"new unfreedom"

The Man Against Everything

Mark Greif has no use for health, youth, or happiness

By Jon Baskin 

This discussion contributes to the book’s central philosophical theme: how concepts like "experience" — also "health," "youth," and "happiness" — have come to ensnare us in a "new unfreedom." Greif unspools the same sad story again and again: In the more privileged parts of the developed West, we have largely emancipated ourselves from biological necessities (hunger, disease) and even from moral ones (God, the old taboos), but, perplexed by our unprecedented liberty, we have fabricated a new set of necessities to take their place. We no longer suffer from food scarcity, so we devise a baroque maze of taboos regarding what we can consume. We no longer prohibit any one form of sex, and yet, in making sex an all-important component of our self-esteem, we bow down to a new set of norms (namely, that we should always want sex, and with different partners) nearly as coercive as the old. We squander our "free time," a relatively recent gift of history, at the gym, in ridiculous outfits, on primitive machines, in order that we may have a little more free time to spend in a future that perpetually recedes.

Hastings Cent Rep. 2017 Jan;47(1):10-19. doi: 10.1002/hast.664.

After the DNR: Surrogates Who Persist in Requesting Cardiopulmonary Resuscitation.

Robinson EM, Cadge W, Zollfrank AA, Cremens MC, Courtwright AM.

Abstract

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR.

Obesity, diabetes prevalent in Arab American communities

Obesity, diabetes prevalent in Arab American communities

By Julia Kassem |

"

Much of the Arab world is following in the same trajectory, with the World Health Organization reporting that more than 30 percent of the Arab world is overweight or obese. Along with rising diabetes rates across the region, other countries show equally concerning signs of poor health. Egypt faces the highest rates of obesity in Africa, while Arabs in Palestine are at significantly higher risk for obesity and diabetes than their Israeli counterparts. 

This phenomenon, plaguing both the extremely lavish and the highly impoverished nations of the Middle East, is also reflected aptly in their American counterparts. 

Evidence shows that Arab Americans may have higher rates of obesity and type II diabetes than the average non-Arab American. A 2003 study by Linda Jaber, concluding that the "prevalence of diabetes and glucose intolerance is extremely high among adult Arab Americans in Michigan", is validated by figures showing overall diabetes prevalence at 15.5 percent for women and 20.1 percent for men, compared with 5-6 percent for non-Hispanic Whites." 

Exercise … it Does a Body Good: 20 Minutes Can Act as Anti-Inflammatory

One moderate exercise session has a cellular response that may help suppress inflammation in the body

The brain and sympathetic nervous system — a pathway that serves to accelerate heart rate and raise blood pressure, among other things — are activated during exercise to enable the body to carry out work. Hormones, such as epinephrine and norepinephrine, are released into the blood stream and trigger adrenergic receptors, which immune cells possess.

This activation process during exercise produces immunological responses, which include the production of many cytokines, or proteins, one of which is TNF — a key regulator of local and systemic inflammation that also helps boost immune responses.

“Our study found one session of about 20 minutes of moderate treadmill exercise resulted in a five percent decrease in the number of stimulated immune cells producing TNF,” said Hong. “Knowing what sets regulatory mechanisms of inflammatory proteins in motion may contribute to developing new therapies for the overwhelming number of individuals with chronic inflammatory conditions, including nearly 25 million Americans who suffer from autoimmune diseases.”

Michelle D. Reid, Melinda M. Lewis, Field F. Willingham, and Volkan Adsay (2017) The Evolving Role of Pathology in New Developments, Classification, Terminology, and Diagnosis of Pancreatobiliary Neoplasms. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

The Evolving Role of Pathology in New Developments, Classification, Terminology, and Diagnosis of Pancreatobiliary Neoplasms

Michelle D. Reid, MD; Melinda M. Lewis, MD; Field F. Willingham, MD, MPH; Volkan Adsay, MD

From the Departments of Pathology (Drs Reid, Lewis, and Adsay) and Digestive Diseases (Dr Willingham), Emory University School of Medicine, Atlanta, Georgia.

Reprints: Michelle D. Reid, MD, Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Rd NE, Rm H-189, Atlanta, GA 30322 (email: michelle.reid@emory.edu).

