How artificial intelligence is changing our lives

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From smart phones that act as personal concierges to self-parking cars to medical robots, the artificial intelligence revolution is here. So where do humans fit in?

In Silicon Valley, Nikolas Janin rises for his 40-minute commute to work just like everyone else. The shop manager and fleet technician at Google gets dressed and heads out to his Lexus RX 450h for the trip on California's clotted freeways. That's when his chauffeur the car takes over. One of Google's self-driving vehicles, Mr. Janin's ride is equipped with sophisticated artificial intelligence technology that allows him to sit as a passenger in the driver's seat.

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At iRobot Corporation in Bedford, Mass., a visitor watches as a five-foot-tall Ava robot independently navigates down a hallway, carefully avoiding obstacles including people. Its first real job, expected later this year, will be as a telemedicine robot, allowing a specialist thousands of miles away to visit patients' hospital rooms via a video screen mounted as its "head." When the physician is ready to visit another patient, he taps the new location on a computer map: Ava finds its own way to the next room, including using the elevator.

In Pullman, Wash., researchers at Washington State University are fitting "smart" homes with sensors that automatically adjust the lighting needed in rooms and monitor and interpret all the movements and actions of its occupants, down to how many hours they sleep and minutes they exercise. It may sound a bit like being under house arrest, but in fact boosters see such technology as a sort of benevolent nanny: Smart homes could help senior citizens, especially those facing physical and mental challenges, live independently longer.

From the Curiosity space probe that landed on Mars this summer without human help, to the cars whose dashboards we can now talk to, to smart phones that are in effect our own concierges, so-called artificial intelligence is changing our lives sometimes in ways that are obvious and visible, but often in subtle and invisible forms. AI is making Internet searches more nimble, translating texts from one language to another, and recommending a better route through traffic. It helps detect fraudulent patterns in credit-card searches and tells us when we've veered over the center line while driving.

Even your toaster is about to join the AI revolution. You'll put a bagel in it, take a picture with your smart phone, and the phone will send the toaster all the information it needs to brown it perfectly.

In a sense, AI has become almost mundanely ubiquitous, from the intelligent sensors that set the aperture and shutter speed in digital cameras, to the heat and humidity probes in dryers, to the automatic parking feature in cars. And more applications are tumbling out of labs and laptops by the hour.

"It's an exciting world," says Colin Angle, chairman and cofounder of iRobot, which has brought a number of smart products, including the Roomba vacuum cleaner, to consumers in the past decade.

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How artificial intelligence is changing our lives

How many times, if ever, have you googled a patient?

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According to a WSJ blog post two years ago, it mentioned and asked, "By now, it’s well known that almost anyone you meet — from a potential employer to a prospective date — might be searching for information about you online. But would you feel strange knowing that your doctor was Googling you?" The blog post goes on to say "The practice appears to be widespread, according to an essay in the latest edition of the Harvard Review of Psychiatry, and it raises some thorny ethical questions for doctors, particularly those dealing with mental health." 

Some folks actually wrote a paper on this.  I happen to come across this news from KevinMD who made mention of this on his site in April of 2010 in a post entitled "Should doctors Google their patients?"

Point is, apparently I am not the first one to think of this, do it or subsequently write about it, but here is my response.

As a physician/pathologist there are a number of forms of data available to you, specimen requisition information, clinical history, electronic medical records, laboratory tests, radiology studies, operative notes, etc...


LetmegoogleyouIn some cases, the information may not be available (brunt of work-up, radiology, pre-operative visit, etc...) performed outside your institution where these impressions and results may normally be available to you.  The specimen requisition may simply state "change in bowel habits" or "liver mass" without much more than patient name, age, sex and a MRN of little value beyond appropriate patient ID.  No radiology, laboratories, physical examination findings, incomplete operative note and/or a clinician/surgeon who did not perform anything beyond the endoscopy or operation and does not recall by phone 2 or 3 days after the "case" anything about medication history, social history, radiology from outside hospital or post-operative course (assumingly these are all "negative", "non-contributory" or "not worth remembering".  When one calls for additional information the question is usually answered in the form of another question "Is it cancer?", "Is the margin negative?", or "How many lymph nodes are involved?"

A recent "liver tumor" submitted by a private physician at our hospital, where the work-up was largely done elsewhere, including pre-operative screening and imaging had an unusual histology.  No additional information was available.  A call to the surgeon about occupation, social history and medication history was met with one response "Is the margin negative?"  If I didn't tell him the patient's first name he would not have known that either. 


