Bioethics. 2016 May 16. doi: 10.1111/bioe.12260. [Epub ahead of print]

Do we Know Whether Researchers and Reviewers are Estimating Risk and Benefit Accurately?

Hey SP, Kimmelman J.

Abstract

Accurate estimation of risk and benefit is integral to good clinical research planning, ethical review, and study implementation. Some commentators have argued that various actors in clinical research systems are prone to biased or arbitrary risk/benefit estimation. In this commentary, we suggest the evidence supporting such claims is very limited. Most prior work has imputed risk/benefit beliefs based on past behavior or goals, rather than directly measuring them. We describe an approach - forecast analysis - that would enable direct and effective measure of the quality of risk/benefit estimation. We then consider some objections and limitations to the forecasting approach.

"Moderate interobserver variability exists in the diagnosis of Grade 3 Endometrioid Carcinoma with a significantly greater diagnostic agreement rate in gynecologic pathology–focused sign-out than in general sign-out practice."

Sumi Thomas, Yaser Hussein, Sudeshna Bandyopadhyay, Michele Cote, Oudai Hassan, Eman Abdulfatah, Baraa Alosh, Hui Guan,Robert A. Soslow, and Rouba Ali-Fehmi (2016) Interobserver Variability in the Diagnosis of Uterine High-Grade Endometrioid Carcinoma. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Interobserver Variability in the Diagnosis of Uterine High-Grade Endometrioid Carcinoma

Sumi Thomas , MD; Yaser Hussein , MD; Sudeshna Bandyopadhyay , MD; Michele Cote , PhD; Oudai Hassan , MD; Eman Abdulfatah , MD; Baraa Alosh , MD; Hui Guan , MD; Robert A. Soslow , MD; Rouba Ali-Fehmi , MD;

Reprints: Robert A. Soslow, MD, Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (email: soslowr@mskcc.org).

Context.—Low interobserver diagnostic agreement exists among high-grade endometrial carcinomas.

Objective.—To evaluate diagnostic variability in International Federation of Gynecology and Obstetrics (FIGO) grade 3 endometrioid adenocarcinoma (G3EC) in 2 different sign-out practices.

Design.—Sixty-six G3EC cases were identified from pathology archives of Wayne State University (WSU, Detroit, Michigan) (general surgical pathology sign-out) and 65 from Memorial Sloan Kettering Cancer Center (MSK, New York, New York) (gynecologic pathology focused sign-out). Each case was reviewed together by 2 gynecologic pathologists, one from each institution, and classified into the G3EC group or a reclassified group. Clinicopathologic parameters were compared.

Results.—Twenty-five WSU cases (38%) were reclassified as undifferentiated (n = 2), serous (n = 4), mixed endometrioid and serous carcinomas (n = 12), and FIGO grade 2 endometrioid adenocarcinomas with focal marked nuclear atypia (n = 7). Eleven MSK cases (17%) were reclassified as undifferentiated (n = 5), serous (n = 1), mixed endometrioid and serous carcinomas (n = 4), and mixed endometrioid and clear cell carcinomas (n = 1). Agreement rate between original and review diagnosis was 83% (54 of 65) at MSK and 62% (41 of 66) at WSU (P = .01) with an overall rate of 73% (95 of 131). There were more undifferentiated carcinomas at MSK than there were at WSU (45% [5 of 11] versus 8% [2 of 25]; P = .02). There were more grade 2 endometrioid adenocarcinomas with focal, marked nuclear atypia at WSU (28%; 7 of 25) than there were at MSK (0%) (P = .03). Mixed endometrioid and serous carcinoma was the most common misclassified subtype (44%; 16 of 36).

Conclusion.—Moderate interobserver variability exists in the diagnosis of G3EC with a significantly greater diagnostic agreement rate in gynecologic pathology–focused sign-out than in general sign-out practice.

“Small changes can have a big impact and it doesn’t need to cost anything – parking 10 minutes further from the office..."

