"We tend to fixate on the measure of lifespan, but overlook morbidity." #PumpIron

Raising the American Weakling

There are two very different interpretations of our dwindling grip strength.

We tend to fixate on the measure of lifespan, but overlook morbidity. Here, Lieberman says, the data are unequivocal. “As we are living longer,” he says, people “are also suffering from much longer periods of chronical illness as they age.” People may be living longer, due to advances in pharmaceuticals or medical care, but as he asks, “is she/he healthy?” Health, he says, “is not just life expectancy.”

Our weakening grips are, if nothing else, a corollary of an increasingly sick population. So, by all means, go to the gym, not to turn back the evolutionary tide, but for your own well-being. Evolution, as Lieberman reminds us in The Story of the Human Body, is just about passing your genes, not ensuring a long and healthy life.  “From an evolutionary perspective, there is no such thing as optimal health.”  Creating that definition is up to you.

Washington State Supreme Court Rules That Obesity Is A Disability

Whether obesity should be considered a disability still remains an unanswered question in many legal systems but the recent Washington ruling is a step in the right direction. If a potential employee can perform job requirements, with or without reasonable accommodations, then the employer must not disqualify the candidate based merely on their physical appearances. It is inherently wrong to “fat shame” someone out of a job or promotion.

"...although AI’s use will fundamentally alter pathology practice, it is perhaps pathologists’ greatest opportunity to invest themselves more fully in their patients’ care."

Arch Pathol Lab Med. 2019 Jul 3. doi: 10.5858/arpa.2019-0229-ED. [Epub ahead of print]

Regulating Artificial Intelligence for a Successful Pathology Future.

Allen TC1.

Author information

1

From the Department of Pathology, University of Mississippi Medical Center, Jackson.

"Artificial intelligence (AI), a set of techniques aimed at approximating some aspect of human cognition using machines,1 promises to provide pathologists a tool to improve inefficiencies and inaccuracies in diagnosis and laboratory testing, and to facilitate an anticipated smaller number of pathologists’ ability to serve an increasing number of patients with timely diagnoses, even as those diagnoses exhibit an increasingly complicated molecular complexity.2–4 Pathology has long examined the use of AI in

pathologic diagnosis5 and is already using AI. Papanicolaou test imaging, approved by the US Food and Drug Administration (FDA) for screening purposes, is now fully, if not widely, used.6,7 Other areas of cytopathology are investigating the use of AI for diagnosis,8 and AI will undoubtedly play a strong and central role in its continuing progress toward becoming fully automated.9–11 Artificial intelligence in pathology promises to outperform human beings in their assessment of the specific characteristics

necessary for pathologic and radiologic diagnosis.9,12 Despite the initial hysteria,13–16 it is now clear that AI will be, at least for the foreseeable future, a tool for pathologists, not a replacement for  pathologists, and it is evident that although AI’s use will fundamentally alter pathology practice, it is

perhaps pathologists’ greatest opportunity to invest themselves more fully in their patients’ care.3,7 Pathologists’ success with AI, however, will depend to a large degree on the successful implementation of efficient AI governance and regulation."

"Classifying obesity as a disease is neither essential nor beneficial. It’s much more complicated than that."

Should obesity be recognised as a disease?

"Classifying obesity as a disease is neither essential nor beneficial. It’s much more complicated than that."

US blood donation crisis: Millennials not keen on 'anonymous' act, 'want to know the impact they have on others', say experts

The fundamental reason for the crisis is not just a decline in the frequency of donors. There has been a decline in the number of donors too. What started off as a civic duty-driven phenomenon, she says, has changed into more of an "individual transformational impact". 

HT:DA

Doctors Are Turning to Artificial Intelligence to Diagnose Cancer Patients

"Now we can look at the individual genetic pathways of a patient's tumor, and in the lab we can measure the different unique features of a cancer, so that we can often specify drugs that target that cancer's individual mechanisms. Twenty-five years from now we'll be at a whole new, deeper level of diagnostics that goes beyond genetics with new pathology tests that point to new types of drugs we can't imagine yet."