DnacredithistoryGoogle did.  And where he worked (irrelevant) what his "Likes" were, hobbies, interests and favorite TV shows.  The data I saw did not necessarily help to replace the normally present clinical data (assuming accurate when it is available), did not make the diagnosis less or more likely by itself, assuming the infomation online was accurate (i.e. did I have the right "John Doe") but it did help to substantiate the findings, albeit given circumstantial data.

As KevinMD and the WSJ blog notes and reader comments mention, there are many issues with this.   For some physicians apparently, using Google and the Internet to find publicly available information about their patients may shed some light into their diagnoses or management.  

One physician commented "I've done it, and it yielded invaluable info on a sick non-psych patient. Nailed the diagnosis."

What if there is something "out there" about an overtly litiginous patient?  Or one who smokes, is an admitted alcoholic, brags about excessive BMI, has started a blog on his/her personal battle with cancer, could any of these influence your diagnosis or approach after finding out?  

Perhaps in some cases and that is the point - shouldn't you know to help the patient and providers?

I have yet to meet a hepatologist who has not googled the name of a drug, prescription, over-the-counter or "other" health food store variety to look up any reports of hepatotoxicity or chemical compunds in those drugs that have been associated with hepatotoxicity.  

An old cardiologist (older now) told me as a first-year medical student, "Keith, there are two keys to practicing medicine; 1.  Do everything the same way, everytime.  This lowers the likelihood you will miss something. Whether it is a taking a clinical history, physical exam, reading an EKG, reading a chest x-ray (from outside in, or inside out, top-down, down-up), however you choose to do it, do it the same way everytime. And 2.  Cheat.  Cheat all the time.  Meaning get as much information as you possibly can.  MD stands for medical detective.  Get information from as many sources as possible.

This was shortly before Ask Jeeves or Yahoo!

I wonder what he would do if he had Google and an unresponsive patient, missing clinical information, radiology studies, unresponsive surgeon, forgetful clinician, etc...

Does this replace physician communication, documentation, the EMR, solid clinical business practices, actually talking to the patient, looking at his/her medical records, the slide(s) or X-rays?  Of course not.  May it yield information not mentioned and potentially useful? Ask Google.

 

 

 

 

 

 

 

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Can 2007 ASCO/CAP Scoring Guidelines for HER2 Protein Expression and Gene Amplification Be Applied to Gastroesophageal Adenocarcinoma?

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Review of: Tafe, LJ, Janjiigian
YY, Zaidinski M, et al.  Human Epidermal
Growth Factor Receptor 2 Testing in Gastroesophageal Cancer Correlation Between
Immunohistochemistry and Fluorescence In Situ Hybridization.  Arch Pathol Lab Med; 2011;135:1460-1465.


Nrgastroher2Experienced pathologists are
familiar with the bumpy and often controversial evolution of HER2/neu testing
in breast cancer patients. 

First, there was a breast
cancer drug trial employing a poorly designed trial assay followed by release
of the high demand drug Herceptin into a medical system without a remotely
adequate companion assay.  This was
followed by a confusing application of multiple anti-HER2 antibodies in no
standardized immunohistochemical assays interpreted by a range of pathologists
using different criteria all in parallel with a separate evolution of different
FISH assays. 

Before arriving at a reasonable
degree of standardization as outlined in the 2007 ASCO CAP guidelines, there
was a relatively prolonged period of sometimes heated consternation over which
assay was best, under what conditions, and using interpretive criteria.  And, during that period, we wrestled with a
lot of published laboratory correlation studies—the vast majority lacking any
clinical outcome data.  It’s not pleasant
to recall all of this controversy associated with HER2 testing in breast cancer
but hopefully it is a reminder of mistakes not to be repeated. 

We should remember these
lessons as we step into a new era of anti-HER2 therapies for gastroesophageal
and almost certainly other cancers from other primary sites.  The combination of Herceptin and chemotherapy
was very recently proven effective against HER2 positive advanced gastric and
gastroesophageal junction carcinomas in the TOGA clinical trial. 


Gastricher2Of great importance, the
standardized HER2 scoring systems used for breast cancer were not used in this
trial.  Instead, a body of preceding work
suggested that an alternative scoring system was needed for gastroesophageal cancers.  Basically, the traditional breast scoring
requirement for complete circumferential staining was modified to score
incomplete basal lateral membrane staining of gastric cancers as positive. 

