When Elizabeth Blackwell, daughter of an Ohio sugar refiner, decided she wanted to become a doctor, she applied to 29 medical schools across the country. All rejected her because she was a woman. She was finally admitted to Geneva Medical College (now Hobart College) in New York, where it was rumored that her admission had been meant as something of a joke. In 1849, Blackwell, ranked first in her class, became the first woman to graduate from medical school in the United States. Today, more than 150 years later, nearly half of medical school students nationwide are female, and the influx of women physicians over the last quarter-century has changed both the face and character of medicine. Women physicians and the cultures of medicine, edited by Ellen S. More, Elizabeth Fee, and Manon Parry, comprises 12 essays, all but one written by women, that examine the wide-ranging experiences of women physicians in the United States, shedding light on their accomplishments and struggles from the mid-19th century to the present. The first section, “Performing gender, being a woman physician,” focuses on the overwhelming challenges faced by the first generations of women physicians entering the male-dominated field of medicine. Many spent a substantial part of their careers trying to convince others that there were no biological or intellectual barriers that should prevent women from practicing medicine. Mary Putnam Jacobi conducted a substantial amount of clinical research in the late 19th century that she hoped would prove that biological functions such as menstruation and childbearing were not obstacles for women wanting to enter traditionally male-dominated professions. Marie Zakrzewska, one of the most accomplished medical practitioners and educators of the 19th century, insisted that men and women did not differ anatomically or psychologically in any significant way (although she modified her position late in her career.) The middle section of the book deals with the personal challenges women physicians faced as they tried to make inroads into the traditional model of health-care professionalism. Although more women were entering the field of medicine in the early to mid-20th century, they still faced a masculine and often hostile culture. An insightful essay by Sandra Morgen links the growing acceptance of women physicians in the 1960s and 1970s with the women’s health movement, which encouraged women to take more control over their bodies and health care. My favorite piece, “Feminists fight the culture of exclusion in medical education,” by Naomi Rogers, chronicles the generation of activist women who attended medical school in the 1970s and 1980s. They demanded, and eventually received, more respect from their professors and fellow students. As I graduated from medical school in 1974 and was a student, resident, and then faculty member at four different medical schools during this time, I share many of the kinds of experiences discussed, including being told: that I should “stay home and take care of my children” (many times by many people); “we don’t need women in medical school because there aren’t enough ladies’ rooms”; and “we can’t have a woman on our board because then we wouldn’t be able to smoke cigars, drink brandy, and tell jokes after dinner.” In response I became determined, even early in my career, to do what I could to help other women advance in medicine. The final section, “Expanding the boundaries,” is the most problematic in the book. It is composed of a brief group of essays dealing with everything from the growing number of women practicing homeopathic medicine to the evolution of health services for college students. While individually these essays are not without interest, they seemed to be thrown together simply because there was nowhere else in the book to put them. That said, Virginia Metaxas’s exploration of American medical women who carved out careers serving populations in crisis overseas recounts the stories of Esther Pohl Lovejoy and Ruth Parmelee, who provided medical aid to the war-torn nations of Greece and Turkey in the early 20th century, and is one of the most fascinating pieces in the book. The book’s conclusion analyzes the modern state of affairs for women physicians in the United States and their prospects for the future. This section draws heavily from the Women Physicians’ Health Study conducted in 1993 and 1994. The study found that while women practicing medicine today have overall found great career satisfaction, inequality still persists, particularly among African American and Hispanic women physicians. While Women physicians and the cultures of medicine doesn’t provide a major new perspective on the narrative of women in American medicine, it is a more than satisfactory introduction to that colorful history. This lively collection of essays will no doubt be enlightening to the current generation of medical students, historians, and scholars.

