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aapan e w s l e t t e r

american association of pathologists’ assistants inc.

A . A . P . AEditor: Tisa Lawless, PA(ASCP)

Before I get down to the business of this report, I would like to congratulate Skip Winters, our new Administration Committee Chair, for the great job he has done since taking

over as chair. Skip has, among other things, orchestrated this year’s election process very well, both identifying and obtaining commitments from five excellent candidates for the three open Board of trustees positions. Welcome, Skip, and congratulations!

In regards to the elections, I would like to express my appreciation to the two board members, Larry Marquis and Leo Limuaco, who are running again. I know I speak for the entire board in saying that your leadership skills and continued commitment to the AAPA are greatly appreciated. For excellent bios on Larry and Leo, please refer to this summer’s newsletter issue.

May I also say on behalf of the entire board, that we will miss Jon Wagner, whose term is up and who has chosen not to run again this year? Jon has always given 100 percent to the AAPA, as an officer and president, and as an invaluable member of the board, particularly in heading up the team tasked with reorganizing our governance/membership structure. Jon has always offered well and thoroughly considered input on matters before the board. thank you, Jon!

I would also like to congratulate the three AAPA members who are running for the open board positions, members whose commitment to leadership is already well established. Your willingness to take on additional responsibilities and greater leadership roles in the AAPA is commendable! For excellent bios on candidates Susan Morgan, Colleen galvis, and John vitale, please refer to this summer’s newsletter issue.

I know the board is looking forward to finding out what its new configuration will be for the coming year. the results of the election will be announced at the annual business meeting in Montreal. Best of luck to all of the candidates!

In recent years, we have seen, among other things, the advent of national certification for individual pathologists’ assistants, which has the added benefit of elective membership in the ASCP. the AAPA has also created new governance and membership structures and created a set of Bylaws to replace our outdated Code of Regulations. these changes have been driven, in part, by the necessity to adapt to the ever-changing landscape within the “bottom line”-driven healthcare system, and in part because of our success and continued growth as an association. having accomplished these goals, it would be great to be able to take some time to grow into the changes. As nice as that would be, we all know that things just don’t work that way. the board continues to develop long and short term planning goals as we look to and prepare for the future.

the AAPA has become more sophisticated, both in the way we govern ourselves and in the way we present ourselves to the professional world at large. the success and growth of our profession is tied to the successes of individual pathologists’ assistants in their positions. the best advertisement for our profession is, of course, the way that each of us as individuals interacts with our colleagues in the laboratory, in the O.R., in radiology, and elsewhere. I think it is evident that our success as an association has had a positive effect in the medical community, which has translated into a greater awareness of our profession and into the higher level of acceptance that individual pathologists’ assistants enjoy in the marketplace today.

Board of Trustees ReportTom Reilly

B.O.T. continued on page 3

Vol. XXXV No. 3

Fall 2007

IN THIS ISSUE

Page 1BOT Report

Page 2Newsletter Information

Committee Chairpersons Central Office Information

Pages 3-6Committee Reports

Page 7PANE Report

Crossword Solution

Pages 8-9Medical Liability for PAsGross Photo Unknown

Pages 10-11The Traveling Bacterium

Sustaining Members

Page 13Product Review: Blades

Pages 14-15Stem Cell Article

Fall Quiz

Pages 16-17Book Review: A Surgeon’s

Notes on PerformanceGross Photo Tutorial

Page 18Training Programs

Page 19Bulletin Board

2007 aaPa Board of Trusteestom Reilly, Chair • Anne Walsh-Feeks, Vice Chair/Secretary • Jayne Tessitore, Chief Financial Officer

Maryalice Achbach • Rae Rader • Larry Marquis • Tina Rader • Leo Limuaco • Jon Wagner

FROM THE EDITOR…Tisa Lawless

In preparing for the fall conference in Montreal, two newsletter contests are under way. the AAPA Newsletter

Award is now being judged and the winner will be announced at the business meeting during the conference; the winner will receive a plaque and $250. Aside from our newsletter staff writers (Barbara dufour—CME quiz and articles, Jason Balliet—gross Photo tutorial, Chet Sloski—Book & Article Review, dennis Strenk—Current topics in Pathology, and Minda Koval-Watson—Product Review), we received submissions eligible for the Newsletter Award from:

Bruce Koepp—detailing the PAd John Mitchell—Leadership Secrets Bing Mille—PPSS gigi Oien—Bell’s Palsy

For your contributions to this newsletter, you are all winners in my book. thanks for supporting the AAPA and the newsletter.

I hope to find lots of photo entries for the Photography Contest upon arrival in Montreal. I apologize for the absence of the photo contest entry form in the summer newsletter issue. upon discovery (thanks, david), the entry form was forwarded to the Central Office and was posted on our web site. I also sent a broadcast e-mail to the AAPA Chat Room, offering to send the form upon request. hopefully, my oversight had little impact on the contest. the winner will receive a plaque and $250, while the second place photographer will receive $100.

I am pleased to report that Barbara dufour, our CME quiz queen, has graciously agreed to fill an unexpected vacancy and present a safety lecture in Montreal. In addition to standing up in front of all of you, Barbara will be parlaying her lecture into an article with quiz for the winter newsletter. We think that a CME quiz will fulfill the safety requirement mandated by the ASCP CMP, so this will be our test run. depending upon the response, both from the ASCP CMP audit process and the AAPA membership, future safety quizzes may be undertaken in the newsletter.

Since being deposed in a medical malpractice case last November, I’ve been working up an article about professional liability insurance for PAs, which is printed elsewhere in this issue. I spent many

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aaPa NEWSlETTER STaFF

Editor . . . . . . . . . . . . . . . . . . . . Tisa Lawless Associate Editor . . . . . . . . . . Bob Bladek Article & Book Review . . . . . .Chet Sloski CME Quiz . . . . . . . . . . . . Barbara Dufour Current Pathology . . . . . . . .Dennis Strenk Gross Photo Tutorial . . . . . . . Jason Balliet Other Meetings List . . . . . . .Marty Stone Photography Contest . . . . . . Jason Balliet Product Review . . . . Minda Koval-Watson

aaPa NEWSlETTER SUBMISSIONS

The AAPA Quarterly Newsletter encourages any AAPA member or interested party to contribute articles, updates, photos, or upcoming event announcements. In particular, articles of pathologic interest are welcomed.

Articles and photos may be submitted via postal mail or as e-mail attachment files to ensure that a hard copy is available for editing purposes. Photo files must be a minimum of 300 dpi resolution. Use the link on the AAPA web site to send your submissions via e-mail (or you can send your e-mail attachment directly to tibigirl@dishmail.net). With prior editorial approval, faxed submissions will be accepted. All submitted material is edited for content and clarity.

Our goal is for each issue to be mailed to the membership within four to six weeks of the newsletter deadline.

Mail submissions to:Tisa Lawless

Decatur Memorial HospitalDepartment of Pathology2300 N. Edward Street

Decatur, IL 62526

aaPa COMMITTEE CHaIRPERSONS

administration . . . . . . . . . . . .Skip Winters Vice Chair . . . . . . . . . . . Lindsay McCarleyConference . . . . . . . . . . . Jana Joslin-Akers Vice Chair . . . . . . . . . . . . .Elizabeth Claus Audiovisual . . . . . . . . . . . . Steve Suvalsky . . . . . . . . . . . . . . . . . . . . & Dick Dykoski Exhibitor Recruitment . . . . . . Eva Osborn Food & Beverage . . Heather Manternach Fun . . . . . . . . . . . . . .Kostas Kontogiannis Fun Run . . . . . . . . . . . . . . . . . .Lisa Ware Golf . . . . . . . . . . . . . . . . . .Larry Marquis Poster Display . . . . . . . . . . . . . Don Perrin Regional Conference . . . . . . . Laura Welsh Speaker Recruitment . . . . .Elizabeth ClausEducation . . . . . . . . . . . Michelle Rosenow Vice Chair . . . . . . . . . . . . . Susan Morgan CME . . . . . . . . . . . . . . Kathy Washington CME Library . . . . . . . . . . . . . .Sarah Pietz CME Quiz . . . . . . . . . . . . Barbara Dufour Certification Exam Study Course . . . . . . . . . . . . . . . . . . . . Susan Morgan Essay/Scientific Paper . . . James Edwardslegislative . . . . . . . . . . . . . . . Jennifer TitusMembership . . . . . . . . . . . . . . Lori Patruno Vice Chair . . . . . . . . . . . . . Colleen Galvis Membership Survey . . . . . . Debra Martin New Members/Affiliates . . . . . Dan Galvis New Members/Students . . . . . .Tara SheaNewsletter . . . . . . . . . . . . . . . Tisa LawlessPublic Relations . . . . . . . . . . . . . Jon BakstWeb Site . . . . . . . . . . . . . . . . John Eckman

aaPa CENTRal OFFICE

Office Enterprises, Inc.Rosewood Office Plaza,

Suite 300N1711 W. County Road B

Roseville, MN 55113800/532-AAPA or 651/697-9264

Fax: 651/635-0307msok@assocmgmt.orgContact: Michelle Sok

2007 and 2008 Deadlines

Winter 2007 Issue - October 15, 2007Spring 2008 Issue - February 1, 2008Summer 2008 Issue - May 1, 2008Fall 2008 Issue - August 1, 2008

Winter 2008 Issue - November 1, 2008

hours unsuccessfully attempting to find a company that would write a new liability policy for the individual PA (one who is not covered by an employer/hospital policy). Many PAs have reported that they have such an individual policy, but the companies through which they are currently insured are no longer extending coverage for new applicants. If you have recently become covered as an individual PA, please let me know; I think that is an important resource to share with our colleagues.

