Why Conservatives Must Fight Obesity

Big Not Necessarily Better: Why Conservatives Must Fight Obesity

Taking a 'live and let live' approach to the nation's waistline is literally killing us.

By CASEY CHALK

"For fiscal, social, and moral reasons, fighting obesity should be a conservative cause. It has its basis in our most ancient classical traditions, with Aristotle defining temperance as that golden 'mean with regard to pleasures.' A robust conservatism seeks to preserve the traditions not only of family, community, and religion, but of health and well-being as well. "

Normal weight with central obesity increases CV risk

"Patients who had normal weight and central obesity had an increased CV risk compared with those with normal BMI without central obesity and with those with abnormal BMI without central fat distribution, according to data presented at  the American Society for Preventive Cardiology Congress on CVD."

Record number of severely obese children

"It's very concerning that the number of children with a weight that is classified as severely obese is now at an all-time high. Children with obesity are five times more likely to have obesity as adults, putting them at risk of diseases including Type 2 diabetes, cancer, heart and liver disease, as well as associated mental health conditions."

"Good thinking requires patience."

To Think or Not to Think?MIKE ST. THOMAS


"Good thinking requires patience. As David Foster Wallace knew, it requires sticking with one thought for a long enough time to encounter boredom and breakthrough. It requires “waiting five minutes,” as Jacobs points out, quoting Jason Fried, a popular entrepreneur and blogger. Slow thinking is foreign to online communication, and Jacobs himself describes some of the online habits he has changed in hopes of preserving his intellect (and his reputation): creating a private Twitter account (though he still maintains his public one) and cutting out his habit of posting on Anglican blogs. Since the book is intended as a “survival guide” addressing the problems of our online lives, readers may long for more of this kind of practical advice for how to sustain the life of the mind while navigating the cloud."

Gang Wang and Jesse K. McKenney (2018) Urinary Bladder Pathology: World Health Organization (WHO) Classification and American Joint Committee on Cancer (AJCC) Staging Update. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Urinary Bladder Pathology: World Health Organization (WHO) Classification and American Joint Committee on Cancer (AJCC) Staging Update

Gang Wang, MD, PhD; Jesse K. McKenney, MD

From the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Wang); and the Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio (Dr McKenney).

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

Presented at the Houston Society of Clinical Pathologists 58th Annual Spring Symposium on Genitourinary Pathology; April 8, 2017; Houston, Texas.

Corresponding author: Jesse K. McKenney, MD, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195 (email: mckennj@ccf.org).

Context.— Since the publication of the previous World Health Organization (WHO) Classification of Tumours on the Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs in 2004, significant new knowledge has been generated regarding the pathology and genetics of bladder neoplasia. Publication of the 2016 WHO “Blue Book” has codified that new data into updated recommendations for classification and prognostication. Similarly, the recent release of the 8th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, which was implemented in January 2018, has also addressed staging criteria for bladder cancer in several unique settings to clarify their application.

Objective.— To highlight subtle changes within the recent WHO and AJCC publications that may affect daily surgical pathology practice.

Data Sources.— Peer-reviewed published literature, the 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs, and the 8th ed. of the AJCC Cancer Staging Manual were reviewed.

Conclusions.— Selected changes and/or clarifications are discussed and include classification of flat and papillary urothelial neoplasia, select variant patterns of invasive urothelial carcinoma, staging of invasive carcinoma in bladder diverticula, and staging of carcinomas involving the prostate gland.

Loneliness kills

Loneliness kills: A new public health crisis (and what we can do about it)

"Although much of the social isolation research has centered on older people, there is reason for broader concern. Even younger generations– who are hyperconnected thanks to social media and technology – report alarming rates of loneliness and social isolation."

"The cold, hard reality is we have to take responsibility for our own health." #EatRightWorkOut #PumpIron

EDITORIAL: The cold, hard reality is we need to eat less, smoke less[,] and exercise more

"The cold, hard reality is we have to take responsibility for our own health.

If we smoke, if we drink too much, if we are overweight, we are at a much higher risk of a series of diseases including heart-disease, diabetes, and cancer.

