"...young pathologists are only rarely taught specifically about the importance of the role of the pathologist in the overall health care system and are generally not informed about the grand history and distinguished traditions of pathology."

Stephen A. Geller (2016) Pathology Residents Are Not “Trainees”. Archives of Pathology & Laboratory Medicine: April 2016, Vol. 140, No. 4, pp. 301-301.

doi: http://dx.doi.org/10.5858/arpa.2015-0436-LE

LETTERS TO THE EDITOR

Pathology Residents Are Not “Trainees”

Stephen A. Geller , MD

Department of Pathology and Laboratory Medicine, Weill-Cornell Medical College, New York, New York;

Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles;

emeritus chairman and professor, Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California

Brandon R. Driver, Bryce P. Portier, Dina R. Mody, Michael Deavers, Eric H. Bernicker, Min P. Kim, Bin S. Teh, Jose F. Santacruz, Lisa Kopas, Reginald F. Munden, and Philip T. Cagle (2016) Next-Generation Sequencing of a Cohort of Pulmonary Large Cell Carcinomas Reclassified by World Health Organization 2015 Criteria. Archives of Pathology & Laboratory Medicine: April 2016, Vol. 140, No. 4, pp. 312-317.

CONTRIBUTIONS FROM THE PULMONARY PATHOLOGY SOCIETY, PART II

Next-Generation Sequencing of a Cohort of Pulmonary Large Cell Carcinomas Reclassified by World Health Organization 2015 Criteria

Brandon R. Driver , MD; Bryce P. Portier , MD; Dina R. Mody , MD; Michael Deavers , MD; Eric H. Bernicker , MD; Min P. Kim ,MD; Bin S. Teh , MD; Jose F. Santacruz , MD; Lisa Kopas , MD; Reginald F. Munden , MD; Philip T. Cagle , MD

From the Departments of Pathology and Genomic Medicine (Drs Driver, Portier, Mody, Deavers, and Cagle); Medicine, Thoracic Medical Oncology (Dr Bernicker); Thoracic Surgery (Dr Kim); Radiation Oncology (Dr Teh); Interventional Pulmonology, Critical Care, and Pulmonary Medicine (Drs Santacruz and Kopas); Radiology (Dr Munden), Houston Methodist Hospital, Houston; and Weill Cornell Medical College, New York, New York.

Reprints: Brandon R. Driver, MD, Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin St, Houston, TX 77030 (email: brdriver@houstonmethodist.org).

The authors have no relevant financial interest in the products or companies described in this article.

Context.—The classification of pulmonary large cell carcinoma has undergone a major revision with the recent World Health Organization (WHO) 2015 Classification. Many large cell carcinomas are now reassigned to either adenocarcinoma with solid pattern or nonkeratinizing squamous cell carcinoma based on immunopositivity for adenocarcinoma markers or squamous cell carcinoma markers, respectively. Large cell carcinomas that are negative for adenocarcinoma and squamous cell carcinoma immunomarkers are now classified as large cell carcinoma with null immunohistochemical features (LCC-N). Although a few studies investigated the mutation profile of large cell carcinomas grouped by immunostain profile before the publication of the new WHO classification, investigation of tumors previously diagnosed as large cell carcinoma and reclassified according to the 2015 WHO classification has not, to our knowledge, been reported.

Objective.—To determine the mutation profiles of pulmonary large cell carcinomas reclassified by WHO 2015 criteria.

Design.—Archival cases of non–small cell lung carcinoma with large cell carcinoma morphology (n = 17) were reclassified according to 2015 WHO criteria. To determine mutation profile, we employed Ion Torrent (Life Technologies, Carlsbad, California)–based next-generation sequencing (50 genes; more than 2800 mutations) in addition to real-time quantitative reverse transcription polymerase chain reaction for ALK translocation detection.

Results.—Two of 17 cases (12%) were reclassified as LCC-N, and both had mutations—BRAF D594N in one case andKRAS G12C in the other case. Seven of 17 cases (41%) were reclassified in the adenocarcinoma with solid pattern group, which showed one KRAS G12C and one EGFR E709K + G719C double mutation in addition to mutations in TP53. Eight of 17 cases (47%) were reclassified in the nonkeratinizing squamous cell carcinoma group, which showed mutations inPIK3CA, CDKN2A, and TP53. No ALK translocations or amplifications were detected.