I look forward to another great installment of the AAPA conference in Montreal. As always, it will be wonderful to meet old and new friends. I hope to see you there.

The AAPA, as an independent, not-for-profit volunteer organization of allied health practitioners, is dedicated to the advancement of the pathologists' assistant profession and of individual pathologists' assistants through advocating, promoting and sustaining the highest

educational and professional standards for the profession, for its professional credentialing partner, for all associated educational training programs and for individual pathologists' assistants; providing all AAPA members with high quality, targeted continuing education (CE)

opportunities as well as professional development and leadership activities, including networking and support. The AAPA strives to promote and support high quality standards within the scope of practice for pathologists' assistants in anatomic pathology, thereby ensuring the

provision of high quality patient care.

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B.O.T. Report continued from page 1

What’s next for the AAPA? how can we build on these successes? We can continue to develop relationships with other professional organizations, both within our immediate sphere and beyond. As you know, we have already been successful with this approach, having established working relationships with NAACLS, ASCP, ASCP BOR, and CAP. We continue along this track by joining organizations such as NAAhP and others.

We can continue to improve the way we communicate, not only within our association, but also between our association and the world around us. While it may not rise to the level of the all-important personal interaction as a way to advertise the AAPA and the profession, the Internet can be a very powerful and

persuasive tool to help us continue to grow and flourish.

the AAPA web site offers professionals and public alike a window through which to view our organization. It also offers us an opportunity to put our best face forward, to present ourselves in a manner that will reflect positively upon our association. Our Web Site Committee Chair, John Eckman has developed and implemented a great web site. he and Michelle Sok of our Central Office have continually made appropriate upgrades since the site was created. they’ve done a great job and deserve our appreciation.

Our growth and sophistication come at a cost. We have had some problems in keeping information on the web site current. this is an issue that is

primarily a function of the pace of change outstripping our ability to get the information posted in a timely fashion. the board is well aware of this problem, and is striving to improve on present day conditions. We have a great deal more information now to make available to our members and to the public. Our web site is the ideal format to do that, and the board will be discussing ways to help John and Michelle make that happen.

Well, there are other topics I could present here, but the deadline fast approaches, and there will be other newsletters. By the time you get this, our Montreal conference will be nearly upon us. I’m sure it will be a fitting finale to a great summer! See you there.

Administration CommitteeSkip Winters

As you read this, the end of summer will be in sight and the Montreal conference will be close at hand. We will have concluded our first

election under the new format, the votes will be in the process of being counted, and the winners of the seats on the Board of trustees will be announced in the very near future—at the conference and in the next newsletter.

All of the candidates had strong credentials and every one of them deserved to be chosen for the open seats, but only the ones with the three highest vote totals will win. I know full well that those selected will serve the members of the AAPA to the best of their ability and with the best interests of the organization in mind. I sincerely hope that those not selected will be willing to entertain a candidacy in the coming year’s election and will continue to pursue a seat on the BOt.

the one thing that I know was shared by all the candidates was a willingness to volunteer their time in service to the only organization solely dedicated to the advancement of their chosen profession; I urge each of you to carefully assess your own willingness to volunteer. We will need a full slate of candidates for next year’s election and there are a number of committees that would welcome fresh voices.

the new set of AAPA Bylaws that has replaced the AAPA Code of Regulations has been accepted by the BOt and posted on the AAPA web site. I urge all members to take the time to read through the Bylaws and become familiar with this new document. Every member of the Administration Committee has received a copy and read through the new set of regulations that govern the day-to-day running of the AAPA.

In addition, the committee has requested a copy of the Articles of Incorporation for each of its members so we can also be familiar with the

requirements that are listed in that. the Bylaws reference the Articles, and the committee decided we needed to be up to date on what is stated so that we can fulfill the responsibility of ensuring that correct parliamentary procedure is followed by the BOt in the governance of the AAPA.

Any member with a concern about the Bylaws or the Articles of Incorporation may contact a member of the Board of trustees or any member of the Administration Committee to voice their concern or ask a question. I wish to thank the members of this committee for all their effort and help with the election and other duties of the committee. they are truly dedicated, involved, and concerned with and for the AAPA. Administration Committee members are listed below:

Lindsay McCarley, vice ChairBryan RadosavcevKaren RonMinda Koval-Watson

Now on to Montreal!

Public Relations CommitteeJonathan Bakst

As each of you already know, the 33rd annual AAPA conference is right around the corner. the AAPA exhibit booth will be one

of several booths on display during this week. I encourage each of you to take a few minutes during the conference and stop by the booth, talk to the AAPA members at the booth, and read the brochures that the AAPA has put together.

that, however, is not enough–take the time and check out the exhibit booths set up by both the AAPA’s sustaining members and other vendors recruited solely for this conference. talk to the people at the booths, see what they are offering–network with them. this is a great opportunity to see what the vendors are offering, not only in regard to standard instruments we use on a daily basis, but also new technologies that will define anatomic pathology in the future.

Following the annual AAPA conference, the exhibit booth will make stops at CAP in Chicago (Sept. 30–Oct. 3) and ASCP in New Orleans (Oct.18-22). these conferences present the AAPA with the opportunity to promote itself and continue making its presence known in the pathology community.

I hope everyone had a great summer and I look forward to seeing each of you in Montreal.

C o m m i t t e e R e p o R t s

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Membership CommitteeColleen Galvis

It is amazing how much can occur in the short intervals between newsletters. It is almost a good thing that Lori asked to take a break from

writing the newsletter article because it forced me to remember all of the things that she coordinates year round. I forgot all that the committee chair position entails. Luckily, she has subcommittee chairs who effectively manage each of their subcommittees.

With the recent changes in the membership categories, the former OJt application has been revised to be applied to the new affiliate member process. the application is being finalized and will soon be available

for a completely on-line application process. dan galvis is working toward a ‘paperless’ process for application with the hope to reduce the turn around time of applications. If the on-line process succeeds, the Membership Committee will investigate on-line applications for all membership categories.

deb Martin is preparing for the 2007 membership survey. She received an excellent response for the 2006 survey and is hoping to build upon that success. Overall, there were 49 requests for information related to the survey. the Membership Committee is working with Michelle Sok at the Central Office to explore the possibility of using an electronic survey format that would compile and tally the data. this would reduce deb’s work immensely. In

addition, Eric Calinese is working on separate surveys for part time employees and contract PAs. More information will be available at the Montreal conference for those able to attend. For those not attending the conference, more information will be available in the next newsletter.

tara Shea is managing student applications and keeping students informed of the benefits of becoming members. She has done an excellent job maintaining a busy process with the addition of new training programs across the country.

If you have any questions regarding the Membership Committee, please feel free to let us know.

Audiovisual SubcommitteeSteve Suvalsky

the Audiovisual Subcommittee has been very busy working with Conference Committee Chair, Jana Joslin-Akers, and

Central Office Coordinator, Michelle Sok, along with the Av representative from the Fairmont hotel, completing the final schedule for Av equipment and setups. Lessons learned from our Av setups in vancouver/2006 have allowed us to prepare a more reasonable layout and floor plan for the Montreal conference. there is an excitement building within the subcommittee, thanks to the tireless efforts of Ryan Schniederjan, as we utilize his audio and video capabilities within the state-of-the-art lecture hall in Montreal. this year, our new digital camera will again be in the capable hands of our videographer, dick dykoski.

the subcommittee members are also preparing the necessary equipment that will create dvd recordings and enhancements for each of the 2007 Montreal conference lectures. these recordings and enhancements are the beginnings for future AAPA audio and visual media. CME media containing

lectures from the Montreal conference will be created thanks to the efforts of the Av Subcommittee, Education Committee, CME Library Subcommittee, Central Office staff, Conference Committee, and a representative of the AAPA Board of trustees. Other projects are pending among the AAPA Public Relations Committee, Membership Committee, Conference Committee, ASCP, our conference site hosts, and those who support our profession.

the existence of the subcommittee is for the planning, technical understanding, and implementation of all Av equipment owned and rented by the AAPA. the current Av Subcommittee members are dick dykoski—videographer, Ryan Schniederjan—audio and video coordinator, Paul degennaro—technical assistant, Steven Boyle—planning, and Stephen Bullock—background and artwork. As the 2007 projects near an end, the accomplishments are:

• Evaluating the purchase of a back drop for the AAPA conference.• Development of the lecture hall floor plan for the 33rd annual conference in Montreal.

• Sharing ideas to enhance the AAPA conference and learning environment.• Working and sharing AV equipment and technical efforts with other committees.

the attendance in Montreal, previous annual conferences, and regional meetings has grown at an incredible pace. to accommodate this growth and the learning opportunities at our conferences, our subcommittee wishes to improve the AAPA’s conferences, knowing that this requires higher levels of audio and visual expertise!

We hope we aren’t noticed during the lectures or technical glitches. Please contact the Central Office or any member of the subcommittee if you can volunteer to share your time preparing for the various meetings by assisting with the Av equipment. Expertise in audio, video, graphs design, and stage design would be an asset in the coming months as we implement ideas for the many projects on the horizon. the Av Subcommittee wishes to add members to our team during and after Montreal.

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CME SubcommitteeKathy Washington

I’ve been receiving many e-mails regarding AAPA/PACE and ASCP continuing education policies. here is the

rundown:

There are two (2) different CME •systems here: AAPA and ASCP. the AAPA/PACE CME documentation runs on a calendar year from 1 January through 31 december. PACE awards one (1) CME credit for at least 50 minutes of lecture activity—basically a 1 hour-1 credit system. the ASCP Certification Maintenance Program (CMP) runs in three-year cycles, starting with the date of your initial certification. the AAPA program is optional, while the ASCP program is mandatory to maintain ASCP certification.