Warnings as obesity levels continue to grow

“In North Somerset we have seen an increase in obesity in all age groups, and being overweight can seriously increase your risk of developing a number of long-term and even life-threatening health problems, these include type two diabetes, heart disease, some types of cancer, back problems, impaired fertility.

“Small changes can have a big impact and it doesn’t need to cost anything – parking 10 minutes further from the office, or getting off the bus one stop earlier, all helps.

“There’s lots of information and advice on NHS Choices and the North Somerset CCG website and you can talk to your GP for advice and support.”

There is also additional support provided by North Somerset Council through its health trainers scheme, which looks to help people to lose weight with individual assistance from professionals.

Alicia M. Schnebelen, Jerad M. Gardner, and Sara C. Shalin (2016) Margin Status in Shave Biopsies of Nonmelanoma Skin Cancers: Is It Worth Reporting?. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Margin Status in Shave Biopsies of Nonmelanoma Skin Cancers: Is It Worth Reporting?

Alicia M. Schnebelen , MD; Jerad M. Gardner , MD; Sara C. Shalin , MD, PhD

Reprints: Sara C. Shalin, MD, PhD, Department of Pathology, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 517, Little Rock, AR 72205 (email: SCShalin@uams.edu).

Context.—The practice of reporting margin status in biopsies is relatively unique to biopsies of the skin and highly variable among pathologists.

Objective.—To address the accuracy of margin evaluation in shave biopsies of nonmelanoma skin cancers.

Design.—We collected shave biopsies of squamous and basal cell carcinomas that appeared to have uninvolved margins on routine sign out. We obtained deeper levels on corresponding tissue blocks until blocks were exhausted and examined them for tumor at biopsy margins.

Results.—Forty-seven consecutive cases were collected, including 20 squamous cell (43%) and 27 basal cell (57%) carcinomas. Eleven of 47 cases (23%) with negative margins at initial diagnosis demonstrated positive margins upon deeper-level examination. Margins of 8 of 27 basal cell carcinomas (30%) and 3 of 20 squamous cell carcinomas (15%) were erroneously classified as “negative” on routine examination.

Conclusions.—No guidelines exist regarding the reporting of margins in nonmelanoma skin cancer biopsies, and reporting practices vary extensively among pathologists. We found that nearly one-quarter of positive margins in shave biopsies for cutaneous carcinomas are missed on standard histologic examination. Moreover, reporting of a positive margin may also be misleading if the clinician has definitively treated the skin cancer at the time of biopsy. For these reasons, and as routine exhaustion of all tissue blocks is impractical, the decision to include or exclude a comment regarding the margin status should be given conscious consideration, accounting for the clinical intent of the biopsy and any known information regarding postbiopsy treatment.

Intell Inf Manag. 2016 Jan;8(1):9-16.

Translation in Data Mining to Advance Personalized Medicine for Health Equity.

Estape ES1, Mays MH2, Sternke EA3.

Author information

• 1Post-doctoral Master of Science in Clinical and Translational Research (MSc) and Hispanics in Research Capability (HiREC) Endowment Programs, School of Health Professions, Medical Sciences Campus-University of Puerto Rico.
• 2Post-doctoral Master of Science in Clinical and Translational Research (MSc), School of Health Professions, and the Puerto Rico Clinical and Translational Research Consortium, Medical Sciences Campus - University of Puerto Rico.
• 3Post-doctoral Master of Science in Clinical and Translational Research (MSc) School of Health Professions, Medical Sciences Campus-University of Puerto Rico.