As discussed during the Nov, 2008 editorial board meeting (corresponding with the 56th Annual American Society of Cytopathology (ASC) Scientific Meeting at Orlando, FL, USA), CytoJournal has moved to a new platform (MedKnow Publications, http://www.medknow.com/). Currently most of the aspects of the move are complete. PDFs of all the articles published previously in CytoJournal before June 2008[1–86] will continue to be available on the new platform under the same URL of www.cytojournal.com (in the top blue bar, click on ‘Browse articles’ http://www.cytojournal.com/browse.asp) or click on ‘Search CytoJ Articles’ http://www.cytojournal.com/search.asp). They will also be available through other sites including PubMed (http://www.ncbi.nlm.nih.gov/PubMed/). All the articles published after the June, 2008 move would be available free under open access charter in HTML format. The PDFs will be available free to all Cytopathology Foundation members (http://www.cytojournal.com/CFMember.asp) and to the members of various organizations joining the ‘CytoJ OA steward’ program (http://www.cytojournal.com/OASteward.asp).

Significant efforts, time, and resources are devoted for peer-reviewing numerous CytoJournal manuscripts. The Editorial Board of CytoJournal shares a significant proportion of this activity. Additional peers are requested to join periodically as ‘academic editors’ and reviewers to review CytoJournal manuscripts. We thank all the reviewers and academic editors for their time and efforts for completing the peer-review of CytoJournal manuscripts during 2006. The continued success of this important academic exercise depends on their continued enthusiasm to support with their highest standards. We also thank all the contributing authors for selecting CytoJournal and supporting open access initiative, which allows retention of the copyrights to their corresponding academic accomplishments.

CytoJournal organized its first Peer-Reviewer's Retreat of 2006 during the United States and Canadian Academy of Pathology Annual Meeting at Atlanta on Feb 12, 2006. The major topics discussed were open access, peer review, and impact factors. Representative participants volunteered to join the task force to prepare an instructional guide for peer-reviewing cytopathology manuscripts. Concern about the impact factor for CytoJournal was discussed. A feedback to its readers and authors was recommended. Impact factor calculation needs at least three years of journal statistics. It is only possible after two years from the time a journal is first accepted by Thomson-ISI for citation tracking. CytoJournal is still too new for an impact factor to be calculated. However, general progress of CytoJournal suggests an encouraging pattern for high impact factor.

CytoJournal is published by an independent publisher BioMed Central, which is committed to ensuring that the peer-reviewed biomedical research is Open Access. Since its launch, BioMed Central has graciously supported the processing of all the articles published during CytoJournal's first 6 months. However, for long term viability, CytoJournal has to achieve financial viability to support publication expenses. From 1st March, 2005, authors will be asked by the publisher to pay a flat article-processing charge. This editorial discusses how a significant proportion of authors may not have to pay this fee directly under a variety of different mechanisms such as institutional and society memberships with BioMed Central.

Welcome to CytoJournal! We would like to introduce you to your journal, one that is run by and for the scientific cytopathology community with incontestable benefits of Open Access, and support from Cytopathology Fondation, Inc http://www.cytopathology-foundation.org/index.html. CytoJournal is a peer-reviewed, PubMed indexed, online journal, publishing research in the field of cytopathology and related areas, with world wide free access. Authors submitting to CutoJournal retain the copyright to their hard earned work.

The AAMC's Increasing Women's Leadership Project Implementation Committee examined four years of data on the advancement of women in academic medicine. With women comprising only 14% of tenured faculty and 12% of full professors, the committee concludes that the progress achieved is inadequate. Because academic medicine needs all the leaders it can develop to address accelerating institutional and societal needs, the waste of most women's potential is of growing importance. Only institutions able to recruit and retain women will be likely to maintain the best housestaff and faculty. The long-term success of academic health centers is thus inextricably linked to the development of women leaders. The committee therefore recommends that medical schools, teaching hospitals, and academic societies (1) emphasize faculty diversity in departmental reviews, evaluating department chairs on their development of women faculty; (2) target women's professional development needs within the context of helping all faculty maximize their faculty appointments, including helping men become more effective mentors of women; (3) assess which institutional practices tend to favor men's over women's professional development, such as defining “academic success” as largely an independent act and rewarding unrestricted availability to work (i.e., neglect of personal life); (4) enhance the effectiveness of search committees to attract women candidates, including assessment of group process and of how candidates' qualifications are defined and evaluated; and (5) financially support institutional Women in Medicine programs and the AAMC Women Liaison Officer and regularly monitor the representation of women at senior ranks.