AAPA CME record keeping/•tracking is an AAPA member benefit and is entirely optional. If you send documentation of your CME activity to me (AAPA) throughout the course of the CME year, I will keep track of it, record it on your AAPA web page profile for your access, and then send you a year-end PACE Certificate outlining your CME credits for the year. All of your CME credits are in one place—the PACE certificate(s)—and easy to put your hands on if ASCP should audit your renewal. If you choose not to record your CME with the AAPA, your CME activity is still valid for ASCP purposes.

Participation in the ASCP •Certification Maintenance Program (CMP) is mandatory to remain certified through ASCP. ASCP requires 45 CMP points for every three-year period of certification, to include at least one point in safety and twenty points in anatomic pathology. An ASCP CMP renewal form must be sent to ASCP two months prior to the end of each three-year period. A percentage of renewals will be audited, at which time actual documentation of CME activities will be requested by ASCP to verify completion of the program. ASCP accepts many more activities for credit than PACE does. Activities that are approved for credit are listed on pages 5-6 in the ASCP CMP booklet. If your renewal is audited, the types of documentation the ASCP requires are described on pages 10-11 in the ASCP CMP booklet.

The AAPA does not report •CME activity to ASCP—that is each individual’s responsibility when they send in their ASCP certification renewal application. the AAPA tracks and records your CME activity as a benefit of being a member. the AAPA automatically supplies PACE Certificates for any approved AAPA regional or national meeting attended. the AAPA also supplies a year-end PACE Certificate for other credits that you have submitted separately on the AAPA CME worksheet, to include hospital based activities for which you have provided documentation of attendance. AAPA Newsletter quiz responses are also automatically recorded. Any ASCP credits you might earn do not need to be recorded with the AAPA unless you want them to be included on the year-end PACE Certificate.

It is too late to get PACE Certificates •for credits earned prior to 2007. the PACE Certificates for 2006 were already distributed in late January 2007. data for 2007 is currently being recorded throughout the course of the year. After the 31 december 2007 deadline, I will tally the data for each member and generate a 2007 Year-End PACE Certificate. 2007 AAPA PACE Certificates will be distributed late January 2008.

I really recommend visiting the ASCP web site for complete info on certification maintenance and CME requirements—that is where I get all my answers. here are links:

ASCP CMP:•http://ascp.org/certification/CMP/

ASCP CMP Booklet:•

http://ascp.org/Certification/CMP/pdf/cmp_booklet.pdf

ASCP declaration Form:•http://ascp.org/Certification/CMP/pdf/cmp_declaration.pdf

ASCP voucher Form (for those who •have been ASCP Associate Members over the three-year period and can waive the required $50 fee):http://ascp.org/Certification/CMP/pdf/04CMPvoucher.pdf

the take home message of all of this is, whether or not you submit your CME activity to me (AAPA) or not, make sure you have reproducible documentation of your CME activity that meets ASCP’s requirements!!

Fun Run SubcommitteeLisa Ware

hello, fellow exercise enthusiasts! those of you reading this, hoping to find out the course map for the 5K run/walk, are not going to be happy.

But where is your thrill of the unknown? My internet searches and phone calls to hotel personnel have left me undecided as to the route. It will probably be an out-

and-back loop again, with some city roads. I hope to have a route mapped by Friday afternoon; after that, the route information will be available at the conference registration desk. If I get really organized, I might have t-shirts available when you check into the hotel.

If you haven’t decided if you are going to walk/run, then you need to e-mail me so that I can reserve you a one-of-a-kind commemorative t-shirt (Lisa.Ware@

Palmettohealth.org). As always, there will be refreshments and light snacks at the finish line. due to the event taking place in a foreign country, I am still debating on beverage selection. Even if you haven’t signed up to participate, at least come to the finish line and witness a few fellow PAs and others try to outrun Saturday night’s socializing.

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Conference Committee Jana Joslin-Akers

Congratulations to our Early Registration drawing winner, Shawn d. Pottschmidt, from South Bend Medical Foundation in South Bend, Indiana.

Shawn won a $100 CDN gift certificate to the award winning Beaver Club restaurant, which is located in the Fairmont queen Elizabeth hotel. the Beaver Club is one of the top ten restaurants in Canada and I can personally vouch for their impeccable service and delicious food! Enjoy, Shawn, and thank you for registering early!

Many of our workshops and fun activities still have available space and we will be able to accept last minute registrations up until the start of the event, based on availability. Please see either Michelle Sok or Sheryle hazard at the conference registration desk when you get to Montreal for the latest information on what still has availability and/or to register for additional activities and workshops. unfortunately, it was necessary to cancel the scheduled two-day quebec City tour and Mini golf event since we did not meet the required minimum number of participants. We will try to organize a much more affordable Mini golf tournament next year in Long Beach!

this year, we have extended an invitation to our conference to the pathologists’ assistants, pathology residents, and pathologists local to the Montreal area. We do not currently have any members within the province of quebec and this is the perfect opportunity for us to spread the word about our association and perhaps gain some members within the newly created affiliate membership category. I met with several people working as pathologists’ assistants in Montreal while I was on my site visit and they are indeed interested in finding out more about our association and perhaps becoming members. We will identify the local guests with a special colored name badge lanyard, which I will explain Monday morning during our welcome announcements. Please share

your experiences with our special guests and join me in welcoming them to their first ever AAPA conference!

We have contracted with a new lead retrieval company that uses Radio Frequency Identification (RFID) personal data terminals (Pdt), which are able to read a computer chip, imbedded within name badges, from a distance of 3 inches. this new technology will result in faster, easier scanning and, hopefully, shorter lines to enter the lecture hall. You will still be required to have your name badge scanned prior to the start of each lecture to obtain CME credits, which means that you will need to exit the lecture hall during each break in order to be scanned in for the next lecture.

hopefully, most of you have already applied for and received your passports by the time you are reading this newsletter! If you have applied for but not received your passport, don’t dismay since the u.S. has recently eased the restriction on passport requirements for re-entry into the u.S. due to the lengthy processing times passport applicants are experiencing. the following excerpt was taken from the u.S. department of State web site:

“u.S. citizens traveling to Canada, Mexico, Bermuda or countries in the Caribbean region who have applied for, but not yet received passports, can re-enter the united States by air by presentation of a government issued photo identification and department of State official proof of application for a passport through September 30, 2007. the federal government is making this accommodation for air travel due to longer than expected processing times for passport applications in the face of record-breaking demand. Adults who have applied for but not yet received a passport should present government-issued photo identification and an official proof of application from the U.S. department of State. Children under the age of 16 traveling with their parents or legal guardian will be permitted to travel with the child’s proof of application status. Children traveling alone should carry a

copy of their birth certificate, baptismal record or a hospital record of birth in the united States in addition to their passport application status documentation. this accommodation applies to all American citizens who apply for passports, until September 30, when this accommodation period ends. u.S. citizens with pending passport applications can obtain proof of application at: http://travel.state.gov/passport/get/status/status_2567.html.”

As always, the various conference subcommittees have been hard at work organizing their respective areas of responsibility to insure that our annual conference is fabulous! heather Manternach has been busy organizing another yummy menu on top of taking care of her new baby girl, Ashley Evelyn Manternach, who arrived on June 2nd. Steve Suvalsky, Ryan Schniederjan, and dick dykoski have had their noses to the grindstone, coming up with ways to improve the audio/visual aspect of each lecture and improve the digital recordings used to make our lecture dvds for those obtaining CME credits post conference. don Perrin has somehow managed to round up numerous poster presenters for what will undoubtedly be another very interesting and informative Poster Session. Lisa Ware has increased the sponsorship for the Fun Run and is using her creative energy to develop an even funner (is that even a real word?!) Fun Run! Elizabeth Claus has been using her organizational talent and skills of persuasion to put together an outstanding line-up of wonderful speakers and workshop presenters! Larry Marquis is once again on his game and has planned another top notch golf tournament. Eva Osborn has managed to round up another couple of new exhibitors for the Exhibitor’s Session. Laura Welsh, our Regional Conference Subcommittee Chair, has been tracking all developments on the regional conference front and taking care of her new arrival, Liam Patrick Welsh, who arrived on May 22, 2007.

Bon voyage! Safe travels! See you all in Montreal!

AAPA/MONTREALAUGUST 25-31, 2007

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PANE Spring Meeting ReportBy Jennifer Titus

Pathologists’ Assistants of New England (PANE) recently had their

Spring Meeting 2007. PANE was founded in 1995 as a self-supporting, informal organization used to promote interaction among pathologists’ assistants from the New England area. the informal meetings have evolved into more structured events, combining socialization and education, with approved CME credits.

the three-day Regional Spring Meeting was held in hamden, Ct, and had approximately 49 attendees—coming from as far away as Iowa! Four lectures were presented on Saturday in the Physician’s Assistant Building at quinnipiac university.

dr. Steven Schonholz, a surgeon from Mercy Medical Center in Springfield, MA, presented a lecture on Surgical Decision Making in Breast Pathology. he discussed new techniques that are being used by surgeons to remove tumors in their offices, one of which is called the Intact Breast Lesion Excision System (www.intactmedical.com). he also discussed the nomogram used by Memorial Sloan-

Kettering Cancer Center to calculate the likelihood that breast cancer that has spread to the sentinel lymph nodes has also spread to additional axillary lymph nodes (http://www.mskcc.org/mskcc/html/15938.cfm). dr. Schonholz mentioned MammoSite brachytherapy, where a balloon and catheter are inserted into the biopsy cavity of a lumpectomy site. A radioactive pellet is attached to a wire, which is inserted into the catheter and the balloon. A specific amount of radiation is delivered to the surrounding breast tissue twice a day for a period of five days. It was quite an interesting lecture, coming from the opposite side of the scalpel.

three pathologists then followed the surgeon on the podium. dr. giovanna Crisi, an attending from Baystate Medical Center in Springfield, MA, gave a lecture on Breast Cancer Diagnostics. She talked a little about gene carriers and brought it down to the molecular level. She had also taken notes during dr. Schonholz’s presentation and wanted to offer her pathologic viewpoint on the surgeon’s lecture.

dr. Rich Eisen, an attending from greenwich hospital in greenwich, Ct, presented four interesting autopsy cases. he posted a link on the PANE web site prior to the lecture, with clinical histories and photos of the unknowns to pique our interest.

the final presentation of the day was given by dr. Maritza Martel, Associate Professor at Yale university School of Medicine. the title was Pathologic Evaluation of Gynecologic and Breast Specimens in Special Settings. She discussed neoadjuvant therapy as well as prophylactic surgery for gene carriers, and how these specimens should be treated.

