Anatomy of An Offense

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Tuesday, April 17th, 2012 at 12:45 pm | 3 responses

A scattering of thoughts on Princeton, Pete Carril and basketballs most deliberate system.

by Nick Rotunno

As basketball fans across America recovered from a wild, bracket-busting weekend of March Madness, the Princeton University mens team quietly wrapped up the 11-12 season on March 19, falling to the Pitt Panthers in the quarterfinals of the College Basketball Invitational (CBI). Almost no one noticed, because the CBI is an unceremonious little tournament for mostly average teams, and the national media had bigger things to write about.

The game was played in Pittsburgh on the Panthers home floor, and Princeton was wholly outmatched. By halftime Pitt had built a 24-point lead, and the Panthersout-shooting and out-rebounding the smaller Princeton squadcruised to an 82-61 victory. The Tigers hung around in the early going, but Pitts Big East bruisers were too much to handle.

According to the Princeton athletics website, the only good news for the Tigers concerned senior guard Douglas Davis, whose game-high 20 points moved him into second place on Princetons all-time scoring list (1,550 career points). An impressive achievement, to be sure, but Davis is still a long way from the incomparable Bill Bradley, the Tigers all-time scoring champion, who tallied a staggering 2,504 points in just three seasons of college ball, before the era of the three-point line. Bradleys total is all but unreachable, though Davis gave it a solid try.

Princeton finished a respectable 20-12 this season (11-4 in the Ivy League). It was an up-and-down year for head coach Mitch Henderson and the Tigers: Princeton kicked off the schedule with a head-scratching home loss to Wagner, nearly beat North Carolina State in Raleigh four days later, won a few, lost a few, then defeated Rutgers 59-57 on December 7. In the conference season, Princeton split with archrival Harvard, but the Crimson played well all winter, won the Ivy League and earned a berth in the NCAA Tournament (they didnt make it very far). The boys from New Jersey had to settle for the CBIPrinceton beat Evansville in the first round before getting hammered by Pitt.

All told, the Tigers 11-12 campaign was a moderate success.

So why spill so much ink on a mediocre team, after an unspectacular season? A fair question. To be honest, Ive never been to Princeton, NJ, and Ive never watched the Tigers play live. Princetons favorite son, the aforementioned Bill Bradleyone of the greatest college ballplayers of all time and a former US Senatorplayed his last game for the Black-and-Orange two decades before I was born. Aside from my natural love of the underdog, that very American tendency to root for the gutsy overachiever (and my idolization of John McPhee, Pulitzer Prize-winning author and teacher of nonfiction writing at Princeton), I have no real connection to the program.

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Anatomy of An Offense

Anatomy of a plague

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Global killer ... scientists have pinpointed the origin of the AIDS virus from chimp to human in Cameroon. Photo: Reuters

Following a trail of death, Craig Timberg and Daniel Halperin tell the grim story of the birth and spread of AIDS.

WE are unlikely to ever know all the details of the birth of the AIDS epidemic. But a series of recent genetic discoveries have shed new light on it, starting with the moment when a connection from chimp to human changed the course of history.

We now know where the epidemic began: A small patch of dense forest in south-eastern Cameroon. We know when: Within a couple of decades on either side of 1900. We have a good idea of how: A hunter caught an infected chimpanzee for food, allowing the virus to pass from the chimp's blood into the hunter's body, probably through a cut during butchering.

As to the why, here is where the story gets even more fascinating. We typically think of diseases in terms of how they threaten us personally. But they have their own stories. Diseases are born. They grow. They falter and sometimes they die. In every case, these changes happen for reasons.

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For decades, nobody knew the reasons behind the birth of the AIDS epidemic. But it is now clear that the epidemic's birth and crucial early growth happened during Africa's colonial era, amid massive intrusion of new people and technology into a land where ancient ways still prevailed. European powers, engaged in a feverish race for wealth and glory, blazed routes up muddy rivers and into dense forests that had been travelled only sporadically by humans before.

The most disruptive of these intruders were thousands of African porters. Forced into service by European colonial powers, they cut paths through the exact area that researchers have now identified as the birthplace of the AIDS epidemic. It was here, in a single moment of transmission from chimp to human, that a strain of virus called HIV-1 group M first appeared.

In the century since, it has been responsible for 99 per cent of all of the world's deaths from AIDS not just in Africa but in Moscow, Bangkok, Rio de Janeiro, San Francisco, New York and Washington. All that began when the West forced its will on an unfamiliar land, causing the essential ingredients of the AIDS epidemic to combine.

It was here, by accident but with motives by no means pure, that the world built a tinderbox and tossed in a spark.

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Anatomy of a plague

Anatomy students at Edward Via honor those who donated bodies to science

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Students in the anatomy lab at Edward Via College of Osteopathic Medicine school of medicine. Chuck Frost, Bralin Bean, Jenna Bates, Nate Benitez, Adam Boiter, Chris Bazemore, and Nate Moore.

The anatomy lab at Spartanburg's new medical school can accommodate 193 bodies, 165 of them alive.

The 28 remaining are human cadavers, subjects of intense scrutiny for the first-year students at the Edward Via College of Osteopathic Medicine.

"Probably the most difficult thing an American medical student has to do is understand human anatomy," said Dr. Lance Paulman, a professor of anatomy at VCOM. "They take the body apart so they can learn to put it back together."

The students have worked with the same bodies since September, when the school opened, and now they're planning a memorial service on Friday in Columbia to honor the deceased.

The University of South Carolina runs the Gift of Bodies program, which allows people to donate their bodies to science after they die. Their gift provides bodies for the USC's medical school and VCOM. The service is a chance for students to honor that gift.

"They get to explain to the families (of the deceased) how beneficial their loved one's gift has been," Paulman said.

The students only learn the age, cause of death and primary occupation of the dead person they are assigned. But they learn much more about the body.

They make incisions and remove the skin. They look at the musculoskeletal system, the placement of the body's organs, and the interconnectedness of all of its systems.

"Until you go in and you see it and you look at those relationships, that's when it really hits home," said Randy Baxley, 36, a VCOM student. "You don't realize who's whose neighbor."