In the trial,
immunohistochemistry was slightly more powerful than FISH in predicting drug
response with therapeutic responses in IHC 3+ tumors as well as IHC 2+ FISH
amplified tumors but not in FISH amplified tumors with lower
immunohistochemical scores 1 and 2. 

As a result, in Europe patients
with advanced gastroesophageal adenocarcinoma who are HER2 3 positive by
immunohistochemistry or IHC 2 positive with FISH amplification are eligible for
Herceptin therapy.  Slightly differently
in the United States, metastatic tumors that are IHC 3+ or HER2 amplified by FISH
are eligible. 

Some investigators have not
bought into the modified HER2 scoring system and hope to justify a more uniform
application of the existing breast cancer scoring system across different tumor
types.  Reporting in the November 2011
issue of Archives of Pathology and Laboratory Medicine [provide reference],
senior author Violetta Barbashina and co-authors measure concordance between
immunohistochemistry and FISH for evaluating HER2 status in gastroesophageal
carcinomas. 

Notably, in contrast to the
clinically validated scoring criteria for gastroesophageal carcinoma
established by the TOGA trial for Herceptin therapy, these authors deliberately
applied more traditional HER2 scoring criteria that are established for breast
cancer. 

They evaluated 135 paraffin
embedded advanced gastroesophageal carcinomas from the pathology files of
Memorial Sloan Kettering Cancer Center by HER2 automated immunohistochemistry
using PATHWAY Rabbit Monoclonal Antibody 4B5 on a Ventana BenchMark stainer
and, by HER2 FISH using the Path Vision dual probe procedure. 

Again, in this study, both ICH
and FISH were interpreted using criteria for breast cancer per the 2007 ASCO
CAP scoring guidelines.  By ASCO CAP
guidelines, 16 of 16 or 100% of the IHC 3+ tumors were FISH amplified; 16 of 20
or 80% of FISH amplified tumors were IHC 3+. 

Overall, IHC FISH concordance
was 97% for IHC 0 tumors, 93% for IHC 1+ tumors and 100% for IHC 3+ tumors—all
very high concordance rates—but note, that I have not described the FISH IHC
concordance rate for equivocal IHC 2+ tumors. 
Among this group of 8 equivocal IHC 2+ tumors, three were amplified,
four unamplified, and one equivocal indicating a roughly 50% concordance
rate. 

Finally, the authors
reclassified their IHC and FISH scoring using modified TOGA clinical trial criteria
and obtained a similar but no identical concordance rate.  From this, the authors conclude that HER2
testing in gastroesophageal cancers can be performed using 2007 ASCO CAP
scoring guidelines for breast cancer. 
Think about it.  I do not think
that such a bold conclusion is supported by this work. 

In their discussion, the
authors also state that for gastroesophageal cancers IHC 1+ and 2+ results should
be resolved by what they call definitive FISH testing.  Both this statement and the conclusion that
we can apply breast cancer scoring criteria are not supported by any clinical
evidence. 

In fact, the TOGA clinical
trial data contradict the notion that FISH results are in any way more
definitive or more predictive than IHC results. 
The TOGA clinical trial data actually suggests that for gastroesophageal
cancers, IHC results are more predictive of drug response. 

The authors have done a large
amount of work and report very good correlation between PATHWAY Ventana
immunohistochemistry HER2 testing and Path Vision FISH results in
gastroesophageal cancer but as far as I can tell that is all.  I have yet to see any clinical
evidence—certainly not in this paper—to support their suggestion that ASCO CAP
breast cancer scoring is acceptable or that FISH HER2 results are the
definitive answer for gastric cancers. 

I hope that this is not the
beginning of numerous laboratory correlation studies on HER2 testing on gastric
or other types of cancer that lack clinical outcome data but spawn speculative
conclusions about clinical utility.  One
suggestion I would make if it has not already been done is to retrospectively
score TOGA clinical trial gastroesophageal cancers by ASCO CAP breast cancer
criteria and see which system best predicted drug response. 

Short of that effort, someone
would have to essentially repeat the TOGA trial to truly answer the question
posed by these authors. 

To my knowledge and for now,
the modified TOGA scoring criteria for gastroesophageal cancer HER2 status
remain uniquely validated by a clinical trial. 