That is a fact.

And it’s OK to talk about it."

Peter P. Luk, Christina I. Selinger, Annabelle Mahar, and Wendy A. Cooper (2018) Biomarkers for ALK and ROS1 in Lung Cancer: Immunohistochemistry and Fluorescent In Situ Hybridization. Archives of Pathology & Laboratory Medicine: August 2018, Vol. 142, No. 8, pp. 922-928.

SPECIAL SECTION—2017 (10TH BIENNIAL) MEETING OF THE PULMONARY PATHOLOGY SOCIETY, PART I

Biomarkers for ALK and ROS1 in Lung Cancer: Immunohistochemistry and Fluorescent In Situ Hybridization

Peter P. Luk, MBBS; Christina I. Selinger, PhD; Annabelle Mahar, MBBS; Wendy A. Cooper, MBBS, PhD

From the Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia (Drs Luk, Selinger, Mahar, and Cooper); Central Clinical School, University of Sydney, Sydney, Australia (Dr Cooper); and the School of Medicine, Western Sydney University, Sydney, Australia (Dr Cooper).

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

The manuscript is based on an invited talk presented at the Pulmonary Pathology Society Biennial Meeting; June 14, 2017; Chicago, Illinois.

Corresponding author: Wendy A. Cooper, MBBS, PhD, Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown NSW 2050, Australia (email: Wendy.Cooper@health.nsw.gov.au).

Context.— A small proportion of non–small cell lung cancers harbor rearrangements of ALK or ROS1 genes, and these tumors are sensitive to targeted tyrosine kinase inhibitors. It is crucial for pathologists to accurately identify tumors with these genetic alterations to enable patients to access optimal treatments and avoid unnecessary side effects of less effective agents. Although a number of different techniques can be used to identify ALK- and ROS1-rearranged lung cancers, immunohistochemistry and fluorescence in situ hybridization are the mainstays.

Objective.— To review the role of immunohistochemistry in assessment of ALK and ROS1 rearrangements in lung cancer, focusing on practical issues in comparison with other modalities such as fluorescence in situ hybridization.

Data Sources.— This manuscript reviews the current literature on ALK and ROS1 detection using immunohistochemistry and fluorescence in situ hybridization as well as current recommendations.

Conclusions.— Although fluorescence in situ hybridization remains the gold standard for detecting ALK and ROS1rearrangement in non–small cell lung cancer, immunohistochemistry plays an important role and can be an effective screening method for detection of these genetic alterations, or a diagnostic test in the setting of ALK.

Alain C. Borczuk (2018) Uncommon Types of Lung Carcinoma With Mixed Histology: Sarcomatoid Carcinoma, Adenosquamous Carcinoma, and Mucoepidermoid Carcinoma. Archives of Pathology & Laboratory Medicine: August 2018, Vol. 142, No. 8, pp. 914-921.

SPECIAL SECTION—2017 (10TH BIENNIAL) MEETING OF THE PULMONARY PATHOLOGY SOCIETY, PART I

Uncommon Types of Lung Carcinoma With Mixed Histology: Sarcomatoid Carcinoma, Adenosquamous Carcinoma, and Mucoepidermoid Carcinoma

Alain C. Borczuk, MD

From Weill Cornell Medicine, New York, New York.

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

Presented in part at the 2017 Pulmonary Pathology Society Biennial Meeting; June 13–16, 2017; Chicago, Illinois.

Corresponding author: Alain C. Borczuk, MD, Weill Cornell Medicine, 1300 York Ave, ST10-1000A, New York, NY 10065 (email: Alb9003@med.cornell.edu).

Context.— Lung tumors are histologically heterogeneous, but classification of lung carcinoma has prognostic impact and increasingly, specific molecular correlates.

