Clinical Use of Raman Spectroscopy Improves Diagnostic Accuracy for Indeterminate Thyroid Nodules.

BACKGROUND AND OBJECTIVE: Molecular analysis of thyroid fine-needle aspiration (FNA) specimens is believed to improve the management of indeterminate nodules. Raman spectroscopy (RS) can differentiate benign and malignant thyroid lesions in surgically removed tissues, generating distinctive structural profiles. Herein, the diagnostic performance of RS was tested on FNA biopsies of thyroid gland. DESIGN: Prospective, blinded, and single-center study. METHODS: We enrolled 123 patients with indeterminate or more ominous cytologic diagnoses (TIR3A-low-risk indeterminate lesion, TIR3B-high-risk indeterminate lesion, TIR4-suspicious of malignancy, TIR5-malignant). All subjects were surgical candidates (defined by international guidelines) and submitted to FNA procedures for RS analysis. We compared RS data, cytologic findings, and final histologic assessments (as reference standard) using various statistical techniques. RESULTS: The distribution of our study population was as follows: TIR3A:37, TIR3B:32, TIR4:16, and TIR5:38. In 30.9% of patients, histologic diagnoses were benign. For predicting thyroid malignancy in FNA samples, the overall specificity of RS was 86.8%, with 86.5% specificity in indeterminate cytologic categories. In patients with high-risk ultrasound categories, the specificity of RS increased to 87.5% for TIR3A, reaching 100% for TIR3B. Benign histologic diagnoses accounted for 72.9% of patients classified as TIR3A and 31.3% of those classified as TIR3B. Based on positive RS testing, unnecessary surgery was reduced to 7.4% overall (TIR3A-33.3%, TIR3B-6.7%). CONCLUSIONS: This premier use of RS for thyroid cytology confirms its role as a valuable diagnostic tool and a valid alternative to molecular studies, capable of improving the management of indeterminate nodules and reducing unnecessary surgery.

Integrating Human Barriers in Human Reliability Analysis: A New Model for the Energy Sector.

Human reliability analysis (HRA) is a major concern for organizations. While various tools, methods, and instruments have been developed by the scientific community to assess human error probability, few of them actually consider human factors impact in their analysis. The active role that workers have in shaping their own performance should be taken into account in order to understand the causal factors that may lead to errors while performing a task and identifying which human factors may prevent errors from occurring. In line with this purpose, the aim of this study is to present a new methodology for the assessment of human reliability. The proposed model relies on well-known HRA methodologies (such as SPAR-H and HEART) and integrates them in a unified framework in which human factors assume the role of safety barriers against human error. A test case of the new method was carried out in a logistics hub of an energy company. Our results indicate that human factors play a significant role in preventing workers from making errors while performing tasks by reducing human error probability. The limits and implications of the study are discussed.

Non-Technical Skills in Social Networks: The Spread of Safety Communication and Teamwork in a Warehouse.

Safety at work should be considered as the result of the daily interaction of operators. The present research wants to analyze which factors are involved in the development of social networks about safety at work. We assumed that two relational non-technical skills, such as safety communication and safety team member support, affect the in-degree and out-degree bonds of workers in social networks. One hundred and eight workers of a warehouse were the participants of the research, in which they were asked to fill out a self-reported questionnaire. Multiple linear regression analysis was used to test the hypotheses. Results confirmed that safety communication and safety support skills play a role in determining the quantity and the quality of social bonds that workers can create at the workplace. To be specific, while safety communication was found to be associated with out-degree centrality (b = 0.24; p = 0.01), a nonsignificant relationship was found for in-degree centrality. In contrast, safety team member support was found to be associated with in-degree centrality (b = 0.28; p = 0.04). In other words, on the one hand, it was found that high levels of safety communication skills are associated with the tendency of workers to proactively search for colleagues with whom they can share information about safety. On the other hand, workers with high levels of safety support skills tend to be considered as reference points in terms of safety by colleagues, who are more prone to look for their help. Implications for both scientists and practitioners are discussed.

Raman Spectroscopy Discloses Altered Molecular Profile in Thyroid Adenomas.

Follicular patterned nodules are sometimes complex to be classified due to ambiguous nuclear features and/or questionable capsular or vascular invasion. In this setting, there is a poor inter-observer concordance even among expert pathologists. Raman spectroscopy was recently used to separate benign and malignant thyroid nodules based on their molecular fingerprint; anyway, some histologically proved follicular adenomas were clustered as having a characteristic profile of malignant lesions. In this study, we analyzed five follicular thyroid adenomas with a malignant spectroscopic profile compared to five follicular adenomas with a benign Raman spectrum in order to assess possible molecular differences between the two groups. Morphological, immunohistochemical, and molecular analyses evidenced expression of malignancy-associated proteins in four out of five malignant clustered adenomas. The remaining malignant clustered adenoma showed a TSHR mutation previously associated with autonomously functioning follicular carcinomas. In conclusion, thyroid follicular adenomas are a group of morphologically benign neoplasms that may have altered the mutational or expression profile; cases of adenomas with altered immunophenotype are recognized as showing a profile associated with malignancy by Raman spectroscopy. This correlation warrants a more extensive evaluation and suggests a potential predictive value of spectroscopic assessment in recognizing characteristics associated with tumor progression in follicular thyroid neoplasms.

"Woulda, Coulda, Shoulda". Workers' Proactivity in the Association between Emotional Demands and Mental Health.

The present study aimed to explore the mediating role of hostile customer relations in the association between emotional dissonance and workers' mental health. Moreover, the moderating role of proactive personality as a buffer against hostile customer relations was assessed. Emotional demands become crucial within professions that involve a direct relationship with clients and, if poorly managed, can negatively affect workers' health and performance. Accordingly, data were collected on a sample of n = 918 mass-retail employees working for one of the leading Italian supermarket companies. Most participants were women (62.7%) with a mean age = 40.38 (SD = 7.68). The results of a moderated mediation analysis revealed that emotional dissonance was related to more hostile customer relations that, in turn, were associated with higher rates of mental health symptoms. Proactive personality emerged as a protecting factor that prevented the onset of conflicts with clients, particularly among workers experiencing high levels of emotional dissonance. The identification of resources enabling management of emotional demands could suggest suitable adaptive strategies for customer-facing roles, thus preventing the occurrence of adverse mental health symptoms.