Biologically, it seems
imprudent to expect standards for HER2 testing in breast cancer to translate
simply and unchanged across primary and anatomic sites from breast to stomach
to lung or any other organ.  That is not
the case for anti-EGFR drug modality or laboratory testing algorithms in lung
and colon cancers which have benefited from quite different anti-EGFR drugs and
laboratory testing strategies.  In lung
cancer, use of anti- HER2 therapies is currently investigative but already
there is some published literature indicting that HER2 gene mutation status
(not protein over expression and not gene amplification) may identify the
subset of lung cancer patients who respond to Herceptin. 

The name of the game is predicting
drug response and that requires empirical clinical outcome data.

 

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Jerry and his Doctors

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Every once in awhile I come across another physician blog that tells it like it is without ranting and raving about managed care/insurance issues, hospital administrators or patients with unmet expectations.

This one comes from an internal medicine resident recounting an experience with a terminally-ill patient and end-of-life decisions, a living will, the needs of patients and the decisions made by an attending physician and a resident physician.

Her experiences remined me of the 3 months I spent as an intern in critical care units.  The discussion, and perhaps, more importantly, enforcement/following of living wills and the battles that ensue with families, doctors, housestaff, attendings and medical technology in the war against human disease.

For a sobering account and one doctor's piece of mind on this check out:

The only thing I had to do was help Jerry and I failed


Doctors-band-aid-300x243

 

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Sept 11 — Remembering 11 years later

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At around 8 PM, on September 10, 2001 I was on one of the last LaGuardia - Reagan Delta shuttles to leave New York City. I was returning from a trip to the laboratory at the hospital located on the U.S. Military Academy base in West Point, NY.  We had completed a successful AABB blood bank inspection and was returning home to Washington.  It was a trip I had done several times previously as the pathology consultant to Keller Army Community Hospital and would do several more times over the next four years on frequent site visits and to cover frozen sections as Keller did not have a full-time pathologist.  This experience was the nidus for telepathology in the Army.  I figured there had to be an easier way to cover remote frozens than to fly to New York City or drive for hours each way for 15 minutes of work.  

NikkormatFT2 IMGP1333 On this particular trip, leaving LaGuardia, I was able to capture a few images of lower Manhattan and New York harbor. At the time, I was still taking pictures with a film camera (and still do sometimes but it is getting harder to find quality film and processing facilities...). After takeoff I pulled out my old but trusty Nikkormat FT2 camera, snapped on my equally old but reliable 200mm lens and was able to get off 3 exposures. 

The lighting cooperated despite slow film and my telephoto lens.  I like the grainy nature, particularly for black and white photos.  I did not realize what I had on the roll until many months later and saw what are likely some of the last images of the World Trade Center, particularly from the air.  I could not find the original negatives but was able to scan some 4x6 prints I had made.  About 12 hours after I took this picture, the first plane hit the North tower of the World Trade Center. 

WTC1 WTC3

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Hamamatsu – Redefining the art of whole-slide imaging

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Hamamatsu-logo-web-PIOB

Virtual Microscopy / NanoZoomer - Products - NanoZoomer-XR 


Nanozoomer-xrHassle-free

  • Perfect scans at a touch of a button. After slides are loaded, running a batch of slides is virtually hands-free.
  • Scanning profiles can be set up for multiple types and/or users.
  • New viewer software, NDP.View2, speeds and simplifies slide viewing.

Error-free

  • Robust mechanics and optics keep the NanoZoomer error-free and stable.
  • NanoZoomer-XR optimizes scanning conditions to ensure users get the best digital images whenever they scan.

Blur-free

  • Dynamic Pre-Focusing technology (patent pending) maintains a sharp focus on the entire specimen during scanning resulting in crisp and clear images.
  • Slides are automatically evaluated for image quality and re-scanned as needed.

The new NanoZoomer-XR

  • Minimizes work load and speeds slide scanning time by automatically and continuously scanning up to 320 slides per batch.
  • Converts, in as little as 30 seconds, a 15 mm x 15 mm area on a glass slide into an outstanding color image.
  • Scans various types of slides including HE-stained and cytology samples.
  • Features a true multi-Z level acquisition for improved accuracy and viewing of thick specimens.
  • An add-on module for fluorescence scanningwill be available soon.

Learn more 

 

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Simagis Digital Pathology Servers Now Support Leica Microsystems Scanners

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 Simagislive

HOUSTON--(BUSINESS WIRE)--Smart Imaging Technologies has signed a license agreement with Leica Microsystems and added support for Leica Slide Scanners to Simagis Live Digital Pathology Servers.