Pancreatobiliary tract lesions are increasingly being discovered because of more sensitive imaging modalities. Magnetic resonance imaging has identified incidental pancreatic cysts in 13.5% of patients of progressively increasing age. Pancreatobiliary tissue is more accessible through endoscopic ultrasound and magnetic resonance imaging–guided biopsy procedures, and is now an integral part of pathologists' routine practice. Accordingly, several new tumor categories have been recently recognized, including intraductal tubulopapillary neoplasm, a new addition to tumoral intraepithelial neoplasms. Other entities have been reclassified, including the recent transition to 2-tiered grading of preinvasive neoplasms, as well as new perspectives on the distinctive biologic behavior of oncocytic intraductal papillary mucinous neoplasms (IPMNs) compared with other IPMN subtypes. This has led to proposals for revised staging of virtually every segment of the pancreatobiliary tree, with theranostic markers becoming an integral part of workup. Ki-67 is now an integral part of the classification of neuroendocrine tumors, with new definitions of “high-grade neuroendocrine carcinoma.” Although bile duct brushings have opened new avenues for diagnosis, their sensitivity remains low and often requires concomitant fluorescent in situ hybridization to better define ambiguous cases. Various molecular pathways have been elucidated for pancreatic cysts, including KRAS for ductal neoplasia, GNAS for intestinal IPMNs, RNF3 for mucinous cysts, and VHL for serous cystic neoplasms, all key players in diagnostic workup. Integration of these updates into our understanding of pancreatobiliary disease requires active engagement of pathologists for appropriate specimen triage, judicious interpretation of results, and incorporation into reporting and staging. They also provide exciting opportunities for targeted therapy.

Why drinking alcohol makes us hungry

Ever come home from a night of drinking and desperately craved French fries or pizza? Researchers say they have found the underlying mechanism: Alcohol makes your brain think you are starving.

"That people get hungry after a night of drinking has puzzled researchers for a long time. After all, alcohol itself is highly energetic: One gram of pure ethanol - the alcohol in beverages - has 7.1 kilocalories. Only fat is richer in energy.

The body normally registers when high-energetic food arrives and cancels any feeling of hunger. With alcohol, though, the opposite happens. As a consequence, alcoholic drinks are doubly bad for losing weight: They have a lot of calories and make you eat even more."

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

• 1From 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.

Yes. Nannystate slippery slope.

What's next? A tax on cheese or pepperoni? - PennLive letters

"The soda tax could be just the beginning. How about a tax on the cheese I like on my burger? 

And don't even mention the pepperoni on pizza. They are high in sodium and fat leading to high blood pressure and cholesterol. This tax has all the earmarks of the government trying to raise revenue under the guise that they want to help you. The tax imposed in Philadelphia goes to childhood education and 'other initiatives.'" 

The world is gaining weight at a shocking rate

"This is worrisome when you think of the health complications that accompany obesity. An epidemic of these proportions indicates poor nutrition on a vast level, whether through lack of knowledge about how to eat well or no access to healthy food. It also leads to many serious health complications, such as cardiovascular disease, diabetes, cancers, and musculoskeletal disorders. This is costly to governments and individuals, not to mention unpleasant."

The Fightin' Texas Aggie Band

The Fightin' Texas Aggie Band

"...the fortunes of the sciences were rising in academia, and the fortunes of the humanities were declining. So to have a scientist sign on to poststructuralism was such a coup..."

Bait and Switch

How the physicist Alan Sokal hoodwinked a group of humanists and why, 20 years later, it still matters.

An oral history by Jennifer Ruark January 01, 2017 

"The hoax was not all particularly about science studies. It was about an academic culture. People in the humanities, especially people who were particularly ambitious, were aware that the fortunes of the sciences were rising in academia, and the fortunes of the humanities were declining. So to have a scientist sign on to poststructuralism was such a coup that they didn’t bother to read his article carefully.

Part of what poststructuralism was about was an effort of young academics to stake out a particular approach, and that approach pit culture against politics and economics. What they were saying was, unlike those old fuddy-duddy economic determinists, we understand that the main category is culture. But then we had the recession of 1998, and then in 2008 there was the economic meltdown. It became really difficult to argue that economics wasn’t important."

The good news: "Gastric bypass surgery is safe and effective..." The bad news: "...for obese teenagers."