Abstract

Personalized medicine is the development of 'tailored' therapies that reflect traditional medical approaches, with the incorporation of the patient's unique genetic profile and the environmental basis of the disease. These individualized strategies encompass disease prevention, diagnosis, as well as treatment strategies. Today's healthcare workforce is faced with the availability of massive amounts of patient- and disease-related data. When mined effectively, these data will help produce more efficient and effective diagnoses and treatment, leading to better prognoses for patients at both the individual and population level. Designing preventive and therapeutic interventions for those patients who will benefit most while minimizing side effects and controlling healthcare costs, requires bringing diverse data sources together in an analytic paradigm. A resource to clinicians in the development and application of personalized medicine is largely facilitated, perhaps even driven, by the analysis of "big data". For example, the availability of clinical data warehouses is a significant resource for clinicians in practicing personalized medicine. These "big data" repositories can be queried by clinicians, using specific questions, with data used to gain an understanding of challenges in patient care and treatment. Health informaticians are critical partners to data analytics including the use of technological infrastructures and predictive data mining strategies to access data from multiple sources, assisting clinicians' interpretation of data and development of personalized, targeted therapy recommendations. In this paper, we look at the concept of personalized medicine, offering perspectives in four important, influencing topics: 1) the availability of 'big data' and the role of biomedical informatics in personalized medicine, 2) the need for interdisciplinary teams in the development and evaluation of personalized therapeutic approaches, and 3) the impact of electronic medical record systems and clinical data warehouses on the field of personalized medicine. In closing, we present our fourth perspective, an overview to some of the ethical concerns related to personalized medicine and health equity.

Zombie allusions: They just keep on coming™: from Mayo Clinic

J Health Polit Policy Law. 2016 Apr 28. pii: 3621403. [Epub ahead of print]

David Mechanic: Professional Zombie Hunter.

Hafferty FW1, Tilburt J1.

Author information

• 1Mayo Clinic.

Abstract

Within the fields of medicine and sociology, the descriptor "profession" (along with its brethren: profession, professionalization, and professionalism) has had a rich etymological history, with terms taking on different meanings at different times-sometimes trespassing into shibboleth and jargon. This etymological journey has coevolved with the career of David Mechanic to whom this issue of the Journal of Health Politics, Policy and Law is devoted. We exploit a provocative metaphor applied to Mechanic's work on the challenges facing medicine as a profession as a playful exegesis on what we call "profession" to excavate an ensconced and encrusted domain of health jargon operating at the tensive interface of society and modern medical work.

Telemicrobiology

Daniel D. Rhoads, Blaine A. Mathison, Henry S. Bishop, Alexandre J. da Silva, and Liron Pantanowitz (2016) Review of Telemicrobiology. Archives of Pathology & Laboratory Medicine: April 2016, Vol. 140, No. 4, pp. 362-370.

REVIEW ARTICLE

Review of Telemicrobiology

Daniel D. Rhoads , MD; Blaine A. Mathison , BS; Henry S. Bishop ; Alexandre J. da Silva , PhD; Liron Pantanowitz , MD

From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Rhoads and Pantanowitz);

the Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia (Messrs Mathison and Bishop and Dr da Silva);

and the Center for Food Safety and Applied Nutrition, US Food and Drug Administration, Laurel, Maryland (Dr da Silva).

Dr Rhoads is now with the Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio.

Reprints: Daniel D. Rhoads, MD, Department of Laboratory Medicine, Cleveland Clinic, 9500 Euclid Ave, LL1-123, Cleveland, OH 44195 (email: danrhoads@gmail.com).

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

Context.—Microbiology laboratories are continually pursuing means to improve quality, rapidity, and efficiency of specimen analysis in the face of limited resources. One means by which to achieve these improvements is through the remote analysis of digital images. Telemicrobiology enables the remote interpretation of images of microbiology specimens. To date, the practice of clinical telemicrobiology has not been thoroughly reviewed.

Objective.—To identify the various methods that can be employed for telemicrobiology, including emerging technologies that may provide value to the clinical laboratory.

Data Sources.—Peer-reviewed literature, conference proceedings, meeting presentations, and expert opinions pertaining to telemicrobiology have been evaluated.

