Since introducing Congress.gov in September 2012, we have continued to add the databases from THOMAS to the new system. We launched with legislation, followed soon thereafter by the Congressional Record, Committee Reports, and nominations. Today, we are releasing treaty documents. You can select “All Sources” and search across all of these data sets at once, something that was not possible on THOMAS. With this, all of the data sets in the left hand navigation of THOMAS are included in Congress.gov. We have one more data set that was on the legacy system to add, Senate Executive Communications.
The bill text now defaults to the XML/HTML version. What does this actually mean? It is a much better layout that can include a linked table of contents and links to Public Laws and the U.S. Code. It still looks great on mobile devices and is easier to navigate if you can click deeper into the legislation via the table of contents.
The Congress.gov team values user feedback. From user testing, to surveys, and even comments to this blog, we collect and analyze feedback from a variety of users (including those for whom the site is named). After announcing the update last year in February when advanced search, browse, and appropriations tables were added, we received several comments about the appropriations table, including “[t]he old appropriations table was much more detailed, with committee and subcommittee markups.”
In moving from the table on THOMAS to Congress.gov, we made the decision to streamline the table and use responsive design so it would be mobile friendly. Based on feedback, we found that this was not what our users wanted. They missed the detail of the THOMAS table. With this release, the appropriations table is much more comprehensive (but no longer as mobile friendly). Like always, please continue to tell us what you think.
The enhancements in this release follow a busy past twelve months during which we added nominations, accounts, saved searches in June, removed the beta label in September, and added email alerts in February.
New Feature – Treaties:
Treaties, dating from 1949-present, have been added to Congress.gov, and include the following features:
- Support for global search of treaties:
- Text search via resolution text, treaty doc text, treaty topic, originating organization, countries, TIAS number, citation (including old treaty number), and index terms
- Supports cross-data-source facet: Congress
- Supports treaty-specific facets: Status of Treaty Document, Treaty Topic
- The treaty detail page includes a detailed overview, list of Senate actions, and tabs for: resolution of ratification; treaty document; amendments; additional fields.
- The treaties landing page, includes a treaty number search, links to relevant internal and external pages, and a faceted result set.
- A link to treaties has been added to the homepage.
- Treaties have been added to the activity scope of the committee profile page (this feature only affects Senate Foreign Service committee).
- Treaties have been added to overview box for amendments that amend treaties.
New Feature – Executive Reports:
- Executive Reports, dating from 1995-present, have been added to the scope of the existing Committee Reports functionality.
- The Senate Foreign Relations Committee profile will feature treaties, in addition to legislation and nominations.
Enhancement – Advanced Search:
- The following fields have been added:
- Related bills
- Private legislation (in the command line)
- Congress (for the Congressional Record collection)
- Date range searches for “Latest Action” of nominations and treaties
- Treaty fields
- An “Is all of” operator has been added to the following fields:
- Action – Status of Legislation
- Committee – House
- Committee – Senate
- The advanced search form has been widened.
- The advanced search form interface supports curated “popular” legislative action searches that can be selected from a menu.
- Advanced search and command line search results can be refined with facets.
Enhancement – Browse:
- New reports/tables are available, allowing the user to browse:
- Bills with Chamber Action
- Major Actions on Bills and Amendments
- Actions by Committees and Subcommittees
Enhancement – Bills are in XML as the default display option in the Text tab of bill detail page:
- XML will display as the default in Text tab of the bill detail page.
Enhancement – Current information about activity on the House and Senate Floor is now displayed on the homepage:
- Congress.gov displays current Congressional activity on the homepage, including current-day bill, nomination, and treaty record links for items considered by the House and Senate.
- The start and end time of next and previous House and Senate daily chamber sessions will display on the homepage.
Enhancement – Member Profiles:
- URLS now display BioGuide IDs.
Enhancement – Appropriations Table:
- Per user feedback, the appropriation tables have been revised and now include additional fields, such as subcommittee information.
