Health impacts in pathology workforce during mergers and acquisitions (M&A).

AIMS: To compare burn-out in laboratory professionals (LPs) with exposure to consolidation to those without, and to investigate the role of social support as a moderator in the exposure to mergers and acquisitions (M&A). METHODS: Surveys were sent to the clinical LPs, including 732 with exposure to M&A and 819 without. The dependent variable was burn-out, and the independent variable was exposure to M&A. In investigating the role of social support in exposure group, a logistic regression was used with education, time since M&A, gender, merger types, practice setting, lab hierarchy and race as covariates. RESULTS: Exposure to M&A was associated with higher levels of burn-out (p<0.05). In logistic regression of the workforce exposed to M&A, the odds for LP developing a high level of burn-out are lowered by 7.1% for every unit of increase in social support (OR 0.93; 95% CI 0.88 to 0.98; p=0.004). CONCLUSION: LPs exposed to M&A are more likely to experience higher levels of burn-out but having social support can protect against burn-out, which has policy implications for leadership managing laboratories in times of M&A.

A mixed-methods study on the use of a nongynecological virtual microscopy platform in cytology education.

OBJECTIVES: Expanding the virtual microscopy (VM) slide collection for nongynecological cytology is important to teaching. In a mixed-methods approach, this study evaluated VM's performance and user experience to determine its feasibility and usage in an educational setting. METHODS: From September through October 2022, the students reviewed 44 whole-slide imaged nongynecological slides. The concordance rate with reference diagnosis was compared with that from light microscopy (LM) from 4 months earlier. In addition to assessing the overall performance from VM, imaged urinary cytology's accuracy was reviewed for both urinary and nonurinary cytology. Finally, the students' weekly feedback logs were analyzed to gain insights for improving the digital screening experience. RESULTS: The overall nongynecological diagnostic accuracy was significant between the 2 screening platforms (P < .001), favoring LM over the VM platform. Light microscopy also performed better than VM in urine cytology cases, with 84.2% concordance against reference diagnosis, compared with 61.1% for the VM platform (P = .03). As for the accuracy of nonurinary cases, its glass slide (LM) agreement with the reference diagnosis was also superior at 84.8%, compared with 58.8% for VM (P = .03). Finally, the overarching theme discerned from reviewing the user logs was concern over image quality, which was mentioned 76 times. CONCLUSIONS: The VM results were poorer compared with LM in our validation. Its use seems promising, but more focus is needed to improve the VM screening platform.

HPV Primary and Co-testing: An Ethical Analysis Exploring the Role of Cytology in Cervical Cancer Screening and Management.

With the advancement in our understanding of the causative agents involved with cancer, there has been a considerable amount of debate within the laboratory and cytology community regarding how best to screen for cervical cancer. This paper attempts to review the three different approaches to cervical cancer screening through the lens of the four facie prima principles of biomedical ethics, including the respect for autonomy, principle of beneficence, non-maleficence, and justice. Analyzing the debate on cervical cancer screening platforms through the lens of the four principles of biomedical ethics ensures a comprehensive examination of all facets of the discussion, including a review of not only benefits and harm but also ensures that the final policy is fair and respectful for all the stakeholders. The conclusion from the analysis favors the use of co-testing but also supports making HPV primary and Pap testing viable options, depending on the needs of the community, patients, and providers.

Evaluating the use of virtual microscopy in cytology education.

INTRODUCTION: Whole slide imaging is a promising tool for cytology. In the present study, we assessed the performance of and user experience with virtual microscopy (VM) to determine its feasibility and usage in an educational setting. MATERIALS AND METHODS: From January 1 through August 31, 2022, 46 Papanicolaou slides, of which 22 (48%) were abnormal, 23 (50%) were negative, and 1 (2%) was unsatisfactory, were reviewed by the students using both VM and light microscopy (LM) platforms. In addition to assessing VM's overall performance, the SurePath imaged slides' accuracy was reviewed as a potential alternative to ThinPrep because of its cloud storage advantage. Finally, the students' weekly feedback logs were analyzed to gain insights for improving the digital screening experience. RESULTS: The overall diagnostic concordance difference was significant between the 2 screening platforms (Z = 5.38; P < 0.001), favoring LM (86% correct diagnosis) over VM (70% correct diagnosis). The overall sensitivity of VM and LM was 54.0% and 89.6%, respectively. VM also had an overall higher specificity (91.8%) compared with LM (81.3%). LM performed better than whole slide imaging for the correct identification of an organism when one was present, with 77.6% sensitivity compared with 58.9% for the digital platform. The rate of agreement for the SurePath imaged slides with the reference diagnosis was 74.3% compared with 65.7% for the ThinPrep slides. Finally, 4 themes were discerned from reviewing the user logs, with issues about image quality and the lack of fine focus functionality most frequently mentioned, followed by themes associated with a higher learning curve and novelty associated with the digital screening. CONCLUSIONS: Although the VM results were poorer than the LM results in our validation, its use in an educational setting is promising considering the continued technological improvements and the renewed focus on improving the digital user experience.