Objective.— To update the gross, microscopic, and molecular pathology of unusual lung carcinomas to assure accurate classification. In entities with mixed histology, the recognition of specific features or rare patterns is critical to diagnosis. These diagnoses can identify tumors with aggressive clinical behavior, and diagnostic pitfalls can therefore result in underdiagnosis of these already rare entities. Incorrect classification of more indolent tumors into the more aggressive categories can also occur. In the area of molecular pathology, these unusual tumors have a specific spectrum of molecular alterations.

Data Sources.— PubMed searches for lung and sarcomatoid carcinoma, pleomorphic carcinoma, blastoma, carcinosarcoma, and adenosquamous and mucoepidermoid carcinoma were undertaken and this information was integrated with clinical experience of the author.

Conclusions.— These uncommon carcinomas have specific clinicopathologic features, and attention to their gross and microscopic pathology leads to classification with important associated molecular findings.

Accepted: February 20, 2018;

From Richard Attanoos and Matthew Pugh: The Diagnosis of Pleural Tumors Other Than Mesothelioma

Richard Luther Attanoos and Matthew Richard Pugh (2018) The Diagnosis of Pleural Tumors Other Than Mesothelioma. Archives of Pathology & Laboratory Medicine: August 2018, Vol. 142, No. 8, pp. 902-913.

SPECIAL SECTION—2017 (10TH BIENNIAL) MEETING OF THE PULMONARY PATHOLOGY SOCIETY, PART I

The Diagnosis of Pleural Tumors Other Than Mesothelioma

Richard Luther Attanoos, BSc, MBBS, FRCPath; Matthew Richard Pugh, BSc, MSc, MBBCH, FRCPath

From the Department of Cellular Pathology, Cardiff and Vale University Local Health Board, School of Medicine, Cardiff University, Cardiff, Wales.

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

Based on a presentation by Dr Attanoos at the 2017 Pulmonary Pathology Society Biennial Meeting; June 16, 2017; Chicago, Illinois.

Corresponding author: Richard Luther Attanoos, BSc, MBBS, FRCPath, Department of Cellular Pathology, University Hospital of Wales and Cardiff University, University Hospital of Wales, Heath Park, Cardiff, South Glamorgan CF14 4XW, United Kingdom (email: richard.attanoos@wales.nhs.uk).

Context.— Pleural pathology has been dominated by discussions relating to the diagnosis, prognosis, etiology, and management of malignant mesothelioma. However, there exists a diverse group of other neoplasms that involve the pleura; the most common by far is metastatic carcinoma, usually of pulmonary origin. Other metastatic tumors of varied histogenesis do occur but are less common. Primary pleural neoplasms other than diffuse malignant mesothelioma are either uncommon or rare and have received less attention.

Objective.— To provide a review of those diverse tumors that can involve the pleura other than mesothelioma in order to facilitate their accurate diagnosis.

Data Sources.— Review of relevant literature published via PubMed and other search engines.

Conclusions.— A wide variety of tumors can involve the pleura. In most cases, the approach of considering the morphologic features with appropriate immunohistochemistry, in the correct clinical context, allows for a confident diagnosis. For a number of those soft tissue tumors that are well recognized in the pleura, such as solitary fibrous tumor, desmoid-type fibromatosis, synovial sarcoma, and epithelioid hemangioendothelioma, novel markers now exist based on an understanding of the individual tumors' molecular characteristics. Primary pleural lymphomas are rare with poor prognosis. They represent localized specific diffuse large B-cell lymphomas, with either post–germinal center B-cell or plasma cell lineage, arising in the context of either immunodeficiency or immune sequestration and with viral infection.

SPECIAL SECTION—2017 (10TH BIENNIAL) MEETING OF THE PULMONARY PATHOLOGY SOCIETY, PART I: Exciting Advances in the Pathogenesis of Neoplastic and Nonneoplastic Lung Diseases, Their Diagnosis, Prognosis, and Treatment

Anja C. Roden (2018) Exciting Advances in the Pathogenesis of Neoplastic and Nonneoplastic Lung Diseases, Their Diagnosis, Prognosis, and Treatment. Archives of Pathology & Laboratory Medicine: August 2018, Vol. 142, No. 8, pp. 891-892.

