Herbage testing for herd nutrition assessment

Total nutrition including energy, protein, macro and micronutrients during calving and early lactation is critical to cow health while also determining milk production both this year and next.

Animal Nutrition Manager from farm nutrition company Altum, Jackie Aveling, says that an energy deficit in this period could impact cycling and conception rates, so it is important to provide a high quality balanced diet to meet nutrient needs.

"One of the best methods to determine if a herd is consuming adequate nutrients is herbage testing to pinpoint any limiting factors in the diet in combination with analysis from other supplementary feeds."

Dairy pasture data collected over the last five years from thousands of Altum clients has been statistically analysed to a 95% confidence interval by region, element and month to confirm seasonal trends:

Potassium levels are higher over winter and spring, then trend down over summer.

Magnesium and calcium - both key elements for the lactating cow - trend lower in winter and spring.

The majority of trace elements trend lower over the spring period as pasture growth increases, with a few exceptions.

"In a forage based diet, pasture potassium levels exceed the needs of calving and lactating cows.

"Potassium can negatively impact the availability of magnesium in the cow which increases the risk of milk fever. Identifying pasture potassium and magnesium levels will help farmers plan an effective supplementation programme," says Jackie.

"A robust supplementation programme includes a combination of methods including high quality magnesium directly provided to the herd through water, dry cow molasses lick blocks and pasture dusting."

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Herbage testing for herd nutrition assessment

NASA releases new Mars photo

NASA has released the first images from the Mars rover which landed earlier in the week.

The rover was sent on a fact finding mission, attempting to analyze and discover whether elements on Mars contain the potential to harbor life.

The rover sent back its first images within moments of landing inside a crater.

'I really love these images because you know, later we are going to get magnificent color panoramas and 3d images and magnificent things on Mars. But these first images somehow are always the best ones to me,' Mission manager Mike Watkins told Reuters.

'You know, to me, it's representative of, of course a successful landing on Mars, it's representative of a new home, for the rover, of a new mars we have never seen before, and so every one of those pictures is the most beautiful I have ever seen'.

This history making moment was a rare opportunity for celebration by NASA which has had a tough few years with the cancellation of the space shuttle and budget cuts.

'It's just mind blowing to me, I think to all of us, so, I cannot say more than that, it's just the coolest thing,' added Miguel San Martin, of NASA's Descent and Landing Team.

Despite these tougher times the $US2.5 billion project is the first biological endeavor since the 70s.

See the article here:

NASA releases new Mars photo

Mars rover Curiosity, and NASA scientists, take a little break

The Mars rover Curiosity -- and NASA scientists -- are taking a little break.

After transmitting dramatic photos from the Red Planet during the first week of the operation, NASA said the rover is going through a four-day "brain transplant."

As the rover goes under the digital knife, many scientists will be taking a break and getting used to their newfound fame.

"I got recognized in a pizza parlor on Wednesday," said systems engineer Allen Chen, who emceed the rover's landing on Aug. 5. "That was a little weird for me."

During the "brain transplant," engineers are to be updating Curiosity's software, currently primed for its flight stage, to prepare it for its operations on the surface of Mars. The update will add two crucial functions -- the ability to use the geochemistry lab's sampling system, and to drive.

The update had to wait until after the rover landed because its processor, built years ago to withstand the harsh environment of interplanetary space, is limited compared with today's consumer technology, said senior software engineer Ben Cichy.

"My phone has a processor that is 10 times as fast as the processor that's on Curiosity and has 16 times as much storage as Curiosity has," Cichy said. "And my phone doesn't have to land anything on Mars."

Also Friday, engineers offered their most detailed assessment of Curiosity's landing. The craft, they said, landed about 1.5 miles away from its predicted touchdown zone -- not bad, given that the site was more than 150 million miles away and that the projected landing zone was an ellipse 12 miles wide.

ALSO:

Curiosity's mysterious Mars photo stirs speculation

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Mars rover Curiosity, and NASA scientists, take a little break

Uni targets rural medical students

In 2011, final-year University of Adelaide medical students Rachel Jones and Ben Rogers were looking forward to gaining rural practice experience. Now their uni is doubling the number of interviews with rural candidates. Picture: Calum Robertson Source: The Advertiser

THE University of Adelaide's medical school aims to double the number of rural students it interviews for places with changes to its entry process.