Workplace Bullying in Pathology and Laboratory Medicine.

OBJECTIVES: The specific aims of the study are to explore the prevalence of workplace bullying and to understand the impact of bullying on individual wellness in order to facilitate the development of future organizational solutions to mitigate workplace incivility. METHODS: Cross-sectional data were collected via a web-based survey to gather exploratory demographic information and to assess the relationships between intensity of the exposure to the negative acts with laboratory productivity. Associations between laboratories offering resources to employees and their impacts on productivity and professional job fulfillment were also explored. RESULTS: Results of the survey showed that over two-thirds of laboratorians (68.56%) were classified as victims of workplace bullying, and the perpetrator is most likely a peer of the victim (55.3%). The study revealed the intensity of workplace incivility was positively correlated with the number of sick days taken by the laboratory practitioner (F(2, 217) = 24.245, P < .001). Facilities with a supportive work environment were also associated with a reduction in the number of sick mental days taken (P < .001), a proxy for improved work and health outcomes. CONCLUSIONS: The results of this study shed light on the prevalence of incivility at the workplace and offer evidence on the importance of providing a supportive work environment toward reducing workplace bullying.

Human Sustainability in Pathology Medical Laboratory Workforce.

While having a dedicated and productive workforce is the cornerstone of a functioning society, the key is sustainability. Allied health laboratory burnout, characterized by mental exhaustion which negatively affects workplace performance, has worsened during the COVID pandemic. For purposes such as these, the issue must be addressed to ensure that the US will have an adequate workforce to meet the laboratory testing needs of an aging population and any potential future pandemics that may arise. The answer to reducing toxic or challenging workplace environments and improving human workforce sustainability is through transparency and anonymous reporting mandates so the data collected from individual laboratories can be reported as a single "human sustainability" score that reflects the health measure of the laboratory. The 10 laboratories with the highest scores could be listed in the laboratory professional magazine's version of "America's Most Admired Laboratories" and the worst performers in the "Improvements-Needed" listing. Companies are inherently competitive, and this forces laboratories to be more cognizant of workforce well-being and the rate of burnout and work-related chronic conditions. This article outlines how the human sustainability advocacy plan can be implemented using ideas gleaned from Bardach's eight-fold path paradigm.

On building cytomorphology skills: Influence of slide reviewing habits on diagnostic competency in cytology.

OBJECTIVES: The specific aims of the study are to assess whether the amount of time a cytology learner spends reviewing slides correlates with increased diagnostic competency and to determine whether time spent reviewing slides immediately after the multi-head sessions correlates with a higher level of proficiency. The paper also seeks to explore the impacts of the time of day at which slides were reviewed on diagnostic learning outcome. METHODS: Data obtained through the cytology laboratory screening logs were reviewed, and the number of hours per day and the times of the day at which the students were present at the glass slide library were tabulated and compared against each of the seven-unit slide exam scores in the semester to explore possible relationships. RESULTS: There was a positive linear relationship (r = 0.29) between the number of hours students spent in the laboratory reviewing cases and competency. When the students' unit diagnostic test scores were classified into low and high categories for each test, there was a significant correlation (P = 0.008) between a lack of time spent screening slides in the lab and the number of times a student was ranked at the bottom of the class. Our data do not support a recency effect nor a difference in test scores between those who reviewed cases in the morning vs in the afternoon. CONCLUSIONS: While educating and training a strong cytology workforce may be challenging, our study provides new insights and sheds light on the importance of spending time reviewing slides, and provides guidance for struggling students on how best to improve. Inside this month's Cytopathology: The aims of this study are to assess whether the amount of time a cytology learner spent reviewing slides correlates with increased diagnostic competency, and to determine whether time spent reviewing slides immediately after the multi-head sessions correlates with a higher level of proficiency. The paper also seeks to explore the impacts of the time of day at which slides were reviewed on diagnostic learning outcome.

Influence of Certification on a Pathology Laboratory Professional's Career Mobility.