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Anatomy students at Edward Via honor those who donated bodies to science

Scientists' hopes for yacon leaf as a treatment for diabetes

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Scientists' hopes for yacon leaf as a treatment for diabetes are crushed due to long-term toxicity
By Donna Earnest Pravel

Yacon leaf (Smallantus sonchifolius) is an herb that has become popular in recent years due to a few controlled medical studies showing the positive effects of yacon leaf on diabetic rats. The herb is used in South America to control blood sugar. Some commercial green superfood formula makers list yacon leaf as an ingredient. Yacon is considered a superfood because it it high in flavanoids, fructooligosaccharides, and antioxidants. The interest in yacon leaf motivated a team of researchers in 2011 to study the long-term effects of yacon leaf extract. They experimented with yacon leaf tea on diabetic rats for ninety days. The results were that long-term usage of yacon leaf caused kidney damage in the rats. Yacon leaf is no longer being considered as a possible therapy for diabetes. Read more...

AyurGold for Healthy Blood

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Sweetened drinks increase risk of heart disease in men by twenty percent

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by: John PhillipResearchers publishing the results of a study in the prestigious American Heart Association journal Circulation have found that men who drank a 12-ounce sugar-sweetened beverage a day had a 20 percent higher risk of heart disease compared to men who didn't drink any sugar-sweetened drinks. This should come as no surprise as sweetened (and calorie-free) beverages have come under scrutiny for contributing to increased risk of potentially fatal conditions such as diabetes, dementia, stroke, liver necrosis (fatty liver) and obesity.Excess glucose in the bloodstream is easily converted to triglycerides by the liver and promptly stored as fat, typically around the waistline for use during leaner times. This survival mechanism worked very well for our ancestors of several hundred generations past, but times of plenty now exist regularly, several times each day for most.Humans were never metabolically wired to consume the large amount of nutrient-poor calories as we do today, and it is leading to an early grave for millions. The bottom line is simple: eliminate calories from sugar-sweetened beverages and lower your risk of heart disease by one-fifth. Read more... 

AyurGold for Healthy Blood

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6, 12 or 18 biopsies? Would you like a triple stain with that?

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As the story goes that I have heard a couple of versions of, somewhere in Florida in the early 1990s, a urologist or small group of urologists, taking advantage of exceptions in the Stark Law (actually there are multiple parts to this single law) and skirting anti-kickback regulations, started to perform anatomic pathology services and referring those specimens to their laboratories, or themselves.

Folks familiar with this recognize that Stark does allow self-referral of imaging or other diagnostic tests within the practice that is actually ordering or referring the patient for the test.  With passage of Obamacare, these groups are suppose to provide a letter to patients and inform them where else in the area these services may be available.  Kind of like a restaurant showing you a menu for 3 other restaurants after the restaurant manager referred you to his/her restaurant.  Not sure if this happens with any regularity.

Anyways, somewhere in Florida around 20 years ago, in-office pathology was born.

Throughout the 1990s, many urologists had supplemented their revenues through an arrangement with the maker of Lupron, a hormone drug for prostate cancer. Under the arrangement, Lupron producer TAPPharmaceutical Products Inc. sold urologists the drug at a steep discount, while the urologists in turn billed Medicare for the full price.

The arrangement ended in 2001 when several urologists were indicted and TAP Pharmaceutical paid more than $840 million to settle a Justice Department investigation. Deprived of the Lupron profits, some urologists' incomes declined by as much as one-half according to accounts by urologists at that time.  

It is thought that declining reimbursements from Lupron that eventually ended in 2001 led at least in part to urologists looking for other sources of revenue.

According to their website, In-Office Pathology was formed in 2004. The site mentions over 45 installations in eighteen states in urology, gastroenterology, dermatology and multispecialty practices. This company also claims "We do it better than anyone else". Laboratory Economics reviews this regularly and almost every issue contains new physician owned laboratories within urology, GI and dermatology

Recently, as I mentioned earlier this week in a post on over utilization within in-office pathology laboratories, in what may come to be called The Mitchell Report (OK, the Other Mitchell Report), a study published by Dr. Jean MItchell, a noted Geogetown economist confirmed with a multi-year study of such practices an increasing number of biopsies with actually fewer cases of prostate cancer detected by those practices. 

Besides from perhaps doing more rather than less and violating the principle of "first do no harm" fewer diagnosed cases of prostate cancer also hurts their referral rate to their specialized IMRT centers for treatment but that is for another post on another day...

Since the article on this topic was published that American Urologic Association wrote a letter to the editor in the journal the article appeared in referencing a "turf war" and claiming over the past decade the number of jars for best clinical practices increased from 6 to 12, with one biopsy in each jar.  This translates to 12 CPT codes (88305) for the referring physician who will capture the technical and professional component within his/her respective self-owned laboratory.

For more on this story and a copy of the AUA's response and response from In-Office Pathology check out The Pathology Blawg for continuing coverage of the story.

So, what does any of this have to do with digital pathology?  A lot.

I can't really say that I have a horse in this race or any "turf" worth getting into a war over in my practice per se.  This freight train left the station years ago and I do not begrudge IOL, the urology community or pathologists who are employees or part-owners of these laboratories for trying to make a buck, if done correctly and in accordance with best clinical practices.

One of the real problems here is that the technology to process tissue has become so good one can have a tabletop tissue processor, small stainer and coverslipper and IOP with 350 square feet of office space, some drywall and nails and create a full-service anatomic pathology laboratory. I bet it would be hard to find any of the laboratory information system companies geared toward the outreach/outpatient market who does not have at least one install in an operation such as this.  

This is a perfect market for digital pathology.  You could create the possibilty to have a team of prostate experts review cases remote from the provider, patient and histology lab and report those findings with web-based LIS systems.  For straight TC/PC relationships this would work fine where everyone gets paid for what they are doing.  Save the urology or GI group the cost of a pathologist plus additional coverage when that person is attending a prostate pathology meeting or on vacation.

Whole slide imaging could augment the laboratory or completely eliminate the need for pathologists to be onsite beyond some basic medical director functions. Of course the idea here is that some of these urologists and gastroenterologists would want the full global charge capability rather than outsourcing the professional component.  Perhaps if they hire the wrong pathologist they might re-think this model as well.