“We are committed to our mission of providing interoperability and integration in the fragmented and rapidly evolving space of Digital Pathology. We are happy to assure our clients and partners that they can continue business as usual, regardless of the outcome of technology consolidation between merging vendors”

Simagis Live Digital Pathology servers already support digital slides from most manufacturers of microscopy slide scanners including Aperio, the market leader soon to be acquired by Leica Microsystems. Adding Leica to the list of supported scanners provides pathology community with digital platform that handles slides from both merging companies and delivers unified solution that works with any vendor, now and in the future.

“We are committed to our mission of providing interoperability and integration in the fragmented and rapidly evolving space of Digital Pathology. We are happy to assure our clients and partners that they can continue business as usual, regardless of the outcome of technology consolidation between merging vendors,” said CEO of the Smart Imaging Technologies.

About Smart Imaging Technologies

We provide digital slide servers, image analysis applications and cloud hosting services that make Digital Pathology affordable for practice of any size. With our technology users can easily create, annotate, share and analyze digital slides from any web browser. Our servers support most digital slide formats and can be easily integrated with various scanners for a single click slide upload. Our products can be custom branded and deployed on premises or the cloud to deliver unified digital pathology solutions across geographic boundaries. For details about technology and solutions manufacturers and integrators may contact support@simagis.us. End users can learn more and sign-up for free web service at web-pathology.net.

Contacts

Smart Imaging Technologies

Evgenia Harris, 713-589-3500

 

 

 

 

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Free Webinar: Analyzing IHC Images Using Image-Pro Premier for Research Pathology

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Free Webinar: Analyzing IHC Images Using Image-Pro Premier for Research Pathology

September 11, 2012 1pm-2pm EDT Register

Media Cybernetics invites you to attend the free webinar, “Analyzing IHC Images Using Image-Pro Premier for Research Pathology”, Tuesday, September 11, 2012  at 1pm-2pm EDT. 

The Webinar will introduce the features available within Image-Pro Premier image analysis software to set up and create your own image analysis protocols for the analysis of IHC stained samples.  Examples using IHC stained tissue and nuclei will be demonstrated during the webinar.       

Attendees will learn how to: 

  • Evaluate image quality
  • Apply background correction to correct for uneven illumination when required
  • Use image processing techniques to enhance segmentation as related to IHC samples
  • Set up Count/Size for analyzing single or multiple stains
  • Introduce Smart Segmentation, which enables the segmentation of difficult-to-analyze features
  • Configure Data Collector to accumulate data from multiple images


Register

About the Presenter: 
Jeff Knipe is an Image Analysis Trainer with Media Cybernetics. Jeff has extensive hands-on experience in scientific image processing and analysis of both biological and industrial imaging applications.

 

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Meaningful Use Stage 2: Are You Ready?

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Final stage 2 MU rule offers healthcare providers some compromises and EHR tweaks, and also requires greater patient engagement.

By Nicole Lewis,  InformationWeek 
September 04, 2012
URL: http://www.informationweek.com/healthcare/policy/meaningful-use-stage-2-are-you-ready/240006670 


InformationWeek-HealthcareUnder the Meaningful Use stage 2 final rule, eligible professionals (EPs) working in a hospital can apply for incentive payments if they can demonstrate that they've acquired a certified electronic health record (EHR), and are using it in lieu of the hospital's EHR. To qualify, EPs must show that they implemented the EHR and maintain the system, including supporting hardware and interfaces needed to achieve meaningful use, without receiving reimbursements from the hospital.

"We know that there are EPs who work within certain areas or unit of hospitals--for example, neonatal care--but use entirely separate systems, and this application process will allow those EPs to ask for a redetermination of their hospital-based status based on those factors," a spokesman for the Centers for Medicare & Medicaid Services (CMS) told InformationWeek Healthcare. AdTech Ad

Expanding the criteria for EPs to apply for incentive payments is one of the many changes incorporated into the Meaningful Use stage 2 final rule, a 672-page document recently published by CMS.


Ipad_HC_lg2Many of the changes address real-world concerns that healthcare providers face as they prepare their systems to meet Meaningful Use criteria, said Dr. Farzad Mostashari, National Coordinator for Health IT at the Office of the National Coordinator for Health Information Technology.

[ For more on Meaningful Use stage 2, see Meaningful Use Stage 2 Rules Finalized. ]

"What you will see [in the stage 2 final rule] is some compromises frankly between the aspirational goals and the realities of where the market is and the pressures on providers and vendors in terms of timeline," Mostashari said during a webcast August 24 hosted by the National eHealth Collaborative.


