2017 Pulmonary Pathology Society Biennial Meeting, June 13-16, 2017, at the Gleacher Center, Chicago

2017 Pulmonary Pathology Society Biennial Meeting

June 13-16, 2017
Gleacher Center, University of Chicago
450 North Cityfront Plaza Drive, Chicago

OVER 80 INTERNATIONALLY RECOGNIZED EXPERT FACULTY FROM 20 COUNTRIES

Lectures and Panel Discussions by the World’s Experts on Pulmonary Pathology

Register Now!  

https://cme.uchicago.edu/PulmonaryPath2017

The Age of Offence

The politics of outrage, and the crisis of free speech on campus

IRA WELLS

"The unavoidable corollary is that, because offensive speech does not exist in the world, offence can only ever occur when another human claims to have been offended. And who could possibly validate the claim of offence other than the offence-taking party itself? In his London Review of Books essay “What Are We Allowed to Say?” the Yale scholar David Bromwich quotes Tariq Modood, the director of Bristol University’s Centre for the Study of Ethnicity and Citizenship, who argues that “the group which feels hurt is the ultimate arbiter of whether a hurt has taken place.” The Ontario Human Rights Commission already provides this subjective understanding of offence taking with juridical force: “Discrimination happens,” the commission explains, “when a person experiences negative treatment or impact, intentional or not, because of their gender identity or gender expression [or other protected grounds].” The violation resides not in the intention of the offender, but in “experiences” and “impacts” perceptible only to the victim."

Acad Med. 2017 Mar 28. doi: 10.1097/ACM.0000000000001665. [Epub ahead of print]

What Should Guide Health Policy? A Perspective Beyond Politics.

Kirch DG1, Ast C.

Author information

1

D.G. Kirch is president and CEO, Association of American Medical Colleges, Washington, DC. C. Ast is senior director, executive activities, Association of American Medical Colleges, Washington, DC.

Abstract

As the U.S. electorate has become increasingly polarized, these divisions are poised to shape legislative and regulatory work in the years ahead. For those whose focus is on the public goods of health care for all, the advancement of science through rigorous research, and the contribution of higher education to the continual improvement of the nation's workforce, there is profound uncertainty about the future. There are several pressing questions facing the nation and academic medicine, including the future of affordable, accessible insurance; acceptance of scientific evidence; sustainable learning and teaching methodologies; and the well-being and preparation of the nation's health workforce to care for an increasingly diverse nation. For those in academic medicine and policy making alike, the authors propose a framework, grounded in scientific evidence and guided by clinical ethics, for designing and evaluating health policy solutions for these and other pressing questions.

"The smartphone simplifies interprofessional communication, and smartphone applications can facilitate telemedicine activity."

Telemed J E Health. 2017 Mar 29. doi: 10.1089/tmj.2016.0155. [Epub ahead of print]

Being Spontaneous: The Future of Telehealth Implementation?

Mars M1, Scott RE1,2,3.

Author information

1

1 Department of TeleHealth, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban, South Africa .

2

2 Office of Global e-Health Strategy, University of Calgary , Calgary, Canada .

3

3 NT Consulting-Global e-Health, Inc. , Calgary, Canada .

Abstract

INTRODUCTION:

The smartphone simplifies interprofessional communication, and smartphone applications can facilitate telemedicine activity. Much has been written about the steps that need to be followed to implement and establish a successful telemedicine service that is integrated into everyday clinical practice. A traditional and systematic approach has evolved incorporating activities such as strategy development, needs assessment, business cases and plans, readiness assessment, implementation plans, change management interventions, and ongoing monitoring and evaluation. This "best practice" has been promoted in the telehealth literature for many years. In contrast, several recent initiatives have arisen without any such formal undertakings. This article describes the strengths and weaknesses of two "spontaneous" telemedicine services in dermatology and burn management that have evolved in South Africa.

METHODS:

Two spontaneous services were identified and reviewed.

RESULTS:

In one unsolicited service, doctors at rural referring hospitals have been taking photographs of skin lesions and sending them with a brief text message history to dermatologists using the instant messaging smartphone app, WhatsApp. In the other, burns service, admissions to the burns unit or the clinic were triaged by telephonic description of the case and completion of a preadmission questionnaire. More recently, management and referral decisions are made only after completion of the questionnaire and subsequent submission of photographs of the burn sent by WhatsApp, with the decision transmitted by text message.