From this year the university will consider rural applicants' Undergraduate Medicine and Health Sciences Admission Test scores separately from metropolitan applicants in a bid to ensure more get through to the interview stage.

The university hopes to interview about 120 rural students, up from the 61 it saw for this year's cohort.

Faculty of Health Sciences executive dean Professor Justin Beilby acknowledged rural students were under-represented but hoped the changes would see growth.

University of Adelaide second-year medicine student Matt Watson, from Tooligie on the Eyre Peninsula, said: "Where I'm from, the only person I could talk to who'd got into medicine was the GP."

The rest is here:

Uni targets rural medical students

Liberty Pounds Out 20 Hits, Stays Alive At Legion Regional

Posted: Aug. 12, 2012 | 2:02 a.m.

After watching his team strike out 13 times in a loss Friday night, Liberty baseball coach Mike Eshragh wanted to see his players execute better at the plate Saturday.

The Patriots did that, and then some.

Liberty pounded out 20 hits on its way to a 23-9, seven-inning victory over Albuquerque (N.M.) to stave off elimination in the American Legion Western Regional at Fairfield, Calif.

"We struck out 13 times at the plate (Friday) night. That doesn't happen to us," Eshragh said of his team's 9-6 loss to Fairfield. "Responding today with a good offensive output shows these kids know how to make adjustments quickly. It was good to bounce back."

Liberty (28-9) is one of four teams remaining in the double-elimination regional. The Patriots will play Lakewood (Calif.) at 3:30 p.m. today.

The Patriots led 9-0 after two innings, but Albuquerque scored three runs in the fifth to pull within 13-7. But Liberty scored 10 runs in the bottom of the inning to put the run rule into effect.

Liberty's Jay Martz went 4-for-5 with four runs and two RBIs, and Michael Vargas was 3-for-4 with four RBIs.

Jesse Keiser went 3-for-5 with three runs and two RBIs for Liberty. Teammates Daniel Skelly, Nate Bennett and Marcos Rivera added two hits each. Skelly drove in four runs and Bennett three.

"We got to the field a little bit earlier today and had a little bit extra cage time," Eshragh said. "The players knew what was on the table, and we responded right away."

Excerpt from:

Liberty Pounds Out 20 Hits, Stays Alive At Legion Regional

Wildfires ravaging the Canary Islands

Published: Aug. 12, 2012 at 8:13 AM

MADRID, Aug. 12 (UPI) -- Nearly 5,000 people in Spain's Canary Islands have been evacuated as wildfires race through tinder-dry forests and fields, regional officials said.

The worst affected islands are Tenerife and La Gomera, Britain's Sky News television network reported.

More than 7,400 acres of land, including part of a World Heritage nature reserve, on La Gomera have been scorched since Friday, officials said.

"There is no positive change for the moment," an emergency official told reporters.

Firefighters on the ground were being helped by water-dropping aircraft, the report said.

The islands, located off the coast of Morocco, have experienced the driest conditions in some 70 years, the broadcaster said.

Adding to the woes, a heat wave from Africa last week created perfect conditions for the fires with temperatures above 100 degrees, low humidity and breezes.

The environmental secretary for the island of La Gomera, Ventura del Carmen Rodriguez, told reporters it would take at least 30 years for the nature reserve to recover from the fires.

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Wildfires ravaging the Canary Islands

Troubled veterans left without health-care benefits

Afew weeks after Jarrid Starks ended his Army service in May, he went to an office in Albany, Ore., to enroll for veterans health-care benefits.

Starks brought medical records that detailed post-traumatic stress disorder (PTSD), a twisted vertebra and a possible brain injury from concussions. Other records documented his tours of duty in Iraq and Afghanistan, where his bravery fighting the Taliban was recognized with a Bronze Star for Valor.

None of that was enough to qualify him for health care from the Department of Veterans Affairs.