Gastric bypass surgery is safe and effective for obese teenagers

"The rates of teen diabetes dropped from 16 to 2 percent, while high cholesterol and hypertension rates fell 52 and 31 percent respectively. On hindsight, 39 patients suffered from low levels of vitamin D, and 25 suffered from mild anemia. Researchers suggest that these side effects may come from the reduced food consumption and the inability of their digestive tract to absorb all the nutrients."

From Yasmeen Butt, Anna Kurdowska, and me: Acute Lung Injury: A Clinical and Molecular Review

Arch Pathol Lab Med. 2016 Apr;140(4):345-50. doi: 10.5858/arpa.2015-0519-RA.

Acute Lung Injury: A Clinical and Molecular Review.

Butt Y, Kurdowska A, Allen TC1,2,3.

Author information

• 1From the Department of Pathology, The University of Texas Southwestern Medical School, Dallas (Dr Butt);
• 2the Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler (Dr Kurdowska);
• 3and the Departments of Pathology and Laboratory Services, The University of Texas Medical Branch, Galveston (Dr Allen).

Abstract

CONTEXT:

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are a continuum of lung changes arising from a wide variety of lung injuries, frequently resulting in significant morbidity and frequently in death. Research regarding the molecular pathophysiology of ALI/ARDS is ongoing, with the aim toward developing prognostic molecular biomarkers and molecular-based therapy.

OBJECTIVE:

To review the clinical, radiologic, and pathologic features of ALI/ARDS; and the molecular pathophysiology of ALI/ARDS, with consideration of possible predictive/prognostic molecular biomarkers and possible molecular-based therapies.

DATA SOURCES:

Examination of the English-language medical literature regarding ALI and ARDS.

CONCLUSIONS:

ARDS is primarily a clinicoradiologic diagnosis; however, lung biopsy plays an important diagnostic role in certain cases. A significant amount of progress has been made in the elucidation of ARDS pathophysiology and in predicting patient response, however, currently there is no viable predictive molecular biomarkers for predicting the severity of ARDS, or molecular-based ARDS therapies. The proinflammatory cytokines TNF-α (tumor necrosis factor α), interleukin (IL)-1β, IL-6, IL-8, and IL-18 are among the most promising as biomarkers for predicting morbidity and mortality.

"Do those killjoys think we don’t know cakes aren’t the healthiest snack option?"

Roxanne Sorooshian – Cakes: the unkindest cut of all

"The Royal College of Surgeons' Faculty of Dental Surgery said eating cake and biscuits at work was contributing to obesity and poor oral health.

Tips to reducing sugar intake included keeping it for lunchtime and keeping snacks out of view.

So far, so obvious. Do those killjoys think we don’t know cakes aren’t the healthiest snack option?

Professor Nigel Hunt, dean of the faculty, helpfully points out that sugary snacks are detrimental to health and employees should make a New Year's resolution to "combat cake culture" in 2017.

"While these sweet treats might be well meaning, they are also contributing to the current obesity epidemic and poor oral health," Hunt added."

Waist circumference is a stronger predictor of heart disease in diabetics than either overall body weight or BMI

"Although any form of obesity can produce stress on the heart, the new Intermountain Medical Center Heart Institute/Johns Hopkins study shows that abdominal obesity, more so than total body weight or BMI (weight to height ratio), is a strong predictor of left ventricle dysfunction."

Zombie allusions: They just keep on coming™: "One approach would be liquidation..."

China’s Zombie Companies and Japan’s Lost Two Decades

Japan’s experience is instructive for China economy watchers.

By Kai Kajitani

January 07, 2017

"So, are zombie companies really worsening the performance of the Chinese economy? In short, the effects have manifest as a slump in private sector investment. For instance, the year-on-year growth rate for cumulative fixed asset investment in the private sector for the period from January to July 2016 was 2.1 percent, the lowest rate of growth since statistics began to be published. Although private sector investment has rebounded slightly in response to the government’s investment promotion policies in the months since, a situation where the increase in the money supply and bank lending is not adequately linked to the increase in private sector investment has persisted. Per the research of Caballero et al., this slumping private sector investment is precisely the kind of harmful effect that results from the continued existence of many zombie companies.