SPECIAL SECTION—2017 (10TH BIENNIAL) MEETING OF THE PULMONARY PATHOLOGY SOCIETY, PART I

Exciting Advances in the Pathogenesis of Neoplastic and Nonneoplastic Lung Diseases, Their Diagnosis, Prognosis, and Treatment

Anja C. Roden, MD

From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.

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

Corresponding author: Anja C. Roden, MD, Hilton 11, Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905 (email: Roden.anja@mayo.edu).

As some airline seats get bigger, experts caution against ‘fat shaming and bias’

"With passengers on some United Airlines flights poised to get more seating room, health experts caution against shaming people for their size, as obesity continues to be chronic health condition for much of the U.S. population.

'While we’re … working on solving this crisis, we need to accommodate the people that are living with it every day and not discriminate and marginalize them,' said Wendy Scinta, president of the Obesity Medicine Association based in Denver.

Scinta, who leads the organization of physicians, nurse practitioners, physician assistants and other health care providers, praised United Airlines for its announcement this week that the company will buy 29 new regional aircraft, most of which will offer seats an inch wider, with economy seats also getting more legroom."

BRAF and lung cancer

David Planchard and Bruce E. Johnson (2018) BRAF Adds an Additional Piece of the Puzzle to Precision Oncology-Based Treatment Strategies in Lung Cancer. Archives of Pathology & Laboratory Medicine: July 2018, Vol. 142, No. 7, pp. 796-797.

SPECIAL SECTION—COMMENTARIES ON THE UPDATED MOLECULAR TESTING GUIDELINE FOR LUNG CANCER PATIENTS

BRAF Adds an Additional Piece of the Puzzle to Precision Oncology-Based Treatment Strategies in Lung Cancer

David Planchard, MD, PhD; Bruce E. Johnson, MD

From the Department of Medical Oncology, Gustave Roussy, Villejuif, France (Dr Planchard); and the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, (Dr Johnson).

"...based on the high ORR and mPFS with BRAF/MEK inhibition in phase II trials, current data support the recommendation of the association of dabrafenib with trametinib in NSCLC BRAF V600E mutant as an earlier line of treatment as standard of care. Immune checkpoint therapy is an option; however, given the lack of data in this population, clinicians should remain prudent about substituting checkpoint inhibitor therapy for the evidenced-based precision medicine treatment strategies."

Alexkid - Where

"Although it may be tempting to increase the number of subordinates assigned to ethical leaders in an effort to maximize their positive impact, the current findings suggest that the benefits of ethical leadership are diminished as span of control widens."

J Appl Psychol. 2018 Jul 19. doi: 10.1037/apl0000338. [Epub ahead of print]

Too many sheep in the flock? Span of control attenuates the influence of ethical leadership.

Thiel CE1, Hardy JH1, Peterson DR1, Welsh DT1, Bonner JM2.

Author information

1

Department of Management.

2

Department of Marketing and Strategy.

Abstract

There has been growing interest in ethical leadership from both scholars and practitioners because of the positive effects that ethical leaders can have on their subordinates. These benefits come not only from ethical leaders acting as moral exemplars, but also from the tendency for ethical leaders to forge high-quality social exchange relationships with subordinates that help to establish expectations for appropriate conduct and ensure accountability through reciprocal obligation. However, the act of developing and maintaining strong social exchange relationships is resource intensive and requires considerable personal investment from ethical leaders. Extending current theory, we propose that wider spans of control attenuate the positive relationship between ethical leadership and leader-member exchange (LMX). Across two organizational samples, we developed and tested a moderated mediation model in which the effects of ethical leadership on performance, organizational citizenship behavior, and reduced production deviance via LMX were weakened by a widened span of control. Results in both studies supported the hypothesized model. Although it may be tempting to increase the number of subordinates assigned to ethical leaders in an effort to maximize their positive impact, the current findings suggest that the benefits of ethical leadership are diminished as span of control widens.