HT:MM

Obesity linked more to diet than genes: Study #EatRighWorkOut

Obesity linked more to diet than genes: Study

"A study suggests that obesity is more linked to lack of exercise and considerable shift in diet to unhealthy pattern and not just genes.

The study says genes do play a role but the excess kilos don’t just depend on them. Food habits and exercise also do play a part in getting obese."

Expert Opin Investig Drugs. 2019 Jul 1:1-14. doi: 10.1080/13543784.2019.1638363. [Epub ahead of print]

What can independent research for mesothelioma achieve to treat this orphan disease?

Guazzelli A1, Meysami P1, Bakker E2, Bonanni E3, Demonacos C4, Krstic-Demonacos M1, Mutti L5.

Author information

1

a School of Environment and Life Sciences , University of Salford , Salford , UK.

2

b School of Medicine , University of Central Lancashire , Preston , UK.

3

c National Asbestos Observatory , Rome , Italy.

4

d Faculty of Biology, Medicine and Health, School of Health Sciences , University of Manchester , Manchester , UK.

5

e Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology , Temple University , Philadelphia , PA , USA.

Abstract

Introduction: Malignant pleural mesothelioma (MPM) is a rare neoplasm with a poor prognosis, as current therapies are ineffective. Despite the increased understanding of the molecular biology of mesothelioma, there is still a lack of drugs that dramatically enhance patient survival. 

Area Covered: This review discusses recent and complete clinical trials supported by the NIH, other U.S. Federal agencies, universities and organizations found on clinicaltrials.gov. Firstly, chemotherapy-based trials are described, followed by immunotherapy and multitargeted therapy. Then we introduce drug repositioning and the use of drug docking as tools to find new interesting molecules. Finally, we highlight potential molecular pathways that may play a role in mesothelioma biology and therapy. 

Expert Opinion: Numerous biases are present in the clinical trials due to a restricted number of cases, inappropriate endpoints and inaccurate stratification of patients which delay the finding of a treatment for MPM. The most crucial issue of independent research for MPM is the lack of more substantive funding to translate these findings to the clinical setting. However, this approach is not necessarily scientific given the low mutational load of mesothelioma relative to other cancers, and therefore patients need a more solid rationale to have a good chance of successful treatment.

ELO - Telephone Line (Live) #BeforeCellPhones

ELO - Telephone Line (Live)

I am a Candidate for College of American Pathologists' President-Elect, 2019-2021 term. My vision is here.

I am a Candidate for College of American Pathologists' President-Elect, 2019-2021 term.  My vision is here.

Membership Growth. Pathologist Payment.

"...obese and inactive people prefer empowering campaigns, find them more motivating and less stigmatising."

Obesity has become the new normal but it’s still a health risk

"There has, to my knowledge, been no high-quality research comparing the actual effectiveness of shaming versus empowering anti-obesity, or pro-physical activity, campaigns.

However a number of studies show, unsurprisingly, that obese and inactive people prefer empowering campaigns, find them more motivating and less stigmatising."

"Those born after 1970 were far more likely to have a substantially higher BMI as young adults than earlier generations."

Genes, yes, but obesity pandemic mostly down to diet: study

Those born after 1970 were far more likely to have a substantially higher BMI as young adults than earlier generations.

Vehicle - The Ides Of March

"To grasp the affinities between administrative governance and algorithmic governance, one must first get over that intellectually debilitating article of libertarian faith, namely that 'the government' poses the only real threat to liberty."