What policies, then, should be used to address the declining productivity of these zombie companies? One approach would be liquidation – that is, to mercilessly force zombie companies with low profitability and large debts to exit the market, dispose of the debt and ensure that funds are allocated to more productive firms. However, the drastic measures to reorganize debt through a liquidation approach could trigger sweeping lay-offs and cause a sharp rise in the unemployment rate. This could have the unintended effect of actually pushing productivity down further due to human resources not being effectively utilized."

Socialized Medicine: Red Cross declares NHS ‘humanitarian crisis’

Jeremy Hunt accused of ‘hiding’ as Red Cross declares NHS ‘humanitarian crisis’

Opposition parties have rounded on the Health Secretary for keeping a low profile

"Jeremy Hunt cannot say that he wasn’t warned that this crisis was coming. Every major health organisation has been warning for months that the NHS was heading for disaster unless it got more funding. 

He has decided to ignore those warnings and we are now seeing a meltdown in our NHS that he is refusing to acknowledge. Patients the staff and the public deserve better. "

Michelle Obama delivers final remarks as First Lady

“Being your first lady has been the greatest honor of my life and I hope I’ve made you proud,” she said.

Arch Pathol Lab Med. 2016 Aug;140(8):825-9. doi: 10.5858/arpa.2016-0163-SA. Epub 2016 May 19.

Liquid Biopsy in Lung Cancer: A Perspective From Members of the Pulmonary Pathology Society.

Sholl LM, Aisner DL, Allen TC, Beasley MB, Cagle PT, Capelozzi VL, Dacic S, Hariri LP, Kerr KM, Lantuejoul S, Mino-Kenudson M, Raparia K, Rekhtman N, Roy-Chowdhuri S, Thunnissen E, Tsao M, Vivero M, Yatabe Y1.

Author information

• 1From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Drs Sholl and Vivero); the Department of Pathology, University of Colorado Cancer Center, Denver (Dr Aisner); the Department of Pathology, The 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, New York, and 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, 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, France, and J Fourier University-INSERM U 823-Institut A Bonniot, Grenoble, France (Dr Lantuejoul); 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, New York (Dr Rekhtman); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology, VU Medical Center, Amsterdam, the Netherlands (Dr Thunnissen); the Department of Pathology, University Health Network/Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada (Dr Tsao); and the Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan (Dr Yatabe).

Abstract

Liquid biopsy has received extensive media coverage and has been called the holy grail of cancer detection. Attempts at circulating tumor cell and genetic material capture have been progressing for several years, and recent financially and technically feasible improvements of cell capture devices, plasma isolation techniques, and highly sensitive polymerase chain reaction- and sequencing-based methods have advanced the possibility of liquid biopsy of solid tumors. Although practical use of circulating RNA-based testing has been hindered by the need to fractionate blood to enrich for RNAs, the detection of circulating tumor cells has profited from advances in cell capture technology. In fact, the US Food and Drug Administration has approved one circulating tumor cell selection platform, the CellSearch System. Although the use of liquid biopsy in a patient population with a genomically defined solid tumor may potentially be clinically useful, it currently does not supersede conventional pretreatment tissue diagnosis of lung cancer. Liquid biopsy has not been validated for lung cancer diagnosis, and its lower sensitivity could lead to significant diagnostic delay if liquid biopsy were to be used in lieu of tissue biopsy. Ultimately, notwithstanding the enthusiasm encompassing liquid biopsy, its clinical utility remains unproven.

Obesity "...has quietly overtaken the world..."

Nearly 76 per cent of world population is overfat

"With nearly 76 per cent of the world's population becoming 'overfat', it has become the new pandemic that has quietly overtaken the world, a study has showed. 'Overfat' has been defined as a condition of having sufficient excess body fat to impair health.

"This is a global concern because of its strong association with rising chronic disease and climbing healthcare costs, affecting people of all ages and incomes," said lead author Philip Maffetone, CEO of MAFF Fitness in Australia."

"Plato would be alarmed by the lack of shame online. He thought that shame was a crucial emotion, indispensable for doing philosophy and acting morally."

Shame on you

Unburdening ourselves online can feel radical and liberating. But is baring and sharing all as emancipatory as it seems?