DISCUSSION:

Although efficient and effective, potential legal and ethical shortcomings have been identified.

CONCLUSION:

These "spontaneous" telehealth services challenge traditional best practice, yet appear to lead to truly integrated practice and, therefore, are successful and warrant further study.

"obesogenic environments"

Obesity has DOUBLED in the last 20 years – with one in four people now dangerously fat

Some 58 per cent of women and 68 per cent of men are overweight or obese, new NHS figures show

“But we also need to confront the ‘obesogenic environments’ we’ve created that surround us with influences encouraging us to over-eat and under-exercise.

“So we should be much tougher on shops selling junk food near schools, limit the number of takeaways on our high streets and engineer our city centres so that there are fewer escalators so that we’re all incentivised to be more active.”

"Twenty years ago almost no one went home from the hospital with a prescription for opioids. Today if you stub your toe it seems to be the first line of treatment."

Why Is Life Expectancy Going Down In The U.S.?

"Heart disease is once again on the rise, causing four times as many deaths as the rest of the leading causes. Despite advances in cancer treatment cancer deaths are also on the rise. But what’s most disturbing is the increase in accidental deaths related to opioid use and abuse. Twenty years ago almost no one went home from the hospital with a prescription for opioids. Today if you stub your toe it seems to be the first line of treatment. This is leading to addiction, abuse, and eventually heroin use and subsequent overdose deaths. In 2014 alone nearly 30,000 people in the United States died from opioid overdoses."

Avni Santani, Jill Murrell, Birgit Funke, Zhenming Yu, Madhuri Hegde, Rong Mao, Andrea Ferreira-Gonzalez, Karl V. Voelkerding, and Karen E. Weck (2017) Development and Validation of Targeted Next-Generation Sequencing Panels for Detection of Germline Variants in Inherited Diseases. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Development and Validation of Targeted Next-Generation Sequencing Panels for Detection of Germline Variants in Inherited Diseases

Avni Santani, PhD; Jill Murrell, PhD; Birgit Funke, PhD; Zhenming Yu, PhD; Madhuri Hegde, PhD; Rong Mao, MD; Andrea Ferreira-Gonzalez, PhD; Karl V. Voelkerding, MD; Karen E. Weck, MD

From the Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dr Santani); the Division of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Drs Santani, Murrell, and Yu); the Department of Pathology, MGH/Harvard Medical School, Boston, Massachusetts (Dr Funke); the Laboratory for Molecular Medicine at Partners HealthCare, Personalized Medicine, Cambridge, Massachusetts (Dr Funke); the Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia (Dr Hegde); the Department of Pathology, ARUP Laboratories Institute for Clinical and Experimental Pathology (Dr Mao) and the Department of Pathology (Dr Voelkerding), University of Utah School of Medicine, Salt Lake City; the Division of Molecular Diagnostics, Department of Pathology, Virginia Commonwealth University, Richmond (Dr Ferreira-Gonzalez); Genomics and Bioinformatics, ARUP Laboratories, Salt Lake City, Utah (Dr Voelkerding); and the Department of Pathology and Laboratory Medicine and Genetics, University of North Carolina at Chapel Hill (Dr Weck).

Reprints: Avni Santani, PhD, Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, 3615 Civic Center Blvd, 716-ARC, Philadelphia, PA 19104 (email: SANTANI@email.chop.edu).

Context.— The number of targeted next-generation sequencing (NGS) panels for genetic diseases offered by clinical laboratories is rapidly increasing. Before an NGS-based test is implemented in a clinical laboratory, appropriate validation studies are needed to determine the performance characteristics of the test.

Objective.— To provide examples of assay design and validation of targeted NGS gene panels for the detection of germline variants associated with inherited disorders.

Data Sources.— The approaches used by 2 clinical laboratories for the development and validation of targeted NGS gene panels are described. Important design and validation considerations are examined.

Conclusions.— Clinical laboratories must validate performance specifications of each test prior to implementation. Test design specifications and validation data are provided, outlining important steps in validation of targeted NGS panels by clinical diagnostic laboratories.