Meaningful useExtending the timeline to meet Meaningful Use stage 1 deadlines is one area of compromise. In the stage 1 Meaningful Use regulations, CMS established a timeline that required providers to progress to stage 2 criteria after completing two years in the incentive program. This original timeline would have required Medicare providers who first demonstrated Meaningful Use in 2011 to meet the stage 2 criteria in 2013.

However, CMS pushed back the timeline by one year. The earliest that the stage 2 criteria will be effective is fiscal year 2014 for eligible hospitals and critical access hospitals (CAH), or calendar year 2014 for EPs.

Hospitals and physicians must also keep in mind that many of the stage 1 requirements that have been carried forward to stage 2 have a concomitant rise in threshold levels, according to Rob Anthony, a health specialist in the Office of eHealth Standards and Services at CMS.

Explaining the new requirements during the webcast, Anthony said health providers must show that more than 50% of prescriptions are completed through electronic prescribing, up from the stage 1 threshold of 40%. Reporting of demographic information, vital signs, and smoking status has moved from 50% in stage 1 to more than 80% in stage 2. CMS also raised the requirement for reporting instances of clinical decision support and intervention from one to five. These interventions include reporting on drug-to-drug interactions and drug allergy interaction alerts.

Turning to clinical quality measure (CQM) reporting in stage 2, beginning in 2014 EPs must report on nine out of 64 total CQMs, and eligible hospitals and CAHs must report on 16 out of 29 total CQMs.

In addition, all providers must select CQMs from at least three of the six key healthcare policy domains recommended by the Department of Health and Human Services' National Quality Strategy. These are: 1. Patient and Family Engagement; 2. Patient Safety; 3. Care Coordination; 4. Population and Public Health; 5. Efficient Use of Healthcare Resources; and 6. Clinical Processes/Effectiveness.

Stage 2 will also focus more intensely on facilitating patients' access to their records, and replaces stage 1 objectives that call for clinicians to provide electronic copies of health information or discharge instructions, with the stage 2 objectives that allow patients to access their health information online.

For EPs, stage 2 requires that patients have the ability to view online, download, and transmit their health information within four business days of the information being available to the EP. Eligible hospitals and CAHs are required to provide patients the ability to view online, download, and transmit their health information within 36 hours after discharge from the hospital.

Patients must also do their part in stage 2, which calls for more than 5% of patients to send secure messages to their EP, and more than 5% of patients to access their health information online. CMS is introducing exclusions based on broadband availability in the provider's county.

Stage 2 also facilitates batch reporting. Starting in 2014, groups can submit attestation information for all of their individual EPs in one file for upload to the attestation system, rather than having each EP individually enter data.

In the stage 2 criteria, the feds emphasized the need to exchange health information between providers to improve care coordination for patients. One of the core objectives requires EPs, eligible hospitals, and CAHs who transition or refer a patient to another care setting or provider to furnish a summary of care record for more than 50% of those transitions of care and referrals.

Additionally, there are new requirements for the electronic exchange of summary of care documents: EPs, eligible hospitals, and CAHs that transition or refer their patient to another care setting or provider must electronically provide a summary of care record for more than 10% of transitions and referrals.

The EP, eligible hospital, or CAH that transitions or refers a patient to another care setting or provider must either: a) conduct one or more successful electronic exchanges of a summary of care record with a recipient using technology that was designed by a different EHR developer than the sender's, or b) conduct one or more successful tests with the CMS-designated test EHR during the EHR reporting period.

InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital CIO Roundtable issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.)


 

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Educational Flow Cytometry Video (Humor)

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One things for sure, you will not hear the words: multineage dysplasia, macrophages, bcl-6, S-phase, monoclonal, Burkitt’s, Rituxin, MDS, AML, translocated genes, APL, Auer rods, all-trans retinoic acid, DIC, CD45 or CD117 all in the same music video again ever.

From DrdoubleB who also produced among other educational pathology videos, Dynamite Case about an interesting surgical pathology case at the University of Florida.

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Actress Emma Stone Loves The Morbid Anatomy Library: "Vogue UK" and the "Herald Scotland," 2012

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... How does [starlett Emma Stone's] obsession with mortality and death manifest itself? "By going to places like the Morbid Anatomy Library [in Brooklyn, New York] the other day, looking at little foetal pigs in jars. I have an interest in death. Obviously not constantly, but on a daily basis.