All in all, the meeting was an overwhelming success thanks to the hard work of Rocky Ackroyd and Lori Patruno. I would also like to acknowledge Sue Cowan, Liz Regal, and Shelley topper for all their efforts as well. the proposed date and location for the next PANE meeting is April 25-27, 2008, in Portland, Maine. Maybe we’ll see you there.

Crossword Solution

to Pathology Crossword featured in the Summer 2007 AAPA Newsletter

By Tom Shearer

1-800-532-AAPA www.pathologistsassistants.org 8

Medical liability insurance, also known as malpractice insurance, is something that I

think many PAs take for granted. Since pathologists are ultimately responsible for our work, why do we need malpractice insurance? And aren’t we all covered by our employer’s policy, anyway?

I know that I am covered because I receive an annual letter from my hospital medical staff office, reminding me to send them a copy of my current malpractice insurance information. I am listed under the “Allied health Personnel Endorsement” of the pathology group’s policy with ISMIE Mutual Insurance Company, an Illinois medical insurer. I am required to show proof of coverage to maintain my Affiliate Staff status. Since I like my job here in decatur (and my husband would be very unhappy to move again…), it seems like a pretty good reason to have liability insurance. But do I really need it?

According to the Florida State Bar Association’s web site (www.floridabar.org), “Malpractice is the failure of a professional person…to give the kind of professional care or service other professionals would ordinarily give you under the same circumstances.” Liability insurance is a way to protect yourself or a group of professionals from claims of negligence. Patient-generated medical claims are considered first or second party negligence because they involve a direct relationship between professional and patient. (third party suits claiming intentional damage are generally not covered by malpractice.)

It’s been said that PAs are unlikely to be named as defendants in suits brought against a hospital, pathologist, or pathology group. Of course, PAs have an individual responsibility to the patient, but PAs just aren’t in the same earnings class as physicians and hospitals. Most medical malpractice suits are aimed at as many pockets as possible or the organization or individual with the “deepest pockets”—the target that will yield the highest monetary award. So, again, do we really need malpractice insurance?

the answer, to me, is yes. Even though PA salaries are not in the range of physicians, some suits are brought against all links in the diagnosis chain. For our profession, the cost of medical liability insurance is cheap enough that it is more than worth the cost—especially when it is a benefit of our employment.

Knowing that I am covered, just in case, gives me peace of mind. Recently, I

learned of another reason to carry liability insurance. One of the benefits of my liability policy with ISMIE is the provision of a lawyer, free of charge, for deposition assistance (often shortened to “dep assist”). the policy states, in part, that the insurance company obligations extend “to providing counsel to ‘insureds’ when they are deposed or are called to testify in litigation arising out of ‘professional services.’”

A deposition is a legal proceeding, under oath, whereby testimony is recorded. A judge is not present. the witness, known as the deponent, is sworn in by a court reporter and then asked questions by one or more attorneys. the subsequent testimony is part of the discovery process for trial preparation. In most circumstances, the deponent is asked fact questions; for a PA, this usually pertains to observations made during prosection, including clarification of terminology used within a gross description. In addition, deponents in medical cases may be asked to render opinions for which they have specific knowledge, training, or experience.

there are additional benefits to deposing witnesses prior to trial. the testimony is recorded while it is fresh in the mind—some cases may take years to come to trial. during the deposition, attorneys can also get a feel for how witnesses will present themselves in court should the case go to trial. If a witness is unavailable during the course of the trial, a deposition may be presented to the court in lieu of live testimony.

An attorney may be engaged to prepare a witness for deposition. As part of the preparation process, the deponent is strongly reminded to stay within the limits of their professional qualifications. Speculation as to standard of care for other medical specialties is not allowed at deposition (or trial). For instance, it would not be within the pathologists’ assistant’s scope of practice to offer an opinion on a microscopic diagnosis or surgical procedure.

Most fact witnesses who are called upon to give a deposition are compelled to do so via subpoena. the time and place of the deposition are included in the subpoena, however can be rescheduled at the convenience of the deponent. A deposition fee is commonly paid to the deponent for their time and travel expenses. Failure to respond to the subpoena may result in contempt of court.

Initially, one of my pathologists was deposed as a fact witness in a suit brought against a local surgeon. the questions that were addressed to the pathologist

during the deposition focused on the gross examination of the surgical specimen. during the testimony, the attorneys learned that the pathologist did not prosect the specimen, and, as is often the case in practices where PAs are employed, the pathologist did not personally view the specimen. Because I grossed the specimen, I was then subpoenaed for deposition.

the subpoena arrived in the mail, which is contrary to the method most subpoenas are delivered (and what we see on tv and in the movies). Oftentimes, a process server hand delivers subpoenas. When I told my chief pathologist about the subpoena, he recommended I call a local attorney and engage his services to prepare for the deposition. the chief is acquainted with this local attorney, whose primary expertise lies in medical malpractice. Over the course of a recent golf round, the pathologist learned from the local attorney that many malpractice policies include free legal representation for deposition assistance.

So I called Charlie, the local attorney. In quick order, Charlie had the deposition moved from a neighboring community to my town and had the date changed to fit his (and my) schedule. the week prior to the deposition, Charlie met with me in my office to prepare me for the deposition. he gave me an overview of the lawsuit and told me what he thought the attorneys hoped to gain from the deposition. Charlie had a copy of the pathology report upon which my testimony would center. he went over the gross description sentence by sentence, clarifying words and phrases as needed. Charlie also left with me a three-page outline on how to comport oneself during a deposition.

the following is a summary of Charlie’s ten tenets for deposition:

• Tell the truth.• Use common sense• Listen to the question asked and make sure you understand it. Ask for the question to be repeated if you do not understand. • Think before you answer. Don’t speculate. • If you don’t know or cannot answer the question, say so: “I don’t know,” “I don’t recall.” • Qualify your answer, if necessary. “As I recall,” “At that time,” “this means _____ to me.”• Take your time.• Don’t argue.• Don’t assume.• Don’t volunteer.

Medical Liability For Path AssistantsBy: Tisa Lawless

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1-800-532-AAPA www.pathologistsassistants.org 9

The patient is an 86-year-old Caucasian female who presented with a three day history of rectal bleeding (dark red blood). She was anemic (Hgb 9.3 mg/dl), but otherwise appeared in good health. A colonoscopy was performed revealing a large sessile tumor in the right colon. Because the mass appeared to be intramural, a leiomyoma or leiomyosarcoma was suspected. A right hemicolectomy

was performed. A 4.5 x 4.5 x 4.0cm mass was found in the proximal ascending colon (see photographs). Histological examination revealed poorly to moderately differentiated adenocarcinoma

with psammomatous calcification. Similar appearing tumor nodules were also found in the omentum.

Gross Photo Unknown

this tumor most likely represents:1. Metastatic peritoneal carcinomaa) Metastatic melanomab) Primary leiomyosarcomac) Metastatic gastric carcinomad)

Early detection of this tumor by routine 2. colonoscopy screening could have greatly improved the overall prognosis of this patient.

truea) Falseb)

Additional tumor would most likely be found 3. in/on:

vascular spacesa) Lymph nodesb) Small bowel serosa c) the braind)

Charlie’s outline also includes other pointers for testimony. Prior to the deposition, it is suggested that any pertinent information be reviewed. In my case, since I was called as a fact witness, I reviewed the gross description. Other sources for review may include reference texts, departmental manuals, pertinent medical records, and personal notes or correspondence.

“Standard of care” is a common thread that runs through most malpractice complaints. Keep up to date with what is considered standard practice in the gross room (or autopsy suite) and adapt your procedures to reflect it. If a question falls outside the scope of your expertise and/or qualifications, say so.

during the deposition, remember that appearance does matter. Choose attire that is clean and conservative. Speak loudly and clearly; only audible answers can be entered into testimony. Maintain proper posture—do not slouch, fidget, or appear impatient or inattentive. gestures are not written into the court record, but can clearly telegraph state of mind to attorneys, the judge, and/or the jury.

On the day of the deposition, I gave testimony in my chief pathologist’s office. Besides my counsel, Charlie, the court reporter and two other attorneys were present in the room. A third attorney was dialed in to the proceedings via telephone. I would guess that the entire deposition lasted about 30-40 minutes. All in all, I was less nervous during the deposition than when I first met with Charlie for the preparation session. My most flustered moment occurred when I was asked what the initials of my pathology group stood for—and I couldn’t remember!

thanks to Charlie, and my liability insurance policy that provided for his assistance, the deposition experience went quite smoothly. When I was later informed that I would be asked to testify in person at trial, I didn’t feel panicked because I knew I would be able to have Charlie there with me. I do confess, however, that I was relieved when I learned that the case had been dismissed prior to trial and my appearance in court would not be required.