Diana M. Cardona, Stephen Black-Schaffer, Fay Shamanski, and Jonathan L. Myles (2017) Medicare's New Quality Payment Program Has Started—Are You Ready?. Archives of Pathology & Laboratory Medicine In-Press.

doi: http://dx.doi.org/10.5858/arpa.2017-0047-ED

Early Online Release

Medicare's New Quality Payment Program Has Started—Are You Ready?

Diana M. Cardona, MD; Stephen Black-Schaffer, MD; Fay Shamanski, PhD; Jonathan L. Myles, MD

"Additional information regarding the QPP can be found at https://qpp.cms.gov/ (accessed January 14, 2017). The history of such programs suggests that the MIPS requirements within each performance category will become more complex and demanding in future years. The thresholds have intentionally been set low at the start of the program to ease EC transition into the program and to minimize disruption to the delivery of health care. As ECs become more familiar with the program, reporting requirements will likely increase. Another potential threat to pathology is the retirement of our high-performing measures by the CMS. As a whole, pathology has done well within the PQRS program. The quality gaps initially seen at the time of creation of the measure have diminished, and therefore the need for those measures from the perspective of the CMS is less pronounced. However, CAP is striving to maintain these measures because they ensure that the quality of care that best serves Medicare beneficiaries will be promoted within the pathology community. However, additional measures need to be created to facilitate all pathologists’ compliance with the MIPS program. The creation of a pathology-specific QCDR with a broader menu of measures is one potential way to help the pathology community succeed within MIPS. The College of American Pathologists is currently in the process of introducing such a registry to the medical community."

Acquired Cystic Disease–Associated Renal Cell Carcinoma

Michelle Foshat and Eduardo Eyzaguirre (2017) Acquired Cystic Disease–Associated Renal Cell Carcinoma: Review of Pathogenesis, Morphology, Ancillary Tests, and Clinical Features. Archives of Pathology & Laboratory Medicine: April 2017, Vol. 141, No. 4, pp. 600-606.

doi: http://dx.doi.org/10.5858/arpa.2016-0123-RS

RESIDENT SHORT REVIEWS

Acquired Cystic Disease–Associated Renal Cell Carcinoma: Review of Pathogenesis, Morphology, Ancillary Tests, and Clinical Features

Michelle Foshat, MD; Eduardo Eyzaguirre, MD

From the Department of Pathology, University of Texas Medical Branch, Galveston.

Reprints: Eduardo Eyzaguirre, MD, Department of Pathology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555 (email: ejeyzagu@utmb.edu).

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

Acquired cystic disease–associated renal cell carcinoma (ACD-RCC) is a recently described subtype of RCC found in individuals with ACD of the kidney. Because of underrecognition, information regarding this lesion is sparse but continues to accumulate with each new report. Herein, a thorough literature review amassing the current understanding of this unique neoplasm is presented. Discussion focuses on clinical features, pathogenesis, disease outcome, and relation to the duration of dialysis. The macroscopic and characteristic microscopic features are described with illustrations. Compared with previous opinion, compiled immunohistochemical data may now allow for recognition of a unique immunophenotypic pattern of ACD-RCC. Distinction of ACD-RCC from clear cell and papillary RCCs based on molecular genetic information is deliberated, including a summary of the most frequently detected cytogenetic abnormalities. The key morphologic and immunophenotypic patterns used to distinguish this entity from a comprehensive differential diagnosis are provided.

Egad

Chocolate bars may shrink in drive to tackle obesity

Public Health England says changes to nine food groups could lead to 200,000 tons of sugar being taken out of snacks yearly by 2020

“If these recalcitrant companies don’t comply we need Theresa May to bring in tough measures to ensure compliance and put public health first before the profits of the food industry.”

B.C.

Before Cellphones

"...obesity was less common when meals were eaten with the television off and when meals were cooked at home..."

Want to reduce your risk of obesity? Cooking at home and avoiding TV during meals will help!

"Researchers found the lowest odds of obesity for those adults who engaged in both healthy practises – eating home-cooked food and doing it without a TV or video on – every time they ate a family meal.

Obesity was as common in adults who ate family meals one or two days a week as it was in those who ate family meals every day, researchers said.