That's because Starks left the military this year with an other-than-honorable discharge his final year of service scarred by pot smoking and taking absences without leave (AWOL).

He was told to fill out a form, then wait possibly a year or more while officials review his military record to determine whether he is eligible for health care.

"I was absolutely livid," Starks, 26, recalls. "This just isn't right."

Starks is among the more than 20,000 men and women who exited the Army and Marines during the past four years with other-than-honorable discharges that hamstring their access to VA health care and may strip them of disability benefits.

Some were booted out of the military before they deployed.

Others served in combat zones in Iraq and Afghanistan, then struggled upon their return with drug abuse, unauthorized leaves and other misconduct that placed them among the most troubled members of the generation of veterans who fought in the long wars launched after 9/11.

Starks ended his military career this spring with a weeklong stay at Madigan Army Medical Center under psychiatric care. Then, he was escorted to the front gate of Joint Base Lewis-McChord carrying a brown paper bag packed with a 90-day supply for six prescription drugs that included antipsychotics, antidepressants, pain pills and beta-blockers.

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Troubled veterans left without health-care benefits

Freedom soccer tourney set for 15th season

By: STAFF REPORTS | Morganton News Herald Published: August 11, 2012 Updated: August 11, 2012 - 6:50 PM

The Freedom High boys soccer program will play host to county rival Patton and a total of six teams from outside Burke County in the 15th annual Freedom Invitational, which will take place Monday through Thursday at the Catawba River Soccer Complex (CRSC).

One of the longest-running tournaments in western North Carolina, 2012 marks the 13th consecutive year that CRSC hosts the event. Games start on two fields at 5 and 7 p.m. on Monday, Tuesday and Thursday.

Patton and Alexander Central meet Monday at 5 p.m., while Freedom opens the event against South Caldwell at 7 on Monday.

Overtime periods will not be played, but ties will be broken by penalty kick shootouts for the purpose of declaring an overall champion. Wednesday and Saturday have been designated as makeup dates in the case of inclement weather.

An 12-member all-tournament team will be named, along with three individual awards: outstanding defensive player, outstanding attacking player and overall most valuable player.

Read more here:

Freedom soccer tourney set for 15th season

Will we find life in space? | Bad Astronomy

One of my favorite aspects of astronomy is how it tackles the biggest questions we humans have. How did this all begin? What is the ultimate fate of the Universe?

Are we alone?

Oh, that last one. Such an interesting question, and one that for centuries has been essentially unanswerable due to a lack of solid data. But thats changed very recently. Weve started exploring other planets up close. Weve been able to listen to potential signals from other civilizations. And weve begun to get a handle on how many habitable planets there might be in the Universe.

The BBC Future blog asked me to write up my thoughts on this for their clever series, "Will we ever?", and so I did: "Will we ever find life elsewhere in the universe?" is now online.

Ill note this is an opinion piece, but its based on the best data I know about these three avenues of inquiry: physical inspection of other worlds in our solar system, listening for E.T., and observing planets around other stars. Given the current state-of-the-art, and where these programs are going, I predict which of these three I think will pay off first assuming life is out there to find.

I wont spoil it here. Go read the article!

[Note: In June, I also wrote a piece for them called Will We Ever Live on the Moon? which you may also enjoy.]

Related Posts:

- Will we ever live on the Moon? - 50 new worlds join the exoplanet list - Success: SETI array back on track! - Enceladus does and does not have a global ocean - Huge lakes of water may exist under Europas ice

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Will we find life in space? | Bad Astronomy

Vitamin D and cancer – nine facts "they" won't tell you

by: Aurora Geib
Before, to be diagnosed with the big C seemed to be an implied death sentence. Patients even go through a stage of self-denial. Who can blame them? Conventional medicine paints a rather bleak future for cancer patients and the remedy it offers does nothing to improve their quality of life, nausea and falling hair not to mention.
However, the recent breakthroughs in science have allowed a peek into the true nature of cancer, allowing researchers to consider the concept of nutritional care. They are now faced with the idea that preventing and maybe even reversing cancer may not necessarily involve the development of expensive drugs but something already available in nature: food and sunshine! (http://dreddyclinic.com/forum/viewtopic.php?f=14&t=3)
Just the facts
If something so powerful is actually available for everyone, why wouldn't someone take advantage of it?
The recent discovery that the body, with the help of vitamin D, possesses the capacity to fight many chronic illnesses has spurred the interest of many researchers - especially on the possibilities the sunshine vitamin can offer with regard to the prevention and reversal of diseases like cancer. A brief rundown of some facts, revealed by recent studies, can give us a perspective on how vitamin D can help.Read more…