"There's an awareness of mortality, I think, that makes you live much more presently. There's something oddly comforting about death. Not dying. Dying, I'm terrified of, but death -" She pauses. "Sorry, am I getting really serious? Come on, we're in Cancun!"

-- "Emma Stone gets caught in Spider-Man's web," Herald Scotland, June 2012 (full article here)

A few months back, the Morbid Anatomy Library was graced with a visit by lovely, young and--apparently--morbidly inclined starlett Emma Stone, star of Easy A, Crazy, Stupid, Love, The Help and, most recently, The Amazing Spiderman. She was trailed on this wine-soaked visit by reporter Alexa Chung of Vogue UK, and we spent a lovely rainy hour or two paging through some of my favorite books, poking around the taxidermy collection, and discussing our shared love for the macabre. The trip resulted not only in the expected article for Vogue UK--entitled "The Crazy Cool of Emma Stone," in the August 2012 issue--but also the piece from the Herlad Scotland quoted above.

You can read the entire Vogue UK article--in which you will  learn more about Stone's favorite books and artifacts in the collection, among other things--by clicking here, and the entire Herald Scotland piece by clicking here. Thanks so much to Jo Hanks for stumbling across the article, and for the donation of her very own issue of Vogue UK to this worthy cause! And thanks to good friend Eric Huang for alerting me.

Also, please feel free to come visit the library and see the collection for yourself during our next set of open hours this Saturday, September 15th, from 1-6. Details and directions here.

Photos of The Library by Shannon Taggart

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Bon Voyage: Pilgrimages, part one

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Travel for moral and spiritual enlightenment is nothing new. Records of pilgrimages date back millennia. Some sites have long histories of hosting pilgrims, including Jerusalem and Mecca. Some like El Santuario de Chimayo in New Mexico are more recent popular destinations.

This and next week, Bon Voyage features pilgrimages. I asked authors who contribute to the Record Searchlight's Voices of Faith religion column if they'd been on a pilgrimage. Here's what some of them shared.

VATICAN CITY AND ROME

Sacred Heart Catholic Church deacon Mike Evans of Anderson visited Vatican City in August 1978, and again in October 2004.

"It was great to see how things had changed over time and also not changed," Evans said. "Rome is indeed the 'Eternal City.' "

Since the First Century, the Vatican has been the central location for the Christian faith, Evans said. It's rich in history.

Points of interest Evans visited include the Vatican Museum and St. Peter's Basilica and square in Vatican City, and the Coliseum, Spanish Steps, various castles, bridges and catacombs in and around Rome.

"The only way to see the Vatican Museum and Sistine Chapel in depth is to book a tour," Evans said. "You get picked up at your hotel and don't have to stand in a long line for admission. Then there is the interpretation by the tour guide that makes everything understandable (and) more exciting."

Rome is a big embarkation/disembarkation point for cruise ships. Evans recommends cruise travelers take the shore excursions offered to passengers.

"The operators provide the bus, the guide and narrative. (It) saves time and confusion," Evans said.

Link:

Bon Voyage: Pilgrimages, part one

Shuttle Endeavour mated to Jumbo Jet for Final Flight

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Image caption: Endeavour mated to Boeing 747 in the Mate-Demate device at the Kennedy Space Center Shuttle Landing Facility on Sept. 14 for Final Ferry Flight to California on Sep. 17. Credit: Ken Kremer

Space Shuttle Endeavour was joined to the 747 Jumbo carrier jet that will carry her majestically on Sept 17 on her final flight to the California Science Center her permanent new home at the in Los Angeles. Enjoy my photos from onsite at the Kennedy Space Center in Florida.

On Friday (Sept. 14), Endeavour was towed a few miles in the predawn darkness from the Vehicle Assembly Building (VAB ) to the Shuttle Landing Facility (SLF) and the specially modified 747 known as the Shuttle Carrier Aircraft, or SCA.

In a day long process, Endeavour departed the VAB at 5:04 a.m. and was hauled into the gantry-like Mate-Demate device, hoisted and then lowered onto the awaiting 747 Jumbo Jet. The pair were joined at about 2:41 p.m.

Image caption: Endeavour towed past waiting Boeing 747 Shuttle Carrier Aircraft (SCA) at the Kennedy Space Center Shuttle Landing Facility on Sept. 14 for Final Ferry Flight to California on Sep. 17. Credit: Ken Kremer

Final work to hard mate NASAs youngest orbiter to the SCA Jumbo Jet known as NASA 905 is due to be completed by Sunday.