Here is an idea, I can do a one-year endoscopy fellowship for upper and lower GIs, set up an endoscopy center complete with the latest state of the art endoscopes, build a lab in the back of the practice, do my own biospies and read my own biopsies.  Would anyone have a problem with that? I saw the patient, I did the gross examination via endoscopy and can correlate it with the slides.  Perfect. It turns out that the CPT codes and reimbursements for upper or lower GI endoscopy with biopsy is higher than a UGI or LGI examination without biopsy. Even better. And because it is an invasive procedure, I should take more rather than fewer biopsies to diagnose disease. None of this of course would be driven by financial reasons.  It is all evidence-based and presumably my rates of disease detection would go up or I would consider doing fewer biopsies over the course of time (certainly within 3-5 years) if the yield is no greater (or lower) than a control group (self-referring vs. refer to AP lab).

 

 

 

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A survey on digital pathology adoption – Cirdan Imaging

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Cirdan Imaging, a new name in digital pathology, is developing new low-cost digital pathology solutions to improve workflow within the laboratory.

We would like to build up a detailed picture of what digital pathology techniques have been implemented in the laboratory and to determine how far these have penetrated into day-to-day operations.

If you are working anywhere within the pathology laboratory environment or have an interest in new digital pathology techniques, we would appreciate your comments.

You can enter our survey at:

https://www.surveymonkey.com/s/cirdanimaging

The full results of the survey will be available and will be circulated to all respondents. The respondents will also have the opportunity to be entered into a draw for an new iPad.

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Visiopharm further expands strong patent portfolio for Whole Slide Stereology with the revolutionary Proportionator™; an image analysis driven stereology module

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The Proportionator principle is a significant advance for stereology as a discipline, which will allow scientists to implement stereological study designs also in high-throughput environments. 

Hoersholm, Denmark - April 11, 2012 - Visiopharm A/S, a global leader in Quantitative Digital Pathology, announced today that the European Patent Office has issued the European Patent No. EP 2102817, entitled: Proportionator. 

“With the new Proportionator principle, we have demonstrated a several fold increase in efficiency, when compared to traditional Systematic Uniform Random Sampling”, says Prof. Jens Randel Nyengaard. 

Stereology is a method that allows scientists to answer important research questions about the total amount of microstructure in a tissue volume, including at the organ level; and provide statistically unbiased answers with a known precision. Examples are number of cells, trabeculae, alveoli, and other objects. Also total volume, surface area and total length of structures in an organ are examples of what can reliably be quantified. Stereology is the only way to achieve accurate quantitative data about such tissue properties with a known precision. 

Scientific communities and regulators with a genuine concern about the validity of quantitative histomorphometric data are increasingly requesting stereological data, or at least evidence that such data is concordant with an appropriate stereological reference. Stereology is now becoming a critical component for a useful Quantitative Digital Pathology platform; and a technical discipline that research professionals with a need to study tissue properties can no longer afford to ignore. 

With classical stereological methods and tools, implemented on traditional microscope systems, it is time consuming, repetitive, and costly work to produce stereological data. Typically, service requirements for complex microscope systems are not trivial. Until recently, there were no good alternatives. 

Since 2004, when Visiopharm took over the highly respected CAST™ stereology technology developed by Prof. Gundersen, Visiopharm® has invested massively in the development of innovative and efficient stereological techniques and research tools, in close collaboration with the world-leading stereologists at the Stereological Research Laboratory in Aarhus, Denmark. The result is newCAST™ and a patented set of tools and techniques that efficiently overcome the bottlenecks of classical stereology. 

The Proportionator™ is the latest addition to this toolbox and a revolutionary stereological sampling principle that allows image analysis to guide the sampling of fields, while still providing statistically unbiased results, which is the hallmark of stereological methods. The Proportionator™ was co-developed with the Stereological Research Laboratory in Aarhus, Denmark, which remains the leading innovators and practitioners of stereology, and are the founders of modern design-based stereology. 

Says Prof. Jens Randel Nyengaard, “With the new Proportionator principle, we have demonstrated a several fold increase in efficiency when compared to traditional Systematic Uniform Random Sampling. This is a significant advance for stereology as a discipline, and will allow scientists to implement stereological study designs also in high-throughput environments”. 

Johan Doré, CTO at Visiopharm adds “We see this new patent as an important addition to our Automated Physical Disector patent, which has already made Whole Slide Stereology extremely efficient by automatically aligning serial tissue sections and sampling perfectly aligned disector pairs. Powering this technology with the Proportionator will further enhance the efficiency, saving users countless hours of repetitive work, and providing quality results with very high precision. We believe that the combination of Whole Slide Imaging with automation of stereology is the key to successful implementation of stereology in life-science research”. 

“In order to become successful with stereology, it is important to understand that a complete stereology solution is more than a few standard techniques implemented in a software program. It is critical to have a firm grasp of all steps from tissue sampling over Field Of View sampling to counting and reporting of results. Without access to competent application support, the transition can sometimes be a painful and expensive experience for adopters. For almost a decade, Visiopharm have invested significantly in innovation, development, practical work, and people with the right skill-set; and we are developing our technology in close collaboration with the world-leading stereologists from the Stereological Research Lab in Aarhus. This is giving our customers the certainty and comfort that we are able bring them safely all the way through an important and very rewarding transformation, which is in some ways quite radical”, says Michael Grunkin, CEO of Visiopharm. 

The latest example of how Whole Slide Stereology is applied, using AutodisectorTM and ProportionatorTM, is offered in our Webinar on: “The application of whole slide stereology for cost effective assessment of beta cell changes”, on April 12, 2012m by Jacob Jelsing, MSc, PhD, and CSO from Gubra ApS. 

About Visiopharm Over the past 10 years, Visiopharm image analysis and stereology software has become the preferred Quantitative Digital Pathology solution for leading biopharmaceutical companies, clinical researchers, and academic researchers all over the world. Visiopharm has more than 300 deployed systems worldwide and a large network of distribution and support partners, and is featured in over 400 scientific publications. 


 

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Pathology Informatics: Theory & Practice – New Book from ASCP Press

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PIASCPbookLast month ASCP Press published a new book on pathology informatics, the first multi-authored textbook on the subject geared towards a comprehensive review of the field of pathology informatics.  

Drs. Pantanowitz (UPMC), Weinstein (U of Arizona) and myself have a chapter devoted to telepathology and whole slide imaging.  

