Adam Booth and Timothy Craig Allen (2018) Talking to Myself. Archives of Pathology & Laboratory Medicine: June 2018, Vol. 142, No. 6, pp. 682-683.
EDITORIALS
Thursday, May 31, 2018
Saturday, May 26, 2018
Study finds that chewing gum while walking affects both physical and physiological functions, especially in middle-aged and elderly men
Study finds that chewing gum while walking affects both physical and physiological functions, especially in middle-aged and elderly men
While all ages experienced a significantly larger change in heart rate in the gum trial, middle-aged and elderly participants also had a significantly higher mean heart rate while walking compared to the control.
Combining these analyses to incorporate both sex and age showed that chewing gum had the greatest effect in middle-aged and elderly men who experienced a significant positive effect on distance walked, mean walking speed, mean step counts, mean heart rate while walking, change in heart rate, and total energy expenditure compared to the control trial.
The authors conclude: “Chewing gum while walking affects a number of physical and physiological functions in men and women of all ages. Our study also indicates that gum chewing while walking increased the walking distance and energy expenditure of middle-aged and elderly male participants in particular.”
Thursday, May 24, 2018
From Beverly Rogers and colleagues: The Impact of Disruption of the Care Delivery System by Commercial Laboratory Testing in a Children's Health Care System
Beverly B. Rogers, James L. Adams, Alexis B. Carter, Francine Uwindatwa, Cynthia B. Brawley, Charles G. Cochran;, Leah N. Bryan, Elizabeth P. Weinzierl, and Sampath Prahalad (2018) The Impact of Disruption of the Care Delivery System by Commercial Laboratory Testing in a Children's Health Care System. Archives of Pathology & Laboratory Medicine In-Press.
Early Online Release
Beverly B. Rogers, MD; James L. Adams, MS; Alexis B. Carter, MD; Francine Uwindatwa, MBA; Cynthia B. Brawley, MHA; Charles G. Cochran;; Leah N. Bryan, MPH; Elizabeth P. Weinzierl, MD, PhD; Sampath Prahalad, MD, MS
From the Departments of Pathology (Drs Rogers, Carter, and Weinzierl; Mr Adams; and Mss Uwindatwa and Brawley), Pediatrics (Drs Rogers and Prahalad), and Care Transformation (Mr Cochran), Children's Healthcare of Atlanta, Atlanta, Georgia; and the Departments of Pathology (Drs Rogers, Carter, and Weinzierl) and Pediatrics (Drs Rogers and Prahalad; and Ms Bryan), Emory University School of Medicine, Atlanta, Georgia.
Context.— Disruption of outpatient laboratory services by routing the samples to commercial reference laboratories may seem like a cost-saving measure by the payers, but results in hidden costs in quality and resources to support this paradigm.
Objective.— To identify differences when outpatient tests are performed at a Children's Hospital lab compared to a commercial reference lab, and the financial costs to support the reference laboratory testing.
Design.— Outpatient testing was sent to 3 different laboratories, specified by the payer. Orders were placed in the Children's electronic health record, blood samples were drawn by the Children's phlebotomists, samples were sent to the testing laboratory, and results appeared in the electronic health record. Data comparing the time to result, cancelled samples, and cost to sustain the system of ordering and reporting were drawn from multiple sources, both electronic and manual.
Results.— The median time from phlebotomy to result was 0.7 hours for testing at the children's lab and 20.72 hours for the commercial lab. The median time from result posting to caregiver acknowledgment was 5.4 hours for the Children's lab and 18 hours for the commercial lab. The commercial lab cancelled 2.7% of the tests; the Children's lab cancelled 0.8%. The financial cost to support online ordering and resulting for testing performed at commercial labs was approximately $640,000 per year.
Conclusions.— Both tangible monetary costs, plus intangible costs in delay in resulting, occur when the system of laboratory testing is disrupted.
Saturday, May 19, 2018
Is being a night owl bad for you?