We continue to take steps to improve Congress.gov. Thanks to all of you for providing us such great feedback during this period of transition from THOMAS. You have certainly helped improve Congress.gov!
Women outnumber men in the nursing profession by more than 10 to 1. But men still earn more, a new study finds.
The report in this week’s Journal of the American Medical Association found that even after controlling for age, race, marital status and children in the home, males in nursing out-earned females by nearly $7,700 per year in outpatient settings and nearly $3,900 in hospitals.
Even as men flowed into nursing over the past decades, the pay gap did not narrow over the years studied: 1988 to 2013.
According to the Census Bureau, men made up about 9 percent of registered nurses in 2011, roughly a three-fold increase from 1970. And even though men were not permitted in nursing programs at some schools until the 1980s, they have overall earned more, just as in society at large.
The biggest disparity was for nurse anesthetists, with men earning $17, 290 more.This KHN story also ran on NPR. It can be republished for free (details).
Ulrike Muench of the University of California-San Francisco, the study’s lead author, said in an interview that the data do not suggest why men earn more, although “some have suggested men have better negotiating skills” and are able to start out earning higher salaries.
Jennifer Stewart, who oversees nursing and other workforce issues at the health research group The Advisory Board, agrees that’s one possibility. “Also maybe some gender discrimination,” she adds.
But most people who study nursing trends say this is a difficult problem to sort out.
For example, says Stewart, because men have joined the profession more recently, women tend to be more senior nurses. But as such, they get to work preferred day shifts, even though night and weekend shifts tend to pay more.
Peter McMenamin, a health economist at the American Nurses Association, says that while ANA policy “is that there should be pay equity,” he’s not convinced the problem is as large as the study suggests. For one thing, he says, with so many women compared to men in the study, the numbers for women “are much more precise.”
But no one questions the overall finding that men out-earn women. And that is “dismaying,” says McMenamin. “We would like any differentials in pay to be based on skills and experience and not on gender,” he said.
By Michael J. Misialek, MD
If you’re a woman who has ever had a breast biopsy, you may be asking yourself a few serious questions:
“How do I know if my breast biopsy is completely accurate?” And, “Who is the pathologist reading the biopsy, and what is their level of training?”
Many more patients are asking these and similar questions following widespread media coverage on a Journal of the American Medical Association (JAMA) study, which casts doubt about the accuracy of interpreting these biopsies.
Let’s break the study down and ease some anxiety. Perhaps most importantly, this provides a great opportunity to learn about one of the lesser know medical specialties, pathology…which is what I do.
The JAMA study, “Diagnostic Concordance Among Pathologists Interpreting Breast Biopsy Specimens,” revealed the following key finding:
• Overall agreement between individual pathologists’ interpretations and that of an expert consensus panel was 75 percent, with the highest agreement on invasive breast cancer and lower levels of agreement for ductal carcinoma in situ (DCIS) and atypical hyperplasia.
What this means is that the agreement between a general pathologist and an expert was excellent for breast cancer (those with the ability for metastasis), but varied significantly for early cancers and high-risk pre-cancers.
While the study’s findings may not be surprising to physicians who understand the challenges of diagnosing complex breast cases, news of the article could lead to unnecessarily heightened anxiety for patients and the public as breast cancer is a highly publicized and pervasive disease.
The study confirmed that the majority of breast pathology diagnoses, especially at either end of the spectrum (benign disease and invasive breast cancer) are accurately made by practicing pathologists regardless of practice setting. The overall rate of agreement for invasive breast cancer cases was 96 percent.
Issues with diagnostic disagreement mainly center on the borderline cases, between atypical hyperplasia, that is, pre-cancer, and DCIS, early cancer.
Why does this matter? Overdiagnosis can lead to unnecessary surgery, treatment and anxiety. Underdiagnois can lead to a delay in treatment. The bottom line is that experience matters.