Endometrial adenocarcinoma is the leading cause of malignancy of the female genital tract. Prognosis of this tumor, which has implications on patient management, is determined by evaluation of the stage of disease, architectural grade, nuclear grade, myometrial invasion, and peritoneal cytology. These parameters have inherent subjectivity and, therefore, the search for an objective reliable parameter to determine prognosis is required. DNA ploidy is under investigation as an objective and reproducible prognostic parameter. This study will evaluate the role of DNA ploidy and its relationship to the traditional parameters as predictors of prognosis in patients with endometrial carcinoma. Fifty-eight patients were evaluated by two observers for architectural grade according to the International Federation of Gynecology and Obstetrics classification, nuclear grade, and depth of myometrial invasion. DNA ploidy was evaluated using flow cytometer (FACscan, Becton Dickinson, San Jose, CA). Histologic parameters were than compared with DNA ploidy. Survival data were obtained from the tumor registry. Results of patient survival were compared with histologic parameters and DNA ploidy. Higher nuclear grade and aneuploidy correlated with poor survival rate (P < .05). Higher nuclear grade correlated with aneuploidy. The survival of patients with architectural grade 2 (moderately differentiated) endometrial adenocarcinoma is poorer if the tumor is aneuploid as compared with diploid as determined by flow cytometry. In conclusion, aneuploidy and nuclear grade correlates with poor patient survival. The poorer survival rates with aneuploid architectural grade 2 endometrial adenocarcinoma may have an impact on clinical management. Ann Diagn Pathol 5:267-273, 2001.

This is the final report of a panel convened as part of the Association of American Medical College's (AAMC's) Mission-based Management Program to examine the use of metrics (i.e., measures) in assessing faculty and departmental contributions to the clinical mission. The authors begin by focusing on methods employed to estimate clinical effort and calculate a "clinical full-time equivalent," a prerequisite to comparing productivity among faculty members and departments. They then identify commonly used metrics, including relative-value units, total patient-care gross charges, total net patient fee-for-service revenue, total volume per CPT (current procedural terminologies) code by service category and number of patients per physician, discussing their advantages and disadvantages. These measures reflect the "twin pillars" of measurement criteria, those based on financial or revenue information, and those based on measured activity. In addition, the authors urge that the assessment of quality of care become more highly developed and integrated into an institution's measurement criteria. The authors acknowledge the various ways users of clinical metrics can develop standards against which to benchmark performance. They identify organizations that are sources of information about external national standards, acknowledge various factors that confound the interpretation of productivity data, and urge schools to identify and measure secondary service indicators to assist with interpretation and provide a fuller picture of performance. Finally, they discuss other, non-patient-care, activities that contribute to the clinical mission, information about which should be incorporated into the overall assessment. In summary, the authors encourage the use of clinical productivity metrics as an integral part of a comprehensive evaluation process based upon clearly articulated and agreed-upon goals and objectives. When carefully designed, these measurement systems can provide critical information that will enable institutional leaders to recognize and reward faculty and departmental performance in fulfillment of the clinical mission.