For those who must seek out and pay for an individual malpractice policy, there are few options out there. I spent

a few hours navigating the internet, then personally talked with representatives from several regional and national insurance carriers. In fact, I was unable to find a company that would underwrite a policy for the individual PA. the following companies do NOt underwrite and/or no longer offer new individual policies for PAs:

• Marsh Affinity Group/Seabury & Smith• Medical Liability Mutual Insurance Company (MLMIC)• Healthcare Providers Service Organization (hPSO)• Lockton’s Insurance (National Professional group provider accessed via link from ASCP web site) • Chicago Insurance Company

the author wishes to send a big thank you to Charles hughes, Esq., for his expert assistance and encouragement in writing this article.

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1-800-532-AAPA www.pathologistsassistants.org

CURRENT TOPICS IN PATHOLOGYThe Traveling BacteriumBy Dennis Strenk

Imagine this: A man with a potentially lethal infectious

disease boards a plane in the united States and flies to Europe. he then flies to four different countries before flying to Canada. then he rents a car and drives back to the u.S. the man has potentially infected everyone with whom he had contact. unless you haven’t been watching the news, you know that this isn’t something out of a science fiction movie. It actually did happen this past May. though it has turned out to be less serious than originally thought, the situation raised concerns worldwide, and has prompted congressional hearings here in the u.S. In addition, it raises several ethical and legal questions. the disease, of course, is tuberculosis.

Mycobacterium tuberculosis is a microbe that needs no introduction to pathologists’ assistants. I would guess that almost all of us will encounter it at some point in our careers. the scary thing about tB is that it can be transmitted through the air. But the good news is that, since it is a bacterium, it is susceptible to antibiotics.

Since antibiotics became widely available in the 1950s, tuberculosis was on the decline, at least in the united States. however, drug resistant strains of tB began to appear in the 1980s, and this may correspond to the rise of hIv. In fact, tB infection is most common in the immunocompromised, and the majority of cases occur in areas with a high incidence of hIv.

On May 12th, 2007, Andrew Speaker boarded a plane in Atlanta to fly to Europe. At the time, he knew he had tuberculosis. the previous January, because of an injury to his ribs, he had a chest x-ray which revealed a density in his right lung. In March, sputum cultures revealed that he had multiple drug resistant tB, or MdR-tB. It still is not clear whether he was told not to travel, or that it was preferred that he didn’t travel, but in any case, he did travel. Mr. Speaker arrived in France, and later traveled to greece, then Italy. during this time, the Centers for disease Control in Atlanta became involved in the case.

testing at the CdC revealed that Speaker had extensively drug resistant tB, or XdR-tB. the CdC contacted Speaker while he was in Rome and gave him the XdR-tB diagnosis. he was told to either

check into a hospital in Italy or hire a medical evacuation plane. Fearing he would not receive proper care outside of the united States, he booked a flight from the Czech Republic to Montreal, Canada. Because his passport was flagged as a health risk, it was not possible for him to take a direct flight to the u.S. Once Speaker landed in Canada, he was able to drive across the border into New York–the border guard allowed him into the u.S. after he decided Speaker did not look sick. Speaker checked into a hospital in New York and was later transferred to an Atlanta hospital. Several days later, he was again transferred, this time to the National Jewish Medical and Research Center in denver, Colorado, where he became the first u.S. citizen to be put under quarantine since 1963.

Standard treatment for tuberculosis consists of four first line antibiotics: rifampicin, isoniazid, pyrazinamide, and ethambutol. Rifampicin and isoniazid are the most powerful of the four, and are the most commonly used. the existence of tB strains resistant to a single antibiotic has been known for some time. A more dangerous form is MdR-tB, a strain that is resistant to both rifampicin and isonaizid.

drug resistance has several causes, among them inconsistent or incomplete treatment. Sometimes the patient does not complete the entire course of antibiotics because they feel better. Maybe they can’t afford the antibiotics or the drugs aren’t readily available. It’s also possible that the doctor didn’t prescribe the correct antibiotics or an adequate dosage. Resistance can also occur from a spontaneous mutation of the bacterium.

Whatever the reason, MdR-tB has only a 50% cure rate. treatment requires the use of the less effective first line drugs, as well as the second line drugs: kanamycin, capreomycin, and amikacin. the second line drugs have much more severe side effects, including hearing loss, kidney and liver damage, and allergic reactions.

In 2006, the World health Organization defined XdR-tB as a strain resistant to all of the first line antibiotics and at least one of the second line drugs; this form has a 30% cure rate. It is considered a rare disease, but cases have been confirmed in 37 countries. It is also unusual to have a case of XdR-tB in the united States, where only 17 confirmed cases of XdR-tB

have been identified since 2000. usually, XdR-tB is associated with patients with hIv, or those who are otherwise immunocompromised (but that doesn’t apply to Speaker’s case). Often, surgery is used as a treatment option for XdR-tB. the idea is to remove the majority of the infected tissue, thus reducing the bacterial load, so the body can help clear some of the infection. But even with surgery, the recovery time for tB is long—the antibiotic course for tB is six to twelve months and even longer for an antibiotic resistant strain.

doctors at the National Jewish Medical and Research Center have stated that Speaker is a good candidate for surgery. Additional cultures performed at the National Jewish Medical and Research Center revealed that Speaker has MdR-tB, not the more resistant XdR-tB. Regardless of MdR-tB vs. XdR-tB, the treatment is basically the same, and Speaker still would have been flagged as a health risk. his potential to infect the other passengers on his various flights is also the same. Eight of those passengers filed a lawsuit on July 12th. One had a positive tB skin test, although it has not been confirmed that Speaker was the cause of that infection.

this case has prompted hearings in the united States house of Representatives. One issue at these hearings is how Speaker was able to cross the u.S. - Canadian border. (the border guard that let him cross was suspended and has since retired.) the CdC should have been notified, and Speaker should have been detained. there are several other questions, too. Is it legal to quarantine a u.S. citizen against his will? Should it be illegal to travel when you have a known infectious disease? Surely, Speaker didn’t intend to harm anyone, but the fact remains he put a lot of people at risk.

this case had the potential to be a worldwide catastrophe. But so far, a catastrophe has not developed. Still, it has raised tuberculosis awareness, especially XdR-tB. tuberculosis was once a disease on the decline, but recent drug-resistant strains have changed that. Both the CdC and the WhO have proposed strategies to stop the spread of tB. Yet, as this recent case shows, a plan only works as well as it is enforced. Just as there are guidelines for how medical personnel handle infectious diseases, there are guidelines for travel

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1-800-532-AAPA www.pathologistsassistants.org

when you are infected. If you don’t follow the rules in a hospital setting, you could infect yourself and your co-workers. But a traveler has the potential to infect many more people.

Postscript: According to an Associated Press release, Andrew Speaker had minimally-invasive, partial resection of the right lung at the university of Colorado hospital in denver on July 17, 2007.

Following removal of the infected portion of lung, and in conjunction with antibiotic therapy, Speaker hopes to facilitate a complete cure and prevent tB recurrence in the future.

References:1. Extensively drug Resistant tB Fact

Sheet. http://www.cdc.gov/tb/pubs/tbfactsheets/xdrtb.htm (July, 2007).

2. Plane Passengers Sue tB Patient. http://www.cnn.com/2007/hEALth/conditions/07/12/tb.suit/index.html?iref=newssearch (July 13, 2007.)

3. tuberculosis timeline. http://homeland.house.gov/Sitedocuments/20070606160848-79812.pdf June 6, 2007)

Continued from page 10

2007 AAPA SUSTAINING MEMBERS

Brandon KelleyCancer DiagnosticsPO Box 1205Birmingham, MI 48012Phone: 877/846-5393Fax: 877/817-1716E-mail: info@cancerdiagnostics.comWeb Site: www.cancerdiagnostics.com

veronica BedoyaEli ResearchPhone: 901/907-0934E-mail: veronicaf@elireasearch.comWeb Site: www.eliresearch.com

John Barrett, Sales ManagerHavel’s Inc.3726 Lonsdale StreetCincinnati, Oh 45227Phone: 513/271-2117Fax: 513/271-4714E-mail: jbarrett@havels.comWeb Site: www.havels.com

Carre Saunders, AdministratorHealthCare Connections, Inc.3111 N. university drive, Suite 308Coral Springs, FL 33065Phone: 866/346-8522Fax: 954/346-4485E-mail: jobs@labcareer.comWeb Site: www.labcareer.com

tina Cronk, Service Partner—hRMayo Clinichuman Resources200 First St. SWRochester, MN 55905Phone: 507/266-7832Fax: 507/284-1445E-mail: cronk.tina@mayo.eduWeb Site: www.mayoclinic.org

gene Young, Jr.Medical Staffing Network, Inc. Phone: 800/223-9230 x2080 E-mail: www.msnhealth.com

Kathy RogersMerrick Inc.8190 Beechmont AvenueCincinnati, Oh 45255Phone: 800/797-9060Fax: 513/624-0584E-mail: merrickinc@msn.com

Rick BellMOPEC, Inc.21750 Coolidge highwayOak Park, MI 48237Phone: 248/291-2040Fax: 248/291-2050E-mail: rbell@mopec.comWeb Site: www.mopec.com

heiner OphardtPathmor Inc.4743 Christie driveBeamsville, ON L0R 1B4 CANAdAPhone: 905/563-4689Fax: 905/563-6266E-mail: hophardt@hygienetechnik.comWeb Site: www.propath.be

Stephen Peters, MdPathology Innovations LLC410 Old Mill LaneWyckoff, NJ 07481Phone: 201/847-7600E-mail: petepath@yahoo.comWeb Site: www.pathologyinnovations.com

tom O’BrienSurgipath Medical Industries, Inc.5205 Route 12Richmond, IL 60071Phone: 800/225-8867Fax: 815/678-6805E-mail: tobrien@surgipath.comWeb Site: www.surgipath.com

greg Strader, Product Manager,Autopsy & MortuaryAnatomical PathologyThermo Fisher Scientific4481 Campus driveKalamazoo, MI 49008Phone (office): 269/544-5616Phone (mobile): 269/568-1014Fax: 269/372-2674E-mail: greg.strader@thermofisher.comWeb Site: www.thermo.com