Algorithmic Governance and Political Legitimacy

by Matthew B. Crawford

To grasp the affinities between administrative governance and algorithmic governance, one must first get over that intellectually debilitating article of libertarian faith, namely that “the government” poses the only real threat to liberty. For what does Silicon Valley represent, if not a locus of quasi-governmental power untouched by either the democratic process or by those hard-won procedural liberties that are meant to secure us against abuses by the (actual, elected) government? If the governmental quality of rule by algo­rithms remains obscure to us, that is because we actively welcome it into our own lives under the rubric of convenience, the myth of free services, and ersatz forms of human connection—the new opiates of the masses.

To characterize this as the operation of “the free market” (as its spokespersons do) requires a display of intellectual agility that might be admirable if otherwise employed. The reality is that what has emerged is a new form of monopoly power made possible by the “network effect” of those platforms through which everyone must pass to conduct the business of life. These firms sit at informational bottlenecks, collecting data and then renting it out, whether for the purpose of targeted ads or for modeling the electoral success of a political platform. Mark Zuckerberg has said frankly that “In a lot of ways Facebook is more like a government than a traditional company. . . . We have this large community of people, and more than other technology companies we’re really setting policies.”

"...the term 'health care provider' is a generic term that does not communicate the emphasis on education and concern for patients embodied by the traditional term 'physician' or 'doctor.'"

245.002 Health Care Provider

245.002

Health Care Provider: The Texas Medical Association recognizes that the term "health care provider" is a generic term that does not communicate the emphasis on education and concern for patients embodied by the traditional term "physician" or "doctor." Similarly, the term "covered lives" is a dehumanizing phrase that often is used instead of "patients." Therefore, TMA should refrain whenever possible from the use of such terms as "provider," "covered lives," and similar terms in all communications with members, the public, and the media, and "patient" and "physician" should be used in place of these terms (Council on Communication, p 49, I-91; amended CC Rep. 5-A-02; reaffirmed BOT Rep. 12-A-12; reaffirmed BOT Rep. 12-A-12).

Red Skelton - Explains "The Pledge of Allegiance"

Obesity overtakes smoking as the leading cause of cancer

Now, latest figures from a charity showed that excess body weight has overtaken smoking as the main cause of four different types of cancer - bowel, kidney, ovarian and liver cancer. The charity warned that millions of people are at risk of cancer because of their excess weight, adding that obese people now outnumber smokers by two to one in the UK.

Our obsession with paternalism has turned obesity into a disease from which there can be no escape

Where is the personal responsibility, where are the attempts to empower people?

Boris Johnson’s pledge to review the “sin taxes” that have spread across the statute book with the inevitability of holiday weight gain has certainly divided opinion. Some have branded the move irresponsible and even dangerous, highlighting new Cancer Research UK findingslinking obesity to more cases of common cancers in the UK than smoking. Steve Brine, the minister responsible for implementing the tax on sugary drinks, described the move as “transparent dog whistle politics” (whistling to whom? People who enjoy a full-fat Coke?)

Timothy Craig Allen (2019) Regulating Artificial Intelligence for a Successful Pathology Future. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Regulating Artificial Intelligence for a Successful Pathology Future

Timothy Craig Allen, MD, JD
"Physicians, including pathologists, must now rethink what it means to be caring, and how to preserve and foster social interaction with patients while using AI efficiently. It will be especially important that physicians use AI in a manner that respects physician and patient heterogeneity and supports equity. It is physicians, with pathologists at the head of the table, who must lead and forever maintain this conversation with policymakers, providing regulatory guidance that ensures empathy is always considered and respected throughout the complicated discussion around AI regulation and governance." 

"...the Principle of Psychoprofessional Gravitation..."

Your Professional Decline Is Coming (Much) Sooner Than You Think

Here’s how to make the most of it.

“Unhappy is he who depends on success to be happy,” Alex Dias Ribeiro, a former Formula 1 race-car driver, once wrote. “For such a person, the end of a successful career is the end of the line. His destiny is to die of bitterness or to search for more success in other careers and to go on living from success to success until he falls dead. In this case, there will not be life after success.”