"Some health experts warn that eating after dark disrupts the body’s natural overnight fasting, which undercuts the ability to burn fat. Night owls also consume more calories per day than early birds, according to a 2011 study in the journal Obesity. That may have something to do with the fact that willpower decreases as a long day wears on.
The scariest news of all is that night lovers face a higher risk of premature death. As Forbes notes, a large, observational study of roughly half a million participants from the UK Biobank Study, found that evening types have a 10% higher risk of premature death than larks."
The scariest news of all is that night lovers face a higher risk of premature death. As Forbes notes, a large, observational study of roughly half a million participants from the UK Biobank Study, found that evening types have a 10% higher risk of premature death than larks."
Physician Burnout: Resilience Training is Only Part of the Solution
Ann Fam Med. 2018 May;16(3):267-270. doi: 10.1370/afm.2223.
Physician Burnout: Resilience Training is Only Part of the Solution.
Card AJ1.
Author information
- 1
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California alcard@ucsd.edu.
Abstract
Physicians and physician trainees are among the highest-risk groups for burnout and suicide, and those in primary care are among the hardest hit. Many health systems have turned to resilience training as a solution, but there is an ongoing debate about whether that is the right approach. This article distinguishes between unavoidable occupational suffering (inherent in the physician's role) and avoidable occupational suffering (systems failures that can be prevented). Resilience training may be helpful in addressing unavoidable suffering, but it is the wrong treatment for the organizational pathologies that lead to avoidable suffering- and may even compound the harm doctors experience. To address avoidable suffering, health systems would be better served by engaging doctors in the co-design of work systems that promote better mental health outcomes.
Four immunohistochemical assays to measure the PD-L1 expression in malignant pleural mesothelioma
Oncotarget. 2018 Apr 17;9(29):20769-20780. doi: 10.18632/oncotarget.25100. eCollection 2018 Apr 17.
Four immunohistochemical assays to measure the PD-L1 expression in malignant pleural mesothelioma.
Watanabe T1, Okuda K1, Murase T2, Moriyama S1, Haneda H1, Kawano O1, Yokota K1, Sakane T1, Oda R1, Inagaki H2, Nakanishi R1.
Author information
- 1
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
- 2
- Department of Pathology and Molecular Diagnostics, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
Abstract
Immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 pathway are expected to be a novel therapy for combating future increases in numbers of malignant pleural mesothelioma (MPM) patients. However, the PD-L1 expression, which is a predictor of the response to ICIs, is unclear in MPM. We studied the PD-L1 expression using four immunohistochemical assays (SP142, SP263, 28-8 and 22C3) in 32 MPM patients. The PD-L1 expression in tumor cells and immune cells was evaluated to clarify the rate of PD-L1 expression and the concordance among the four assays in MPM. The positivity rate of PD-L1 expression was 53.1% for SP142, 28.1% for SP263, 53.1% for 28-8, and 56.3% for 22C3. Nine cases were positive and 10 were negative for all assays. Discordance among the four assays was found in 13 cases. The concordance rates between SP142 and 22C3 and between 28-8 and 22C3 were the highest (84.4%). The concordance rates between SP263 and the other three assays were low (71.9% to 75.0%). The PD-L1 expression in MPM was almost equivalent for three of the assays. Given the cut-off values set in our study, these findings suggested that these assays, except for SP263, can be used for accurate PD-L1 immunostaining in MPM.
Caring for parents: an evolutionary rationale
BMC Biol. 2018 May 15;16(1):53. doi: 10.1186/s12915-018-0519-2.
Caring for parents: an evolutionary rationale.
Author information
- 1
- MTA-ELTE Theoretical Biology and Evolutionary Ecology Research Group and Department of Plant Systematics, Ecology and Theoretical Biology, L. Eötvös University, Pázmány P. sétány 1/C, Budapest, H-1117, Hungary.