Conclusions.—The adenocarcinoma with solid pattern group showed mutations typical of adenocarcinoma, whereas the nonkeratinizing squamous cell carcinoma group showed mutations typical of squamous cell carcinoma. Both LCC-N cases had mutations associated with adenocarcinoma, supporting the hypothesis that LCC-N is related to adenocarcinoma.

"...becoming overweight may make it harder for an individual to keep track of what and how much he or she has eaten..."

Obesity is growing Problem, Obese people are more forgetful – Pomona Health

"Episodic memory refers to the ability to vividly recall past events that one has taken part in. A person whose episodic memory functions at optimal levels can pinpoint the time and place of various personal experiences, the immediate feelings or thoughts triggered by those occurrences, as well as other contextual elements.

In order to recall the past in such great detail, one must first have to go through a stage called encoding, which allows a particular event to be recorded in one’s memory. Afterwards, consolidation must take place, whereby the old experience becomes more deeply ingrained in one’s long-term memory.

In other words, it is possible that becoming overweight may make it harder for an individual to keep track of what and how much he or she has eaten, potentially making one more likely to overeat."

Anja C. Roden, Ryan M. Kern, Marie Christine Aubry, Sarah M. Jenkins, Eunhee S. Yi, John P. Scott, and Fabien Maldonado (2016) Transbronchial Cryobiopsies in the Evaluation of Lung Allografts: Do the Benefits Outweigh the Risks?. Archives of Pathology & Laboratory Medicine: April 2016, Vol. 140, No. 4, pp. 303-311.

CONTRIBUTIONS FROM THE PULMONARY PATHOLOGY SOCIETY, PART II

Transbronchial Cryobiopsies in the Evaluation of Lung Allografts: Do the Benefits Outweigh the Risks?

Anja C. Roden , MD; Ryan M. Kern , MD; Marie Christine Aubry , MD; Sarah M. Jenkins , MS; Eunhee S. Yi , MD; John P. Scott ,MD; Fabien Maldonado , MD

From the Department of Laboratory Medicine and Pathology (Drs Roden, Aubry, and Yi);

the Division of Pulmonary & Critical Care Medicine (Drs Kern, Scott, and, Maldonado);

and the Department of Health Sciences Research (Ms Jenkins), Mayo Clinic Rochester, Minnesota.

Reprints: Anja C. Roden, MD, Division of Anatomic Pathology, Mayo Clinic Rochester, Hilton 11, 200 First St SW, Rochester, MN 55905 (email: Roden.anja@mayo.edu).

The authors have no relevant financial interest in the products or companies described in this article.

This manuscript was presented in part as an oral presentation at the 35th Annual Meeting & Scientific Sessions of the International Society for Heart and Lung Transplantation; April 17, 2015; Nice, France.

Context.—Transbronchial cryobiopsy technique yields larger biopsies with enhanced quality. The benefits and safety of cryobiopsies have not been thoroughly studied in lung allografts.

Objective.—To compare size, quality, reproducibility of interpretation of rejection and complications of cryobiopsies with those of conventional biopsies from lung allografts.

Design.—All cryobiopsies (March 2014–January 2015) of lung allografts performed at Mayo Clinic, Rochester, and medical records were reviewed. For comparison, conventional biopsies from the same patient or, if unavailable, from a random patient, were selected. Two pathologists blinded to outcome reviewed all biopsies. Specimen volume, number of alveoli, small airways, and pulmonary vessels were counted and statistically compared.

Results.—Fifty-four biopsies (27 cryobiopsies) from 18 patients (11 men) were reviewed. A median of 3 (range, 2–5) and 10 (range, 6–12) specimens were obtained with cryobiopsies and conventional biopsies, respectively. Cryobiopsies were larger and contained more alveoli (P < .001, both) and small airways (P = .04). Conventional biopsies showed more fresh alveolar hemorrhage (procedural) and crush artifact/atelectasis (P < .001, both). Cryobiopsies contained more pulmonary veins and venules (P < .001). There was no significant difference between the types of biopsies with respect to the reviewers' agreement on grades of rejection. Complications were more frequent in the cryobiopsy group, though the difference was not statistically significant.

Conclusions.—Cryobiopsies of lung allografts are larger and have less artifact. However, complications occur and should be considered. Three cryobiopsy specimens appear sufficient for histopathologic evaluation of lung allografts.

