoids, mainly the flavanols sub-class, have been clearly shown to exert cardiovascular benefits. More recently, neuromodulation and neuroprotective actions have been also suggested. Here, we dis-cuss human studies specifically aimed at investigating the effects of acute and chronic administration of cocoa flavanols on different cognitive domains, such as executive func-tions, attention and memory. Through a variety of direct and indirect biological actions, in part still speculative, cocoa and cocoa-derived food have been suggested to possess the potential to counteract cognitive decline and sustain cognitive abilities, particularly among patients at risk. Although still at a preliminary stage, research investigating the relations between cocoa and cognition shows dose-dependent improvements in general cognition, attention, processing speed, and working memory. Moreover, cocoa flavanols administration could also enhance normal cognitive functioning and exert a protective role on cognitive performance and cardiovascular function specifically impaired by sleep loss, in healthy subjects. Together, these findings converge at pointing to cocoa as a new interesting nutraceutical tool to protect human cognition and counteract different types of cognitive decline, thus encouraging further investigations. Future research should include complex experimental designs combining neuroimaging techniques with physiological and behavioral measures to better elucidate cocoa neuromodulatory properties and directly compare immediate versus long-lasting cognitive effects

Ambient but not local lactate underlies neuronal tolerance to prolonged glucose deprivation

Neurons require a nearly constant supply of ATP. Glucose is the predominant source of brain ATP, but the direct effects of prolonged glucose deprivation on neuronal viability and function remain unclear. In sparse rat hippocampal microcultures, neurons were surprisingly resilient to 16 h glucose removal in the absence of secondary excitotoxicity. Neuronal survival and synaptic transmission were unaffected by prolonged removal of exogenous glucose. Inhibition of lactate transport decreased microculture neuronal survival during concurrent glucose deprivation, suggesting that endogenously released lactate is important for tolerance to glucose deprivation. Tandem depolarization and glucose deprivation also reduced neuronal survival, and trace glucose concentrations afforded neuroprotection. Mass cultures, in contrast to microcultures, were insensitive to depolarizing glucose deprivation, a difference attributable to increased extracellular lactate levels. Removal of local astrocyte support did not reduce survival in response to glucose deprivation or alter evoked excitatory transmission, suggesting that on-demand, local lactate shuttling is not necessary for neuronal tolerance to prolonged glucose removal. Taken together, these data suggest that endogenously produced lactate available globally in the extracellular milieu sustains neurons in the absence of glucose. A better understanding of resilience mechanisms in reduced preparations could lead to therapeutic strategies aimed to bolster these mechanisms in vulnerable neuronal populations

Mitigating Ischemic Injury of Stem Cell-Derived Insulin-Producing Cells after Transplant.

The advent of large-scale in vitro differentiation of human stem cell-derived insulin-producing cells (SCIPC) has brought us closer to treating diabetes using stem cell technology. However, decades of experiences from islet transplantation show that ischemia-induced islet cell death after transplant severely limits the efficacy of the therapy. It is unclear to what extent human SCIPC are susceptible to ischemia. In this study, we show that more than half of SCIPC die shortly after transplantation. Nutrient deprivation and hypoxia acted synergistically to kill SCIPC in vitro. Amino acid supplementation rescued SCIPC from nutrient deprivation, likely by providing cellular energy. Generating SCIPC under physiological oxygen tension of 5% conferred hypoxia resistance without affecting their differentiation or function. A two-pronged strategy of physiological oxygen acclimatization during differentiation and amino acid supplementation during transplantation significantly improved SCIPC survival after transplant

Mortality Salience and Metabolism: Glucose Drinks Reduce Worldview Defense Caused by Mortality Salience

The current work tested the hypothesis that a glucose drink would reduce worldview defense following mortality salience. Participants consumed either a glucose drink or placebo, wrote about either death or dental pain, and then completed a measure of worldview defense (viewing positively someone with pro-US views and viewing negatively someone with anti-US views). Mortality salience increased world- view defense among participants who consumed a placebo but not among participants who consumed a glucose drink. Glucose might reduce defensiveness after mortality salience by increasing the effectiveness of the self-controlled suppression of death-related thought, by providing resources to cope with mortality salience and reducing its threatening nature, or by distancing the individual from actual physical death

Influence of combined aerobic and resistance training on metabolic control, cardiovascular fitness and quality of life in adolescents with type 1 diabetes: a randomized controlled trial