The 747 crew will fly perform multiple, crowd pleasing low flyovers of the Florida space coast region, the KSC Visitor complex and the beaches giving every spectator a thrilling front row seat to this exciting but bittersweet moment in space history as the shuttle takes flight for the very final time.

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Shuttle Endeavour mated to Jumbo Jet for Final Flight

School: Doctor disciplined for viewing adult porn

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The Boston Children's Hospital pediatric doctor charged with receipt of child pornography was disciplined for using a school computer to access adult pornography when he was medical director at Phillips Academy boarding school, school officials said Friday.

Richard Keller, 56, who is also a pediatrics clinical instructor at Harvard Medical School, was the medical director at Philips Academy for 19 years, according to John Palfrey, the head of the school.

In an e-mail to faculty, staff, students, alumni and parents on Friday, Palfrey said Keller was reprimanded in 1999 for using an academy computer to access pornography that featured adult subjects, and in 2002 was reprimanded for showing an inappropriate cartoon to students.

According to Palfrey, Keller was cited for "poor management and poor judgment," leading the Andover, Massachusetts, school to place him on administrative probation in 2009.

Palfrey went on to say that as recently as 2010, Keller sent an inappropriate voice-mail message to a colleague at the school. A claim by Keller that the school had discriminated against him was determined to be "groundless," according to Palfrey.

In April 2011, the academy informed Keller that his contract would not be renewed. The doctor resigned that month, the school said.

"We have no reason to believe that any of our students were involved in, or affected by, Dr. Keller's alleged criminal behavior," Palfrey said, adding the federal case made Thursday against Keller is unrelated to alleged misconduct at Phillips.

Keller's name came to the attention of authorities after the U.S. Postal Inspection Service began a 2010 investigation into a movie production company that sold films featuring minor boys, according to the criminal complaint.

Investigators conducted a review of the company's customer database and located alleged customer Richard Keller, who had two addresses listed, authorities said.

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School: Doctor disciplined for viewing adult porn

Libertarians win a round in petition challenge

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HARRISBURG The Libertarian Party won an important round in a challenge of its nominating papers, boosting the chances that its ticket will stay on the Pennsylvania ballot.

A three-judge panel of the state Commonwealth Court ruled 2-1 Thursday that signatures of about 9,000 voters are valid even though they listed addresses that do not match those in the voter registry.

Challengers backed by the Republican Party argued in court this week that all those signatures should be disqualified, which could have knocked out Libertarian presidential candidate Gary Johnson, who said Friday he plans to visit the state next week.

Analysts have said GOP officials are concerned that a Libertarian candidate would siphon votes from Republican nominee Mitt Romney.

My clients are very happy, said attorney Paul Rossi, who is representing the Libertarians. Im confident that were going to be on the ballot in the Nov. 6 election.

Both sides said Friday they plan to jointly appeal to the state Supreme Court.

The challengers want the justices to overturn the mismatched-address ruling, while the Libertarians are appealing the panels 2-1 decision to disqualify nearly 1,500 voters who omitted the year from the date they signed the petition.

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Libertarians win a round in petition challenge

MSU to host forum on health care policy

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MANKATO Glen Peterson was looking at the responses to a survey sent out earlier this year by state Sen. Kathy Sheran of Mankato.

The question on health care reform jumped out at Peterson, not surprising for a retired professor in Minnesota State Universitys College of Allied Health and Nursing.

But it wasnt the number of respondents who favored a single-payer health care system that struck him, or the percentage who preferred President Obamas Affordable Care Act.

It was the most popular response to the question that got him moving.

Not sure I dont have enough information was selected by 40 percent of the 793 respondents, more than any other answer. For a teacher, the idea of people not having enough information was about as grating as fingernails on a chalkboard.

Doesnt this really call for some sort of educational forum? Peterson recalls thinking.

So he got to work, and his efforts will culminate with a public informational forum Saturday afternoon featuring some prominent Minnesota experts on health care policy.

Options for Structure of Our Health Care System will run from 1 p.m. to 4 p.m. at MSUs Centennial Student Union ballroom. Three experts will offer in-depth looks at three possible reforms: the Affordable Care Act (frequently called Obamacare) and health care exchanges; a more state-based approach where federal health care programs are replaced by vouchers and block grants to states; and a national health care/single-payer approach.

The goal is for the audience to leave better informed about all three approaches after hearing the panelists speak and answer audience questions.

Weve asked them all to take the educational/informational focus rather than trying to win converts, Peterson said.

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MSU to host forum on health care policy