Andrew Churg, Brandon S. Sheffield, and Francoise Galateau-Salle (2016) New Markers for Separating Benign From Malignant Mesothelial Proliferations: Are We There Yet?. Archives of Pathology & Laboratory Medicine: April 2016, Vol. 140, No. 4, pp. 318-321.

CONTRIBUTIONS FROM THE PULMONARY PATHOLOGY SOCIETY, PART II

New Markers for Separating Benign From Malignant Mesothelial Proliferations: Are We There Yet?

Andrew Churg , MD; Brandon S. Sheffield , MD; Francoise Galateau-Salle , MD

From the Department of Pathology, Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada (Drs Churg and Sheffield); and Service Anatomie Pathologique, Centre National Référent MESOPATH, CHU du Caen, Caen, France (Dr Galateau-Salle). Dr Galateau-Salle is now with the Department of Pathology, Centre Leon Berard, Lyon, France.

Context.—The separation of benign from malignant mesothelial proliferations is crucial to patient care but is frequently morphologically difficult.

Objective.—To briefly review adjunctive tests claimed to be useful in this setting and to examine in detail 2 new tests: p16 fluorescence in situ hybridization (FISH) and BRCA1-associated protein 1 (BAP1) immunohistochemistry.

Design.—Literature review with emphasis on p16 FISH and BAP1 immunohistochemistry.

Results.—Glucose transporter-1, p53, insulin-like growth factor 2 messenger RNA–binding protein 3 (IMP-3), desmin, and epithelial membrane antigen have all been claimed to mark either benign or malignant mesothelial processes, but in practice they at best provide statistical differences in large series of cases, without being useful in an individual case. Homozygous deletion of p16 by FISH or loss of BAP1 has only been reported in malignant mesotheliomas and not in benign mesothelial proliferations. BAP1 appears to be lost more frequently in epithelial than mixed or sarcomatous mesotheliomas. Homozygous deletion of p16 by FISH is seen in pleural epithelial, mixed, and sarcomatous mesotheliomas, but it is much less frequent in peritoneal mesothelioma. The major drawback to both these tests is limited sensitivity; moreover, failure to find p16 deletion or BAP1 loss does not make a mesothelial process benign.

Conclusions.—In the context of a mesothelial proliferation, the finding of homozygous deletion of p16 by FISH or loss of BAP1 by immunohistochemistry is, thus far, 100% specific for malignant mesothelioma. The limited sensitivity of each test may be improved to some extent by running both tests.

Philip T. Cagle, Timothy C. Allen, Eric H. Bernicker, Yimin Ge, Abida Haque, and Roberto Barrios (2016) Impact of Recent Developments in Lung Cancer on the Practice of Pathology. Archives of Pathology & Laboratory Medicine: April 2016, Vol. 140, No. 4, pp. 322-325.

CONTRIBUTIONS FROM THE PULMONARY PATHOLOGY SOCIETY, PART II

Impact of Recent Developments in Lung Cancer on the Practice of Pathology

Philip T. Cagle , MD; Timothy C. Allen , MD, JD; Eric H. Bernicker , MD; Yimin Ge , MD; Abida Haque , MD; Roberto Barrios , MD

From the Department of Pathology and Genomic Medicine (Drs Cagle, Ge, Haque, and Barrios)

and Houston Methodist Cancer Center (Dr Bernicker),

Houston Methodist Hospital, Houston, Texas; and the Department of Pathology and Laboratory Medicine, University of Texas Medical Branch, Houston (Dr Allen).

"Even with these caveats, the participation of surgical pathologists and cytopathologists in biomarker testing for lung cancer, while already crucial, becomes even more intimate when the test is directly interpreted by the pathologist using tools of routine practice and is performed in the pathologist-managed histology laboratory. Current requirements of the FDA will likely be modified in the future by pressures from the patients, their oncologists, and their advocates. The potential for impact of biomarker testing with IHC on the practice of pathology is extremely large, given the number of patients receiving a diagnosis of lung cancer."

Check out the Archives of Pathology and Laboratory Medicine April issue, featuring Part 2 of the Pulmonary Pathology Society Special Section

Check out the Archives of Pathology and Laboratory Medicine April issue, featuring Part 2 of the Pulmonary Pathology Society Special Section.