Conclusions.—A number of modalities have been employed for telemicroscopy, including static capture techniques, whole slide imaging, video telemicroscopy, mobile devices, and hybrid systems. Telemicrobiology has been successfully implemented for several applications, including routine primary diagnosis, expert teleconsultation, and proficiency testing. Emerging areas of telemicrobiology include digital plate reading of bacterial cultures, mobile health applications, and computer-augmented analysis of digital images. To date, static image capture techniques have been the most widely used modality for telemicrobiology, despite newer technologies being available that may produce better quality interpretations. Telemicrobiology adds value, quality, and efficiency to the clinical microbiology laboratory, and increased adoption of telemicrobiology is anticipated.

FDA to modify food label guidelines to include added sugar details

"Michael Jacobson, president of the Center for Science in the Public Interest, which first petitioned the FDA to put added sugars on Nutrition Facts labels in 1999, said the new rules could prompt food makers to rethink their recipes."

Time to End Free Drug Samples

Time to End Free Drug Samples

"...the real but meager benefits of free drug samples are overwhelmed by the social costs, including the insidious erosion of patient trust. Half measures such as increased regulation and physician  education have failed and there is no evidence adding new measures would be of any benefit. It is time to end free drug samples."

"Hawaii and Colorado...are the only two states that boast obesity rates below one fifth of their adult population."

The States With the Fastest Growing Obesity Problem

"West Virginia ranks as the heftiest state, with an adult obesity rate of 37 percent. In a close second, Mississippi has an obesity rate of 35.5 percent, and Delaware rounds out the top three with a rate of 33.8 percent. 

Hawaii ranks as the leanest state, with an adult obesity rate of 18.5 percent. Hawaii and Colorado, which has the second-lowest obesity level at 19.8 percent, are the only two states that boast obesity rates below one fifth of their adult population."

"Despite the excitement surrounding liquid biopsy that has been generated by coverage in the lay press and scientific literature, its utility in clinical practice is still relatively unproven."

"Despite the excitement surrounding liquid biopsy that has been generated by coverage in the lay press and scientific literature, its utility inclinical practice is still relatively unproven."

Utilization of Cell-Transfer Technique for Molecular Testing on Hematoxylin-Eosin–Stained Sections

Howard H. Wu, Stephen M. Jovonovich, Melissa Randolph, Kristin M. Post, Joyashree D. Sen, Kendra Curless, and Liang Cheng(2016) Utilization of Cell-Transfer Technique for Molecular Testing on Hematoxylin-Eosin–Stained Sections. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Utilization of Cell-Transfer Technique for Molecular Testing on Hematoxylin-Eosin–Stained Sections

A Viable Option for Small Biopsies That Lack Tumor Tissues in Paraffin Block

Howard H. Wu , MD; Stephen M. Jovonovich , MD; Melissa Randolph , CT(ASCP); Kristin M. Post , MLS(ASCP), MPH; Joyashree D. Sen , MD; Kendra Curless , MLS(ASCP); Liang Cheng , MD

Reprints: Howard H. Wu, MD, Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, 350 W 11th St, IUHPL-Room 4086, Indianapolis, IN 46202 (email: hhwu@iupui.edu).

Context.—In some instances the standard method of doing molecular testing from formalin-fixed, paraffin-embedded block is not possible because of limited tissue. Tumor cell–enriched cell-transfer technique has been proven useful for performing immunocytochemistry and molecular testing on cytologic smears.

Objective.—To establish the cell-transfer technique as a viable option for isolating tumor cells from hematoxylin-eosin (H&E)–stained slides.

Design.—Molecular testing was performed by using the cell-transfer technique on 97 archived H&E-stained slides from a variety of different tumors. Results were compared to the conventional method of molecular testing.

Results.—Polymerase chain reaction–based molecular testing via the cell-transfer technique was successfully performed on 82 of 97 samples (85%). This included 39 of 47 cases for EGFR, 10 of 11 cases for BRAF, and 33 of 39 cases for KRASmutations. Eighty-one of 82 cell-transfer technique samples (99%) showed agreement with previous standard method results, including 4 mutations and 35 wild-type alleles for EGFR, 4 mutations and 6 wild-type alleles for BRAF, and 11 mutations and 21 wild-type alleles for KRAS. There was only 1 discrepancy: a cell-transfer technique with a false-negativeKRAS result (wild type versus G12C).