OBJECTIVES: Competency in managing laboratory careers is important for retaining and ensuring a well-trained laboratory workforce. The objective of this study was to identify predictors for career advancement in pathology laboratories-specifically, whether the number of certifications obtained affects career mobility beyond what is accounted for with personality, gender, experience, and tenure. METHODS: Cross-sectional data from nonphysician laboratory professionals were collected through a web-based survey tool. These data were examined in the context of a binary logistic regression model to assess how well independent variables predict career advancement. RESULTS: We included 170 responses in the analysis. According to the statistical model, the odds of career advancement is significant-70% higher for every additional certification a laboratory profession obtains (P = .018), with other predictors being equal. Moreover, technologists with an outgoing personality (ie, extroverts) are 178% more likely to be promoted from entry-level positions than are introverts (P = .045), all else being equal. The number of years the employee has been with the laboratory (tenure) also contributes significantly to promotion (P = .012). Surprisingly, gender and industry experience do not contribute significantly to laboratory mobility and advancement, after accounting for the other variables. CONCLUSIONS: Laboratories should provide incentives for obtaining certifications as a way to improve quality and retain workforce talent.

Exploring staff turnover, burnout, and resilience in cytology reference laboratories: A workforce qualitative study.

OBJECTIVES: The aims of the study were to investigate cytology laboratory staff turnover in the context of workplace stressors and burnout and to explore qualities associated with long career tenure, in order to facilitate the development of future workplace intervention programs. METHODS: Using an interpretive qualitative approach, semi-structured interviews were conducted and analysed using a directed and conventional content analysis. Seven participants who had left large cytology reference laboratories were purposively sampled to interview about their experience of leaving their former laboratories. Conventional content analysis was used to inductively generate themes and deductive content analysis was conducted with categories from the Transactional Model of Stress and Coping (ie, stress appraisal and coping style). RESULTS: Three main themes were discerned from the interviews: concerns about the cytology workplace, reasons for choosing to leave, and strategies for coping with stress. Demand for productivity was the most commonly cited concern among cytotechnologists, followed by work-life balance, and musculoskeletal strain related to microscopic screening. The top reason given for people choosing to leave the commercial laboratories was the lack of work-life balance, and the second was the lack of professional challenges and growth opportunities. Participants with longer job tenure who experienced a promotion described coping with job stress as more optimistic and problem focused. CONCLUSIONS: Opportunities exist within large commercial laboratories for improving the work environment to reduce workplace burnout and turnover.

On Pathology Laboratory Recruitment and Retention.

OBJECTIVES: The specific aims of the study are to analyze relationships between the personality traits of laboratory professionals and choice of profession and preferred work settings. METHODS: Data from practicing laboratory professionals were collected via a web-based survey tool to gather information about personality types, choice of profession, and work setting preferences among medical laboratory professionals. RESULTS: Results of the survey showed that INFJ (Introversion, Intuition, Feeling, Judging) is the most common medical laboratory personality type across the various laboratory work settings and that there are no significant differences between the practitioners' personality type and the choice of profession within pathology. The study revealed laboratorians from higher-volume laboratories were 1.2 times more likely to prefer Judging than lower-volume laboratories, and younger medical laboratory practitioners were 2.3 times more likely to gravitate toward Perceiving than their older counterparts. CONCLUSIONS: The results of this study shed light on how employers can build on the personality preferences of the laboratory workforce to improve personal job satisfaction and laboratory productivity, quality, and work culture. The research implications are useful for laboratory recruitment and retention.

Walk in the Woods--The Road to Master's Cytology Practitioner.

As the Cytotechnology Program Review Committee (CPRC) shared its intent to transition all undergraduate and certificate training programs to a Master's degree curriculum by 2022, mixed opinions have been expressed by various stakeholders from the larger pathology and allied health communities. In order to build a consensus path forward, a framework entitled "Walk in the Woods," an international diplomacy approach, is described. Unlike many problem-solving approaches which directly identify a problem and potential solutions, this approach is a four-step process which includes: (1) self-interest, (2) enlarged interest, (3) enlightened interest, and (4) aligning interest; each step builds on the preceding step. While four steps may take longer than the traditional "problem to solution" paradigm, the purpose of each step is to increase transparency and clarity in a complex multiparty negotiation, such as the path forward for cytotechnology. This commentary demonstrates, in a step-by-step manner, how a "Walk in the Woods" can aid in the facilitation of the transition of the cytology degree to an entry-level Master's degree curriculum and evidence- and interest-based negotiation approach.

Learning cytology in times of pandemic: an educational institutional experience with remote teaching.