"Plato would be alarmed by the lack of shame online. He thought that shame was a crucial emotion, indispensable for doing philosophy and acting morally. In Plato’s famed dialogues, the character of Socrates is always being pestered by people who complain that his wisdom makes them feel ashamed, as soon as his arguments start to sink in. At one point in the section known as the Symposium, the drunken Alcibiades declares his disgruntled love for the philosopher, saying: ‘I know that I cannot answer him or say that I ought not to do as he bids, but when I leave his presence the love of popularity gets the better of me.’"

"...39.4 percent of Wisconsin adults are obese. The state’s obesity rate is 4.5 percent higher than the national average..."

Obesity rates annouced as New Year’s resolutions begin

"Obesity rates among Wisconsin adults are higher than previously reported for the state. According to findings from the Survey of the Health of Wisconsin (SHOW), a population-based health examination survey, 39.4 percent of Wisconsin adults are obese. The state’s obesity rate is 4.5 percent higher than the national average obesity rate of 34.9 percent. Obesity rates are higher in persons who are older, poor, less educated, minorities or who live in a community with high economic hardship. The prior estimate of 31 percent for Wisconsin was based on phone surveys and self-reported height and weight."

Diagnostic Management Team (DMT) Conference - February 7-8 - Galveston Texas

Diagnostic Management Team (DMT) Conference

Diagnostic Management Team (DMT) consultation services have been endorsed by the National Academy of Medicine, formerly the Institute of Medicine, in September, 2015, as a mechanism to reduce diagnostic error in the United States. This is a quantum leap forward for our patients and providers alike.

In this first ever conference on the diagnostic management team, the activities associated with these teams will be described and the function of one particular diagnostic management team will be illustrated in a mock session. Individuals who have addressed each one of the barriers listed above are speaking at the conference. Those emerging from this one and a half day conference should have enough information to initiate an effective diagnostic management team, and will have had the opportunity to meet individuals who have faced barriers in DMT development and overcome them.

Arch Pathol Lab Med. 2016 Jul 21. [Epub ahead of print]

Transbronchial Lung Cryobiopsy for Interstitial Lung Disease Diagnosis: A Perspective From Members of the Pulmonary Pathology Society.

Raparia K, Aisner DL, Allen TC, Beasley MB, Borczuk A, Cagle PT, Capelozzi V, Dacic S, Hariri LP, Kerr KM, Lantuejoul S, Mino-Kenudson M, Rekhtman N, Roden AC, Roy-Chowdhuri S, Sholl L, Smith ML, Thunnissen E, Tsao MS, Yatabe Y.

Abstract

Transbronchial lung cryobiopsy involves using a cryoprobe rather than forceps to obtain a bronchoscopic biopsy. Recent studies have shown that transbronchial cryobiopsy provides a larger specimen than conventional transbronchial forceps biopsy, and that the interobserver agreement in the interpretation of cryobiopsy specimens is comparable to that of a surgical lung biopsy. This is encouraging, and transbronchial lung cryobiopsy clearly has a role in the workup and diagnosis of interstitial lung diseases. However, very few patients who have been studied underwent both transbronchial lung cryobiopsy and surgical lung biopsy, and the available data suggest that the diagnostic accuracy of cryobiopsy may not be similar to that of surgical lung biopsy. Further study is needed before transbronchial lung biopsy can be recommended as a replacement for surgical lung biopsy.

Parents’ Obesity May Slow Child Development

By Rick Nauert PhD

"New findings from the National Institutes of Health suggest children of obese parents may be at risk for developmental delays.

Investigators discovered that children of obese mothers were more likely to fail tests of fine motor skill — the ability to control movement of small muscles, such as those in the fingers and hands.


Children of obese fathers were more likely to fail measures of social competence, and those born to extremely obese couples also were more likely to fail tests of problem solving ability."

Eur J Cancer. 2016 Dec 24;72:71-77. doi: 10.1016/j.ejca.2016.11.005. [Epub ahead of print]

Impact of industry collaboration on randomised controlled trials in oncology.

Linker A1, Yang A2, Roper N3, Whitaker E4, Korenstein D5.