Conclusions.—Molecular testing performed on H&E-stained sections via cell-transfer technique is useful when cell blocks and small surgical biopsy samples run out of tissue and the only available material for testing is on H&E-stained slides.

Licensure in the Era of Genomic Medicine. c.f., Digital pathology and federalism.

Jason Y. Park, Stanley T. Leung, and Jason Wang (2016) Licensure in the Era of Genomic Medicine. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Licensure in the Era of Genomic Medicine

Jason Y. Park , MD, PhD; Stanley T. Leung , MD, JD; Jason Wang , MD
c.f., 

Arch Pathol Lab Med. 2014 Feb;138(2):162-5. doi: 10.5858/arpa.2013-0258-ED. Epub 2013 Jun 5.

Digital pathology and federalism.

Allen TC1.

Author information

• 1From the Department of Pathology, University of Texas Health Science Center at Tyler. Dr Allen is now located at the University of Texas Medical Branch at Galveston, Texas.

From @DrMisialek and me: You're On Social Media! So Now What?

Michael J. Misialek and Timothy Craig Allen (2016) You're On Social Media! So Now What?. Archives of Pathology & Laboratory Medicine: May 2016, Vol. 140, No. 5, pp. 393-393.

EDITORIAL

You're On Social Media! So Now What?

Michael J. Misialek , MD; Timothy Craig Allen , MD, JD

From the Department of Pathology, Newton-Wellesley Hospital, Newton, Massachusetts (Dr Misialek);

and the Department of Pathology, The University of Texas Medical Branch, Galveston (Dr Allen).

Pharrell Williams is Happy

Pharrell Williams is Happy

From UTSW's David Wang and Jason Park: Precision Medicine in Gastrointestinal Pathology

David H. Wang and Jason Y. Park (2016) Precision Medicine in Gastrointestinal Pathology. Archives of Pathology & Laboratory Medicine: May 2016, Vol. 140, No. 5, pp. 449-460.

KOPANA 2015 SPRING SEMINAR

Precision Medicine in Gastrointestinal Pathology

David H. Wang , MD, PhD; Jason Y. Park , MD, PhD

From the Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center and Dallas Veterans Affairs Medical Center, Dallas (Dr Wang);

and the Department of Pathology, Eugene McDermott Center for Human Growth and Development, Children's Medical Center, and University of Texas Southwestern Medical Center, Dallas (Dr Park).

Reprints: Jason Y. Park, MD, PhD, Department of Pathology, Children's Medical Center, 1935 Medical District Dr, Dallas, TX 75235 (email: jaspar@childrens.com).

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

Presented at the 14th spring seminar of the Korean Pathologists Association of North America (KOPANA); March 19–21, 2015; Boston, Massachusetts.

Context.—Precision medicine is the promise of individualized therapy and management of patients based on their personal biology. There are now multiple global initiatives to perform whole-genome sequencing on millions of individuals. In the United States, an early program was the Million Veteran Program, and a more recent proposal in 2015 by the president of the United States is the Precision Medicine Initiative. To implement precision medicine in routine oncology care, genetic variants present in tumors need to be matched with effective clinical therapeutics. When we focus on the current state of precision medicine for gastrointestinal malignancies, it becomes apparent that there is a mixed history of success and failure.

Objective.—To present the current state of precision medicine using gastrointestinal oncology as a model. We will present currently available targeted therapeutics, promising new findings in clinical genomic oncology, remaining quality issues in genomic testing, and emerging oncology clinical trial designs.

Data Sources.—Review of the literature including clinical genomic studies on gastrointestinal malignancies, clinical oncology trials on therapeutics targeted to molecular alterations, and emerging clinical oncology study designs.

Conclusions.—Translating our ability to sequence thousands of genes into meaningful improvements in patient survival will be the challenge for the next decade.