- 2
- MTA Centre for Ecological Research, Evolutionary Systems Research Group, Klebelsberg Kuno utca 3, Tihany, 8237, Hungary.
- 3
- RECENS "Lendület" Research Group, MTA Centre for Social Science, Tóth Kálmán u. 4, Budapest, H-1097, Hungary.
- 4
- Department of Mathematics, Szent István University, Páter K. u. 1, Gödöllő, H-2103, Hungary.
- 5
- Parmenides Center for the Conceptual Foundations of Science, Kirchplatz 1, 82049, Pullach/Munich, Germany. szathmary.eors@gmail.com.
- 6
- MTA Centre for Ecological Research, Evolutionary Systems Research Group, Klebelsberg Kuno utca 3, Tihany, 8237, Hungary. szathmary.eors@gmail.com.
Abstract
BACKGROUND:
The evolutionary roots of human moral behavior are a key precondition to understanding human nature. Investigations usually start with a social dilemma and end up with a norm that can provide some insight into the origin of morality. We take the opposite direction by investigating whether the cultural norm that promotes helping parents and which is respected in different variants across cultures and is codified in several religions can spread through Darwinian competition.
RESULTS:
We show with a novel demographic model that the biological rule "During your reproductive period, give some of your resources to your post-fertile parents" will spread even if the cost of support given to post-fertile grandmothers considerably decreases the demographic parameters of fertile parents but radically increases the survival rate of grandchildren. The teaching of vital cultural content is likely to have been critical in making grandparental service valuable. We name this the Fifth Rule, after the Fifth Commandment that codifies such behaviors in Christianity.
CONCLUSIONS:
Selection for such behavior may have produced an innate moral tendency to honor parents even in situations, such as those experienced today, when the quantitative conditions would not necessarily favor the maintenance of this trait.
"A serval is a wildcat native to Africa, and it's a legal pet in our state. It is not to be confused with the elusive Alabama cougar, whose existence is unproven despite numerous reported sightings over the years."
The week Down in Alabama: Signs, signs, everywhere signs
"A 25-pound missing pet serval named Juno was trapped by Pelham police.
It had been missing since April 24.
A serval is a wildcat native to Africa, and it's a legal pet in our state. It is not to be confused with the elusive Alabama cougar, whose existence is unproven despite numerous reported sightings over the years."
"But personal health records carry a different kind of value for more sophisticated attackers. Information about someone’s personal or family health history could be used for blackmail or phishing, or help an adversary masquerade as someone else."
The Cybersecurity 202: Why cybersecurity experts are so concerned about the health-care industry
The health-care sector makes an appealing target for hackers for a few reasons, according to Brown. For one, hospitals and insurers keep troves of data that are easy for a cybercriminal to monetize — such as billing and insurance information. The biggest risks to most patients are identity theft and fraud.
But personal health records carry a different kind of value for more sophisticated attackers. Information about someone’s personal or family health history could be used for blackmail or phishing, or help an adversary masquerade as someone else. State-sponsored attackers could use such details for intelligence purposes, according to Brown.
“Any information they can get on someone they’ve targeted is useful little pieces that become valuable, even if they’re not monetizable,” she said.
"Widespread epidemics, pandemics, and other risk-prone disasters occur with disturbing regularity. When such events occur, how should, and will, clinicians respond? The moral backbone of medical professionals-a duty to put the needs of patients first-may be sorely tested."
J Emerg Med. 2018 May 14. pii: S0736-4679(18)30359-7. doi: 10.1016/j.jemermed.2018.04.021. [Epub ahead of print]
Must I Respond if My Health is at Risk?
Author information
- 1
- International Federation for Emergency Medicine and Department of Emergency Medicine, The University of Arizona, Tucson, Arizona.
Abstract
BACKGROUND:
Widespread epidemics, pandemics, and other risk-prone disasters occur with disturbing regularity. When such events occur, how should, and will, clinicians respond? The moral backbone of medical professionals-a duty to put the needs of patients first-may be sorely tested.
