Monthly Archives: August 2011

2011 CAP Election Results

Posted on by

Congratulations to Dr. Gene Herbek and the newly elected governors.  Excellent choices!

From CAP: The results of this summer’s ballot for the CAP election are now final. The College would like to thank all Fellows and Life Fellows who voted in this year’s election.

The winners of this year’s election are:

  • President-elect:
    • Gene N. Herbek, MD, FCAP, Omaha, Nebraska
  • Governors:
    • Patrick E. T. Godbey, MD, FCAP, Brunswick, Georgia
    • William F. Hickey, MD, FCAP, Lebanon, New Hampshire
    • Stephen J. Sarewitz, MD, FCAP, Renton, Washington
    • Elizabeth A. Wagar, MD, FCAP, Houston, TX

The results will be officially announced and the winners sworn in at the CAP Business Meeting in conjunction with the House of Delegates/Residents Forum joint session on Saturday, September 10, 2011, in Grapevine, Texas. All CAP members are welcome to attend.

Source:
http://feeds.feedburner.com/DigitalPathologyBlog

Pathology woes continue in Canada

Posted on by

From Dark Daily 8/15/2011: Even as the Province of Manitoba deals with some highly-publicized issues in anatomic pathology, over in the neighboring Province of Saskatchewan, a sizeable backlog in anatomic pathology cases earlier in the year caused the Saskatoon Health Region to refer pathology cases to another region within the province.

Read full story at Dark Daily.

Source:
http://feeds.feedburner.com/DigitalPathologyBlog

Do you order stains requested by clinicians?

Posted on by

Dr. Tom Wheeler has an interesting blog post over at his blog Lab Line by the Doctor’s Doctor.

It starts "I was out of town attending a conference when I got an email from an infectious disease internist wondering if I had done the AFB stain on a bone biopsy that had been specifically ordered by the attending physician on the pathology requisition slip accompanying the specimen.  On the surface this might seem as a reasonable request – the patient had been treated for active tuberculosis involving the bone for over one year and there was a desire to complete the placement of an artificial joint, but only if the tissue was negative for TB."

One of many comments received mentioned "You forget your place; yours is to perform a test at the direction of the attending physician (and in most cases that test is set up by a technician for you to review so you aren't in on the front end). You are not the physician of record and while you have an opinion and level of knowledge that the ordering physician may not (or then again they may have) you do not get to dictate to the "Customer of the Lab" whether or not you will perform the service ordered. Try that on a regular basis and they will take their business elsewhere and there are literally hundreds of labs looking for work. "

Dr. Wheeler goes on to explain that in communication with the clinician, justification for not ordering the stain was provided with an amicable resolution of the matter and reassurance to the clinician was provided and all ended well.  The stain was not done; Dr. Wheeler exercised his right as a physician to use his judgement based on what he knew and saw of the case and did not perform the test, even though it was specifically requested by the ordering physician.

The anonymous comment above takes a different approach and one I must admit is more like I have thought and generally follow.  If a specific stain is ordered, take congo red, to rule out amyloid, I could either a) after reviewing the case if I think it is warranted, order the stain; b) order the stain even if I do not think the histologic findings warrant doing so but performing the stain "just in case"; c) order the stain regardless of what I see on the histology to avoid a subsequent phone call, e-mail or text asking me why I did not order the stain; d) not perform the stain based on what I see on the histology and head off the question or another request to do so with my own phone call or e-mail. 

Depending on the particular request, I must admit I sometimes take the easy way out and do the stain becuase I think if the clinician made the request, they may have some information I do not have in front of me or in the EMR (yes, this does happen -- EMRs only contain information someone puts into them), unless I think the request if completely off the wall.  This way when they ask about the stain, I can report it was done at their request and was negative.  

To some extent, we do this already as standing orders, which in some cases, are not justified.  Helicobacter stains on all "gastric" biopsies. Alcian blue stains on all "esophagus" or liver "panels".  The problem is that for non-gastritis, non-Barrett's cases and liver biopsies to rule out tumors, you may still get stains that are not warranted. Why is this done?  Because the clinicians usually requested it at some point -- Dear medical diretor/chairman/group head -- please do a Helicobacter stain on all stomach biopsies or an alcian blue on all esophagus biopsies so "you don't miss anything".