A must read (at a great price) for resident or practicing pathologist alike as well as anyone with interests in the diverse nature of pathology informatics for practical management, operations, budgeting and project planning.

 

Editors:

Liron Pantanowitz, MD
J. Mark Tuthill, MD
Ulysses G.J. Balis, MD
Add to Cart

Description:

Order#5831 | ISBN:9780891895831

Pathology Informatics: Theory & Practice is the first multi-authored, current and comprehensive compendium of the diverse and rapidly expanding field of pathology informatics.

It includes all of the critical and practical advice for management, operations, budgeting, and project planning and will serve as a comprehensive review of the field for students, pathologists, and laboratory professionals. This book deals with the role of computing hardware, software and databases involved in the efficient information management for pathology practice, as well as the fundamental science of informatics that is so deeply embedded in this subspecialty.

The text builds from basic principles of computer theory to more sophisticated informatics concepts.

  • Databases and data mining; networks and workstations; system interfaces and interoperability. 

  • Bioinformatics, imaging informatics, clinical informatics, and public health informatics. 

  • Automation and middleware that facilitate complex workflows encountered in both anatomic and clinical pathology practice. 

  • Molecular testing and point of care solutions. 

  • Coding and nomenclature. 

  • Standards in Laboratory Information Systems (LIS) and imaging systems. 

  • Project management and business skills. 

  • Pathology reporting. 

  • Electronic medical records. 

  • Specimen tracking and identification. 

  • Error reduction and quality management. 

  • Training and education in pathology informatics.

Hardbound • 336 pages • 112 figures • 368 tables

List Price: $135.00

Member Price: $105.00

Add to Cart

 

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Study Co-Funded by CAP Shows Evidence of Self-Referral Overutilization

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A CAP Statline from yesterday I saw on another blog mentions that an independent study shows the first clear evidence of self-referral of anatomic pathology services leads to increased utilization as well as higher Medicare spending and lower rates of cancer detection.

For CAP members, there will be a special webinar on the topic end of this week (see below for details).

This is a topic that any pathologist who is aware of anatomic pathology services being insourced, or "brought in house" by clinicians, referred to as in-office labs (IOLs) or POD labs, has suspected for as long as the practice has been in place.  The idea that perhaps some, if not all, of urologist IOLs or POD labs, and let's for the sake of argument, just say that is a minority of labs doing so, perform more testing, bill Medicare more, but do not increase their yield of cancer detection beyond conventional means of doing so with fewer tests wil come as no surprise to practicing pathologists aware of some of these practices at least.

At first glance it does not appear that the study looked at excess immunohistochemical stains that may be performed without providing clinically relevant information.  It looks like without more complete reading of the study design and findings that the author looked at number of biopsies inasmuch as additonal ancillary studies.  Nonetheless, it is a form of overutilization whether you look at number of biopsies or cups or stains, particularly if doing more biopsies does not increase the yield of cancer detection.

This is however a sensitive issue as pathologists are also physicians who own and/or operate laboratories where additional testing may also provide some financial incentives without necessarily being in the bests interests of patient care.  And pathologists can also self-refer vis-a-vis immunohistochemical stains, special histochemistry stains or perhaps molecular tests that are not needed, indicated or non-contributory in terms of diagnosis, treatment and management.

Do we reallly need to perform Alcian blue stains on every esophageal biopsy to insure we do not miss intestinal metaplasia?  Are Giemsa stains terribly helpful on every stomach biopsy? Some will claim their clinicians request these for these types of specimens and so they do it.  It reminds me of taking a "shotgun" approach with immunohistochemistry illustrated in this video.  Make sure to order the vimentin stain.  A negative or positive result among the other 26 stains will help to cinch the diagnosis and by doing them at once, despite not using the H&E morphology as a guide, will surely lead the right diagnosis quicker and more accurately without any prejudice to perhaps just doing a few fewer stains which will provide the same result with the correct diagnosis. 

I was saw a case in referral of a liver biopsy from an elderly gentlemen with biopsy proven colon cancer processed at the same lab and read by the same pathologist who was interpreting the liver biopsy.  The H&E appearance on the liver biopsy was identical to the colon cancer from the biopsy of that a week prior.  This, however, not to be undone and believing no case is complete unless the requisite number of immunostains are done, ordered 18 immunohistochemical stains on the liver biopsy.  18.  For a routine, typical, colon cancer metastatic to liver, of course metastatic at the time of the initial biopsy a week prior. The patient was seen at our institution for treatment.  The H&E of the liver biopsy and the H&E of the colon biopsy were likely all that would have been needed.  The CK20 and CDX-2 stain were confirmatory and the other stains, including MUC antigens I did not know existed, help proved, in case there was any doubt, that this was not likely a brain, lung, kidney, liver, pancreas, testicular, prostate, bladder or gallbladder primary metastatic to the liver.

The point is the urologists with the labs, specifically those in this study to be clear and without knowing specifically who they are, are not the first physicians/lab directors to come up with this or take advantage of the ability to self-refer on lab specimens within their shop.  

As a pathologist, we should applaud CAP's efforts on this issue in providing sound data to illustrate the iappropriate clinical business practices but we should also as a specialty be mindful of what is appropriate as well in our own laboratories if we are going to claim these in-office labs are conducting themselves inappropriately.

Perhaps this could be the start of removing anatomic pathology services from the exception on the Stark Law but we must also set clear examples of appropriate use of ancillary tests.

April 9—Self-referring urologists billed Medicare for nearly 75% more anatomic pathology (AP) specimens compared to non self-referring physicians, according to a study published today in a leading health care policy journal. Furthermore, the study found no increase in cancer detection for the patients of self-referring physicians—in fact, the detection rate was 14% lower than that of non self-referring physicians.

These findings, from an independent study co-funded by the CAP, provide the first clear evidence that self-referral of anatomic pathology services leads to increased utilization, higher Medicare spending, and lower rates of cancer detection. The study, led by renowned Georgetown University health care economist Jean Mitchell, PhD, will appear in the April 2012 issue of Health Affairs and is now available on the journal’s website.

“The findings are irrefutable,” said CAP President Stanley J. Robboy MD, FCAP. “The Mitchell study raises a red flag on self-referral, giving evidence that it tends to increase utilization and cost with little or no patient benefit.”