DISCUSSION:
It is incumbent on health care professionals to ask what we must do and what we should do if a dangerous health care situation threatens both ourselves and our community. Despite numerous medical ethical codes, nothing-either morally or legally-requires a response to risk-prone situations from civilian clinicians; it remains a personal decision. The most important questions are: What will encourage us to respond to these situations? And will we respond? These questions are necessary, not only for physicians and other direct health care providers, but also for vital health care system support personnel. Those who provide care in the face of perceived risk demonstrate heroic bravery, but the choice to do so has varied throughout history. To improve individual response rates, disaster planners and managers must communicate the risks clearly to all members of the health care system and help mitigate their risks by providing them with as much support and security as possible.
CONCLUSIONS:
The decision to remain in or to leave a risky health care situation will ultimately depend on the provider's own risk assessment and value system. If history is any guide, we can rest assured that most clinicians will choose to stay, following the heroic example established through the centuries and continuing today.
New Look has been accused of charging 'fat tax' on its plus-size range
New Look has been accused of charging 'fat tax' on its plus-size range
Shoppers claim over-sized clothes are more pricey
She told the Times, “It's like I'm being discriminated against for being plus size when I'm only slightly bigger than average, the average size for a British woman is now a size 16.
Digital pathology is here, and a solution to the issue of state licensure must be found soon. I am a candidate for College of American Pathologists' President-Elect, 2019-2021 term. My vision is here. #MembershipGrowthPathologistPayment
I am a candidate for College of American Pathologists' President-Elect, 2019-2021 term.
My vision is here.
Membership Growth. Pathologist Payment.
Vaccination as a cause of autism-myths and controversies
Dialogues Clin Neurosci. 2017 Dec;19(4):403-407.
Vaccination as a cause of autism-myths and controversies.
Author information
- 1
- University of Nicosia Medical School, Engomi, Cyprus.
Abstract
Despite significant progress in the study of the epidemiology and genetics of autism, the etiology and patho-physiology of this condition is far from being elucidated and no curative treatment currently exists. Although solid scientific research continues, in an attempt to find explanations and solutions, a number of nonscientific and pure myths about autism have emerged. Myths that vaccines or mercury are associated with autism have been amplified by misguided scientists; frustrated, but effective parent groups; and politicians. Preventing the protection provided by vaccination or administration of mercury-chelating agents may cause real damage to autistic individuals and to innocent bystanders who as a result may be exposed to resurgent diseases that had already been "extinguished. " That such myths flourish is a consequence of the authority of scientific evidence obtained by scientific methodology losing ground to alternative truths and alternative science. This article presents a narrative of the origin of the myths around autism.
Untreated hypertension turns out to be leading cause of diseases in India
Untreated hypertension turns out to be leading cause of diseases in India
New Delhi, May 17 (ANI): Hypertension is ranked as the third biggest risk factor for heart disease in India. As per World Health Organisation (WHO), it is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in the country. Hypertension is often called the "silent killer" and can cause damage to the cardiovascular system and internal organs, such as the kidneys. Hypertension can cause significant damage to women during pregnancy. Obesity is another risk factor of hypertension. It is advisable to focus on the lifestyle risk factors of hypertension that you can change such as limit the amount of alcohol, quit smoking, exercise regularly, manage body weight, balanced diet.
Friday, May 18, 2018
The politics of ageing: health consumers, markets[,] and hegemonic challenge
Sociol Health Illn. 2018 May 8. doi: 10.1111/1467-9566.12743. [Epub ahead of print]
The politics of ageing: health consumers, markets and hegemonic challenge.
Author information
- 1
- Kings College London, London, UK.
- 2
- University of East Anglia, Norwich, UK.