Artificially Sweetened Beverages Linked To BETTER Cancer Outcomes

Using a statistical analysis method called substitution modeling, Fuchs and his colleagues demonstrated that replacing one 12-oz serving of a sugar-sweetened drink per day with a 12-oz diet drink lowered recurrence and mortality risk by 23 percent – meaning that half of the benefit of artificial sweeteners can be explained by the fact that they are removing unhealthy sugar from one’s diet. The authors do not speculate what mechanism could be behind the other 23 percent, though they note that there is a possibility that people who favor diet beverages develop less aggressive tumors than those who do not.

“While the association between lower colon cancer recurrence and death was somewhat stronger than we suspected, the finding fits in with all that we know about colon cancer risk in general,” Fuchs said. “We now find that, in terms of colon cancer recurrence and survival, use of artificially sweetened drinks is not a health risk, but is, in this study, a healthier choice.”

"Combined positive score is a robust, reproducible PD-L1 scoring method that predicts response to pembrolizumab in patients with gastric and gastroesophageal cancer." #WhyPathologistsMatter

Karina Kulangara, Nancy Zhang, Ellie Corigliano, Lindsay Guerrero, Stephanie Waldroup, Dipeshkumar Jaiswal, Malinka Jansson, MS, Supriya Shah, Debra Hanks, Jiangdian Wang, Jared Lunceford, Mary J. Savage, Jonathan Juco, and Kenneth Emancipator (2018) Clinical Utility of the Combined Positive Score for Programmed Death Ligand-1 Expression and the Approval of Pembrolizumab for Treatment of Gastric Cancer. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Clinical Utility of the Combined Positive Score for Programmed Death Ligand-1 Expression and the Approval of Pembrolizumab for Treatment of Gastric Cancer

Karina Kulangara, PhD; Nancy Zhang, MD; Ellie Corigliano, PhD; Lindsay Guerrero, MS; Stephanie Waldroup, BSc; Dipeshkumar Jaiswal, MS; Malinka Jansson, MS; Supriya Shah, PhD; Debra Hanks, MD; Jiangdian Wang, PhD; Jared Lunceford, PhD; Mary J. Savage, PhD; Jonathan Juco, MD; Kenneth Emancipator, MD

Corresponding author: Kenneth Emancipator, MD, Merck Research Laboratory, Merck & Co, Inc, 2000 Galloping Hill Rd, Kenilworth, NJ 07033 (email: kenneth.emancipator@merck.com).

Drs Zhang, Corigliano, and Shah and Mss Guerrero and Jansson are employees of Agilent Technologies. Drs Kulangara and Hanks, Ms Waldroup, and Mr Jaiswal are employees of Agilent Technologies and own stock and hold stock options in the company. Ms Waldroup has pending patents broadly relevant to the work described. Dr Wang is an employee of Merck & Co, Inc. Drs Lunceford, Savage, Juco, and Emancipator are employees of Merck & Co, Inc, and own stock with this company. The authors have no other relevant financial interest in the products or companies described in this article.

Context.— Regulatory approval of pembrolizumab for treatment of gastric and gastroesophageal junction (G/GEJ) adenocarcinoma required a reproducible scoring method for use of programmed death ligand-1 (PD-L1) protein expression as a companion diagnostic to identify likely responders to therapy.

Objective.— To develop an immunohistochemical scoring algorithm that includes PD-L1 expression for tumor and immune cells, that is, the combined positive score.

Design.— Four previously treated tumor types in the KEYNOTE-012 and KEYNOTE-028 studies were analyzed descriptively with a version of the PD-L1 immunohistochemical 22C3 pharmDx assay labeled for investigational use only to determine the relative importance of PD-L1 expression in tumor versus immune cells as a biomarker for pembrolizumab response. A combined positive score was developed as a novel scoring method and was compared with the tumor proportion score in cohort 1 from the KEYNOTE-059 study (G/GEJ cancer). External reproducibility was assessed.