INTRODUCTION: As the coronavirus pandemic swept across national and state borders, institutions of higher learning, including cytology, began closing campuses and moving instruction online. We have described a method of remotely teaching cytology in our institution, including using the telecytology concept used with rapid onsite evaluation and remote conferencing and educational tools to conduct eCytology learning. This is a cost-effective method to transition a traditional in-classroom program into online teaching for cytology. It can also be implemented quickly. MATERIALS AND METHODS: In March 2020, our cytology program developed a method for teaching cytology remotely. The distance-learning teaching method included the use of remote conferencing (Zoom platform) and learning management platforms (Canvas) to present lectures and administer tests. Remote multihead sessions were conducted by adapting the telecytology rapid onsite evaluation concept, which attaches a mobile device to the microscope to transmit live video to remote learners. RESULTS: When asked about their experience with online learning, the students had responded positively. All the students indicated a willingness to attend classes remotely in the future, even when the traditional in-classroom learning option is available. CONCLUSIONS: We have presented a method for educating students remotely using existing technology that is affordable and can be implemented quickly by nearly all cytology education programs.

Employer Expectations for the MS-Level Cytology Practitioner.

OBJECTIVES: The specific aims of the study are to determine skillsets most valuable to regional employers of cytotechnologists and assess the employers' willingness to use graduating MS cytology practitioners in the expanded scope of practice. METHODS: Data from the greater New York region were collected via a web-based survey distributed to a broad sample of laboratory professionals involved with hiring in a variety of institutions. RESULTS: The three skillsets most important to New York employers and most employable are fine-needle aspiration adequacy assessment, regulatory acumen, and prescreening cell blocks. The skills that are of least important and least employable are prescreening high-volume tissue biopsy specimens and histology. CONCLUSIONS: The results of this survey shed light on regional employers' perspectives regarding the skillsets that are most important and marketable in the greater New York region and may be useful for subsequent curriculum development.

A comparative study of US EPA 1996 and 1999 emission inventories in the west Gulf of Mexico coast region, USA.

Emission inventory is one of the required inputs to air quality models. To assist in the urban and regional modeling efforts, United States Environmental Protection Agency (EPA) has compiled a National Emission Inventory (NEI) for criterion pollutants, and the precursors of ozone and particulate matter (PM). In December 2002, EPA released the 1999 NEI estimates (NEI99), which represent the most recent national emission data. However, the data sets are not in model-ready format for air quality simulations. This present work converts the NEI99 Final Version 2 data sets into Inventory Data Analyzer (IDA) format and processes the data using the Sparse Matrix Operator Kernel Emissions (SMOKE) modeling system to generate a gridded emission inventory in a domain covering the west Gulf Coast Region, USA. The spatial and diurnal emission characteristics of the gridded emission inventories are then assessed and compared with those of the National Emission Trend 1996 (NET96). The NEI99 database contains more complete emission records in both area and point sources. It is also found that NEI99 data exhibit greater emissions with respect to point and mobile sources but smaller emissions with respect to area sources when compared to the corresponding gridded NET96 data in the same study domain. The most distinct differences between the NEI99 and NET96 databases are CO emission of mobile sources, SO2 emissions of point sources, and VOC/PM/NH3/NOx emissions of area and non-road sources. The gridded NEI99 data show low VOC/NOx ratios (<2-5) in the urban areas of the study domain.

Sensitivity analysis of ground-level ozone concentration to emission changes in two urban regions of southeast Texas.

Air pollutant emission is one of the predominant factors affecting urban air quality such as ground-level ozone formation. This paper assesses the impact of changing emission inventory scenarios, based on combinations of point, mobile, area/non-road and biogenic sources, on the tropospheric ozone concentration in two southeast Texas urban areas, i.e. Houston-Galveston and Beaumont-Port Arthur, during the rapid ozone formation event (ROFE) on August 25, 2000. The EPA's Community Multiscale Air Quality (CMAQ) modeling system with 1999 national emission inventory (NEI99) estimates and updated SAPRC99 chemical mechanism are used in the sensitivity analysis for twelve different emission scenarios. Based on model results, it is found that the point source emission of NOx and VOC contributes the greatest ozone peak in the ROFE. Removing Texas point sources of VOC and NOx emission from the inventory results in a reduction in peak O3 concentration by 128 and 70 ppbv in Houston urban area, respectively. Similar but less drastic impact from point source is also observed in the Beaumont-Port Arthur area. The effect on peak ozone concentration due to mobile, area and non-road sources emissions are less significant compared to that of point source emission. Reducing VOC emission appears to be more effective than reducing NOx emission in lowering peak O3 concentration in the studied region. Although biogenic emission can contribute up to 37 ppbv of peak ozone level over a large area, the affected area is away from the urban region of concern, and should not be the main cause for O3 non-attainment in the two urban areas. Removing CO emission from mobile sources does not lead to significant reduction (< 1 ppbv) in ozone concentrations. The modeled data also show that the transport of O3 precursors from adjacent states can cause a significant ozone plume near Beaumont due to its proximity to the state border based on the conditions during the August 25, 2000 O3 episode.