"Regardless of family meal frequency, obesity was less common when meals were eaten with the television off and when meals were cooked at home," said Sarah Anderson of Ohio State University."

Earlier Onset of Arthritis in More Recent Generations Linked to Obesity

"We found that each succeeding generation had a higher prevalence of arthritis.  The effect of obesity was such that the differences between generations were more marked for obese individuals compared to those of normal weight. Our findings also suggest that obese individuals report arthritis a few years earlier than normal weight individuals.   Looking at other things which might affect arthritis prevalence, our statistical analyses suggest that the adverse effect of obesity on increasing the prevalence of arthritis has offset potential benefits of improved education and income over time."

Br Med Bull. 2017 Feb 23:1-13. doi: 10.1093/bmb/ldx002. [Epub ahead of print]

Ethical issues of CRISPR technology and gene editing through the lens of solidarity.

Mulvihill JJ1, Capps B2, Joly Y3, Lysaght T4, Zwart HA5, Chadwick R6; International Human Genome Organisation (HUGO) Committee of Ethics, Law, and Society (CELS).

Author information

1

Section of Genetics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Suite 12100, 1200 Children's Avenue, Oklahoma City, OK 73104, USA.

2

Department of Bioethics, Dalhousie University, 5849 University Avenue, Room C-312, CRC Bldg, PO Box 15000, Halifax, Nova Scotia, Canada B3H 4R2.

3

Department of Human Genetics, Centre of Genomics and Policy, McGill University, 740 Avenue Dr. Penfield, Suite 5200, Montreal (Quebec), Canada H3A 0G1.

4

Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Level 2 Block MD11, Clinical Research Centre, 10 Medical Drive, Singapore 117576, Singapore.

5

Faculty of Science, Department of Philosophy and Science Studies, Radboud UniversityNijmegen, P.O. Box 9010, NL-6500 GL Nijmegen, The Netherlands.

6

School of Law, University of Manchester, Williamson Building-2.13, Manchester M13 9PL, UK.

Abstract

BACKGROUND:

The avalanche of commentaries on CRISPR-Cas9 technology, a bacterial immune system modified to recognize any short DNA sequence, cut it out, and insert a new one, has rekindled hopes for gene therapy and other applications and raised criticisms of engineering genes in future generations.

SOURCES OF DATA:

This discussion draws on articles that emphasize ethics, identified partly through PubMed and Google, 2014-2016.

AREAS OF AGREEMENT:

CRISPR-Cas9 has taken the pace and prospects for genetic discovery and applications to a high level, stoking anticipation for somatic gene engineering to help patients. We support a moratorium on germ line manipulation.

AREAS OF CONTROVERSY:

We place increased emphasis on the principle of solidarity and the public good. The genetic bases of some diseases are not thoroughly addressable with CRISPR-Cas9. We see no new ethical issues, compared with gene therapy and genetic engineering in general, apart from the explosive rate of findings. Other controversies include eugenics, patentability and unrealistic expectations of professionals and the public.

GROWING POINTS:

Biggest issues are the void of research on human germ cell biology, the appropriate routes for oversight and transparency, and the scientific and ethical areas of reproductive medicine.

AREAS TIMELY FOR DEVELOPING RESEARCH:

The principle of genomic solidarity and priority on public good should be a lens for bringing clarity to CRISPR debates. The valid claim of genetic exceptionalism supports restraint on experimentation in human germ cells, given the trans-generational dangers and the knowledge gap in germ cell biology.

Chicago - Call On Me

Chicago - Call On Me

The worst carcinogen

The worst carcinogen: Being overweight

"For instance, for every 5 kilograms/m2 gain of body mass index, there was a 9 percent increase in the risk of colon cancer and a 56 percent increase risk of biliary tract (such as gallbladder) cancer in men. For postmenopausal women not using hormone replacement therapy, every 11-pound weight gain increased the risk of breast cancer by 11 percent. The affect was cumulative, meaning being overweight by 25 pounds increases the risk of breast cancer by 25 percent. Even scarier, the risk of endometrial (lining of the uterus) cancer increased by 21 percent for every 1/10th increase in the ratio of waist circumference to hip circumference. For those of you who have heard that being “pear-shaped” is better than “apple-shaped,” meaning carrying your extra weight on your hips, this is one of those cancers that highlight the difference."