What do you do/does your practice do about specific stain requests?  Which ones do you do routinely largely because, historically, a clinician or group of clinicians made a standing request at some time?

 

 

Source:
http://feeds.feedburner.com/DigitalPathologyBlog

Seoul, Korea

Posted on by

















Hi all. My sincere apologies for falling behind on Morbid Anatomy. I am currently living in Seoul, Korea as part of the very generous Apex Art Outbound Residency Program (thanks, Josh Foer!), and one of the obligations of the residency is to blog about my experiences. Sadly, this had taken my focus off Morbid Anatomy a bit.

I promise to do my best over this next month in Korea to get some Morbid Anatomy reportage done; in the meantime, if you are curious about what I am finding in Seoul, you can check out my Apex Art blog here.

Thanks for your patience, and I will be back in full force in mid-September!

Source:
http://morbidanatomy.blogspot.com/feeds/posts/default?alt=rss

Ares 1 Deja Vu?

Posted on by

Is the answer to heavy-lift rocket cost issue bringing back Ares I?, Huntsville Times

"As NASA's new heavy-lift rocket struggles to get off the drawing board, a national space analyst says the answer to moving into deep space may be bringing back Ares I, the rocket NASA just canceled. Dr. Scott Pace, director of the Space Policy Institute at George Washington University, raised the Ares option last week as one way out of political and financial thicket that has enmeshed the Space Launch System (SLS), which is the formal name for the heavy-lift rocket project."

Black Ops busts down guy’s door for not cleaning up his House

Posted on by

Tales from America's continuing War on Drugs

by Clifford F. Thies

Better start cleaning up, America! You never know when a dozen or more heavily armed black ops officers will bust through the doors, with semi-automatic rifles and other special weapons, and arrest you for having a disorderly house.

No, you read that right. That is no typo. They were given a citation for having a "disorderly house."

From KCRG.org Cedar Rapids, Aug. 12:

Police in SWAT gear busted through a door and searched a Cedar Rapids home for drugs Thursday morning, but came up empty.

At least 12 officers surprised the tenants at 1135 33rdSt. NE when they arrived around 7 a.m. with a narcotics search warrant. Sgt. Cristy Hamblin, a police spokeswoman, later confirmed that nothing was seized from the house.

No one was taken to jail, but the tenants of the house, Justin Davis, 28, and his girlfriend, Erica Lewis, 26, were charged with disorderly house and signed a promise to appear in court, police said. No one was injured during the raid.

I mean, if you don't actually have any illegal drugs, what do you expect them to do, overlook your stash of high fructose candy bars, half-eaten double cheese pizza, your continued use of incandescent light bulbs, or the thermostat on your air conditioner unit set too low? What, do you think you're still living in the land of the free??? Don't you know, comrade, you are now living in the USSA!

Photo credit - SodaHead

Michigan Islamist Rep. calls critics of Sharia Law "Racists!"

Posted on by

From Eric Dondero:

Republican representative Dave Agema of Granville has introduced a bill in the Michigan legislature to ban foreign laws in U.S. courts.

According to clickonDetroit.com "Mich. Rep. Proposes Anti 'Foreign Laws' Bill

Critics Say Bill Attacks Muslim Sharia Law" Aug. 16:

Although the bill does not specifically mention Sharia law, critics are still saying that it directly targets Muslim Americans.

Radical Islamist legislator Rashida Talib is defending Sharia and fiercely criticizing supporters of the bill. Continuing:

"This is racism at its core," said Rep. Rashida Talib (D-Detroit). "This is how it all starts. This is how the conflict among neighbors starts when you cast suspicion onto people with the introduction of this bill."

So far the legislation has 41 co-sponsors.

Here we go again… Libertarians just a bunch of mis-guided "Pot-smoking Republicans"

Posted on by

Under libertarianism, "little Tommy" would be working at the local factor, making wages "just a few nickels above slavery"

Michael Kindt is a writer living in South Dakota whose work has appeared in College Times, Midwest Lit Review and in the poetry anthology “It’s Dark & Scary In Here.” He’s the author of “Early Onset of Night, Volume One” and blogs at Early-Onset-of-Night.tumblr.com.