This analysis also supports the College’s long-standing position that self-referral of anatomic pathology services needs to end by removing anatomic pathology from the exception in the Stark Law.

“We need to close a loophole in the law to prevent anatomic pathology from being referred to labs where referring physicians have a financial self interest,” said Dr. Robboy.

 

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The Royal College of Pathologists uses PathXL for their Pilot Project in the use of Digital Pathology

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PathXL is working alongside The Royal College of Pathologists to coordinate a pilot project with the aim of exploring the benefits and usage requirements of Digital Pathology by College fellows.

Other objectives include investigating whether the College should create an archive of slides in support of e-learning.

PathXL, a global pioneer in the use of web-based solutions for digital pathology, is providing the image and content management software as well as secure cloud hosting for the pilot. With PathXL, slides can be accessed from any location, including within NHS firewalls. Slide management tasks can also be conducted from any location.

There are two digital scanners installed at the College – one fromNikon /Hamamatsu and the other from Laser 2000/3D Histech. The equipment is available for fellows to use and test, and is located in the Fellows room on the first floor of 2 Carlton House Terrace.

All fellows are welcome and encouraged to use the equipment to scan slides and to comment on the suitability of the equipment and the results generated. A short evaluation form has been designed to capture feedback from users and this important feedback will be used to write a report at the end of the pilot for consideration by Council.

The pilot will run until 6th May – to book a particular time slot please contact the front of house team on scanning@rcpath.org or telephone 020 7451 6707. All of the front of house staff have been trained to use the scanners and software and will be available to help out if required.

For more information please visit http://www.rcpath.org/

 

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The Great Morbid Anatomy Library Flood of 2012: List of Destroyed Books Now Posted

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Thanks so very much to all of you for your outpouring of support, donations, and offers to help in the aftermath of The Great Morbid Anatomy Flood of 2012 (more details on that here). Many of you have asked to see a list of those books lost, in the interest of ordering or sending particular books for the library; I have created a special Amazon wish list that contains all books lost, and will ship directly to the library; you can check it out by clicking here.

For those of you who would like to mail books directly, our mailing list is:

Joanna Ebenstein
c/o The Morbid Anatomy Library
543 Union Street #1E
Brooklyn, NY 11215

Thanks so much, again, for all your support, and please save the date for an upcoming benefit party to take place Saturday May 12. Please contact me if you'd like to donate objects or artworks for a silent auction, or talent for performances, or labor!

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Disaster Has Hit The Morbid Anatomy Library!

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Tis' a sad day indeed.

Some of you might already have already heard, but last Friday night, the building in which The Morbid Anatomy Library is located suffered a small artwork-related fire. The fire was quickly extinguished, but not before The Library and its collection of books, artworks, and artifacts suffered severe water damage from the building's fire sprinklers. Stay tuned for news about a benefit party to raise money for rebuilding the library, but, in the meantime, here are some photos of the water-logged chaos we are digging ourselves out of. I should mention, the damage could have been much, much worse, and I am very grateful we got off as easy as we did. Still, if any of you are interested in making a monetary donation to help the collection, simply click on the "donate here" button on the right side of this blog. If you are interested in donating books or artifacts--or time and/or talent for the benefit!--please email me at morbidanatomy [at] gmail.com.

I would also like to send out a very special heartfelt thank you to G. F. Newland, Wythe Marschall, Ethan Gould, Grace Baxter, Emi Brady, Sasha Chavchavadze, PK Ramani, Tammy Pittman, Benjamin Warnke, Aaron Beebe, Lado Pochkhua, Ted Enik, the fellows from Curious Matter, and everyone else who for pitched in to make this disaster so much less of a one than it could have been, while I was far from home and unable to help at all.

Ok, off to assess the damage in greater detail. Thanks to everyone, and more to come!

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The immune boosting power of garlic

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by: Dr. David Jockers

Garlic is a pungent herb and one of nature's best anti-biotics. Due to the powerful sulfur containing nutrients and immune stimulators within garlic, it is classified as a superfood herb. Consumption of garlic daily may be one of the best defense's against infection and inflammatory based disease.

Garlic has been used by many cultures throughout the history of mankind as a medicinal tool. The Sumerians and other groups around the Mediterranean region had a great reverence for its ability to fight infection. An Egyptian writing dating back to 1500 BC discusses the use of garlic for over 22 common health challenges. These same Egyptians fed a heavy garlic diet to their slaves to increase their strength as they built the great pyramids. Read more...

AyurGold for Healthy Blood

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GE Healthcare completes acquisition of SeqWright, Inc., expanding capabilities in fast growing molecular diagnostic segment

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GE Healthcare adds to its medical diagnostics business with additional sequencing and next generation technologies.  

In a few years it is entirely conceivable all of one's healthcare from cradle to grave will be supplied by a few providers for technical services.  From the amniocentesis to imaging your broken bones in childhood, to personalizing your colon, breast, lung or colon cancer and then the directed therapy to treat such cancer, could all be provided for by the likes of GE or Roche or another multi-national health services technology and treatment provider with personalized diagnoses, companion diagnostics, imaging and therapy.  

Addition of high growth company builds on Clarient’s biopharma service capabilities and provides platform to offer sequencing-based clinical diagnostics in the future

St Giles,UK – 4 April 2012 – GE Healthcare, a unit of GE (NYSE: GE) announced today that it has acquired SeqWright, Inc., a provider of nucleic acid sequencing and other genomic services.  The acquisition adds complementary genomics capabilities to Clarient, a unit of GE Healthcare and a leader in the fast-growing molecular diagnostics sector. The deal also provides a platform for Clarient to expand its clinical diagnostic offerings to include next generation sequencing. Financial terms of the acquisition were not disclosed.

“Understanding how genetic variation at the molecular level impacts disease is critical in the continued discovery and development of new and more effective therapies, and increasingly in the management of patient care through the use of more precise diagnostic tests,” said Pascale Witz, President and CEO, GE Healthcare, Medical Diagnostics.  “Combining the expertise and capabilities of the two companies will enable GE Healthcare to offer a substantially wider range of services to the biopharmaceutical, diagnostic and research industries and eventually to patients and health care providers.”