Arch Pathol Lab Med. 2016 Apr 15. [Epub ahead of print]

Biomarker Testing in Lung Carcinoma Cytology Specimens: A Perspective From Members of the Pulmonary Pathology Society.

Roy-Chowdhuri S, Aisner DL, Allen TC, Beasley MB, Borczuk A, Cagle PT, Capelozzi V, Dacic S, da Cunha Santos G, Hariri LP, Kerr KM, Lantuejoul S, Mino-Kenudson M, Moreira A, Raparia K, Rekhtman N, Sholl L, Thunnissen E, Tsao MS, Vivero M, Yatabe Y1.

Author information

1

From the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology, University of Colorado Cancer Center, Denver (Dr Aisner); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Beasley); the Department of Pathology, Weill Cornell Medical College, New York (Drs Borczuk and Cagle); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Cagle); the Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil (Dr Capelozzi); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, University Health Network, Princess Margaret Cancer Centre, and the University of Toronto, Toronto, Ontario, Canada (Drs da Cunha Santos and Tsao); the Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, Boston (Drs Hariri and Mino-Kenudson); the Department of Pathology, Aberdeen University Medical School, and Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom (Dr Kerr); the Department of Biopathology, Centre Léon Bérard, Lyon, and J Fourier University, Institut National de la Santé et de la Recherche Médicale-Institut Albert Bonniot, Grenoble, France (Dr Lantuejoul); the Department of Pathology, New York University, New York (Dr Moreira); the Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (Dr Raparia); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York (Dr Rekhtman); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston (Drs Sholl and Vivero); the Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands (Dr Thunnissen); and the Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan (Dr Yatabe).

Abstract

The advent of targeted therapy in lung cancer has heralded a paradigm shift in the practice of cytopathology with the need for accurately subtyping lung carcinoma, as well as providing adequate material for molecular studies, to help guide clinical and therapeutic decisions. The variety and versatility of cytologic-specimen preparations offer significant advantages to molecular testing; however, they frequently remain underused. Therefore, evaluating the utility and adequacy of cytologic specimens is critical, not only from a lung cancer diagnosis standpoint but also for the myriad ancillary studies that are necessary to provide appropriate clinical management. A large fraction of lung cancers are diagnosed by aspiration or exfoliative cytology specimens, and thus, optimizing strategies to triage and best use the tissue for diagnosis and biomarker studies forms a critical component of lung cancer management. This review focuses on the opportunities and challenges of using cytologic specimens for molecular diagnosis of lung cancer and the role of cytopathology in the molecular era.

Canadian Obesity Network calls for media to consider how obesity is portrayed

A recent survey found 86% of Canadians believe that lifestyle choices concerning diet and physical activity are the leading cause of obesity; 55% also said that they thought people living with obesity did not have self-discipline, according to a press release from the organization.

“We want to work with the media to encourage a shift from the use of imagery that depicts people living with obesity in a negative light, to one that looks at the whole picture,” Arya Sharma, MD, FRCPC, founder and scientific director of the Canadian Obesity Network, said in the release. “These body-focused images can perpetuate negative stereotypes and don’t accurately reflect the whole person, a person who has a life, accomplishments and who is living with a chronic disease versus what many people wrongly assume, a lifestyle choice.”

"Oh, there are real conservative health ideas out there. But the party as a whole, and the House in particular, just didn't bother."

A Republican Fiasco Years in the Making

By

Jonathan Bernstein

Meanwhile, despite pledging as soon as they took office to write a bill to replace Obamacare, they never bothered to do the hard work of actually putting together a policy. Oh, there are real conservative health ideas out there. But the party as a whole, and the House in particular, just didn't bother. And it's not just health care: They can't, or won't, create viable policy. There's no Republican immigration bill, no Republican replacement for Dodd-Frank, and on and on. They rarely even manage to talk policy beyond cliches and symbols. 

"The word 'tyranny' is perhaps just a bit extravagant as a description of tendencies at work in the contemporary academy, and yet..."