Results.— Per combined positive score cutoff of 1 or more, the prevalence of PD-L1 expression in patients with G/GEJ cancer was 57.6% (148 of 257 patients), with reasonable enrichment of responses (odds ratio, 2.8). Per tumor proportion score cutoff of 1% or more, prevalence was 12.5% (32 of 257 patients), with minimal enrichment (odds ratio, 1.4). External reproducibility assessments demonstrated interpathologist overall agreement of 96.6% (591 of 612; 95% CI, 94.0%–98.7%) and intrapathologist overall agreement of 97.2% (595 of 612; 95% CI, 95.3%–98.9%).

Conclusions.— Combined positive score is a robust, reproducible PD-L1 scoring method that predicts response to pembrolizumab in patients with G/GEJ cancer. This novel scoring method supported US Food and Drug Administration approval of pembrolizumab as third-line therapy for G/GEJ cancer and has facilitated investigation in other indications.

Heart Attacks On The Rise Among Pregnant American Women

Study: Heart Attacks On The Rise Among Pregnant American Women

“The risk of heart attacks during pregnancy may be increasing because women are waiting longer to have children,” Dr. Nathaniel Smilowitz said. “Diabetes and obesity have gone up during that same time period.”

"But here were people of unquestioned authority that believed in me long before I learned to believe in myself."

Black Males in Medicine

My View

Gregory A. Threatte, MD

"Then, at Colgate, I needed a part-time job and the financial aid office sent me to the physics department. Shortly after I started to work there, 2 faculty members began trying to talk me into becoming a physics major, and a physics major is what I became. As little as I knew about college as a freshman, it probably helped not knowing that physics was supposed to be hard! But here were people of unquestioned authority that believed in me long before I learned to believe in myself."

Three quarters of UK children ‘overfed from birth’

These statistics are “of concern in relation to wider evidence on the prevalence and risk of overweight and obesity in childhood”, according to the SNAC report.

“Experts know that people who are overweight as children are more likely to be overweight as adults,” says the BBC, but a link with overfeeding in infancy is “less clear”. Public Health England says that more up-to-date data is needed to investigate.

Blank & Jones - Balearic Blue

Blank & Jones - Balearic Blue

Schools not ‘silver bullet’ to tackling childhood obesity

Ofsted has released a report on obesity, healthy eating[,] and physical activity in primary schools.

"Inspectors found that schools put too much effort into activities designed to influence parents without any evidence that they either have an impact or are what parents want. Eighty-three per cent of parents said they had been invited to an event at school. But many of them told Ofsted they are time-poor and what they really want is readily available information about what their child is doing at school: what they are eating and learning about, so that this can be followed up on at home."

From Bill Funkhouser and colleagues: Interpathologist Diagnostic Agreement for Non–Small Cell Lung Carcinomas Using Current and Recent Classifications

William K. Funkhouser Jr, D. Neil Hayes, Dominic T. Moore, W. Keith Funkhouser III, Jason P. Fine, HeeJoon Jo, Nana Nikolaishvilli-Feinberg, Mervi Eeva, Juneko E. Grilley-Olson, Peter M. Banks, Paolo Graziano, Elizabeth L. Boswell, Goran Elmberger, Kirtee Raparia, Craig F. Hart, Lynette M. Sholl, Norris J. Nolan, Karen J. Fritchie, Ersie Pouagare, Timothy C. Allen, Keith E. Volmar, Paul W. Biddinger, Daniel T. Kleven, Michael J. Papez, Deborah V. Spencer, Natasha Rekhtman, Mari Mino-Kenudson, Lida Hariri, Brandon Driver, and Philip T. Cagle (2018) Interpathologist Diagnostic Agreement for Non–Small Cell Lung Carcinomas Using Current and Recent Classifications. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Interpathologist Diagnostic Agreement for Non–Small Cell Lung Carcinomas Using Current and Recent Classifications