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Zoom tool stitches together thousands of nanoscopic cell images

By Liat Clark Courtesy of WIRED.CO.UK

07 August 12
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A team of molecular biologists has published a paper revealing how its "virtual nanoscopy" method creates detailed, high resolution images of cellular structures by "stitching" together thousands of electron microscope photos.

Electron microscopes can magnify an image by up to 10 million times using beams of electrons. However, the tool can only be used to either capture a single, detailed image of part of a cell or, at a lower resolution, a less-detailed overview of the cell. There was no way, until now, to relate the one to the other and give a contextual and detailed overview of the entire cell structure at once.

In the paper Virtual nanoscopy: Generation of ultra-large high resolution electron microscopy maps, Leiden University Medical Centre molecular biologist Frank Faas and his team explain how they have enabled "unbiased high resolution data access while maintaining the lower resolution overview of the cellular context". It's a little like Google Earth's zoom tool, but for cell biologists.

The team joined together 26,434 detailed photos of a 1.5 millimetre-long zebrafish embryo taken using an FEI Eagle CCD camera linked up to an electron microscope. The total data of all the photos that made up the full embryo picture amounted to 281 gigapixels, with a resolution of 16 million pixels per inch -- to visualise just what incredible detail that resolution offers, compare that pixel count to the 220 pixel-per-inch resolution boasted by Apple's new Retina display Macbook Pro. Seems pretty paltry now, doesn't it. The final image slide was created using a program specifically developed for the task -- MyStitch extracts metadata from transmission electron microscopy (TEM) images and uses this to pair the images, noting any overlaps and adjusting the joins appropriately. Images have been stitched together in a similar manner in the past, using tools such as Adobe Photoshop, but only on a much smaller scale. Generating a full image of a cellular structure calls for huge amounts of time-consuming data collection, so the team achieved its feat by automating some of the processes, from the data-stitching down to the photo-taking.

The final image has been published at the upgraded JCB DataViewer site where interested parties can play around with the zoom function and take in not only the embryo, but images of mouse glomeruli, human dendritic cells and mouse embryonic fibroblasts.

Medical professionals often zoom in on the part of a cell they believe to be the main area of focus, or the root of a problem. By presenting a comprehensive image, the new "virtual nanoscopy" method ensures they get the whole picture and do not miss or inadvertently skim over important elements.

"Virtual nanoscopy does not suffer from sparse or possibly biased selection of regions of interest for high resolution imaging," states the paper. "[It] provides an objective and representative approach to record, communicate, and share data of large areas of biological specimens at nanometre resolution."

And in a related story from newswise (Rockefeller University Press):

Virtual Nanoscopy: Like “Google Earth” for Cell Biologists

Just as users of Google Earth can zoom in from space to a view of their own backyard, researchers can now navigate biological tissues from a whole embryo down to its subcellular structures thanks to recent advances in electron microscopy and image processing, as described inThe Journal of Cell Biology (JCB). An upgrade to the JCB DataViewer (http://jcb-dataviewer.rupress.org), JCB’s browser-based image presentation tool, now also makes these data publicly accessible for exploration and discovery.

Since the early days of cell biology, electron microscopy has revealed cellular structures in exquisite detail. The technique has always been limited, however, by the fact that it can only capture a tiny portion of the cell in a single image at high resolution, making it difficult for researchers to relate the structures they see to the cell as a whole, let alone to the tissue or organ in which the cell is located. Viewing samples at lower resolution, on the other hand, can reveal the larger picture of a cell or tissue, but researchers then lose the benefit of seeing fine details.