The Academy’s Assault on Intellectual Diversity

By Robert Boyers MARCH 19, 2017

The word "tyranny" is perhaps just a bit extravagant as a description of tendencies at work in the contemporary academy, and yet, when we speak of the attempt to create a total culture, dedicated to promoting a perfect consensus, we may well feel that we are confronting a real and present danger. The danger that context and complexity will count for nothing when texts or speech acts become triggers for witch hunts, and that wit and irony will be regarded as deplorable deviations from standard protocol. "Tyrants always want language and literature that is easily understood," Theodor Haecker observes.

At my own college, when a senior colleague at a public meeting last fall uttered an expression ("in their native habitat") felt by some to be "offensive" — though clearly not intended to be so, and followed by a clear apology when a complaint was voiced — there were calls for her to resign from the faculty. And though she is, and will remain, with us, the incident prompted a volley of abusive and self-righteous rhetoric, drove more than one faculty member to advise students away from courses taught by "that woman," and stirred a renewed emphasis on "re-education" and "rehabilitation."

Astonishing, of course, that those very terms — "re-education" and "rehabilitation" — do not scare the hell out of academics who use them and hear them. That they do not call to mind the not so distant history of authoritarian regimes in Europe, or lead on to the thought that "diversity," for many of us in the academy, has now come to mean a plurality of sameness. More important: The words, apparently, do not suggest how vulnerable we are — all of us — to error, slippage, and hurt, and how the protocols, tribunals, and shamings currently favored by many in the academy have distracted us from our primary obligation, which is to foster an atmosphere of candor, good will, kindness, and basic decency without which we can be of no use to one another or to our students.

Bariatric divorce

Weight isn't all bariatric surgery patients stand to lose

Justin Thomas

March 26, 2017

The rates of bariatric (weight-loss) surgery in the Arabian Gulf are among the highest in the world. It was once reserved for the morbidly obese, but these days moderately obese individuals and even chubby children might undergo the procedure. The benefits of surgery can be huge, including remission of type 2 diabetes and better liver function. However, bariatric surgery patients don’t always end up happily ever after.

Beyond the occasional physical complications, there can also be psychological and social consequences. One such consequence appears to be an elevated risk of divorce. A review study published in Social Work Today suggests that the two-year, post-operative divorce rate in bariatric patients is as high as 75 to 85 per cent. This high frequency of marital breakdown has given rise to the phrase "bariatric divorce".

Middle age spread can cause dementia with lack of exercise leading to 'rapid mental decline' according to study

Resistance to the hormone insulin sees the body fails to burn sugar and instead store it as fat - which is linked to Type 2 diabetes and brain disease

"A study found patients with insulin resistance, caused partly by obesity and lack of exercise, had more rapid mental decline.

Resistance to the hormone is where the body fails to burn sugar and stores it as fat, and is linked to Type 2 diabetes.

The University of Tel Aviv in Israel tested insulin levels and cognitive function in 500 people.

Follow-up tests 15 and 20 years later showed those in the top 25% for insulin inefficiency were more likely to have accelerated cognitive decline."

HHS Secretary Backs Medicare Balance Billing

3/20/2017 by Norman Tabler, Jr.  | Faegre Baker Daniels

"Price’s rationale is that balance billing would help persuade more physicians to accept Medicare patients—physicians who currently don’t accept Medicare patients because the payment rates are too low.  Attracting more physicians would help address the physician shortage that currently  limits access by the elderly to health care."

Erin Allen and me: Toward Clarity in the Use of Human Tissue in Research

Toward Clarity in the Use of Human Tissue in Research

Abstract:
The issues of ownership of human tissue and individuals’ consent for its use in research are of national importance. Three influential court cases have determined that individuals do not retain a property interest in research tissues. The issue currently in question is what degree of individual understanding and informed consent is appropriate to both protect researchers from lawsuits for their use of human tissue in research, while simultaneously providing individuals and groups of individuals with the appropriate degree of understanding and informed consent. We present a 2-tiered approach that might resolve this issue.

Am J Bioeth. 2017 Apr;17(4):36-43. doi: 10.1080/15265161.2017.1284914.

Catholic Social Teaching and the Duty to Vaccinate.

Carson PJ1, Flood AT2.

Author information

1

a North Dakota State University and University of North Dakota School of Medicine.