Call it the Principle of Psychoprofessional Gravitation: the idea that the agony of professional oblivion is directly related to the height of professional prestige previously achieved, and to one’s emotional attachment to that prestige. Problems related to achieving professional success might appear to be a pretty good species of problem to have; even raising this issue risks seeming precious. But if you reach professional heights and are deeply invested in being high up, you can suffer mightily when you inevitably fall.

Spyro Gyra - Morning Dance

Spyro Gyra - Morning Dance

J Thorac Dis. 2019 Jan;11(Suppl 1):S81-S88. doi: 10.21037/jtd.2019.01.46.

Update on emerging biomarkers in lung cancer.

Bernicker EH1, Allen TC2, Cagle PT3.

Author information

1

Houston Methodist Hospital, Cancer Center, Houston, Texas, USA.

2

Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA.

3

Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA.

Abstract

There has been considerable progress made in identifying oncogenic driver mutations in advanced lung cancer. The recognition that lung cancer is actually an umbrella classification that is comprised of multiple molecular subgroups has had a profound impact on how medical oncologists make treatment decisions. These mutations are clinically important as available targeted therapies can achieve significant responses and prolonged disease control. This review will summarize the current guidelines for biomarker testing and available therapeutic agents.

"'If we want to keep people out of hospital, then we need to think about prevention, wellness, health, exercise, [and] fitness.' But that may be easier said than done."

Nearly 50 per cent of Australians now have a chronic disease — many of them preventable

"If we want to keep people out of hospital, then we need to think about prevention, wellness, health, exercise, fitness."

But that may be easier said than done.

Med Care Res Rev. 2019 Jun 19:1077558719856787. doi: 10.1177/1077558719856787. [Epub ahead of print]

The Personal and Professional Consequences of Physician Burnout: A Systematic Review of the Literature.

Williams ES1, Rathert C2, Buttigieg SC3.

Author information

1

1 The University of Alabama, Tuscaloosa, AL, USA.

2

2 Virginia Commonwealth University, Richmond, VA, USA.

3

3 University of Malta, Msida, Malta.

Abstract

The well-being of the health care workforce has emerged as both a major concern and as a component of the "quadruple aim" to enable the "triple aim" of improving patient experiences, reducing costs, and improving population health. Physician burnout is problematic given its effects on physicians, patients, health care organizations, and society. Using conservation of resources theory as a frame, we conducted a systematic review of the empirical literature on the relationship of physician burnout with physician personal and professional outcomes that includes 43 articles. Nine outcomes were organized into three categories illustrating burnout as a dynamic loss spiral rather than a static end-state. Findings show that emotional exhaustion had the greatest impact with the outcomes explored, while depersonalization and lack of professional accomplishment manifested fewer associations. The results suggest that burnout is a complex, dynamic phenomenon, which unfolds over time. Future research and implications of these results are discussed.

Weight discrimination is unacceptable

Weight discrimination is unacceptable

Although legal protections are needed to prevent weight discrimination, the conversation also needs to address the stigmatization of obesity. Despite obesity being recognized as a disease by the American Medical Association since 2013, weight bias continues to exist within society, as well as within the medical community. Obese individuals experience this bias at an early age. Most children who are obese admit to being teased at some point in their childhood. Obesity is a mutifactorial disorder and is not caused by a “lack of willpower.”

Obesity: How diet changes the brain and promotes overeating

Whereas LHAVglut2 neurons from control mice maintained their responsivity to sucrose consumption, LHAVglut2 neurons from [the high fat diet] mice became progressively less responsive to sucrose consumption and less active at rest," the team writes in the study paper.

In other words, the neurons did not send such a strong "stop eating" signal to the brain when the mice consumed sugar or when the mice were resting. Instead, the animals overate and developed obesity.