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The Cutting Edge of Cutting EdgesProduct Review by Minda Koval-Watson

If there was a single item in the gross room that I just couldn’t be without, it would be a good sharp blade. Scalpel, knife, razor…whatever you would like to call it. Frankly, I call it a blade.

there was a time when knives (the big brain- and liver-cutting ones) were used often in the gross room or autopsy suite, but with all the re-sharpening and the contamination, there are only a few places I know that still use them. We have a few hidden in our morgue somewhere, but this has yet to be confirmed.

then there are the scalpels. there are #11, #12, #15, #22, #60, and #70 scalpel blades, just to name a few. I think scalpels work best for delicate dissections, but I find that, unless you’re using the very expensive, sterile blades, the blades just aren’t sharp enough and dull out quickly. So many scalpel blades. So many handles. Who really has the time? Not me.

there are so many different types of cutting utensils—blades, razors, knives, scalpels—that to review them all would be wearisome (for you and me) and, not to mention, redundant. So I’m going to stick with my favorite: disposable blades. Chances are you have used every blade that’s in this article and, if so, the following will be no news to you. But if not, allow me to introduce you to my best friends in the gross room. (Well, second-best...first best goes to the blonde who saves my butt every day and chips in for coffee.)

First up are those little one-sided razor blades. these look just like they sound...like one-sided razor blades. Impressive, yes? these are simple, inexpensive, tough, and very sharp. Not only are they very sharp, they maintain their sharpness for a while (unless you come across sutures, staples, or calcium). the only problem with these blades is, well, they’re sharp. And they’re small. If you’re used to using a handle, practice on a fruit or vegetable first.

I’ve worked with two different types of one-sided razor blades and love them both. there is the individually wrapped razor by Personna, which come in a box of 50 for $29.02 (Fisher Scientific can distribute. 800/776-7000). the other type is the razor dispenser by gEM® Scientific Blades, which come packaged in little

plastic boxes of ten. Each box of ten starts at $3.96 (Structure Probe, Inc. / SPI Supplies, P.O. Box 656, West Chester, PA 19381-0656, 800/2424-SPI.)

For the handle users out there, these next types were made for you: the double edge blade and the trim blades. the double edge blade is, again, just what it sounds like. And again, this blade is very sharp. I find that it dulls out faster than the razor blades, but it should last through a whole case (unless you’re attracted to staples, like me). And if it dulls out…presto-change-o! Flip it over. Problem solved. Path-Co makes these, with the handles starting at $66.00 and the blades at $51.26/100. Personna also makes the blades for the Path-Co handle for $46.10/100. Fisher Scientific distributes the double edge blades and handles (800/776-7000).

Last up are the trim blades. Like some things in life, size does matter. the previous blades are fine for run of the mill grossing, but I bet you’re the kind of person who isn’t going to attack a 2,000-some gram fibroid uterus with a #22 scalpel or a razor blade, are you? Path Assistant, meet Sakura's tissue-tek® Accu-Edge® trimming Blades. these come in two lengths, short (130mm) and long (260mm), and are perfect for the larger, bulkier specimens like uteri, mastectomies, brains, or whatever your surgical department may be throwing at you. these blades are super sharp. Like, hattori hanzo sharp. It is their gift. It is their curse. You have to be pretty careful when interchanging the blades (which takes a little finesse and pressure). this means no chatting with someone, or looking away, or even thinking about what you’re going to have for lunch. Personally, I find that I hold my breath when I change the blades. Others are partial to humming.. Sakura's tissue-tek® tends to dull sooner than most blades—partly because it is so sharp, partly because

of what it is cutting. But, again, you should be able to get through a whole case without having to change it. the handles are $81 (short) and $87 (long), and the blades are packaged at 50 blades/case for $117 (short) and $250 (long).

Finally, last but not least, you can’t have an article about sharp blades without mentioning bandages. My favorite is the 3M Nexcare Waterproof Bandage. (I hear that CvS makes a store brand of these, but I can’t attest to their quality.) these are a little tricky to get on, but if you can change the above blades, this should be cake. Make sure your skin is clear from moisture or lotions and this sucker will stay on until you take it off. Plus, it’s waterproof. these run around $2.50-$3.00 or so at your local store. You can even get them with Nemo.

there’s nothing like a sharp blade. It just makes things easier. Whether you’re dicing through a uterus or slicing up a brain, it just doesn’t feel right—or is as efficient— unless it’s good and sharp. Not sold yet? try doing a few cases with a single blade for a while and then having a shot at a fresh colon. go on, change that blade….trust me, you’ll feel better.

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For years, stem cell researchers have been divided into two basic schools of thought: one focused on cells from adults, and the other on the controversial technique that destroys embryos. As the debate over stem cell research rages on Capitol hill, a new discovery has been made which, to some researchers, could end the controversial debate. the Bush Administration has restricted federal funding for work with embryonic stem cells since 2001, leading many scientists to search for alternative stem cell sources. Researchers have recently reported that scientists have found stem cells in amniotic fluid, a discovery that would allow them to sidestep the controversy over destroying embryos for research. Some researchers believe that amniotic fluid stem cells hold much the same promise as embryonic stem cells.

the placenta is comprised of three layers: amnion, chorion, and decidua. Each layer is derived from vastly different sources. Although the decidua is derived from the mother, the amnion and chorion are derived from the embryo. Amniotic membrane is the innermost layer of placenta and consists of a thin epithelial layer, a thick basement membrane, and an avascular stroma. In the amniotic membrane, two cell types of different embryological origin are present: amnion epithelial cells derive from embryonic ectoderm and amnion mesenchymal cells from embryonic mesoderm. Amniotic fluid is known to contain a heterogeneous population of cell types derived from fetal tissues and the amnion.

the hallmark of human embryonic stem cells, which are created in the first days after conception, is the ability to turn into any of the more than 220 cell types that make up the human body. Pluripotentiality is the ability of a cell to form all the cells of the body, and is generally considered to be confined to embryonic stem cells of the preimplantation embryo, embryonal carcinoma cells, and embryonic germ cells of the primitive gonad. Rare multipotential or pluripotential stem cells have also been isolated from cultured bone marrow cells and spermatogonial cells of the testis. Scientists are working to develop techniques for harvesting embryonic stem cells without destroying

embryos, however, the main objection to embryonic stem cell research remains: these cells must be harvested from a fertilized human egg, which is destroyed in the process. In contrast, amniotic stem cells can be collected during deliveries or routine medical procedures that draw fluid from the womb without harming the developing fetus.

Amniotic fluid stem cell samples can be taken in many ways. during most routine amniocentesis procedures, 10–20 ml of amniotic fluid is recovered, and the cell sample is divided into a test sample and back-up samples to be used if suitable preparations are not obtained from the original test sample. If the additional testing is not needed, many of these samples are discarded. Many researchers have been working with these discarded amniotic fluid samples, with patient permission, to harvest the amniotic fluid stem cells.

Amniotic fluid stem cells represent about 1% of the cells found in amniotic fluid. They can also be harvested from chorionic villous samples commonly done on older women to test for chromosomal abnormalities. One of the more promising aspects of research is that some of the dNA of the amniotic stem cells contains Y chromosomes, which means the cells are elaborated from the babies rather than the pregnant moms. the consistent presence of a Y chromosome in lines derived from cases in which the amniocentesis donor carried a male child implies that amniotic stem cells originate in the developing fetus.

Amniotic fluid stem cells share many of the same characteristics with embryonic stem cells. the amniotic cells are neither human embryonic stem cells nor slightly less resilient adult stem cells. they multiply quickly, are remarkably long-lived, and have a high renewal capacity. Amniotic stem cells have been documented to grow readily into independent cell lines, or colonies, doubling in just 36 hours. Like those from embryos, the amniotic stem cells are pluripotent. Researchers have been able to get amniotic stem cells to differentiate into fat, bone, muscle, cardiac, blood, nerve, and liver. Researchers have already grown replacements heart valves and bladders, then experimentally implanted

them in patients—with remarkable results. Like embryonic stem cells, the amniotic cells retained their genetic makeup and showed no signs of aging over multiple generations.

What is even more remarkable is that some of the cells that researchers have been growing even functioned as they would be expected to in the human body. Cultured liver cells have been shown to secrete urea, an activity otherwise seen exclusively in their natural counterparts. Cultured nerve cells have been shown to secrete glutamate, a neurotransmitter that is crucial to memory and helps to form dopamine, which Parkinson’s patients lack. Other researchers have formed functional osteoblasts that produce bone-like material when embedded in alginate/collagen scaffolds and grafted to immunodeficient mice.

In addition, for reasons that are still poorly understood, the amniotic stem cells do not seem to form teratomas that sometimes arise from embryonic stem cells implanted in animals. In support of the conclusion that amniotic stem cells are not tumorigenic, research has reported no evidence so far of tumorigenicity when amnion membrane or membrane-derived cells were transplanted into patients.

Placenta is abundantly available as a discard tissue after normal delivery. Current statistics from the u.S. Census Bureau indicate that there are more than four million total births and more than one million cesarean sections performed in the united States each year. Amniotic fluid is so easy to harvest, it would make it possible to create thousands of cell lines. the cells can also be taken from the expelled placenta after delivery. Amniotic membrane has many additional advantages, since such tissue is usually discarded, yet easily accessible, and allows a very high recovery of cells. these findings also raise the possibility that, some day, expectant parents can freeze amniotic stem cells for future tissue replacement, just as many parents bank cord blood today.