A team of scientists from Leiden University Medical Center in the Netherlands has addressed this problem by developing new tools for stitching together thousands of electron microscopy images into single, high-resolution images of biological tissues—a “Google Earth” for cell biologists—which can be explored using the newly enhanced JCB DataViewer.

Faas et al. describe their recent advances to a technique called “virtual nanoscopy” in the August 6th issue of JCB. The researchers were able to stitch together over 26,000 individual images to generate an almost complete electron micrograph of a zebrafish embryo encompassing 281 gigapixels in total at a resolution of 16 million pixels per inch. Using the JCB DataViewer, anyone can navigate the zebrafish image from the level of the whole, 1.5 millimeter-long embryo down to subcellular structures.

The ability to integrate information across cells and tissues will provide researchers with exceptional opportunities for future discoveries. But the image’s large size and complexity meant that providing access to Faas et al.’s data necessitated a major upgrade to the JCB DataViewer, a browser-based image hosting platform originally launched in 2008 to promote the sharing of original data associated with JCB publications.

“If you can image it, you should be able to publish it,” says JCB Executive Editor Liz Williams. As a journal, “JCB remains committed to developing cutting-edge tools for the presentation of the data that drive progress in the field of cell biology.”
# # #
About The Journal of Cell Biology 
Founded in 1955, The Journal of Cell Biology (JCB) is published by The Rockefeller University Press. All editorial decisions on manuscripts submitted are made by active scientists in conjunction with our in-house scientific editors. JCB content is posted to PubMed Central, where it is available to the public for free six months after publication. Authors retain copyright of their published works and third parties may reuse the content for non-commercial purposes under a creative commons license. For more information, please visit http://www.jcb.org.

About the JCB DataViewer
The JCB DataViewer is an image hosting and presentation platform for original image data associated with articles published in JCB. Developed in a collaboration between Glencoe Software, Inc. (www.glencoesoftware.com) and the Rockefeller University Press (www.rupress.org), the JCB DataViewer was the first browser-based viewer for multidimensional microscopy image data. It is based on open source software built by the Open Microscopy Environment (OME; http://openmicroscopy.org).

Faas, F.G.A., et al. 2012. J. Cell Biol. doi:10.1083/jcb.201201140
Williams, E.H., et al. 2012. J. Cell Biol. doi:10.1083/jcb.201207117

 

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New SprintPicâ„¢ Macro Imaging System from SPOT Imaging Solutions

Sprint Pic

The new SPOT SprintPic turnkey macro imaging system makes it effortless to capture great images, increasing efficiency and saving photography time.   Including a scientific grade digital camera with a software-controlled motorized zoom lens on a lighted copy stand, the SprintPic system is preconfigured and ready to use so you can get up and running quickly.  Its large number of zoom levels accommodates a wide range of samples, from industrial parts to crime scene evidence to pathology grossing sections.  The SprintPic Software provides a monitor-sized live image preview with sliders for adjusting zoom level and iris aperture, so it’s easy to see when your sample is ready for capture.  Crosshair and grid reticles can be applied to the live preview to aid in counting or for visual inspection of part size.  When you snap a photo, it is immediately ready for adding annotations, measurements, or for saving to reports - no need to wait for images to download.   Images can be automatically transferred to laboratory information systems or saved to network file servers for archival.  Built-in high-output oblique and bottom lighting ensures true color reproduction and shadow removal.  The SprintPic macro imaging system takes the guesswork out of digital documentation.

SPOT Imaging Solutions

http://www.spotimaging.com/sprintpic

586-731-6000

 

 

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Submit your Visions Poster Presentation by August 31


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2012 PATHOLOGY VISIONS POSTER PRESENTATIONS
Deadline for Poster Abstract Submissions is August 31, 2012

Don’t miss the opportunity to submit an abstract for a poster presentation at the Digital Pathology Association’s (DPA) annual conference Pathology Visions, which will be held October 28-31, 2012 at the Hilton Baltimore in Baltimore, MD. Presented posters at Pathology Visions will be displayed for two days and discussed between presenters and meeting attendees. The posters will also be judged by appointed experts in the following categories:

- “Best Poster By a Resident”
- “Best Poster Submitted in the
   Research Category”
- “Best Poster Submitted in the
   Education Category”
- “Best Poster Submitted in the
   Clinical Category”
- “Peoples’ Choice Best Poster”

Awards will be handed out to the winner of
each category at Pathology Visions and a
cash prize will be given to the winner of the Resident category.