Molecular diagnostics provide precise information about a patient’s disease and can help doctors decide on the best treatment.  The rapid increase in the incidence of cancer worldwide, together with advances in specific cancer-focused therapies, is driving significant demand for molecular diagnostics. 

“As a CLIA-certified service provider, we are in a position to capitalize on the growing role next- and third -generation DNA sequencing technologies will play in clinical diagnostics,” said Fei Lu, President and CEO of SeqWright. “This partnership will put us in a position to apply the power of new direct detection technologies to clinical and companion diagnostics, potentially revolutionizing the way healthcare decisions are made. 

As biopharma companies continue to develop large portfolios of increasingly targeted therapies, the need for fast, accurate and cost effective sequencing technologies and services to determine the genetic profile of patient samples becomes vital to clinical trials and the development of companion diagnostics.  SeqWright has an extensive history of projects that focus on clinical trial and regulatory support for companion diagnostic submissions. The complementary capabilities of Clarient & SeqWright will allow the combined business to add immediate incremental value to existing pharmaceutical and biotechnology partnerships throughout their drug development and companion diagnostic development efforts. 

“Sequencing, including next-generation DNA sequencing, is an important technology for GE’s medical diagnostics business,” said Carrie Eglinton-Manner, CEO of Clarient.  “The acquisition of a specialized laboratory with long-standing expertise in the sequencing field as well as an established customer base allows us immediate entry into this high-growth space, and is an ideal complement to Clarient’s existing protein and gene expression profiling in support of pharmaceutical and in vitro diagnostic studies.”

Clarient provides pathologists and oncologists with access to diagnostic tests that shed light on the complex nature of various cancers by combining innovative diagnostic technologies with pathology expertise to assess and characterize cancer.  Clarient is focused on developing novel, proprietary diagnostic markers and tests for the profiling of breast, lung, colon, melanoma and blood-based cancers, to help clinicians make informed decisions on how best to treat their patients.  Given the increasing importance of more targeted cancer diagnostics, Clarient is well positioned to bring differentiated, added-value molecular diagnostic products and services to market.  Since 2007, Clarient’s revenues have grown at an approximate 30 percent compounded annual growth rate.

About GE Healthcare

GE Healthcare provides transformational medical technologies and services that are shaping a new age of patient care. Our broad expertise in medical imaging and information technologies, medical diagnostics, patient monitoring systems, drug discovery, biopharmaceutical manufacturing technologies, performance improvement and performance solutions services help our customers to deliver better care to more people around the world at a lower cost. In addition, we partner with healthcare leaders, striving to leverage the global policy change necessary to implement a successful shift to sustainable healthcare systems.

Our "healthymagination" vision for the future invites the world to join us on our journey as we continuously develop innovations focused on reducing costs, increasing access and improving quality around the world. Headquartered in the United Kingdom, GE Healthcare is a unit of General Electric Company (NYSE: GE). Worldwide, GE Healthcare employees are committed to serving healthcare professionals and their patients in more than 100 countries. For more information about GE Healthcare, visit our web site at http://www.gehealthcare.com.

For our latest news, please visit http://newsroom.gehealthcare.com

About SeqWright, Inc. 

Founded in 1994, SeqWright, Inc. is a full-service nucleic acid technology contract research organization focused primarily on traditional and next-generation nucleic acid sequencing.  SeqWright is CLIA certified and GLP compliant, enabling the company to offer services in support of product regulatory submissions.  With over 17 years of genomics experience, SeqWright has built a reputation for quality, technical expertise and a willingness to customize services to meet its customers' individual needs.  The company’s mission is to drive scientific and medical innovation by helping to facilitate and accelerate the research and development efforts of its customers. 

SeqWright is based in Houston, Texas and employs approximately 34 people. For more information, please visit the company’s website at http://www.seqwright.com

 

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Frost & Sullivan: Industry Push toward Quantitative Imaging Positions Computer Aided Detection and Diagnosis Adequately for Renewed Clinical Expansion

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Notwithstanding recessionary trends, participants continue spirited R&D efforts to expand product portfolios

MOUNTAIN VIEW, Calif., April 4, 2012 /PRNewswire/ -- Since the inception of the market in 1998 and until 2008, revenue from the North American computer aided detection and diagnosis (CAD) market continued to grow rapidly year over year. It surpassed the $100 million mark for the first time in 2007. However, this upward trend was reversed in 2009 due to several factors affecting global healthcare. Once confined to image analysis and pattern recognition algorithms, CAD solutions have expanded dramatically in recent years to provide more workflow management functions for the diseases and conditions they cover.

New analysis from Frost & Sullivan's (http://www.medicalimaging.frost.com) North American Market for Computer-aided Detection and Diagnosis research finds that the market earned revenue of $103.5 million in 2010 and estimates this to reach$181.7 million in 2017.

If you are interested in more information on this research, please send an email to Britni Myers, Corporate Communications, atbritni.myers@frost.com, with your full name, company name, job title, telephone number, company email address, company Web site, city, state and country.

"From CAD solutions used on the spot, some have evolved into computer-assisted decision-making solutions or computer-assisted pre-surgical assessment solutions, whereby they provide more of an end-to-end solution used prior, during and after treatment or surgery and for accessing databases for clinical decision support," said Frost & Sullivan Principal Analyst Nadim Daher. "Applications such as prostate treatment or liver transplantation will drive CAD from a mere detection and diagnosis tool to a more complete solution providing image based analytics, disease quantification, treatment assessment, and workflow management."

Regardless of the unfavorable market conditions prevailing in North America since 2008, CAD industry participants have continued to fuel their R&D efforts and expand their product portfolio. As a result, the market is slowly starting to move towards multi-modality solutions, a trend that is poised to broaden market appeal of CAD through numerous sales channels.

Reimbursement is a key element in the business model for CAD purchases. The profitability of medical imaging service lines is being challenged as reimbursement rates for procedures continue to fall at the rate of a few percentage points annually due to various Medicare reimbursement cuts and healthcare reforms. In this tough economic landscape, it becomes difficult for clinicians to justify the extra cost that CAD adds to imaging procedures, without a clear financial return.

The business case for CAD becomes more challenging within, as well as outside, mammography. As for its clinical case, it is balanced by greater clinical acceptance on one hand, and slowing technology innovation on the other.