William K. Funkhouser Jr, MD, PhD; D. Neil Hayes, MD, MPH; Dominic T. Moore, MPH, MS; W. Keith Funkhouser III, MS; Jason P. Fine, PhD; HeeJoon Jo, BA; Nana Nikolaishvilli-Feinberg, PhD; Mervi Eeva, BS; Juneko E. Grilley-Olson, MD; Peter M. Banks, MD;Paolo Graziano, MD; Elizabeth L. Boswell, MD; Goran Elmberger, MD; Kirtee Raparia, MD; Craig F. Hart, MD; Lynette M. Sholl, MD;Norris J. Nolan, MD; Karen J. Fritchie, MD; Ersie Pouagare, MD; Timothy C. Allen, MD, JD; Keith E. Volmar, MD; Paul W. Biddinger, MD; Daniel T. Kleven, MD; Michael J. Papez, MD; Deborah V. Spencer, MD; Natasha Rekhtman, MD, PhD; Mari Mino-Kenudson, MD;Lida Hariri, MD, PhD; Brandon Driver, MD; Philip T. Cagle, MD

From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Moore, Nikolaishvilli-Feinberg, and Grilley-Olson; Mr Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson.

Corresponding author: William K. Funkhouser Jr, MD, PhD, Department of Pathology and Lab Medicine, CB No. 7525, UNC School of Medicine, Chapel Hill, NC 27599-7525 (email: Bill_Funkhouser@med.unc.edu).

 Supplemental digital content is available for this article. See text for hyperlink.

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

Context.— Measurement of interpathologist diagnostic agreement (IPDA) should allow pathologists to improve current diagnostic criteria and disease classifications.

Objectives.— To determine how IPDA for pathologists' diagnoses of non–small cell lung carcinoma (NSCLC) is affected by the addition of a set of mucin and immunohistochemical (IHC) stains to hematoxylin-eosin (H&E) alone, by recent NSCLC reclassifications, by simplification of these classifications, and by pathologists' practice location, pulmonary pathology expertise, practice duration, and lung carcinoma case exposure.

Design.— We used a Web-based survey to present core images of 54 NSCLC cases to 22 practicing pathologists for diagnosis, initially as H&E only, then as H&E plus mucin and 4 IHC stains. Each case was diagnosed according to published 2004, 2011, and 2015 NSCLC classifications. Cohen's kappa was calculated for the 231 pathologist pairs as a measure of IPDA.

Results.— Twenty-two pathologists diagnosed 54 NSCLC cases by using 4 published classifications. IPDA is significantly higher for H&E/mucin/IHC diagnoses than for H&E-only diagnoses. IPDA for H&E/mucin/IHC diagnoses is highest with the 2015 classification. IPDA is estimated higher after collapse of stated diagnoses into subhead or dichotomized classes. IPDA for H&E/mucin/IHC diagnoses with the 2015 World Health Organization classification is similar for community and academic pathologists, and is higher when pathologists have pulmonary pathology expertise, have more than 6 years of practice experience, or diagnose more than 100 new lung carcinoma cases per year.

Conclusions.— Higher IPDA is associated with use of mucin and IHC stains, with the 2015 NSCLC classification, and with pathologists' pulmonary pathology expertise, practice duration, and frequency of lung carcinoma cases.

Sleep Tied to Teenagers’ All-Around Health

Adolescents who got enough sleep had a lower risk of metabolic problems.

"Researchers studied 829 boys and girls, average age 13, who wore electronic measuring devices that tracked sleep time, sleep quality and physical activity over seven to 10 days. They also recorded five factors associated with cardiovascular risk: waist circumference, blood pressure, HDL or 'good' cholesterol, triglycerides and insulin resistance."

Liver cancer death rate in US surged 43% in 16 years

"Xu said he hopes people realize lifestyle changes can decrease their risk of developing liver cancer.

'Some of these liver cancer risk factors like obesity, diabetes and excess consumption of alcohol, those things can be prevented,' he said."

Front Psychol. 2018 Jun 28;9:1082. doi: 10.3389/fpsyg.2018.01082. eCollection 2018.

Angels and Demons: The Effect of Ethical Leadership on Machiavellian Employees' Work Behaviors.

Belschak FD1, Den Hartog DN1, De Hoogh AHB1.

Author information

1

Section of Leadership and Management, Amsterdam Business School, University of Amsterdam, Amsterdam, Netherlands.