Healthc (Amst). 2016 Mar;4(1):15-21. doi: 10.1016/j.hjdsi.2015.12.004. Epub 2015 Dec 22.

How U.S. children's hospitals use social media: A mixed methods study.

Wong CA1, Ostapovich G2, Kramer-Golinkoff E2, Griffis H2, Asch DA3, Merchant RM4.

Author information

• 1Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA, USA; Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: charwong@upenn.edu.
• 2Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA.
• 3Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA, USA; Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA; Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Health Equity Research and Promotion, The Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
• 4Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA, USA; Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA; Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Abstract

BACKGROUND:

Social media provide new channels for hospitals to engage with communities, a goal of increasing importance as non-profit hospitals face stricter definitions of community benefit under the Affordable Care Act. We describe the variability in social media presence among US children's hospitals and the distribution of their Facebook content curation.

METHODS:

Social media data from freestanding children's hospitals were extracted from September-November 2013. Social media adoption was reviewed for each hospital-generated Facebook, Twitter, YouTube, Google+ and Pinterest platform. Facebook page (number of Likes) and Twitteraccount (number of followers) engagement were examined by hospital characteristics. Facebook posts from each hospital over a 6-week period were thematically characterized.

RESULTS:

We reviewed 5 social media platforms attributed to 45 children's hospitals and 2004 associated Facebook posts. All hospitals maintained Facebook and Twitter accounts and most used YouTube (82%), Google+ (53%) and Pinterest (69%). Larger hospitals were more often high performers for Facebook (67% versus 10%, p<0.01) and Twitter (75% versus 17%, p<0.05) engagement than small hospitals. The most common Facebook post-themes were hospital promotion 35% (706), education and information 35% (694), community partnership or benefit 24% (474), fundraising 21% (426), and narratives 12% (241). Of health education posts, 73% (509) provided pediatric health supervision and anticipatory guidance.

CONCLUSIONS:

Social media adoption by US children's hospitals was widespread.

IMPLICATIONS:

Beyond its traditional marketing role, social media can serve as a conduit for health education, engagement with communities, including community benefit.

Maternal Obesity Tied to Increase in Child Behavior Problems

"The researchers found that increased offspring problem behaviors, including internalizing behaviors, externalizing behaviors, and attention problems on the CBCL, were seen in association with prepregnancy obesity (body mass index [BMI] of 30 kg/m²) compared with normal-weight mothers (BMI of 22 kg/m²)."

Trop Parasitol. 2016 Jan-Jun;6(1):5-7. doi: 10.4103/2229-5070.175024.

Utilitarian and deontological ethics in medicine.

Mandal J1, Ponnambath DK1, Parija SC1.

Author information

• 1Department of Microbiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.

Abstract

Medical ethics is a sensible branch of moral philosophy and deals with conflicts in obligations/duties and their potential outcome. Two strands of thought exist in ethics regarding decision-making: deontological and utilitarian. In deontological approach, outcomes/consequences may not just justify the means to achieve it while in utilitarian approach; outcomes determine the means and greatest benefit expected for the greatest number. In brief, deontology is patient-centered, whereas utilitarianism is society-centered. Although these approaches contradict each other, each of them has their own substantiating advantages and disadvantages in medical practice. Over years, a trend has been observed from deontological practice to utilitarian approach leading to frustration and discontentment. Health care system and practitioners need to balance both these ethical arms to bring congruity in medical practice.

J Med Ethics. 2016 Mar 17. pii: medethics-2015-102941. doi: 10.1136/medethics-2015-102941. [Epub ahead of print]

In what circumstances will a neonatologist decide a patient is not a resuscitation candidate?

Murray PD1, Esserman D2, Mercurio MR3.

Author information

• 1Division of Newborn Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts, USA.
• 2Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA.
• 3Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA Program for Biomedical Ethics, Yale University School of Medicine, New Haven, Connecticut, USA.

Abstract

OBJECTIVE:

The purpose of this study was to determine the opinions of practising neonatologists regarding the ethical permissibility of unilateral Do Not Attempt Resuscitation (DNAR) decisions in the neonatal intensive care unit.

STUDY DESIGN:

An anonymous survey regarding the permissibility of unilateral DNAR orders for three clinical vignettes was sent to members of the American Academy of Pediatrics Section of Perinatal Medicine.