From Dr. Maren Fuller and me: Let's Have a Tweetup The Case for Using Twitter Professionally

Maren Y. Fuller and Timothy Craig Allen (2016) Let's Have a Tweetup. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Let's Have a Tweetup

The Case for Using Twitter Professionally

Maren Y. Fuller , MD; Timothy Craig Allen , MD, JD

Reprints: Timothy Craig Allen, MD, JD, Department of Pathology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555 (email: tcallen@utmb.edu).

Social media use is very common and can be an effective way for professionals to discuss information and interact with colleagues. Twitter (Twitter, Inc, San Francisco, California) is a social media network where posts, termed tweets, are limited to 140 characters. Professional use of Twitter is ideal for physicians interested in both networking and education and is optimally used to facilitate in-person networking. Live-tweeting (posting real-time reactions to events) at professional meetings is also a popular and highly successful use of Twitter. Physicians report patient privacy as the top concern preventing use of social media for professional reasons, and although generally social media use is safe, it is essential to understand how to protect patient confidentially. Other social media platforms with potential for professional use include Facebook (Facebook, Inc, Menlo Park, California), Instagram (Facebook, Inc), YouTube (YouTube, LLC, San Bruno, California), and Periscope (Twitter, Inc). With Twitter and other social media options, now is the time for pathologists to increase our visibility on social media and worldwide.

A Low-Cost Adapter for Smartphone Microscopic Photography Using a Cardboard Toilet-Paper Roll

Saranya Singaravel and Mohammed Abdul Aleem (2016) Hands-free: A Low-Cost Adapter for Smartphone Microscopic Photography Using a Cardboard Toilet-Paper Roll. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Hands-free: A Low-Cost Adapter for Smartphone Microscopic Photography Using a Cardboard Toilet-Paper Roll

Saranya Singaravel , MBBS, DCP, DNB (Path)¹; Mohammed Abdul Aleem , MD²

¹ Department of Pathology, King Edward Memorial Hospital, Mumbai, Maharashtra, India;

² Department of Pathology, Osmania Medical College, Koti, Hyderabad, Telangana State, India

Lynette M. Sholl, Dara L. Aisner, Timothy Craig Allen, Mary Beth Beasley, Philip T. Cagle, Vera L. Capelozzi, Sanja Dacic, Lida P. Hariri, Keith M. Kerr, Sylvie Lantuejoul, Mari Mino-Kenudson, Kirtee Raparia, Natasha Rekhtman, Sinchita Roy-Chowdhuri, Eric Thunnissen, Ming Tsao, Marina Vivero, and Yasushi Yatabe (2016) Liquid Biopsy in Lung Cancer. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Liquid Biopsy in Lung Cancer

A Perspective From Members of the Pulmonary Pathology Society

Lynette M. Sholl , MD; Dara L. Aisner , MD, PhD; Timothy Craig Allen , MD, JD; Mary Beth Beasley , MD; Philip T. Cagle , MD;Vera L. Capelozzi , MD, PhD; Sanja Dacic , MD, PhD; Lida P. Hariri , MD, PhD; Keith M. Kerr , MD, BSc, MB, ChB, FRCPath, FRCPE; Sylvie Lantuejoul , MD, PhD; Mari Mino-Kenudson , MD; Kirtee Raparia , MBBS; Natasha Rekhtman , MD, PhD; Sinchita Roy-Chowdhuri , MD, PhD; Eric Thunnissen , MD, PhD; Ming Tsao , MD; Marina Vivero , MD; Yasushi Yatabe , MD, PhD

Reprints: Timothy Craig Allen, MD, JD, Department of Pathology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555 (email: tcallen@utmb.edu).

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.

From U Chicago: "Believing one 'less evil than thou' seems more reliable than believing one is 'holier than thou.'"

J Pers Soc Psychol. 2016 May;110(5):660-74. doi: 10.1037/pspa0000050.

Maybe holier, but definitely less evil, than you: Bounded self-righteousness in social judgment.

Klein N1, Epley N2.