Author information

• 1University of California San Francisco, 631 Diamond Street, San Francisco, CA 94114, USA. Electronic address: Anne.linker@ucsf.edu.
• 2Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY 10017, USA. Electronic address: yanga1@mskcc.org.
• 3National Institutes of Health/National Cancer Institute, 10 Center Drive, Bethesda, MD 20892, USA. Electronic address: Nitin.roper@nih.gov.
• 4Library and Center for Knowledge Management, University of California San Francisco, 530 Parnassus Avenue, San Francisco, CA 94143, USA. Electronic address: Evans.whitaker@ucsf.edu.
• 5Department of Medicine, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY 10017, USA. Electronic address: korenstd@mskcc.org.

Abstract

BACKGROUND:

Industry funders can simply provide money or collaborate in trial design, analysis or reporting of clinical trials. Our aim was to assess the impact of industry collaboration on trial methodology and results of randomised controlled trials (RCT).

METHODS:

We searched PubMed for oncology RCTs published May 2013 to December 2015 in peer-reviewed journals with impact factor > 5 requiring reporting of funder role. Two authors extracted methodologic (primary end-point; blinding of the patient, clinician and outcomes assessor; and analysis) and outcome data. We used descriptive statistics and two-sided Fisher exact tests to compare characteristics of trials with collaboration, with industry funding only, and without industry funding.

RESULTS:

We included 224 trials. Compared to those without industry funding, trials with collaboration used more placebo control (RR 3·59, 95% CI [1·88-6·83], p < 0001), intention-to-treat analysis (RR 1·32, 95% CI [1·04-1·67], p = 02), and blinding of patients (RR 3·05, 95% CI [1·71-5·44], p < 0001), clinicians (RR 3·36, 95% CI [1·83-6·16], p≤·001) and outcomes assessors (RR 3·03, 95% CI [1·57-5·83], p = 0002). They did not differ in use of overall survival as a primary end-point (RR 1·27 95% CI [0·72-2·24]) and were similarly likely to report positive results (RR 1·11 95% CI [0·85-1·46], p = 0.45). Studies with funding only did not differ from those without funding.

CONCLUSIONS:

Oncology RCTs with industry collaboration were more likely to use some high-quality methods than those without industry funding, with similar rates of positive results. Our findings suggest that collaboration is not associated with trial outcomes and that mandatory disclosure of funder roles may mitigate bias.

Most middle aged adults living unhealthy lives, say experts

"Officials said that nine in 10 men (87%) and eight in 10 women (79%) are not doing enough exercise , exceeding the recommended limits for alcohol or are either overweight or obese.

Figures taken from the Health Survey for England show that 77% of men and 63% of women in middle age are either overweight or obese - with the rate of obesity shooting up 16% in the last two decades.

The diabetes rate among this age group also doubled in this period in England, PHE said.

Meanwhile, many are also not being physically active and drinking too much."

The Demise Of The Part B Demo: Doom For Value-Based Payment?

Rachel Dolan

December 27, 2016

"CMMI has piloted a number of demonstrations on bundled payments, hospital payments, and accountable care, and MACRA moves Medicare physician payment towards a value structure. But we aren’t there yet. So far, most demonstrations have not made significant changes to health care spending. Participants have had little downside risk while receiving additional bonuses for meeting certain quality and savings targets. While this approach is key to drawing in participants at the outset, it shows little will among providers to risk profits."

"...they’re both interested in the same thing: smooth operations at any cost. Often that cost is the mission of the university itself."

Low Definition in Higher Education

When college students are told what to think and what not to say, who suffers in the end?

By Lyell Asher

NOVEMBER 16, 2016

"This covert consumerist ethos helps explain what otherwise seems especially incongruous about higher education in America today: how to square the putatively “progressive”—but in fact retrograde—imposition of speech codes, safe spaces, bias response teams, and the like on college campuses, with the simultaneous emphasis on commerce and entrepreneurship, an emphasis especially favored by the business-oriented boards of trustees. The answer is that they’re both interested in the same thing: smooth operations at any cost. Often that cost is the mission of the university itself."

Or not: "When it comes to combating health problems like obesity or diabetes, most people think it’s the responsibility of doctors and nutritionists."

The Key To Healthier Living In North Texas Might Be Better Urban Planning

By STEPHANIE KUO

"When it comes to combating health problems like obesity or diabetes, most people think it’s the responsibility of doctors and nutritionists. But urban planners, architects and engineers say they play a role as well. The way a city or a building is planned can encourage people to walk more and be healthier in their everyday lives."