RESULTS:

There were 490 out of a possible 3000 respondents (16%). A majority (76%) responded that a unilateral DNAR decision would be permissible in cases for which survival was felt to be impossible. A minority (25%) responded 'yes' when asked if a unilateral DNAR order would be permissible based solely on neurological prognosis.

CONCLUSIONS:

A majority of neonatologists believed unilateral DNAR decisions are ethically permissible if survival is felt to be impossible, but not permissible based solely on poor neurological prognosis. This has significant implications for clinical care.

Nature. 2016 Mar 9. doi: 10.1038/nature17160. [Epub ahead of print]

Intrinsic honesty and the prevalence of rule violations across societies.

Gächter S1,2,3, Schulz JF1,4.

Author information

• 1University of Nottingham, University Park, Nottingham NG7 2RD, UK.
• 2CESifo, Schackstrasse 4, 80539 Munich, Germany.
• 3IZA, Schaumburg-Lippe-Strasse 5-9, 53113 Bonn, Germany.
• 4Yale University, 1 Prospect Street, New Haven, Connecticut 06510, USA.

Abstract

Deception is common in nature and humans are no exception. Modern societies have created institutions to control cheating, but many situations remain where only intrinsic honesty keeps people from cheating and violating rules. Psychological, sociological and economic theories suggest causal pathways to explain how the prevalence of rule violations in people's social environment, such as corruption, tax evasion or political fraud, can compromise individual intrinsic honesty. Here we present cross-societal experiments from 23 countries around the world that demonstrate a robust link between the prevalence of rule violations and intrinsic honesty. We developed an index of the 'prevalence of rule violations' (PRV) based on country-level data from the year 2003 of corruption, tax evasion and fraudulent politics. We measured intrinsic honesty in an anonymous die-rolling experiment5. We conducted the experiments with 2,568 young participants (students) who, due to their young age in 2003, could not have influenced PRV in 2003. We find individual intrinsic honesty is stronger in the subject pools of low PRV countries than those of high PRV countries. The details of lying patterns support psychological theories of honesty. The results are consistent with theories of the cultural co-evolution of institutions and values, and show that weak institutions and cultural legacies that generate rule violations not only have direct adverse economic consequences, but might also impair individual intrinsic honesty that is crucial for the smooth functioning of society.

PLoS One. 2016 Mar 16;11(3):e0150881. doi: 10.1371/journal.pone.0150881. eCollection 2016.

Life Satisfaction and the Pursuit of Happiness on Twitter.

Yang C1, Srinivasan P1.

Author information

• 1Computer Science, The University of Iowa, Iowa City, Iowa, United States of America.

Abstract

Life satisfaction refers to a somewhat stable cognitive assessment of one's own life. Life satisfaction is an important component of subjective well being, the scientific term for happiness. The other component is affect: the balance between the presence of positive and negative emotions in daily life. While affect has been studied using social media datasets (particularly from Twitter), life satisfaction has received little to no attention. Here, we examine trends in posts about life satisfaction from a two-year sample of Twitter data. We apply a surveillance methodology to extract expressions of both satisfaction and dissatisfaction with life. A noteworthy result is that consistent with their definitions trends in life satisfaction posts are immune to external events (political, seasonal etc.) unlike affect trends reported by previous researchers. Comparing users we find differences between satisfied and dissatisfied users in several linguistic, psychosocial and other features. For example the latter post more tweets expressing anger, anxiety, depression, sadness and on death. We also study users who change their status over time from satisfied with life to dissatisfied or vice versa. Noteworthy is that the psychosocial tweet features of users who change from satisfied to dissatisfied are quite different from those who stay satisfied over time. Overall, the observations we make are consistent with intuition and consistent with observations in the social science research. This research contributes to the study of the subjective well being of individuals through social media.

George Osborne's sugar tax won't stop "stupid people" feeding their kids sugary food

"The greatest penalty of excommunication became exclusion from that space: the only space in which one could be buried as a human being. To be cast out meant to be buried like a dog."

Booked: The Living Dead

Timothy Shenk  March 10, 2016

"Gradually churches came to have churchyards which gathered together the dead of the community over the generations. The greatest penalty of excommunication became exclusion from that space: the only space in which one could be buried as a human being. To be cast out meant to be buried like a dog. So in the old order there was only one place for the body—the churchyard—to which access was guarded by ecclesiastical authorities who also attended to the dying and prayed for their souls. The thousand-year-old regime was one in which the dead belonged to priests and not as in classical antiquity to families or on occasion to the state."