Stem cell research has many implications in multiple disease processes. By harnessing the remarkable generative properties of stem cells, scientists hope to find new treatments for such things as

Is the Debate Over? Amniotic Fluid Stem Cells vs. Embryonic Stem CellsBy Barbara Dufour

Barbara Dufour

1-800-532-AAPA www.pathologistsassistants.org 15

FALL 2007 QUIZBased upon "Is the Debate Over?

Amniotic Fluid Stem Cells vs. Embryonic Stem Cells"Article by Barbara Dufour • Quiz by Tisa Lawless

neurological injuries and degenerative diseases. At this time, while amniotic stem cells do clearly generate a broad range of important cell types, they do not appear to be as prolific as embryonic stem cells. It will take more research to prove the true value of amniotic stem cells.

While researchers believe that amniotic stem cells aren’t going to replace embryonic stem cells, they do agree that it is another solution to the stem cell controversy. Other studies have tried to find alternative sources of stem cells with similar properties. If techniques for engineering a range of tissue types from amniotic stem cells can be fully developed, the effects would be far reaching.

References:

1. Weiss, R Scientists See Potential In Amniotic Stem CellsWashington Post Online (http://www.washingtonpost.com/wp-dyn/content/article/2007/01/07/AR2007010700674.html)

2. Norris, S Stem Cells discovered in Amniotic Fluid, Scientists Announce National geographic Online (http://news.nationalgeographic.com/news/2007/01/070108-stem-cells_2.html)

3. de Coppi, P. et al Isolation of amniotic stem cell lines with potential for therapyNature Biotechnology 2007, 25:100-106

4. Alviano, F. et al term Amniotic membrane is a high throughput source for multipotent Mesenchymal Stem Cells with the ability to differentiate into endothelial cells in vitro. BMC dev Biol. 2007;7:11.

5. trounson, A .A fluid means of stem cell generation Nature Biotechnology 2007,25:62-63

1. Which is not a source of pluripotent stem cells? a) Embryo b) Amniotic fluid c) Peripheral blood d) Embryonal cancer cells

2. the placental decidua is derived from fetal cells. a) true b) False

3. Which is not a layer of the placenta? a) Amnion b) Nodosum c) Chorion d) decidua

4. Amnion epithelium is derived from: a) Endoderm b) Mesoderm c) Ectoderm

5. Amniotic fluid stem cells represent what percentage of cells found in amniotic fluid? a) 1% b) 10% c) 20% d) 50%

6. When stem cells are harvested from an embryo, the embryo remains viable. a) true b) False

7. Amniotic fluid stem cells are derived from maternal dNA. a) true b) False

8. Which is not a proven property of amniotic fluid stem cells? a) Retention of genetic makeup over time b) Known to form teratomas c) Long-lived d) high renewal rate

9. Approximately what percentage of u.S. births is performed by C-section? a) 1% b) 10% c) 25% d) 50%

10. Amniotic fluid stem cells are found in chorionic villous tissue. a) true b) False

**IN ORDER TO RECEIVE CME CREDIT FOR THIS QUIZ, RESPONSES MUST BE RECEIVED PRIOR TO OCTOBER 15, 2007.

www.pathologistsassistants.org 16 1-800-532-AAPA

BetterA Surgeon's Notes on Performance

Written by Atul gawande2007, Metropolitan Bookshenry holt and Company, New York257 pagesReview by Chet Sloski

this book is not about scientific breakthroughs. No, that is not entirely correct. In a way, it is about scientific breakthroughs. But probably not the kind of scientific breakthroughs you would find on the front page of JAMA. Because, if you’re like me, when you think of scientific or medical breakthroughs, you have thoughts about genetic engineering, miracle drugs, or stem cell transplants.

In his new book, BETTER: A Surgeon’s Notes on Performance, Atul gawande picks out practices—tried and true—that are already widely known to improve and save lives. he suggests ways to better implement them, improve upon them, and—no doubt most difficult—to stick to them. diligence and vigilance are virtues.

take hand washing. According to the u.S. Centers for disease Control, two million American patients acquire an infection while in the hospital. Some ninety thousand die of their infections. the rate of infection could be significantly reduced if only the medical staff—doctors, nurses, and lab techs—would wash their hands between seeing patients. It is not that they are ignorant or uncaring. It is that they are often rushed and don’t have the time, or that too much washing can cause skin irritation, or etc. there are many excuses.

hospitals have come at it from all angles. Signs have been posted. New sinks have been installed, some even automated. And to the hospital units with the best compliance, they have even awarded free movie tickets, the poor quality of hollywood movies notwithstanding. Still, gawande says that doctors and nurses wash their hands

one-third to one-half as often as they should. he notes that it has been 140 years since Joseph Lister made the case for antisepsis in surgery. And while antisepsis in surgery is thankfully not a major problem, antisepsis is a problem on the hospital floors. Interestingly, in gawande’s experience, the people who are most careful in the operating room are frequently the least careful on the hospital ward.

gawande’s hospital started to use a 60% alcohol gel. Personnel seemed to like it. the compliance rates for proper hand hygiene improved from 40 to 70%. But the infection rates did not drop at all. this is an interesting point. You have 70% compliance, but the 30% noncompliance was enough to keep transmitting infections. One wonders what the compliance rate would have to be to significantly drop the infection rate.

At a hospital in Pittsburgh, they used the “positive deviance” theory. the theory is that you build on capabilities people already have rather than telling them how to change. Meetings were held with health care workers at all levels. Food service workers, janitors, and nurses were all asked for their ideas. It worked. Some ideas that came out were proper placement of hand-gel dispensers, how to keep gloves in supply, how to diplomatically remind coworkers to wear gloves, etc. the ideas were not new or terribly exciting. But according to gawande, the MRSA wound infection rates fell to zero. As gawande says, making medicine go right is less often like making a difficult diagnosis than like making sure everyone washes his or her hands.

In the chapter titled Casualties of War, gawande researches battlefield injuries and comments on how we have improved treating our wounded soldiers. As he says, firepower has increased, but lethality has decreased. during the Revolutionary War, 42% of the wounded died by injuries caused by bayonets and single-shot rifles. In World War II, only 30% of the wounded died, but by grenades, bombs, shells, and machine guns. By vietnam, we did not improve much at 24% wound mortality. But in the current Iraq and Afghanistan wars, there was a significant reduction in the lethality of battle wounds. Just 10% of wounded American soldiers have died.

how did they do it? Was it new treatments or technology? According to gawande, it was not. the doctors came up with simple changes that led to large improvements. One change was with the Kevlar vests. turns out the soldiers had not been wearing them. too hot and heavy. the commanders then made it mandatory to wear the vests and the percentage killed on the battlefield immediately dropped. Also, it was found that the soldiers were suffering a high incidence of blinding injuries. the soldiers hadn’t been wearing their goggles. too “ugly.” So they swapped for “cooler” looking goggles and the problem was solved.

Another insight involved transport time and treatment of the wounded. A “golden hour” was not good enough. they needed a “golden Five Minutes.” the army created Forward Surgical teams (FSts) consisting of twenty medical personnel, including three general surgeons, one orthopedic surgeon, two nurse anesthetists, three nurses, medics, and support personnel. they traveled in six humvees behind the troops. the FSts focused on damage control and not definitive repair. they packed injuries with pads to stop the bleeding, stapled perforated bowel, etc. they tried to keep operations less than two hours. Once they stabilized the patient, they transported them to the next level of care.

the next level of care is Combat Support hospitals. the maximal stay here is only three days. If they need more care, they are transferred to a level Iv hospital. For more than thirty days of treatment, they are transferred home to Walter Reed or Brooke Army hospital in the States.

this system took some getting used to. the normal impetus of the surgeon is to operate until healed, not to patch somebody up and turf to the next level. But they did get used to it. And the results were that medical teams were saving 90% of those wounded in battle.

there is an interesting chapter titled The Bell Curve. It focuses on medical performance, noting that performance follows a bell curve. gawande focused on cystic fibrosis and how it’s treated at the major centers. You would think that, if you had a child with CF, you could

Chet Sloski

Book Review continued on page 17

www.pathologistsassistants.org 17

go to any major hospital in, say, Philadelphia, houston, or Los Angles, and the care there would

approximate the standard of care given

in any American hospital, including those with the top CF

programs. After all, the physicians who treat patients with cystic fibrosis all attend the same medical conferences, right? Well, they may attend the same conferences, but the outcomes in care for the CF patient can be significantly different at different institutions.

gawande relates a story about a child recently diagnosed with CF. the family lived in a Cincinnati suburb and took her to Cincinnati Children’s hospital, which is among the most respected pediatric hospitals around. As a matter of fact, the chapter on cystic fibrosis in the Nelson Textbook of Pediatrics was written by one of the hospital’s pediatricians. But Cincinnati Children’s hospital was not among the top centers for children with CF. It was, according to data from that year, an average program. And there is a big difference between the average and top programs. In 1997, at an average center, the life expectancy was just over thirty years old. At the top centers, there were patients living to be forty-six years old. What could account for this wide discrepancy?

Again, it was not that those physicians at the top centers had better technology or scientific expertise. It was that they treated their patients with focus, aggressiveness, and inventiveness. they were not afraid to push their patients hard when they had to.

gawande visited Cincinnati Children’s hospital and was impressed with its CF program. the physicians were caring and competent. then he visited a top CF center at Fairview-university Children’s hospital in Minneapolis, which was

headed by pediatrician Warren Warwick. Warwick had made a study of what it takes to do better. his secret: do whatever you can to keep your patient’s lungs as open as possible. Warwick thinks hard about his patients, pushes them, motivates them, and, when he has to, he improvises.