Excerpted from his column - "What do you call a Republican who smokes marijuana? A Libertarian" Aug. 21, TheAdvertiser.com (Baton Rouge, LA):

As far as I can make out, Libertarians are just basically Republicans who are really for smaller government—no, like, really —and who are unencumbered by the self-righteousness, love of telling others how to behave, and cosmic levels of hypocrisy found among the Religious Wrong. Libertarians talk a great game about personal liberty, about freedom, but really advocate an increased empowering of business and corporate interests at the expense of everything else...

little Tommy would be down at the factory earning a fair wage as determined entirely by the company he works for and without any input or support from anyone else. In other words, he would be earning a few nickels above slavery.

What’s funny about this to me is that they don’t seem to realize just how much personal and private liberty would diminish if the corporate powers-that-be are allowed to run unchecked. Why, it would be just like things are now, only worse.

I even respect a lot of the Libertarians I know. They seem like honest Republicans, which is rare. They blessedly lack the empty god-talk while still doing everything in their power to force those in need to fend for themselves.

Libertarianism is simply anarchy for rich people — and rich people alone. Nothing more. [emphasis added]

The reality of Libertarianism in America is that it is diametrically opposed liberty. It is the opposite of what it claims to be. It wants to remove the tyranny of the state, which is at least mitigated somewhat by the elective process, and give it over to private organizations who would then be completely unaccountable.

Editor's comment - There are just so many things wrong with this piece, who knows where to start? LR readers are encouraged to visit Mr. Kindt's blog and leave a comment or two, showing him the error of his ways.

One Ron Paul supporter says he might go Bachmann

Posted on by

New emphasis - Ronald Reaganesque "Peace through Strength"

From Eric Dondero:

Michele Bachmann was on a recent campaign swing through South Carolina.

Of special interest to pro-defense libertarians, from WestAshley.Patch.com "Bachmann: South Carolina essential to Victory" Aug. 19:

Calling herself a "peace through strength conservative," Bachmann said she would not close the prison at Guantanamo Bay because the United States needs a place to carry out interrogations to capture people like Osama Bin Laden.

Bachmann said she is seeking to consolidate the conservative base of national defense conservatives, fiscal conservatives, social conservatives and the Tea Party movement into an unstoppable force in 2012.

And then this interesting comment from a Ron Paul supporter. Continuing:

Bachmann has anti-establishment qualities Libertarians like Franz Meier of Mount Pleasant can appreciate.

“If I had my way, I’d like to see Ron Paul win, but if he’s not a viable candidate, I’ll vote for Bachmann,” Meier said. “She is well-spoken, very knowledgeable. She sees Washington for what it is.”

Photo credit - ConservativeDailyNews.com

Republican Liberty Caucus staying out of Libertarian vs. Republican special in NH

Posted on by

From Eric Dondero:

Brendan Kelly is the Libertarian Party candidate for State House in a special election set after Labor Day. The incumbent Republican resigned after a DUI conviction. The GOP nominee for the seat is viewed as too moderate for conservative voters. Thus Kelly has been winning a great deal of support on the Right.

But the RLC in the State is not making any formal commitments in the race.

From SeaCoastonline.com "Libertarian Kelly makes bid for House in District 14" Aug. 21:

"I know there has been some talk about that," said Andrew Hemingway, chairman of the Republican Liberty Caucus of New Hampshire. Hemingway said the RCLNH will make no endorsement in the race. The RCLNH endorsed Janvrin opponent Lou Garioulo of Hampton Falls in the primary, but Hemingway said there is not much enthusiasm among its members for Janvrin. "We're not going to support someone who doesn't represent our values," he said.

But the organization will not endorse Kelly. "While we have liberty-leaning principles, we are a Republican organization and won't support a third-party candidate," Hemingway said.

Editor's comment - Since the founding of the group, the RLC has stayed out of such races, as they should. Unless there is no Republican in the race. But for the record, as founder of the Republican Liberty Caucus, I formally endorse Brendan Kelly for State Rep.

Moon balloon | Bad Astronomy

Posted on by

Last Tuesday was back-to-school day for TLA*. On that day we got up early for the first time in a long time, prepped her, and with remarkably little fuss got her sent out the door.

… only to have her banging on the door literally ten seconds later. Figuring we had forgotten something, Mrs. BA† and I opened the door, whereupon TLA said "Come see this!"

We went outside, and this is what we saw:

[Click to hotairinflatenate.]

I ran back inside to grab my camera, and there ya go. We get lots of hot air balloons around here — the view of the foothills and Rockies must be stunning from up there — but I’ve never had such a perfectly framed shot like this one before.