How the Merrick Garland nomination explains the rise of Donald Trump

How the Merrick Garland nomination explains the rise of Donald Trump


"You may hear the word "norms" and think about things like courtesy or shopworn habits, but the truth is that there are many norms whose function is to permit government to operate in something like an efficient fashion. For instance, the norm by which the Federal Election Commission used to operate is that while the Commission's three Democratic and three Republican commissioners will have different views about election law, all will accept the basic premise that whatever they think the laws ought to be, the laws currently in place should be enforced. But the Republican commissioners have abandoned that norm, and as a result our election laws are simply not being enforced; at this point it's basically an honor system."

"...an ambivalence-free life."

How 'Safe Spaces' Stifle Ideas

"Nor are advanced thinkers who operate in this way to be found only on the political or cultural left. In France, to argue for divestment from Israeli enterprises, as a protest against Israeli actions in Gaza, is now regarded not merely as a terrible idea, which perhaps it is, but as a form of incitement to violence and thus a criminal offense. No doubt, in the wake of the recent terrorist attacks in Paris, further restrictions on political discourse will be introduced, always with the standard, high-minded appeals to solidarité and liberté. So much for openness and the clash of ideas in a Western-enlightenment capital, where the going consensus has it that, if you teach people not to have bad thoughts, you will save them from error, that is, from drawing unwanted conclusions about the things they see, and that you will thereby offer them an ambivalence-free life."

Health Serv Res. 2016 Mar 15. doi: 10.1111/1475-6773.12477. [Epub ahead of print]

Effects of State Cervical Cancer Insurance Mandates on Pap Test Rates.

Bitler MP1, Carpenter CS2,3,4.

Author information

• 1Department of Economics, University of California, Davis, Davis, CA.
• 2Department of Economics, Vanderbilt University, Nashville, TN.
• 3Department of Health Policy, Vanderbilt University, Nashville, TN.
• 4Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN.

Abstract

OBJECTIVE:

To evaluate the effects of state insurance mandates requiring insurance plans to cover Pap tests, the standard screening for cervical cancer that is recommended for nearly all adult women.

DATA SOURCES:

Individual-level data on 600,000 women age 19-64 from the CDC's Behavioral Risk Factor Surveillance System.

STUDY DESIGN:

Twenty-four states adopted state mandates requiring private insurers in the state to cover Pap tests from 1988 to 2000. We performed a difference-in-differences analysis comparing within-state changes in Pap test rates before and after adoption of a mandate, controlling for the associated changes in other states that did not adopt a mandate.

PRINCIPAL FINDINGS:

Difference-in-differences estimates indicated that the Pap test mandates significantly increased past 2-year cervical cancer screenings by 1.3 percentage points, with larger effects for Hispanic and non-Hispanic white women. These effects are plausibly concentrated among insured women.

CONCLUSIONS:

Mandating more generous insurance coverage for even inexpensive, routine services with already high utilization rates such as Pap tests can significantly further increase utilization.

J Evol Biol. 2016 Mar 14. doi: 10.1111/jeb.12859. [Epub ahead of print]

Evolutionary routes to stable ownership.

Hare D1, Reeve HK2, Blossey B1.

Author information

• 1Department of Natural Resources, Cornell University, Ithaca, New York, 14853, USA.
• 2Department of Neurobiology and Behavior, Cornell University, Ithaca, New York, 14853, USA.

Abstract

Ownership can evolve in potentially any species. Drawing on insights from across disciplines, we distinguish between possession and ownership and present species-neutral criteria for ownership, defined as respect for possession. We use a variant of the tug-of-war evolutionary game to demonstrate how ownership can evolve in the form of a new, biologically realistic strategy, Restraint With Retaliation (RWR). In our game, resource holding potential (RHP) is assumed to be equal between interactants, and resource holding asymmetry determines whether ownership is adaptive. RWR will be evolutionarily stable when the ratio of resource holdings between interactants is relatively low, but not when this ratio is sufficiently high. We offer RWR as one evolutionary route to ownership among many, and discuss how ownership unites previously described behavioural phenomena across taxa. We propose that some but not all mechanisms of territory formation and maintenance can be considered ownership, and show that territories are not the only resources that can be owned. We argue that ownership can be a powerful cooperative solution to tragedies of the commons and problems of collective action throughout the biological world. We advance recent scholarship that has begun to investigate the biological importance of ownership, and we call for a comprehensive account of its evolutionary logic and taxonomic distribution. We propose that ownership should be considered a fundamental, unifying biological phenomenon.