OBJECTIVE: To evaluate the effect of combined exercise training on metabolic control, physical fitness and quality of life in adolescents with type 1 diabetes. DESIGN: A double-blind randomized controlled trial with patients receiving combined aerobic and strength or no training. SETTING: University Hospital Ghent (Belgium). SUBJECTS: Sixteen children with type 1 diabetes were randomized into a control group (n = 8) and an intervention group (n = 8). INTERVENTIONS: Patients participated twice a week for 20 weeks in the combined aerobic and strength group. The control group continued their normal daily activities. MAIN MEASURES: Before and after the intervention anthropometric variables (weight, length, BMI, body composition), metabolic control (glycaemia, HbA1c, daily insulin injected), aerobic capacity (peak Vo(2), peak power, peak heart rate, 6-minute walk distance), strength (1 repetition maximum of upper and lower limb, hand grip strength, muscle fatigue resistance, sit-to-stand) and quality of life (SF-36) were assessed. RESULTS: At baseline, none of the measured parameters differed significantly between the two groups. There was no significant evolution in the groups concerning anthropometric indices, glycaemia and HbA1c. However, the daily doses of insulin injected were significantly lowered in the training group (0.96 IU/kg.day pre versus 0.90 IU/kg.day post; P < 0,05), while it was increased in the control group. Physical fitness increased significantly in the training group. General health, vitality and role emotional had a tendency to improve. CONCLUSION: Combined exercise training seemed to lower daily insulin requirement and improve physical fitness, together with better well-being

Application of electro-active biofilms

The concept of an electro-active biofilm (EAB) has recently emerged from a few studies that discovered that certain bacteria which form biofilms on conductive materials can achieve a direct electrochemical connection with the electrode surface using it as electron exchanger, without the aid of mediators. This electro-catalytic property of biofilms has been clearly related to the presence of some specific strains that are able to exchange electrons with solid substrata (eg Geobacter sulfurreducens and Rhodoferax ferrireducens). EABs can be obtained principally from natural sites such as soils or seawater and freshwater sediments or from samples collected from a wide range of different microbially rich environments (sewage sludge, activated sludge, or industrial and domestic effluents). The capability of some microorganisms to connect their metabolisms directly in an external electrical power supply is very exciting and extensive research is in progress on exploring the possibilities of EABs applications. Indeed, the best known application is probably the microbial fuel cell technology that is capable of turning biomass into electrical energy. Nevertheless, EABs coated onto electrodes have recently become popular in other fields like bioremediation, biosynthesis processes, biosensor design, and biohydrogen production

Quantifying cognitive function in concussed athletes before and after acute exercise using a choice reaction time task

Following a concussion, cognitive deficits have been shown to last longer than symptom resolution. Currently clinicians rely heavily on symptom emergence following the fundamental exercises of the return to play (RTP) protocol, which may leave athletes at risk of returning to play too early if cognitive deficits have not been detected. The purpose of this study was to assess the effects of exercise on choice reaction time (CRT) both at rest and following an acute exercise in 3 populations: non-concussed (NC), recently concussed (RC), and post-concussion syndrome (PCS) individuals. A CRT task in the form of an iPad application measured each individual’s decision-making capabilities at four blocks: (1) 10 minutes prior to exercise, (2) Immediately prior to exercise, (3) immediately post exercise, and (4) 5 minutes post exercise. Participants were also fitted with an eye-tracking system during CRT task performance at rest in order to assess higher levels of cognitive processing. Results demonstrated a facilitative effect of learning and exercise arousal on CRT task performance in both NC and PCS but not in RC. Average RT in RC was not significantly different from NC while average RT in PCS was found to be significantly higher than NC. Gaze behaviour was significantly worse in PCS compared to NC while RC and NC were not significantly different. The absence of symptoms does not inherently mean that cognitive performance under acute physical stress has completely recovered in recently concussed individuals. On the other hand, PCS individuals continue to experience concussion-related symptoms, but appear to display partially recovered cognitive performance. Findings from the current study encourage the use of cognitive assessments following acute exercise during the RTP protocol in order to detect possibly lingering cognitive deficits

Drivers for change in primary care of diabetes following a protected learning time educational event: interview study of practitioners

Background: A number of protected learning time schemes have been set up in primary care across the United Kingdom but there has been little published evidence of their impact on processes of care. We undertook a qualitative study to investigate the perceptions of practitioners involved in a specific educational intervention in diabetes as part of a protected learning time scheme for primary health care teams, relating to changing processes of diabetes care in general practice. Methods: We undertook semistructured interviews of key informants from a sample of practices stratified according to the extent they had changed behaviour in prescribing of ramipril and diabetes care more generally, following a specific educational intervention in Lincolnshire, United Kingdom. Interviews sought information on facilitators and barriers to change in organisational behaviour for the care of diabetes. Results: An interprofessional protected learning time scheme event was perceived by some but not all participants as bringing about changes in processes for diabetes care. Participants cited examples of change introduced partly as a result of the educational session. This included using ACE inhibitors as first line for patients with diabetes who developed hypertension, increased use of aspirin, switching patients to glitazones, and conversion to insulin either directly or by referral to secondary care. Other reported factors for change, unrelated to the educational intervention, included financially driven performance targets, research evidence and national guidance. Facilitators for change linked to the educational session were peer support and teamworking supported by audit and comparative feedback. Conclusion: This study has shown how a protected learning time scheme, using interprofessional learning, local opinion leaders and early implementers as change agents may have influenced changes in systems of diabetes care in selected practices but also how other confounding factors played an important part in changes that occurred in practice