In light of the U.S. Food and Drug Administration (FDA) draft guidance documents for CAD technology issued in October 2009, CAD vendors are facing a toughening regulatory environment and, as a result, will be slower in bringing CAD innovation to the marketplace.

"Despite imaging providers' budgets starting to free up during the latter part of 2010, CAD has not been in the best position to return to its historical double-digit growth rates," said Daher. "Current market dynamics suggest that the market will continue upon a steady, but not explosive, growth path."

A careful analysis of the clinical benefits, the impact on workflow, and the return on investment (ROI) of CAD solutions will be crucial for CAD vendors to drive more favorable purchasing decisions within a widening addressable marketplace. This market reality calls for greater customer education efforts from the vendors about CAD, as well as more effective communication and collaboration with existing and prospective customers.

North American Market for Computer-aided Detection and Diagnosis is part of the Advanced Medical Technologies Growth Partnership Service program, which also includes research in the following markets: Cloud Computing in Medical Imaging (Vital Signs); Molecular Imaging Equipment (PET, SPECT, and Hybrid Systems); Computer Aided Detection and Diagnosis; Healthcare Reform and Medical Imaging (Vital Signs); Cardiovascular Image and Information Management Systems; U.S. Core Modality Market Update: CT, MRI, DR/CR, Fusion Imaging (Vital Signs); Digital Pathology Image Management Systems; Personalized Medicine (Vital Signs); and Medical Ultrasound Imaging Equipment. All research services included in subscriptions provide detailed market opportunities and industry trends evaluated following extensive interviews with market participants.

About Frost & Sullivan
Frost & Sullivan, the Growth Partnership Company, enables clients to accelerate growth and achieve best-in-class positions in growth, innovation and leadership. The company's Growth Partnership Service provides the CEO and the CEO's Growth Team with disciplined research and best-practice models to drive the generation, evaluation, and implementation of powerful growth strategies. Frost & Sullivan leverages 50 years of experience in partnering with Global 1000 companies, emerging businesses and the investment community from more than 40 offices on six continents. To join our Growth Partnership, please visithttp://www.frost.com.

 

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Where does all of healthcare gather to discuss digital?

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“The International Healthcare Social Media & Web 2.0 Conference”

  • NEW: EARLY BIRD III EXTENDED UNTIL APRIL 10, 2012! Sign-Up Now!
  • Sample our Testimonials   Angel Gonzalez ”my sincere message of congratulations for all of  your effort on bringing to life this special conference that, for me, has got the category of ‘Gold-Standard’ in Health 2.0!”  Giovanna Marsico ”I recommend this rendez-vous in Paris as the major event in Europe for all people interested in Health and Medicine 2.0 and Social Media.”  Berci Mesko  “Doctors 2.0 and You 2011 in Paris was THE medical social media conference of the year and I can’t even imagine how great the next event will be with more participants with even more topics covered. I look forward to speaking there and I encourage everyone from pharma to patient groups and doctors to participate in these discussions.”  Pedro Pinto ”…pragmatic shared experiences, excellent network and great business opportunities… we are now involved in a vibrant and collaborative community of people who really want to make things change. Congratulations for this excellent work!”  

Producers/Organizers

Basil Strategies Team is delighted to prepare this exciting event. See the Basil Strategies team page.

What is Doctors 2.0™ & You?

The second edition of the must-attend annual health care social media conference in Paris ; the only international congress devoted to the understanding of how physicians use New Technologies, Web 2.0 tools, Social Media to communicate with other health care professionals, patients, payers, pharmaceutical companies, public agencies…

Who should participate?

Those who decide on and or benefit from e-services to physicians : professional and patient associations, pharmaceutical companies, governments, payors.
Who within these organizations is concerned? Program organizers, strategists, trainers, communicators, marketing professionals and IT specialists.
Please note that physicians practicing in France will benefit from CPD credit by attending this conference.

When / Where?

May 23-24 2012 in the City of Lights – Paris! The conference will take place at Cité Universitaire in Paris (to know more, click here). There will also be an amazing Cocktail Soirée on the 23rd, taking place at at an exclusive location to be announced soon!

Why?

Doctors 2.0™ & You will again be THE conference on this subject in 2012. You will meet the stars of Web 2.0 and Social Media for Health Care and Medicine. You will get a special look at the impact of the latest technologies on the relation between physicians and patients, colleagues, industry, the public sector. And maybe, just maybe,  you might win one of the contest’s prizes.

Meet our Advisory Board

Doctors 2.0™ & You is supported by the combined effort of Basil Strategies and the Advisory Team which include: (Austria) Michaela Endemann, (Canada) Pat Rich, (France) Catherine Cerisey, Alain Clergeot, Raphaëlle Laubie, (Germany) Alex Schachinger, Len Starnes, (Greece) Kathi Apostolidis, (Hungary) Berci Mesko, (Israel) Yossi Bahagon, (Italy) Roberto Ascione, Giovanna Marsico, (Netherlands) Janine Budding, Rob Halkes, (Spain) Jorge Juan Fernandez Garcia, Angel Gonzalez, (Switzerland) Silja Chouquet, (UK) Felix Jackson, (USA) Larry Chu, John Mack and Lawrence Sherman. For more information about the Advisory Board, please visit the Board of Advisors 2012 page.

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ATA 2012: The Year’s Biggest Telemedicine, Telehealth & mHealth Event

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San Jose event features 200 exhibitors, 450 peer-reviewed presentations, and keynote by Apple co-founder, Steve Wozniak

WASHINGTON, April 2, 2012 /PRNewswire via COMTEX/ -- The ATA 2012 Annual Meeting (April 29 - May 1 in San Jose, California) is the world's largest meeting and tradeshow focusing exclusively on telemedicine, telehealth, mHealth and cutting-edge remote healthcare technologies. With more than 4,000 attendees, 200 exhibitors, 450 peer reviewed presentations and a keynote by Apple co-founder, Steve Wozniak, ATA 2012 will keep you up-to-date on the rapidly changing field of telemedicine.