2

b North Dakota State University.

Abstract

Since the last century, vaccination has been one of the most important tools we possess for the prevention and elimination of disease. Yet the tremendous gains from vaccination are now threatened by a growing hesitance to vaccinate based on a variety of concerns or objections. Geographic clustering of some families who choose not to vaccinate has led to a number of well-publicized outbreaks of vaccine-preventable diseases. Of note is that some of these outbreaks are centered within some Christian religious groups that increasingly avoid vaccination due to moral concerns, fears about safety, or doubts about the necessity of vaccines. We argue from the perspective of Catholic social teaching on why there is a moral duty to vaccinate.

"'Ultimately, we see our story as about the collapse of the white, high-school-educated working class after its heyday in the early 1970s, and the pathologies that accompany that decline,' they conclude."

'Sea of despair': Death rates stay up for US working-class whites

Offering what they call a tentative but "plausible" explanation, they write that less-educated white Americans who struggle in the job market in early adulthood are likely to experience a "cumulative disadvantage" over time, with health and personal problems that often lead to drug overdoses, alcohol-related liver disease and suicide.

"Ultimately, we see our story as about the collapse of the white, high-school-educated working class after its heyday in the early 1970s, and the pathologies that accompany that decline," they conclude.

Burden of childhood obesity shifting to poorer families in Mexico

"Among all children in 2012, 28.8% were either at risk for obesity (preschool children) or had overweight or obesity. Among preschool children, 23.8% were considered at risk for obesity; 9.7% had overweight or obesity, with a higher combined prevalence observed in boys (35.2%) vs. girls (31.8%; P < .001). The combined prevalence of overweight and obesity among school-aged children was 34.4%, again with a higher prevalence observed in boys (36.9%) vs. girls (32%; P < .001). The combined prevalence of overweight and obesity among adolescents was 35.8% for girls and 34.1% for boys, with a slightly higher trend observed for girls (P = .03), according to the researchers."

Teach Learn Med. 2017 Mar 8:1-9. doi: 10.1080/10401334.2016.1275971. [Epub ahead of print]

The Development and Impact of a Social Media and Professionalism Course for Medical Students.

Gomes AW1,2, Butera G1,2, Chretien KC3, Kind T4.

Author information

1

a Himmelfarb Health Sciences Library , The George Washington University , Washington, DC , USA.

2

b Department of Medicine , The George Washington University , Washington, DC , USA.

3

c Department of Medicine , The George Washington University , Washington, DC , USA.

4

d Department of Pediatrics , Children's National, The George Washington University , Washington, DC , USA.

Abstract

PROBLEM:

Inappropriate social media behavior can have detrimental effects on students' future opportunities, but medical students are given little opportunity to reflect upon ways of integrating their social media identities with their newly forming professional identities.

INTERVENTION:

In 2012, a required educational session was developed for 1st-year medical students on social media and professional identity. Objectives include identifying professionalism issues and recognizing positive social media use. The 2-hour large-group session uses student-generated social media examples to stimulate discussion and concludes with an expert panel. Students complete a postsession reflection assignment.

CONTEXT:

The required social media session occurs early in the 1st year and is part of the Professionalism curriculum in The George Washington University School of Medicine. Reflection papers are graded for completion.

OUTCOME:

The study began in 2012 and ran through 2014; a total of 313/505 participants (62%) volunteered for the study. Assessment occurred through qualitative analysis of students' reflection assignments. Most students (65%, 203/313) reported considering changes in their social media presence due to the session. The analysis revealed themes relating to a broader understanding of online identity and opportunities to enhance careers. In a 6-month follow-up survey of 76 students in the 2014 cohort who completed the entire survey, 73 (94%) reported some increase in awareness, and 48 (64%) made changes to their social media behavior due to the session (response rate = 76/165; 46%), reflecting the longer term impact.

LESSONS LEARNED:

Opportunities for discussion and reflection are essential for transformational learning to occur, enabling understanding of other perspectives. Incorporating student-submitted social media examples heightened student interest and engagement. The social media environment is continually changing, so curricular approaches should remain adaptable to ensure timeliness and relevance. Including online professionalism curricula focused on implications and best practices helps medical students develop an awareness of their electronic professional identities.