Hernandez, Enrique; Atkinson, Barbara F.; Iksander, Muna I. M.D., D.C.P., M.R.c.Path. Author Information

Objective: To determine whether the order of cell collection, endocervical or ectocervical cells first, has an effect on the quality of the Papanicolaou smear.Methods: One thousand smears were obtained using an Ayre spatula and an endocervical brush. Tn 500 cases the endocervical brush was used first, and in 500 cases the spatula was used first. All Papanicolaou smears were collected by resident physicians in our university hospital gynecologic clinics. A smear was considered limited for interpretation for the following reasons: 1) lack of endocervical component, 2) obscured by blood, 3) obscured by inflammation, 4) drying artifact, and 5) too thick.Results: The brush-first group had 405 (81%) adequate smears compared with 410 (82%) adequate smears in the spatula-first group. More smears were obscured by blood when the brush was used first (22 or 4.4% compared with three or 0.6%, P < .001). No endocervical component tie, metaplastic cells, endocervical cells, or mucus) was found in 29 (5.8%) smears from the brush-first group compared viith 45 (9.0%) of the spatula-first group, an insignificant difference. More squamous intraepithelial lesions were found when the spatula was used first (55 or 11% compared with 35 or 7.0%, P < .05).Conclusion: The quality of the Papanicolaou smear can be improved by using the Ayre spatula first followed by the endocervical brush. Fewer smears will be obscured by blood, which could result in more squamous intraepithelial lesions being detected. (C) 1997 by The American College of Obstetricians and Gynecologists.

OBJECTIVE:To define the clinical significance of qualifying the cytologic diagnosis of atypical squamous cells of undetermined significance (ASCUS) as favoring either a reactive process or a low grade squamous intraepithelial lesion (LSIL) in an effort to provide management guidelines.STUDY DESIGN:A total of 118 consecutive nonpregnant women with a cytological diagnosis of ASCUS favoring either a reactive process or LSIL were evaluated in our colposcopy clinic by repeat cervical cytologic smear, colposcopy and colposcopically directed biopsies and/or endocervical curettage, as indicated.RESULTS:Of the 58 patients evaluated for a smear of ASCUS, favoring a reactive process, 5 (8.6%) had cervical intraepithelial neoplasia (CIN) CIN 1 documented by biopsy. None had a high grade lesion. Twenty-six (45%) of the 58 patients who had a cytologic diagnosis of ASCUS favoring a reactive process had a repeat smear that was normal. None was found to have CIN. Of the 60 patients who had a cervical diagnosis of ASCUS favoring LSIL, 9 (15%) had CIN 1 or CIN 2. Nineteen (32%) of the 60 patients who had a cytologic diagnosis of ASCUS favoring LSIL had a repeat smear that was normal. One of these patients had CIN 1 on biopsy. The sensitivity of a repeat smear, in this limited series, after an initial smear of ASCUS favoring a reactive process is 100%, while it was 66% after an initial smear of ASCUS favoring LSIL.CONCLUSION:This study showed that in our laboratory a cytologic diagnosis of ASCUS favoring either a reactive process or LSIL is associated with a very low risk that the patient is haboring CIN. In the patient whose initial smear shows ASCUS favoring a reactive process, a repeat smear that is normal is reassuring. The patient whose smear shows ASCUS favoring LSIL probably requires further evaluation even in the presence of a normal repeat smear.

It is our hypothesis that if Helicobacter pylori could be demonstrated conclusively to have transgressed the mucosal surface into the lamina propria, this would help explain how H pylori recruits inflammatory cells. We report our immunohistochemical and electron microscopic findings that demonstrate that H pylori can be detected in the lamina propria of the stomach, offering evidence of its invasive potential. We stained 67 endoscopic gastric biopsy specimens with Warthin-Starry silver and immunoperoxidase stains for H pylori. In addition, transmission electron microscopy was performed on 1 case. The presence of surface H pylori was associated significantly with active (P < .0001) and chronic (P < .0001) inflammation. H pylori could not be identified in the lamina propria using the Warthin-Starry silver stain alone. Immunoreactivity for H pylori in the lamina propria was detected in 20 (30%) of 67 gastric biopsy specimens. Transmission electron microscopy confirmed the immunohistochemical findings. H pylori can infiltrate the lamina propria of the gastric mucosa, thereby proving morphologic evidence of its invasive capability.