Register now to stay up-to-date on the research, technologies and applications that are changing modern healthcare -- and save 15 percent in the process with code ata15disc. The ATA 2012 Educational Program features diverse and critical topics for the up-to-date healthcare professional and contains over 450 peer-reviewed presentations, exploring an array of topics related to telemedicine, telehealth, mHealth and remote medical technologies.

2012 will be our biggest exposition ever with more than 200 exhibiting companies showcasing the latest telemedicine technologies--many of which are being unveiled for the first time to the public. Whether you are just getting familiar with telemedicine or you're in the market to buy now, register today for a FREE Expo-Only Pass to see, test and handle the latest telehealth technology.

To view the multimedia content associated with this story, click here

Register here.

SOURCE: American Telemedicine Association

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Amazon Web Services Hosts Human Genetics Catalog in the Cloud

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By hosting the human genetics catalog in the cloud, AWS gives researchers instant access to the complete 1000 Genomes Project on AWS, enabling scientists to accelerate disease research.

Amazon Web Services (AWS) and the U.S. National Institutes of Health (NIH) announced that the complete 1000 Genomes Project is now available on AWS as a publically available data set.

AWS and NIH announced the news at the White House Big Data Summit on March 29. The announcement makes the largest collection of human genetics available to researchers worldwide, free of charge. The 1000 Genomes Project is an international research effort coordinated by a consortium of 75 companies and organizations to establish the most detailed catalog of human genetic variation, AWS officials said.

The project has grown to 200 terabytes of genomic data, including DNA sequenced from more than 1,700 individuals that researchers can now access on AWS for use in disease research. The 1000 Genomes Project aims to include the genomes of more than 2,600 individuals from 26 populations around the world, and the NIH will continue to add the remaining genome samples to the public data set this year.

The 1000 Genomes Project started out with pilot phases in 2008 that included just a couple terabytes of data, AWS told eWEEK. In 2010, NIH made a small portion of that data available on AWS as a public data set, and due to the positive feedback from scientists, it decided to make the 1000 Genomes Project as it stands today at more than 2000TB of data fully accessible on AWS. The amount of data produced by the 1000 Genomes Project is unprecedented in biomedical research, NIH officials said. NIH, part of the U.S. Department of Health and Human Services, serves as one of the data coordinators for the 1000 Genomes Project.

"Previously, researchers wanting access to public data sets such as the 1000 Genomes Project had to download them from government data centers to their own systems, or have the data physically shipped to them on discs," said Lisa D. Brooks, Ph.D., program director for the Genetic Variation Program, National Human Genome Research Institute, a part of NIH, in a statement. "This process took a long time, and that's assuming a lab had the bandwidth to download the data and sufficient storage and compute infrastructure to hold and analyze the data once they had it. We are happy that the 1000 Genomes Project data are on AWS to give researchers anywhere in the world a simple way to access the data so they can put the data to work in their research."/p>

"Putting the data in the AWS cloud provides a tremendous opportunity for researchers around the world who want to study large-scale human genetic variation but lack the computer capability to do so," said Richard Durbin, Ph.D., co-director of the 1000 Genomes Project and joint head of human genetics at the Welcome Trust Sanger Institute, in Hinxton, England.

AWS said for researchers to download the complete 1000 Genomes Project on their own servers, it would take weeks to months, and that s assuming they had the bandwidth to download the data and enough hardware and storage to hold it. To do meaningful analysis on the data, researchers often needed access to very large, high performing compute resources, which cost hundreds of thousands and sometimes millions of dollars, AWS officials said. The NIH was selected as one of the data coordinators for the 1000 Genomes Project, and it wanted to remove this friction and make the data as widely accessible as possible, so researchers can immediately start analyzing and crunching the data, even if they don t have the large budgets that are traditionally required for this level of data analytics, AWS said.

Public Data Sets on AWS provide a centralized repository of public data stored in Amazon Simple Storage Service (Amazon S3) and Amazon Elastic Block Store (Amazon EBS). The data can then be directly accessed from AWS services such as Amazon Elastic Compute Cloud (Amazon EC2) and Amazon Elastic MapReduce (Amazon EMR), eliminating the need for organizations to move the data in-house and then procure enough technology infrastructure to analyze the data effectively, AWS said.

For its part, AWS highly scalable compute resources are being used to power big data and high-performance computing applications such as those found in science and research. NASA's Jet Propulsion Laboratory, Langone Medical Center at New York University, Unilever, Numerate, Sage Bionetworks and Ion Flux are among the organizations leveraging AWS for scientific discovery and research. AWS is storing the public data sets at no charge to the community. Researchers pay only for the additional AWS resources they need for further processing or analysis of the data.

To read the original eWeek article, click here: AWS Hosts Human Genetics Catalog in the Cloud

 

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"O Death Where Is Thy Sting?" or Happy Easter Everyone!

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Easter week celebrates the moment when, in Christian metaphysics, mortality is overcome by everlasting life. The crucifixion of Jesus Christ redeems mankind from the sinful state into which mankind fell through Adam's disobedience to the will of God in the garden of Eden. His resurrection liberates us from eternal perdition: in Saint Paul's famous words (I Corinthians, XV.54-55) "So when this corruptible shall have put on incorruption, and this mortal shall have put on immortality, then shall be brought to pass the saying that is written, 'Death is swallowed up in victory'. O death where is thy sting? O grave where is thy victory?".

These concepts were articulated with fresh force in the later sixteenth century through the Counter-Reformation, in media such as altarpieces, sermons, the educational work of the Jesuit Order, and through devotional prints which were widely disseminated. Here we present four such prints from the holdings of the Wellcome Library...

Read the entire article from which this excerpt is drawn--and see more images!--on the excellent Wellcome Library blog by clicking here; click on image to see a much larger, more detailed view.

Image: Engraving after Maerten de Vos, late 16th century. Wellcome Library no. 23283i.

As described on the blog:

Finally in this sequence, we have the powerful figure of Christ triumphing over death. The upper part combines two scenes: Christ is simultaneously resurrected from the tomb and ascends into heaven. In the lower left corner, Death itself is about to be swallowed up by a monster, while in the centre the snake that led Adam and Eve astray, and who is entwined around the secular world, is about to be trampled down by the wounded foot of Christ. On the right a tablet engraved with the Ten Commandments faces upwards, indicating that Christ is triumphing over righteousness of the law, replacing it with righteousness of faith...

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