 

Andrew P. Norgan, Kurt E. Simon, Barbara A. Feehan, Lynn L. Saari, Joseph M. Doppler, G. Scott Welder, John A. Sedarski, Christopher T. Yoch, Nneka I. Comfere, John A. Martin, Brian J. Bartholmai, and R. Ross Reichard (2019) Radio-Frequency Identification Specimen Tracking to Improve Quality in Anatomic Pathology. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Radio-Frequency Identification Specimen Tracking to Improve Quality in Anatomic Pathology

Andrew P. Norgan, MD, PhD; Kurt E. Simon, MBA, PMP; Barbara A. Feehan, CBAP; Lynn L. Saari, MSN, RN, CPAN; Joseph M. Doppler, MT(ASCP), CLSp(MB); G. Scott Welder, MA; John A. Sedarski, BS; Christopher T. Yoch, MAI; Nneka I. Comfere, MD;John A. Martin, MD; Brian J. Bartholmai, MD; R. Ross Reichard, MD

From the Departments of Laboratory Medicine and Pathology (Drs Norgan, Comfere, and Reichard, Messrs Simon, Sedarski, and Yoch, and Ms Feehan), Nursing (Ms Saari), Dermatology (Messrs Doppler and Welder and Dr Comfere), and Radiology (Dr Bartholmai) and the Division of Gastroenterology and Hepatology (Dr Martin), Mayo Clinic, Rochester, Minnesota.

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

Corresponding author: R. Ross Reichard, MD, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (email: reichard.robert@mayo.edu).

Context.— Preanalytic errors, including specimen-labeling errors and specimen loss, occur frequently during specimen collection, transit, and accessioning. Radio-frequency identification tags can decrease specimen identification and tracking errors through continuous and automated tracking of specimens.

Objective.— To implement a specimen-tracking infrastructure to reduce preanalytic errors (specimen mislabeling or loss) between specimen collection and laboratory accessioning. Specific goals were to decrease preanalytic errors by at least 70% and to simultaneously decrease employee effort dedicated to resolving preanalytic errors or investigating lost specimens.

Design.— A radio-frequency identification specimen-tracking system was developed. Major features included integral radio-frequency identification labels (radio-frequency identification tags and traditional bar codes in a single printed label) printed by point-of-care printers in collection suites; dispersed radio-frequency identification readers at major transit points; and systems integration of the electronic health record, laboratory information system, and radio-frequency identification tracking system to allow for computerized physician order entry–driven label generation, specimen–transit-time tracking, interval-based alarms, and automated accessioning.

Results.— In the 6-month postimplementation period, 6 mislabeling events occurred in collection areas using the radio-frequency identification system, compared with 24 events in the 6-month preimplementation period (75% decrease; P = .001). In addition, the system led to the timely recovery of 3 lost specimens. Labeling expenses were decreased substantially in the transition from high-frequency to ultrahigh-frequency radio-frequency identification tags.

Conclusions.— Radio-frequency identification specimen tracking prevented several potential specimen-loss events, decreased specimen recovery time, and decreased specimen-labeling errors. Increases in labeling/tracking expenses for the system were more than offset by time savings and loss avoidance though error mitigation.

Ann Diagn Pathol. 2019 Apr 24;41:43-50. doi: 10.1016/j.anndiagpath.2019.04.008. [Epub ahead of print]

Micropapillary adenocarcinoma of lung: Morphological criteria and diagnostic reproducibility among pulmonary pathologists.

Monroig-Bosque PDC1, Morales-Rosado JA2, Roden AC3, Churg A4, Barrios R1, Cagle P1, Ge Y1, Allen TC5, Smith ML3, Larsen BT3, Sholl LM6, Beasley MB7, Borczuk A8, Raparia K9, Ayala A1, Tazelaar HD10, Miller R1, Kalhor N11, Moran CA12, Ro JY13.

Author information

1

Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA.

2

Health Sciences Research Department, Mayo Clinic, Rochester, MN, USA.

3

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.

4

Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.