Warwick invented a new cough for his patients. the patient would stretch his arms upward, yawn, pinch his nose, bend down as far as he could, let the pressure build up, and then straighten up and let everything out. two decades ago, he invented a chest-thumping device for patients to wear. It’s like a flak jacket with two vacuum hoses coming out the sides that are hooked up to a compressor that shoots in blasts of air. today, 45,000 patients use it. Warwick’s thesis was to stave off the disease before his patients became visibly sick.

gawande also has a chapter on polio vaccinations. We know vaccinations save lives, but the problem is one of logistics. We need to get the vaccine to remote areas around the world as soon as there is a polio outbreak. thanks to the diligence of dedicated health care workers, the Americas, Europe, and the western Pacific, along with almost all of Africa and Asia, are currently free of the disease. however, we must be diligent because outbreaks occur periodically.

In the chapter titled The Doctors of the Death Chamber, gawande interviewed a few of the physicians that assist in lethal injections. At first, I was puzzled as to why gawande would include this in his book. But after I read it, it made sense, if in a twisted way.

If the majority of our society is in favor of the death penalty, and if it is legal, then do we not owe the condemned a quick and painless death? (Especially since we know a certain percentage of the convicted are actually innocent.) And isn’t that why we now have lethal injection and no longer death by firing squad, hanging, or electric chair? But, believe it or not, death by lethal injection does not always

go smoothly. Sometimes they can’t find a vein. Sometimes the drugs don’t work as quickly as they should. Shouldn’t a competent physician be present to make sure things go smoothly?

gawande himself is not against the death penalty, but he is not in favor of having physicians participate in executions. It doesn’t sit well with him. After interviewing a few of the physicians that participated in executions, he found that none of them were death penalty zealots. they just sort of backed their way into it. First they were present to pronounce death. then one thing led to another and they were finding veins and offering advice, etc. As one participating physician put it, “I think that if I had to face someone I loved being put to death, I would want that done by lethal injection, and I would want to know that it is done competently.”

the AMA does not allow physicians to assist in executions. You can lose your license. they don’t even allow physicians to pronounce death because the physician is not permitted to revive the prisoner if he or she is still alive. they can, however, do two things. they can give the prisoner a sedative to calm anxiety and they can sign a death certificate after another qualified person has pronounced death.

Still physicians participate. Indeed, seventeen states require it. the physicians who participate are almost always anonymous and legally protected by the state they practice in. Still some physicians have faced license challenges, but none have as yet lost their licenses. As gawande put it, “Execution has become a medical procedure in the united States.”

In the same vein, I would be interested in what gawande would have to say about physician assisted suicide. Perhaps he will address this in his next book.

Book Review continued from page 16

GROSS PHOTO TUTORIALMetastatic Papillary Serous Carcinoma • by Jason Ballietthe overall features of this tumor are

consistent with a primary ovarian or peritoneal carcinoma. the patient was status post hysterectomy although it was unclear from her history if her ovaries had been removed. Subsequent Ct scans of

the abdomen and pelvis were performed. Although no definite ovarian tissue was found, a 3.5 cm “fluid density structure” was noted adjacent to the rectum. It was felt that this could represent a cystic ovarian or peritoneal tumor. there is

no record of this mass being removed.

Jason Balliet

1-800-532-AAPA

DREXEL UNIVERSITY COLLEGE OF MEDICINEtwo-year program, MS degreeJames W. Moore, MhS, PA(ASCP) Program Directortina Rader, MhS, PA(ASCP) Program Co-Directordivision of Post-Baccalaureate Pre-Professional Educationdrexel university College of MedicineMail Stop 1009—Room 12316 245 N. 15th StreetPhiladelphia, PA 19102-1192215/762-2141James.Moore@drexelmed.edutina.Rader@drexelmed.eduhttp://www.drexelmed.edu/Graduate Studies/Programs/ProfessionalMasters Programs/MasterofScienceinPathologists Assistant/tabid/698/Default.aspx hannah M. Coleman, Student Liaison Chester County hospital department of Pathology 701 E. Marshall St. West Chester, PA 19380 610/431-5182 hcoleman@cchosp.com

DUKE UNIVERSITYtwo-year program, MhS degree dr. Kenneth Broda, Program Director Pamela vollmer, PA(ASCP), Associate Director department of Pathology PO Box 3712 durham, NC 27710 919/684-2159 vollm003@mc.duke.edu http://pathology.mc.duke.edu/website/WebForm.aspx?id=AP_PathAssistMain Jennifer Johnson, Student Liaison duke Medical Center department of Pathology Box 3712 durham, NC 27710 919/681-3909 johns374@mc.duke.edu

INDIANA UNIVERSITYtwo-year program, MS degree Charles R. Stine, MhS, PA(ASCP) Program Director diane S. Leland, Phd, Graduate Program Adviser Clarian Pathology Laboratory 350 W. 11th Street Indianapolis, IN 46202 317/491-6646 dleland@iupui.edu http://www.pathology.iupui.edu/htm/path-ast-main.htm

Janel M. Mosburg, Student Liaison AmeriPath Indiana 2560 N. Shadeland Ave., Suite A Indianapolis, IN 46219 317/888-6119 jrenna11@hotmail.com

OHIO STATE UNIVERSITYtwo-year program, MS degree Charles hitchcock, Md, Phd, Program Director gretchen Staschiak, Pathology Education Coordinator N-308A doan hall 410 W. tenth Avenue Columbus, Ohio 43210 614/293-3055 staschiak.2@osu.eduhttp://www.pathology.med.ohio-state.edu/ext/GradProg/PAP/default.htm Sandra Banky, Student Liaison OSu Medical Center 417 East doan hall 410 W. 10th Avenue Columbus, Oh 43210 614/293-4875 banky-1@medctr.osu.edu

QUINNIPIAC UNIVERSITYtwo-year program, MhS degree Scott Farber, Graduate Admissions Director 275 Mount Carmel Avenue, AB-gRd hamden, Ct 06518 203/582-8795 graduate@quinnipiac.eduhttp://www.quinnipiac.edu/x1042.xml Leo Kelly, MhS, Clinical Coordinator (contact to list a job) 203/932-5711, ext. 4758 Ray Schneider, Student Liaison Norwalk hospital dept. of Pathology 24 Stevens Street Norwalk, Ct 06856 203/852-2657 raymond.schneider@norwalkhealth.org

ROSALIND FRANKLIN UNIVERSITY OF MEDICINEAND SCIENCEtwo-year program, MS degree John vitale, MhS, Program Director trina A. Sherlitz, Pt, MS, Clinical Coordinator Pathologists’ Assistant department 3333 green Bay Road North Chicago, IL 60064 847/578-8638 john.vitale@rosalindfranklin.edu trina.sherlitz@rosalindfranklin.eduhttp://66.99.255.20/srhs/pathasst/

Lisa L. dionisi, Student LiaisonMedical College of Wisconsin Pathology department, Lab Building 8701 West Watertown Plank Road Milwaukee, WI 53226414/805-8485 (lab) 414/917-0999 (pager) 414/805-8444 (fax)ldionisi@mcw.edu

UNIVERSITY OF MARYLANDtwo-year program, MS degree Raymond Jones, Phd, Program Director department of Pathology 22 S. greene Street Baltimore, Md 21201 410/328-1221 rjones@som.umaryland.eduhttp://medschool.umaryland.edu/pathology/PAFrames/PAOverview.htm Katie Flickinger, Student Liaison Johns hopkins hospital department of Pathology 600 N. Wolfe Street Pathology B 107A Baltimore, Md 21287-6667 443/287-6134 kflicki1@jhmi.edu

WAYNE STATE UNIVERSITYtwo-year program, BS degree Peter Frade, Phd, Program Director department of Fundamental and Applied Sciences 5439 Woodward Avenue detroit, MI 48202 313/577-2050 ab8123@wayne.edu or pfrade@wayne.edu http://www.mortuarysciencewayne.org/apa_info.htm diane Moric, Clinical Coordinator and Student Liaison Anatomic Pathologists’ Asst. Program Wayne State university Mortuary Science Building 5439 Woodward Avenue detroit, MI 48202 313/966-0575 dianemoric@wayne.edu

NAACLS-Accredited Pathologists’ Assistant Training Programs

18

www.pathologistsassistants.org. 19

CAP ‘07September 30-October 3, 2007Chicago, ILwww.cap.org

ASCP Annual MeetingOctober 18-21, 2007New Orleans, LAwww.ascp.org

National Society for Histotechnology33rd Annual Conference and SymposiumOctober 26-31, 2007denver, COwww.nsh.org

Contact Marty Stone (martystone14@yahoo.com) with any comments/questions about alternate meetings for PAs.

The Other Conferences... You may respond to the newsletter quiz in two ways: via web site or postal mail. Quiz answers must be submitted no later than October 15, 2007. On the AAPA web site, go to the Members Only area, click on CME Page, and then select the Newsletter CME quiz Form. For postal replies, send your responses to: Kathy Washington Abington Memorial hospital department of Pathology 1200 Old York Road Abington, PA 19001

Answers to Summer 2007 quiz:1) d 2) B 3) A 4) B 5) d

6) C 7) A 8) d 9) A 10) B

gross Photo tutorial quiz Answers:1. A 3. B2. C

Jana Joslin-Akers to wed Christopher Sovereign on August 16th at Bishops Lodge in Santa Fe!

Laura & Matt Welsh welcomed baby Liam on May 22, weighing in at 8 lbs. 9oz. and measuring 21 inches.

Ashley Evelyn Manternach was born to Heather Manternach and husband on June 2, 2007, at 9:36am. She is welcomed at home by a sister, Molly. Ashley weighed 7lbs. 8 oz. and measured 19 ¾ inches.

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