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June 2013

With TSH testing, no lack of discord

June 2013—In 219 BCE, after he had unified the seven warring states to establish the nucleus of the Chinese empire, the First Emperor of China promulgated uniform administrative practices throughout the land. One section of his decree read: All men under the sky toil with a single purpose. Tools and measures are made uniform. The written script is standardized. Wherever the sun and moon shine.

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From the President’s Desk: Now and Future Policy Agenda

June 2013—My father and his brother were teenagers when they found steerage on a ship to the United States in 1910. They arrived with neither English nor assets but with a firm belief that this democracy would provide opportunity. My father completed high school, college, and medical school under difficult circumstances; the long effort gave shape to his hopes. He became a physician who loved his work. We absorbed by osmosis the satisfactions of a life devoted to thoroughly unreasonable goals. I still believe what we learned then: In this country, effort that is intentional and persistent will be respected and rewarded.

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Keeping an eye on H7N9, and learning from the past

June 2013—What began as a trickle of reports in China earlier this year swelled into a flood of patients with grave flu-like symptoms. Each time, PCR assays returned the same result: unsubtypable influenza A. Amid a rising mortality rate, viral samples were sent to China’s national laboratories for sequencing analyses. On March 31, Chinese officials posted the results to an open-access database and alerted the World Health Organization to a public health emergency of international concern: The H7N9 epidemic had begun.

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How labs are taming test utilization

June 2013—It might be a legacy of the economic downturn. Perhaps it is the prospect of increased capitation under health care reform. Or it could be the stunning price tags of some new tests on the clinical laboratory test menu. Whatever the cause, health systems across the country are increasingly moving beyond education and retrospective review to more specific, targeted, prospective controls on test utilization.

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Newsbytes, 6/13

June 2013—Clinical IT help desks bring service to new level; PathCentral introduces plug-and-play AP system; ONC guideline addresses transition of care under meaningful use criteria; Laboratory systems certified as electronic health record modules

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Q & A, 6/13

June 2013—Say an individual is stuck with an HIV-contaminated needle or occult infected with HIV by bodily fluid transmission and is started on preventive antiretroviral treatment to prevent permanent infection. (Treatment protocol is one-month intensive treatment.) Is there any known laboratory procedure by which a specimen could be isolated to determine by culture if the patient was indeed infected (assuming the patient is seronegative six months plus after treatment was initiated)?

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Anatomic Pathology Selected Abstracts, 6/13

June 2013—Prolonged cold ischemia time and ER immunohistochemistry in breast cancer: To aid detection of estrogen receptor expression in breast tumors, the American Society of Clinical Oncology and College of American Pathologists recommend that cold ischemia time be kept under one hour. However, data to address the upper threshold of cold ischemia time are limited.

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Clinical Pathology Selected Abstracts, 6/13

June 2013—Ehrlichiosis is a tick-borne disease that may be asymptomatic or result in fatal sepsis. Ehrlichiosis transmitted from transfusion of blood products has not been documented. A case report of a 9-year-old Georgia boy with a history of acute lymphoblastic leukemia is the first report of Ehrlichia ewingii infection transmitted by a platelet transfusion. The authors first describe the patient as presenting to the hospital with complaints of fever, fatigue, malaise, vomiting, diarrhea, and petechial rash.

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