Abstract

Machiavellians can be characterized as goal-driven people who are willing to use all possible means to achieve their ends, and employees scoring high on Machiavellianism are thus predisposed to engage in unethical and organizationally undesirable behaviors. We propose that leadership can help to manage such employees in a way that reduces undesirable and increases desirable behaviors. Studies on the effects of leadership styles on Machiavellian employees are scarce. Here we investigate the relationship of ethical leadership with prosocial (helping colleagues or affiliative OCB) and antisocial work behavior (knowledge hiding and emotional manipulation) for employees who are higher or lower in Machiavellianism. The effect of an ethical leadership style on employees predisposed to engage in unethical behaviors has not been investigated so far. In a cross-sectional multi-source survey study among a sample of 159 unique leader-follower dyads, we find interaction effects between leadership and employee Machiavellianism for prosocial and antisocial work behavior. As expected, employee Machiavellianism comes with reduced helping behavior and increased knowledge hiding and emotional manipulation, but only when ethicalleadership is low. Under highly ethical leaders, such increases in organizationally undesirable behaviors of Machiavellian employees do not occur. While the cross-sectional design precludes conclusions about the direction of causality, findings of our study suggest to further explore (and from a practical perspective to invest in) ethical leadership as a potential remedy for undesirable behavior of Machiavellian employees.

Self-control and obesity: Gender matters in children

Relationship between self-regulation and weight different for girls and boys, study finds

A toddler's self-regulation -- the ability to change behavior in different social situations -- may predict whether he or she will be obese come kindergarten, but the connection appears to be much different for girls than for boys.

Self-regulation is something all children must develop, and poorer self-control in childhood is associated with worse adult health, economic and social outcomes. However, a new study from The Ohio State University found that more self-regulation may not necessarily reduce the risk of obesity, especially in girls.

Girls who scored at either the low or the high end on measures of self-regulation when they were 2 years old were more likely than girls with average self-regulation to be obese at age 5, while boys with high self-regulation were less likely to be obese than their peers with low or average self-regulation, found the study, which appears in the journal JAMA Pediatrics.

Prog Cardiovasc Dis. 2018 Jul 9. pii: S0033-0620(18)30144-0. doi: 10.1016/j.pcad.2018.07.014. [Epub ahead of print]

The Effects of Exercise and Physical Activity on Weight Loss and Maintenance.

Swift DL1, McGee JE2, Earnest CP3, Carlisle E2, Nygard M2, Johannsen NM4.

Author information

1

Department of Kinesiology, East Carolina University, Greenville, NC, United States of America; Human Performance Laboratory, East Carolina University, Greenville, NC, United States of America. Electronic address: swiftd@ecu.edu.

2

Department of Kinesiology, East Carolina University, Greenville, NC, United States of America; Human Performance Laboratory, East Carolina University, Greenville, NC, United States of America.

3

Department of Kinesiology, Texas A&M University, College Station, TX, United States of America.

4

Department of Kinesiology, Louisiana State University, Baton Rouge, LA, United States of America.

Abstract

Obesity represents a major health problem in the United States and is associated with increased prevalence of cardiovascular (CV) disease risk factors. Physical activity (PA) and exercise training (ET) are associated with reduced CV risk, improved cardiometabolic risk factors, and facilitated weight loss through creating a negative energy balance. Clinicians need to counsel overweight and obese patients on how much PA/ET is needed to promote weight loss and weight loss maintenance. This will help establish realistic expectations and maximize improvements in CV risk factors. Although the minimum guidelines for aerobic PA (150 min of moderate or 75 min of vigorous physical activity per week) can improve CV health, these levels are generally inadequate for clinically significant weight loss or weight maintenance without caloric restriction. The purpose of this review is to evaluate the role of ET to promote clinically significant weight loss and promote weight maintenance. In particular, we will evaluate the likelihood of weight loss from ET programs composed of aerobic training only, resistance training only and programs that combine diet and ET. We will also explore the role of PA in promoting short-term and long-term weight maintenance.

Brothers Johnson - Strawberry Letter #23 1977