Tiredness upon awakening may be sign of sleep apnea

"Men have double the risk of sleep apnea compared to women. Other risk factors include alcohol intake, weight, family history, and having a nasal obstruction."

Arch Pathol Lab Med. 2016 Mar;140(3):211. doi: 10.5858/arpa.2015-0335-ED.

Twenty Years of the Pulmonary Pathology Society.

Allen TC1.

Author information

• 1From the Department of Pathology, University of Texas Medical Branch, 301 University Blvd, Galveston.

"People become obese because they eat more calories than they burn through physical activity."

Childhood obesity still a growing concern to the country

"Two thirds of Americans do not meet the health standards for military service.

People become obese because they eat more calories than they burn through physical activity.

There are three million new cases of obesity in the United States each year. The rate of obesity in children and adolescents has doubled in the past thirty years. In 1980 seven percent of children ages 6-11 were obese. In 2010 one in five children in the same age group were obese. Not overweight. Obese."

Eric Bernicker: Next-Generation Sequencing and Immunotherapy Biomarkers: A Medical Oncology Perspective

Eric Bernicker (2016) Next-Generation Sequencing and Immunotherapy Biomarkers: A Medical Oncology Perspective. Archives of Pathology & Laboratory Medicine: March 2016, Vol. 140, No. 3, pp. 245-248.

CONTRIBUTIONS FROM THE PULMONARY PATHOLOGY SOCIETY, PART I

Next-Generation Sequencing and Immunotherapy Biomarkers: A Medical Oncology Perspective

Eric Bernicker, MD

From the Cancer Center, Houston Methodist Hospital, Houston, Texas.

Reprints: Eric Bernicker, MD, Cancer Center, Houston Methodist Hospital, 6445 Main Street, Floor 24, Houston, TX 77030 (email:Bernicker@houstonmethodist.org).

The author has no relevant financial interest in the products or companies described in this article.

Presented at the Biennial Meeting of the Pulmonary Pathology Society; June 3–5, 2015; San Francisco, California.

The two most important scientific developments of the past decade regarding therapies for patients with non–small cell lung cancer are the ability to exploit particular genetic mutations with targeted therapies and the discovery of drugs that can help the patient's own immune system attack the cancer. Despite these advances, many patients do not yet benefit from either approach. To maximize patient benefit, clinicians and pathologists will need to rationally apply the growing scientific knowledge to best characterize a patient's tumor and possible driver mutations. A growing understanding of host-tumor immune interactions will hopefully help expand our therapeutic options. Lastly, the still elusive identification of immunotherapy biomarkers will hopefully help identify patients most likely to derive a therapeutic response to immune checkpoint inhibitors, and promises to be an important field of study for years to come.

J Clin Psychol. 2016 Mar 18. doi: 10.1002/jclp.22290. [Epub ahead of print]

"The Worst Experience of My Life": The Internship Crisis and Its Impact on Students.

Parent MC1, Bradstreet TC1, Wood M2, Ameen E2, Callahan JL3.

Author information

• 1Texas Tech University.
• 2American Psychological Association.
• 3University of North Texas.

Abstract

OBJECTIVE:

The objective of the present study was to understand how internship applicants perceive themselves as being affected by the ongoing imbalance between the number of internship spots available and the number of applicants to internship.

METHOD:

The present study undertook a qualitative, and supplemental quantitative, analysis of 1,076 internship applicant responses to an item included in the 2011 postmatch survey asking participants how the internship crisis has affected them.

RESULTS:

Results indicated that the internship application process in general was viewed overwhelmingly negatively. Respondents described personal stress and system issues in their responses. Respondents described reciprocal stresses; applications spur on stresses, which are compounded by fears of not matching. Such fears cast negative light on training. Participants also described resiliencies that buffered against stresses and perceptions of discrimination or bias that add to stress.

CONCLUSIONS:

The implications of these findings for supporting students, working to resolve the internship crisis, and adapting policy are discussed.