Abstract
In recent years ageing has travelled from the placid backwaters of politics into the mainstream of economic, social and cultural debate. What are the forces that have politicised ageing, creating a sustained opposition to the supply side hegemony of pharmaceuticals, medicine and state which has historically constructed, propagated and legitimised the understanding of ageing as decline in social worth? In addressing this question, the paper develops Gramsci's theory of hegemony to include the potentially disruptive demand side power of consumers and markets. It shows how in the case of ageing individuals acting in concert through the mechanisms of the market, and not institutionalised modes of opposition, may become the agents of hegemonic challenge through a combination of lifecourse choice and electoral leverage. In response, the hegemony is adapting through the promotion of professionally defined interpretations of 'active ageing' designed to retain hegemonic control. With the forces of hegemony and counter-hegemony nicely balanced and fresh issues such as intergenerational justice constantly emerging, the political tensions of ageing are set to continue.
The impact of HIV prevalence, conflict, corruption, and GDP/capita on treatment cascades: data from 137 countries
J Virus Erad. 2018 Apr 1;4(2):80-90.
The impact of HIV prevalence, conflict, corruption, and GDP/capita on treatment cascades: data from 137 countries.
Author information
- 1
- Imperial College London, UK.
- 2
- Chelsea and Westminster NHS Foundation Trust, London, UK.
- 3
- Oxford University, UK.
Abstract
OBJECTIVE:
In 2014, UNAIDS and partners set the 90-90-90 targets for the HIV treatment cascade. Multiple social, political and structural factors might influence progress towards these targets. We assessed how close countries and regions are to reaching these targets, and compared cascade outcomes with HIV prevalence, gross domestic product (GDP)/capita, conflict and corruption.
METHODS:
Country-level HIV cascade data on diagnosis, ART coverage and viral suppression, from 2010 to 2016 were extracted from national reports, published papers and the www.AIDSinfoOnline database, and analysed. Weighted least-squares regression was used to assess predictors of cascade achievement: region, HIV prevalence, GDP/capita, the 2016 Corruption Perceptions Index (CPI), which is an international ranking system, and the 2016 Global Peace Index (GPI), which ranks all countries based on three main categories: societal safety, militarisation and conflict.
RESULTS:
Data were available for diagnosis for 84 countries, ART coverage for 137 countries, and viral suppression for 94 countries. Regions with the lowest ART coverage were South-east Asia and Pacific (36%), Eastern Europe and Central Asia (17%), and Middle East and North Africa (13%). Lower HIV prevalence was associated with poorer cascade results. Countries with higher GDP/capita achieved higher ART coverage (P<0.001). Furthermore, countries with lower levels of peace and higher corruption had lower ART coverage (P<0.001). Countries with a GPI >2.5 all had ART coverage of <40%.
CONCLUSION:
Only one country has reached the UNAIDS 90-90-90 targets. International comparison remains difficult due to heterogeneous data reporting. Difficulty meeting UNAIDS targets is associated with lower GDP/capita, lower HIV prevalence, higher corruption and conflict levels.
GPs afraid to bring up patients' weight problems - study
GPs afraid to bring up patients' weight problems - study
"The delicacy of initiating talk about weight was evident in our video analysis of GP consultations, affirming that GPs do not wish to risk offending their patient or creating imbalance in their doctor-patient relationship," said lead researcher Lesley Gray of the University of Otago.
"For example, fewer doctors would ask a question like: 'Have you put on a bit of weight?' Instead, they were more likely to ask a question like: 'Weight-wise, where do you think you're at?'
"By avoiding a question of statement that directly or explicitly referred to the patient being overweight, GPs opened up a face-saving 'escape-route' if the patient proved to be resistant to pursuing the discussion."
"What has changed is not so much the level of noise, which previous centuries also complained about, but the level of distraction, which occupies the space that silence might invade."
People crave silence, yet are unnerved by it
Two authors pursue silence in nets of words
"What has changed is not so much the level of noise, which previous centuries also complained about, but the level of distraction, which occupies the space that silence might invade. There looms another paradox, because when it does invade—in the depths of a pine forest, in the naked desert, in a suddenly vacated room—it often proves unnerving rather than welcome. Dread creeps in; the ear instinctively fastens on anything, whether fire-hiss or bird call or susurrus of leaves, that will save it from this unknown emptiness. People want silence, but not that much."