Author information

• 1Harris School of Public Policy, University of Chicago.
• 2Booth School of Business, University of Chicago.

Abstract

Few biases in human judgment are easier to demonstrate than self-righteousness: the tendency to believe one is more moral than others. Existing research, however, has overlooked an important ambiguity in evaluations of one's own and others' moral behavior that could lead to an overly simplistic characterization of self-righteousness. In particular, moral behavior spans a broad spectrum ranging from doing good to doing bad. Self-righteousness could indicate believing that one is more likely to do good than others, less likely to do bad, or both. Based on cognitive and motivational mechanisms, we predicted an asymmetry in the degree of self-righteousness such that it would be larger when considering unethical actions (doing bad) than when considering ethical actions (doing good). A series of experiments confirmed this prediction. A final experiment suggests that this asymmetry is partly produced by the difference in perspectives that people adopt when evaluating themselves and others (Experiment 8). These results all suggest a bounded sense of self-righteousness. Believing one "less evil than thou" seems more reliable than believing one is "holier than thou."

Exercise plays significant role in combating obesity

"Some have claimed that exercise may not play a significant role in weight loss, as exercise can increase appetite resulting in greater food intake and potentially reduce activity throughout the day," said Vicki Vieira-Potter, assistant professor of nutrition and exercise physiology at MU. "The purpose of this study was to look at exercise independently from weight loss and to determine other metabolic benefits associated with physical activity. Our team aimed to tease out what effects on adipose, or fat tissue, were due to weight loss from diet, and what could be attributed to exercise."

Am J Perinatol. 2016 May 9. [Epub ahead of print]

Pregnancy and Brain Death: Lack of Guidance in U.S. Hospital Policies.

Lewis A1, Varelas P2, Greer D3.

Author information

• 1Division of Neurocritical Care, Departments of Neurology and Neurosurgery, NYU Langone Medical Center, New York, New York.
• 2Departments of Neurology and Neurosurgery, Henry Ford Hospital, Detroit, Michigan.
• 3Department of Neurology, Yale University School of Medicine, New Haven, Connecticut.

Abstract

Objective The death of Marlise Muñoz, a pregnant woman who suffered an anoxic brain injury in November 2013, highlights the social, ethical, legal, and medical controversies associated with brain death in pregnancy. We sought to evaluate whether institutions in the United States have policies in place for situations in which a pregnant woman is declared brain dead. Study Design Institutional brain-death protocols from hospitals in the United States were obtained in cooperation with local and regional organ procurement agencies. Each protocol was reviewed to determine if and how it addressed brain death in pregnancy. Results We reviewed 317 unique brain-death protocols. In eight protocols (2.5%), it was noted that a pregnant patient could not be evaluated for brain death if the fetus could be preserved. Of the protocols that permitted brain-death evaluation, 289 (93.8%) did not include guidance about fetal management after maternal brain death and 305 (99%) did not indicate who was responsible for making decisions for the fetus. Conclusion Very few institutional brain-death policies address the issue of pregnancy. The creation of guidelines on management of the social and ethical challenges associated with brain death in pregnancy may be helpful.

Brandon S. Sheffield, Julie Lorette, Yaoqing Shen, Marco A. Marra, and Andrew Churg (2016) Immunohistochemistry for NF2, LATS1/2, and YAP/TAZ Fails to Separate Benign From Malignant Mesothelial Proliferations. Archives of Pathology & Laboratory Medicine: May 2016, Vol. 140, No. 5, pp. 391-391.

LETTERS TO THE EDITOR

Immunohistochemistry for NF2, LATS1/2, and YAP/TAZ Fails to Separate Benign From Malignant Mesothelial Proliferations

Brandon S. Sheffield , MD¹; Julie Lorette , MLT²; Yaoqing Shen , MD³; Marco A. Marra , PhD^3,4; Andrew Churg , MD^1,5

¹ Departments of Pathology and Laboratory Medicine and

⁴ Medical Genetics, University of British Columbia, Vancouver, Canada;

² Department of Pathology and

³ Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, Canada;

⁵ Department of Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada

More Southerners at risk for kidney stones

"Experts haven’t pinpointed an exact cause for the increase. Poor diet, higher temperatures, not drinking enough fluids, hours of sunlight exposure and obesity are likely factors in the frequency of kidney stones."