Sometimes I like to use pictures like this as an excuse to talk about science — adiabatic expansion would fit here, or perspective and distance — but you know what? I think this is fine pretty much as it is.

* The Little Astronomer, who’s not so little anymore.

† Decidedly not her real name, either.

Related posts:

- Ephemeral snow ...


August continues

Posted on by
A nice surprise - a Wood Warbler (Ciaran Hatsell)

Shag family ready to go (Andy Denton)

Last of the Puffins (Andy Denton)

Suneet over Inner Farne (Andy Denton)

Sunday 21st August comments: Late August is a quiet time on the Farnes as the majority of our breeding seabirds have gone and only a handful remain. The last few breeding Puffins can be seen daily although as they are feeding hungry chicks, they spend one a brief moment on the islands before disappearing in search for more food. I did wonder whether these late besters enjoy having the place to themselves, after all, the waters around the Farnes have plenty of fish but with less competition!

The warden team are busy working on various management aspects of the islands including plenty of vegetation work alongside some ground preparation for next year. Small numbers of migrants are filtering through the islands including a stunning Wood Warbler recently, but any switch in wind direction to the east will bring a lot more birds. Watch this space, the forecast next week looks very very interesting….

Huntsman Takes His Pro-Science Message On the Air | The Intersection

Posted on by

By Jon Winsor

According to Tech President and 140elect.com, Thursday’s pro-science tweet by Jon Huntsman was one of the most effective tweets on record by a GOP candidate. The 90 character message was retweeted over 3600 times (50% higher than Sarah Palin’s best) and earned him 4,275 followers on a single day. It also earned attention from major newspapers, such as the New York Times. Attention isn’t poll numbers (Huntsman isn’t polling well) but it’s attention.

Perhaps sensing that this could be an important theme for him, Huntsman is taking it to the airwaves. Jake Tapper posted some excepts from his interview with Huntsman airing tomorrow on ABC’s This Week:

TAPPER: These comments from Governor Perry prompted you to Tweet, quote: ”To be clear, I believe in evolution and trust scientists on global warming. Call me crazy.” Were you just being cheeky or do you think there’s a serious problem with what Governor Perry said?

HUNTSMAN: I think there’s a serious problem. The minute that the Republican Party becomes the party – the anti-science party, we have a huge problem. We lose a whole lot of people who would otherwise allow us to win the election in 2012. When we take a position that isn’t willing to embrace evolution, when we take a position that basically runs counter to what 98 of 100 climate scientists have said, what the National Academy of Science – Sciences has said about what is causing climate change and man’s contribution to it, I think we find ourselves on the wrong side of science, and, therefore, in a losing position.

The Republican Party has to remember that we’re drawing from traditions that go back as far as Abraham Lincoln, Theodore Roosevelt, President Eisenhower, Nixon, Reagan and Bush. And we’ve got a lot of traditions to draw upon. But I can’t remember a time in our history where we actually were willing to shun science and become a – a party that – that was antithetical to science. I’m not sure that’s good for our future and it’s not a winning formula.

Huntsman also took on another subject that we’ve covered on this blog, the GOP debt ceiling deniers. (Early on, we covered Huntsman’s position opposing default.)

TAPPER: You were one of the only, if not the only Republican candidate, to support the deal to raise the debt ceiling. You called Congresswoman Bachmann’s position a, quote, “crash and burn” approach. Would you trust a President Bachmann to do the right thing with the economy?

HUNTSMAN: Well, I wouldn’t necessarily trust any of my opponents right now, who were on a recent debate stage with me, when every single one of them would have allowed this country to default. You can imagine, even given the uncertainty of the marketplace the last several days and even the last couple of weeks, if we had defaulted the first time in the history of the greatest country that ever was, being 25 percent of the world’s GDP and having the largest financial services sector in this world by a long shot, if we had defaulted, Jake, this marketplace would be in absolute turmoil. And people who are already losing enough as it is on their 401(k)s and retirement programs and home valuations, it would have been catastrophic.

To be fair, the notion that the other candidates would all have ”let the country default” is probably hyperbole. But the presidential candidates and other political actors did make noises that they didn’t take default seriously–to such an extent that this affected the S & P decision making (according to S & P officials’ own statements).

I’ll post an interview clip from ABC when it becomes available.