5

Department of Pathology, The University of Mississippi Medical Center, MS, USA.

6

Department of Pathology, Harvard Medical School, Boston, MA, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.

7

Department of Anatomic Pathology, The Mount Sinai Hospital, New York, NY, USA.

8

Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY, USA.

9

Kaiser Permanente, Santa Clara Medical Center and Medical Offices, Santa Clara, CA, USA.

10

Department of Pathology, Mayo Clinic, Phoenix, AZ, USA.

11

Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

12

Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA; Health Sciences Research Department, Mayo Clinic, Rochester, MN, USA.

13

Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA. Electronic address: JaeRo@houstonmethodist.org.

Abstract

CONTEXT:

Invasive micropapillary adenocarcinoma (MPC) is an aggressive variant of lung adenocarcinoma, frequently manifesting with advanced stage lymph node metastasis and decreased survival.

OBJECTIVE:

Identification of this morphology is important, as it is strongly correlated with poor prognosis regardless of the amount of MPC component. To date, no study has investigated the morphological criteria used to objectively diagnose it.

DESIGN:

Herein, we selected 30 cases of potential MPC of lung, and distributed 2 digital images per case among 15 pulmonary pathology experts. Reviewers were requested to diagnostically interpret, assign the percentage of MPC component, and record the morphological features they identified. The noted features included: columnar cells, elongated slender cell nests, extensive stromal retraction, lumen formation with internal epithelial tufting, epithelial signet ring-like forms, intracytoplasmic vacuolization, multiple nests in the same alveolar space, back-to-back lacunar spaces, epithelial nest anastomosis, marked pleomorphism, peripherally oriented nuclei, randomly distributed nuclei, small/medium/large tumor nest size, fibrovascular cores, and spread through air-spaces (STAS).

RESULTS:

Cluster analysis revealed three subgroups with the following diagnoses: "MPC", "combined papillary and MPC", and "others". The subgroups correlated with the reported median percentage of MPC. Intracytoplasmic vacuolization, epithelial nest anastomosis/confluence, multiple nests in the same alveolar space, and small/medium tumor nest size were the most common criteria identified in the cases diagnosed as MPC. Peripherally oriented nuclei and epithelial signet ring-like forms were frequently identified in both the "MPC" and "combined papillary and MPC" groups.

CONCLUSIONS:

Our study provides objective diagnostic criteria to diagnose MPC of lung.

I am a practicing pathologist and currently serve on the College of American Pathologists Board of Governors. I am a Candidate for the College of American Pathologists' President-Elect, 2019-2021 term. My vision is here.

I am a practicing pathologist and currently serve on the College of American Pathologists Board of Governors.  I am a Candidate for the College of American Pathologists' President-Elect, 2019-2021 term.  My vision is here.

Membership Growth. Pathologist Payment.

A pair of glasses were left on the floor at a museum and everyone mistook it for art HT:KL

A pair of glasses were left on the floor at a museum and everyone mistook it for art

The Trust Revolution How the Digitization of Trust Will Revolutionize Business and Government - Todd Henderson and Salen Churi

The Trust Revolution

How the Digitization of Trust Will Revolutionize Business and Government

M.Todd Henderson, University of Chicago , Salen Churi, Trust Ventures

Book description

While conventional wisdom dictates that people's trust – in the government, in corporations, in each other - is at a historic low, the rise of the internet is offering new ways to rehabilitate and strengthen trust. Uber is probably the best example of a new company that, on the surface, allows individuals with smartphones to get rides with strangers, but at a deeper level is in the business of trust. In The Trust Revolution, M. Todd Henderson and Salen Churi trace the history of innovation and trust, linking companies such as Uber with medieval guilds, early corporations, self-regulatory organizations, and New-Deal era administrative agencies. This book should be read by anyone who wants to understand how trust - and its means of creation - has the potential not only to expand opportunities for human cooperation, but also to reduce the size and scope of government and corporate control over our lives.