Nurs Inq. 2016 May 6. doi: 10.1111/nin.12133. [Epub ahead of print]

Politics of change: the discourses that inform organizational change and their capacity to silence.

McMillan K1.

Author information

• 1Faculty of Nursing, University of Ottawa, Ottawa, ON, Canada.

Abstract

Changes in healthcare organizations are inevitable and occurring at unprecedented rates. Such changes greatly impact nurses and their work, yet these experiences are rarely explored. Organizational change discourses remain grounded in perspectives that explore and explain systems, often not the people within them. Change processes in healthcare organizations informed by such organizational discourses validate only certain perspectives and forms of knowledge. This fosters exclusionary practices, limiting the capacity of certain individuals or groups of individuals to effectively contribute to change discourses and processes. The reliance on mainstream organizational discourses in healthcare organizations has left little room for the exploration of diverse perspectives on the subject of organizational change, particularly those of nurses. Michel Foucault's work challenges dominant discourse and suggest that strong reliance's on specific discourses effectively disqualify certain forms of knowledge. Foucault's writings on disqualified knowledge and parrhesia (truth telling and frank speech) facilitate the critical exploration of discourses that inform change in healthcare organizations and nurses capacities to contribute to organizational discourses. This paper explores the capacity of nurses to speak their truths within rapidly and continuously changing healthcare organizations when such changes are often driven by discourses not derived from nursing knowledge or experience.

Believing you are a foodie makes you eat less: study

People who believe themselves to be "food addicts" eat less, claims a new study which found that the perception of being a foodie makes them concerned about their eating behaviour.

"London, May 8: People who believe themselves to be “food addicts” eat less, claims a new study which found that the perception of being a foodie makes them concerned about their eating behaviour. Obesity is often attributed to an addiction to food and many people believe themselves to be “food addicts.” However, until now no studies have looked at whether believing oneself to be a food addict influences how much we eat, researchers said. Researchers from University of Liverpool in the UK examined the impact of changing participants’ personal food addiction beliefs on eating behaviour."

Soc Sci Med. 2016 Apr 29;159:22-29. doi: 10.1016/j.socscimed.2016.04.033. [Epub ahead of print]

Understanding global health and development partnerships: Perspectives from African and global health system professionals.

Barnes A1, Brown GW2, Harman S3.

Author information

• 1School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA, UK. Electronic address: a.barnes@sheffield.ac.uk.
• 2Department of Politics, University of Sheffield, Elmfield, Northumberland Road, Sheffield, S10 2TU, UK.
• 3School of Politics and International Relations, Queen Mary University of London, Mile End Road, London, E1 4NS, UK.

Abstract

Partnership is a key idea in current debates about global health and development assistance, yet little is known about what partnership means to those who are responsible for operationalising it or how it is experienced in practice. This is particularly the case in the context of African health systems. This paper explores how health professionals working in global health hubs and the health systems of South Africa, Tanzania and Zambia understand and experience partnership. Drawing on semi-structured interviews with 101 professionals based in each country, Washington DC and Geneva between October 2012 and June 2013, the paper makes four key arguments. First, partnership has a legitimating function in global health policy processes for international development institutions, government agencies and civil society organisations alike. Second, the practice of partnership generates idiosyncratic and complicated relationships that health professionals have to manage and navigate, often informally. Third, partnership is shaped by historical legacies, critical events, and independent consultants. Fourth, despite being an accepted part of global health policy, there is little shared understanding of what good partnership is meant to include or resemble in practice. Knowing more about the specific socio-cultural and political dynamics of partnership in different health system contexts is critical to equip health professionals with the skills to build the informal relations that are essential to effective partnership engagement.