The deadline for poster abstract submissions is August 31, 2012. Click below to submit your poster abstract now.

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Automated, Reagent- and Scanner Independent CE-IVD Module for Her2-IHC Assessment in Breast Cancer – Validated on Data from More than 170 Pathology Labs

Visiopharm A/S, a global leader in Quantitative Digital Pathology, announced today release of its novel CE-IVD module HER2-CONNECT for assessing Her2 status in breast cancer patients

Without any requirements for manual outlining of tumor cells, the level of automation is very high.

Quote startIn summary, HER2-CONNECT™ showed 94% agreement with manual scoring and 95% diagnostic sensitivity and 99% diagnostic specificity.Quote end

Hoersholm, Denmark (PRWEB) August 07, 2012

As the first in a series of innovative CE-IVD diagnostic modules for cancer, Visiopharm is now releasing the HER2-CONNECT™ module in Europe for assessment of Her2 status in breast cancer patients.

In close collaboration with the NordiQC, the clinical performance of HER2-CONNECT has been determined by three studies comprising 796 tissue specimens prepared from breast carcinomas from 222 patients, using 6 expert reviewers/pathologists and representing 178 clinical pathology laboratories using DAKO, Roche-Ventana, Leica-Bond, and other HER2 IHC reagents. In summary, HER2-CONNECT™ showed 94% agreement with manual scoring and 95% diagnostic sensitivity and 99% diagnostic specificity.

Without any requirements for manual outlining of tumor cells, the level of automation is very high. Automation is achieved using a novel and patent pending principle of membrane connectivity for membranes detected in the tissue under examination [1,2 ].

Professor Mogens Vyberg, Director of the NordiQC, states: “Three requirements must be met in order for Digital Pathology to be useful in a routine diagnostic setting: It must be independent of reagent manufacturer and based on optimized and standardized staining procedures, exhibit high diagnostic performance in terms of sensitivity and specificity, and finally it must provide a high degree of automation. Our studies, of which some are still under preparation for publication, have demonstrated that the HER2-CONNECT™ module meet those requirements”.

"This is our first CE-IVD module in a series of modules coming out of our development pipeline. In our development, we are focusing on robustness, diagnostic quality, and last but not least automation. The critical step here is clinical validation and technical documentation. Visiopharm has invested significant resources in establishing the internal procedures and a quality system allowing us to develop, validate, and release CE-IVD modules for diagnostics in Europe", adds Johan Doré, CTO and co-founder of Visiopharm.

“We have now established the necessary platforms for rapid development of new image analysis algorithms and for providing comprehensive technical and clinical documentation. This will allow us to further accelerate an ambitious development program for new innovative techniques in diagnostics and companion diagnostics. We are doing that in collaboration with what we consider to be world-leaders in quality- and evidence based pathology”, says Michael Grunkin, CEO and co-founder of Visiopharm.

1. Brügmann, A., Eld, M., Lelkaitis, G., Nielsen, S., Grunkin, M., Hansen, J.D., Foged, N.T. & Vyberg, M., Digital image analysis of membrane connectivity is a robust measure of HER2 immunostains. Breast Cancer Res Treat. 2012; 132:41-9. 
2. Laurinaviciene, A., Dasevicius, D., Ostapenko, V., Jarmalaite, S., Lazutka, J. & Laurinavicius, A. Membrane connectivity estimated by digital image analysis of HER2 immunohistochemistry is concordant with visual scoring and fluorescence in situ hybridization results: algorithm evaluation on breast cancer tissue microarrays. Diagn Pathol, 2011, Vol. 6, pp. 87. 

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Mayo Clinic Settles Billing Lawsuit

According to the The Pathology Blawg this matter I first talked about in October 2010 has been settled by Mayo Clinic for $1.26 million.