From Jun Fukuoka and colleagues: Interobserver Agreement of Usual Interstitial Pneumonia Diagnosis Correlated With Patient Outcome

Mikiko Hashisako, Tomonori Tanaka, Yasuhiro Terasaki, Toshimasa Uekusa, Rosane D. Achcar, Bassam I. Aswad, Hanaa S. Bamefleh, Vera L. Capelozzi, John C. English, Alexandre T. Fabro, Kensuke Kataoka, Tomayoshi Hayashi, Yasuhiro Kondoh, Hiroyuki Taniguchi, and Junya Fukuoka (2016) Interobserver Agreement of Usual Interstitial Pneumonia Diagnosis Correlated With Patient Outcome. Archives of Pathology & Laboratory Medicine: December 2016, Vol. 140, No. 12, pp. 1375-1382.

ORIGINAL ARTICLES

Interobserver Agreement of Usual Interstitial Pneumonia Diagnosis Correlated With Patient Outcome

Mikiko Hashisako, MD; Tomonori Tanaka, MD; Yasuhiro Terasaki, MD, PhD; Toshimasa Uekusa, MD, PhD; Rosane D. Achcar, MD; Bassam I. Aswad, MD; Hanaa S. Bamefleh, MBChB; Vera L. Capelozzi, MD, PhD; John C. English, MD, FRCPC; Alexandre T. Fabro, MD, PhD; Kensuke Kataoka, MD, PhD; Tomayoshi Hayashi, MD, PhD; Yasuhiro Kondoh, MD, PhD; Hiroyuki Taniguchi, MD, PhD; Junya Fukuoka, MD, PhD

From the Department of Pathology, Nagasaki University Hospital, Sakamoto, Nagasaki, Japan (Drs Hashisako, Tanaka, and Fukuoka); the Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan (Dr Terasaki); the Department of Pathology, Japan Labour Health and Welfare Organization, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan (Dr Uekusa); the Division of Pathology, National Jewish Health, Denver, Colorado (Dr Achcar); the Department of Pathology, Rhode Island Hospital, Providence (Dr Aswad); the Department of Pathology and Laboratory Medicine, King Abdullah Medical City, Riyadh, Saudi Arabia (Dr Bamefleh); the Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Drs Capelozzi and Fabro); the Department of Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada (Dr English); the Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan (Drs Kataoka, Kondoh, and Taniguchi); and the Department of Pathology, Nagasaki Prefecture Shimabara Hospital, Shimabara, Nagasaki, Japan (Dr Hayashi). Dr Hashisako is now with the Research Institute for Diseases of the Chest, Kyushu University, Fukuoka, Japan.

Reprints: Junya Fukuoka, MD, PhD, Department of Pathology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan (email: fukuokaj@nagasaki-u.ac.jp).

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

Context.— The histopathologic criteria for idiopathic pulmonary fibrosis were revised in the American Thoracic Society/European Respiratory Society/Japan Respiratory Society/Latin American Thoracic Association guidelines in 2011. However, the evidence of diagnosis based on the guidelines needs further investigation.

Objective.— To examine whether the revised histopathologic criteria for idiopathic pulmonary fibrosis improved interobserver agreement among pathologists and the predicted prognosis in patients with interstitial pneumonia.

Design.— Twenty, consecutive, surgical lung-biopsy specimens from cases of interstitial pneumonia were examined for histologic patterns by 11 pathologists without knowledge of clinical and radiologic data. Diagnosis was based on American Thoracic Society/European Respiratory Society guidelines of 2002 and 2011. Pathologists were grouped by cluster analysis, and interobserver agreement and association to the patient prognosis were compared with the diagnoses for each cluster.

Results.— The generalized κ coefficient of diagnosis for all pathologists was 0.23. If the diagnoses were divided into 2 groups: usual interstitial pneumonia (UIP)/probable UIP (the UIP group) or possible/not UIP (the non-UIP group), according to the 2011 guidelines, the κ improved to 0.37. The pathologists were subdivided into 2 clusters in which 1 showed an association between UIP group diagnosis and patient prognosis (P < .05).

Conclusions.— Agreement about pathologic diagnosis of interstitial pneumonia is low; however, results after division into UIP and non-UIP groups provided favorable agreement. The cluster analysis revealed 1 of the 2 clusters providing high interobserver agreement and prediction of patient prognosis.