Factors that contributed to greater disagreement included: a low case volume, small practice size, nonacademic practice and high breast density.
The study has many weaknesses. Chief among them was that only a single slide per case was given to each pathologist. As a practicing pathologist, this never happens. I will review multiple slides, often ordering several additional deeper sections and ancillary special stains, studying each carefully. This practice was prohibited in the study.
Additionally, the study cases were a mixture of core biopsy and excision specimens. A core biopsy is obtained using a needle, often by a radiologist, in which a small core of tissue is removed. An excision is a “lumpectomy” which is done in the operating room where a large section of breast tissue is removed. Diagnostic criteria vary between a needle core and excision. Often times it is not necessary to render an exact diagnosis on the core biopsy, but rather recognize an abnormality and recommend an excision for which additional tissue will clarify the diagnosis.
Even the experts disagreed in the study (75 percent initial agreement then 90 percent after discussion).
This illustrates the fact that pathology is both a science and art. Experts may stress slightly different criteria in their pathology training programs. The “eye of a pathologist” is a difficult measure to quantify and is dependent on multiple factors that best function in real time, not an artificial study.
Another weakness is that there is no evidence that the experts were more accurate in predicting outcomes than test subjects. Perhaps most importantly, a second opinion was not allowed in the study, even when study participants indicated uncertainty. These are in fact the very cases that would most likely have been shown around, sent out for consult and further worked up.
It is not realistic to introduce such a large caseload of breast biopsies that are heavily weighted towards atypical hyperplasia and DCIS. Since these borderline cases represent only a small fraction of breast biopsies in actual practice, diagnostic agreement in routine practice is higher than that reported in this study. No clinical information other than patient’s age was given to the study pathologists, and no imaging findings were included. In actual practice, integration of the clinical setting and imaging findings is routinely used in making a diagnosis.
The findings are not unique to pathology. All of medicine has grey zones, where controversy often exists. The study does have an important message for pathologists. As noted in the accompanying editorial, it should serve as a “call to action.” A better, more reproducible definition of atypical hyperplasia is needed.
The article highlights the need for an active quality management program in surgical pathology that includes targeted review of difficult or high risk cases. The College of American Pathologists (CAP) and the Association of Directors of Anatomic and Surgical Pathology have been developing an evidence-based guideline expected to be released in May to provide recommendations to reduce interpretive diagnostic errors in anatomic pathology.
The CAP is proactively addressing educational opportunities through advanced breast pathology training programs designed to provide a route for pathologists to demonstrate their expertise regardless of the setting in which they practice.
Patients can take steps to help ensure their breast biopsy is read accurately:
o Inquire about the pathology laboratory that will examine your tissue sample. Is the laboratory accredited? The CAP accredits more than 7,600 laboratories worldwide and provides an online directory for patients.
o Make sure the pathologists who are examining your tissue samples are board-certified.
o Find out if your hospital has a multidisciplinary breast conference. This is a team of physicians and other health care professionals that meets regularly to discuss diagnosis and management of patients with breast disease, guaranteeing more consultation about the best approach for your care.
o If your hospital doesn’t have a multidisciplinary breast conference, consider getting a second opinion. Second opinions are always welcome. Have your doctor send the biopsy slides to another laboratory and request they be read by a pathologist who specializes in breast pathology. Insurance typically covers second opinions.
o Seek out accurate and credible resources to help you understand your pathology report and diagnosis, such as the CAP’s resource, “How to Read Your Pathology Report.”
o Most accredited surgical pathology laboratories include second opinion slide review as part of their quality management program. Ask about this.
Remember, all treatment begins with a diagnosis. Take control of your healthcare, ask questions, get answers and become engaged, it makes for better care.
Dr. Michael Misialek is Associate Chair of Pathology at Newton-Wellesley Hospital and Assistant Clinical Professor of Pathology at Tufts University School of Medicine.