Suit Alleges Mayo Overbilled for Pathology Services, Justice Department Joins Suit (Originally posted October 2010)

The below news item has been circulating for a couple of weeks following a suit originally filed about 3 years ago.  Several folks have asked me what I know about this.  

Did Mayo intentionally defraud the government of potentially millions of dollars for frozen sections not performed?

It is a difficult question to answer and I really do not know how strong the lawsuit claim is. 

I do not think Mayo intentionally would do this but it is a complicated issue.

The story actually begins about 100 years ago when Dr. Louis B. Wilson, credited with being the Father of Research at Mayo Clinic, developed the first techniques to rapidly fix tissue for sectioning during surgery at the request of Dr. William Mayo or what we recognize in pathology as the "frozen section". His techniques live on at Mayo today much like they did over 100 years ago.  The history of the procedure has recently been reviewed with reference to the original article by Dr. Wilson.

Enough history.  Fast forward about 100 years and according to Mayo's GME FAQ's on the frozen section practice it mentions: "The frozen section rotation is probably best thought of as neither a frozen section rotation nor a general surgical pathology rotation, and perhaps that is why residents have come to refer to it as the “sink” rotation. The volume and variety of specimen material seen by residents while on the sink is comparable to what would be seen during a general surgical pathology rotation at a large medical center, yet the workflow is that of a frozen section laboratory. " The site goes on to mention " In the Mayo frozen section labs, a single-color toluidine stain is used because it produces a fast and easily readable stain. The toluidine blue stain produces a slightly different staining pattern compared to H&E, but the morphologic features are inherent to the tissue."

I never understood "morphologic features are inherent to the tissue".  Histology is artifact.  We create it with dyes - a chemical process creates purple nuclei and pink cytoplasm.  In the case of toluidine blue stain, as above, it is largely monochromatic with less contrast than traditional H&E stains, whether frozen or fixed.  

Until recently, with increasing pressure from CAP inspectors, slides reviewed at frozen may not have had a corresponding H&E permanent slide to review for frozen-final correlation.  The tissue used in the frozen section was "blocked" without making an H&E slide.  Again, the practice is unique and would be difficult to validate in many other labs if one takes an objective view.

It also turns out that given the water based nature of the stain and the stain itself it was difficult to make a "permanent" slide for later review as the stain may continue to permeate the tissue.

Given the unique practice, essentially a general surgical pathology practice with final diagnosis made on frozens at the time of surgery rather than "permanent" sections,  issues related to frozen section slides, blocks and permanent slides could all potentially complicate billing algorithms as the suit alleges.  

While the parties bringing forth the suit and the Justice Department are looking at the letter of the law, a persistent question will remain whether whatever may have happened here in regards to billing was justifiable (i.e. cost effective) given potential lack of need for second surgeries, immediate intraoperative staging and overall costs to the system for additional laboratory technical and professional resources to generate additional slides, reviews and reports as compared to outcomes in a "frozen section = final diagnosis" practice alone.  This practice is highlighted on Mayo's breast cancer website:

"Mayo Clinic physicians may use frozen section evaluation of tissue during breast cancer surgery to determine whether all of the cancer has been removed. Mayo Clinic's unique frozen section pathology laboratory provides rapid, accurate microscopic analysis of tissue while the patient is in surgery. Mayo surgeons know if they have achieved negative margins (removed all the cancer) while the patient is still in the operating room. Frozen section analysis may prevent the need for patients to undergo additional surgery."

It should be noted from a similar story out of Minneapolis -- "The Justice Departmentindicated in a September 21 court filing that it intends to intervene in the allegation that the Mayo Clinic billed for services that were not performed. The department will not become involved, however, in the claims that the Mayo Clinic improperly obtained laboratory accreditation and failed to retain histopathology slides for the appropriate time period.

Courtesy of genomeweb.com:

The Justice Department has joined a lawsuit against the Mayo Clinic alleging it submitted fraudulent claims to Medicare and Medicaid for thousands of surgical pathology tests over 10 years that its labs never performed.