Can Obesity Ever Be Healthy?
Can Obesity Ever Be Healthy?
The controversial concept of "metabolically healthy obesity" has been around for a while. It's the idea that people can carry extra weight without having high blood pressure, glucose intolerance, or high cholesterol—the signs of metabolic syndrome.
A new study of more than 6800 individuals questions that assumption. It found that metabolically healthy obesity at baseline did not predict a person's future risk for cardiovascular morbidity or mortality. Almost half of the metabolically healthy obese patients eventually developed metabolic syndrome, raising their cardiovascular risk. And the longer a person was metabolically unhealthy, the higher the risk.
"...normal-weight people with a 'spare tire' had a higher risk of dying of heart disease or any other cause compared with people without central obesity, regardless of whether they were normal weight, overweight, or obese."
Belly fat may pose more danger for women than for men
Whittle your waist for better health.
"Regardless of whether women are more vulnerable than men to heart problems related to abdominal weight gain, it's pretty clear that central adiposity presents important health risks, Dr. Kahn says. Researchers have shown that weight gain around the middle represents an increase in the amount of visceral fat, the type of fat that encases your internal organs. "There are many studies showing that an unfavorable waist-to-hip ratio is highly associated with diabetes and cardiovascular risk," says Dr. Kahn.
One such study, in the Dec. 15, 2015, Annals of Internal Medicine, found that normal-weight people with a 'spare tire' had a higher risk of dying of heart disease or any other cause compared with people without central obesity, regardless of whether they were normal weight, overweight, or obese."
Thursday, May 17, 2018
Obesity in the workplace: What role should your employer be playing?
Obesity in the workplace: What role should your employer be playing?
We’re constantly bombarded with info telling us being overweight is dangerous. But what should your employer be doing to encourage healthy living?
Frost says reducing obesity should be an important goal for employers. The economic impact of obesity in the workplace includes:
- High rates of absenteeism among obese and morbidly obesity employees.
- Preventable chronic disease associated with obesity, such as hypertension, cardiovascular disease, diabetes, depression, cancer and respiratory disease affects the cost of treatment and medical insurance.
- Obesity is associated with “presenteeism” – this results in lower energy and productivity in the workplace.
Direct-to-consumer genetic testing: "...companies have a responsibility to provide support and should not rely on traditional healthcare systems to pick up the pieces." #WhyPathologistsMatter
Per Med. 2017 May;14(3):249-257. doi: 10.2217/pme-2017-0001. Epub 2017 May 11.
Direct-to-consumer genetic testing: where and how does genetic counseling fit?
Author information
- 1
- Society & Ethics Research Group, Connecting Science, Wellcome, Genome Campus, Cambridge, UK.
- 2
- UnIGENe & Centre for Predictive & Preventive Genetics (CGPP), IBMC - Institute for Molecular & Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal.
- 3
- School of Community Health & Midwifery, University of Central Lancashire, Preston, UK.
- 4
- Liverpool Women's NHS Hospital Trust, Liverpool, UK.
- 5
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden.
Abstract
Direct-to-consumer genetic testing for disease ranges from well-validated diagnostic and predictive tests to 'research' results conferring increased risks. While being targeted at public curious about their health, they are also marketed for use in reproductive decision-making or management of disease. By virtue of being 'direct-to-consumer' much of this testing bypasses traditional healthcare systems. We argue that direct-to-consumer genetic testing companies should make genetic counseling available, pre- as well as post-test. While we do not advocate that mandatory genetic counseling should gate-keep access to direct-to-consumer genetic testing, if the testing process has the potential to cause psychological distress, then companies have a responsibility to provide support and should not rely on traditional healthcare systems to pick up the pieces.
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