The government's position, filed this week under the federal False Claims Act in a US District Court in Minneapolis, said that "over the course of the last 10 years, Mayo has routinely billed Medicare, Medicaid and other federally sponsored health care programs for surgical pathology services that have not been performed," according to the Pittsburgh Tribune-Review.

The suit, which was originally filed in November 2007 by attorney and neurologist David Ketroser, accuses Mayo of billing Medicare for permanent specimen slides and for examining the slides, "even though no slides were prepared or examined," the paper says. "Instead, the suit charges, Mayo routinely prepared only frozen section slides, which were not retained."

The suit also claims Mayo failed to comply with federal regulations that require clinical lab to retain pathology slides for 10 years.

The plaintiffs in the suit include former Mayo patients, survivors of deceased Mayo patients, and Minnesota attorney David Ketroser.

Mayo officials did not respond to a request for comment, according to the Tribune-Review.

A few days after its original report, the paper wrote that Mayo officials said the Clinic reimbursed the government for what the paper called "billing errors" on the pathology tests.

Mayo spokesman Bryan Anderson said Minnesota-based Mayo discovered the errors three years ago — "long before Mayo became aware that the sealed complaint [against it] had been filed" — and "voluntarily" refunded $242,711, the paper said.

The total amount of Mayo's alleged fraudulent billing was not immediately clear.

 

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23andMe Submits Genetic Test Applications with the FDA

Courtesy of DarkDaily:


45380_web
23andMe executives want the credibility that FDA clearance provides for its DNA tests and declared their intent to eventually support more clinical laboratory test applications

Offering genetic tests directly to consumers is a controversial subject among some pathologists and healthcare ethics experts, who question both the science of these tests and whether consumers will do the right thing with the information.

Read more from the source.

 45380_web

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Natural-language processing tool flags breast, prostate cancer

August 3, 2012 | By Susan D. Hall FierceHealthIT

Researchers claimed success using an SAS-based natural-language processing (NLP) tool to detect breast and prostate cancers from pathology reports, according to a study published this week in the Journal of the American Medical Informatics Association.

Results from the SAS-based coding, extraction, and nomenclature tool (SCENT) were compared with a random sample of 400 breast and 400 prostate cancer patients diagnosed at Kaiser Permanente Southern California whose results were classified manually.

SCENT successfully identified 51 of 54 primary and 60 of 61 recurrent cancers. It flagged only three false positives from 793 known benign results. Measures of sensitivity, specificity, positive predictive value, and negative predictive value exceeded 94 percent in both cancer groups.

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The authors noted that previous research has found natural language processing tools useful in coding and extracting information from clinical text. Indeed a recent paper published in Radiology cited success with a tool to parse data from records to build a repository of data to improve dosing recommendations.

They attributed the slow rate of adoption, however, to difficulty in integration with clinical data systems, technical complexity, and habitual use of medical claims data.

Creating a common dictionary of terms can be painstaking work as illustrated in a study on the use of NLP in breast cancer research published recently in theJournal of Pathology Informatics. It reported 124 ways of saying "invasive ductal carcinoma" and 95 ways of saying "invasive lobular carcinoma" and more than 4,000 ways of saying invasive ductal carcinoma was not present.

The authors noted the system probably would require tweaking to work with clinical text in other medical areas and outside of Kaiser Permanente, but the system "has the potential to provide significant value to clinical and epidemiologic researchers, particularly when statistical NLP is infeasible due to resource or other constraints."

A second article on natural language processing in JAMIA found the technology effective for de-identifying clinical health data for research, promising relief from the tedium of manually coding records from which personal information had been scrubbed.

While much data for research remains outside machine-readable formats, platforms enabling comparative-effectiveness research too often lack natural- language processing capabilities, according to a Medical Care study.

To learn more:
- read the research
- check out the Journal of Pathology Informatics study

Related Articles:
Studies show data mining's promise for radiology dose monitoring
Natural-language processing effective for de-identifying clinical health data
Platforms for comparative effectiveness research still evolving

Read more: Natural-language processing tool flags breast, prostate cancer - FierceHealthIT http://www.fiercehealthit.com/story/natural-language-processing-tool-flags-breast-prostate-cancer/2012-08-03#ixzz22jOsB2kk 

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