![](media/image1.emf){width="2.14375in" height="2.201388888888889in"}

![](media/image2.emf){width="1.6465277777777778in"
height="0.7986111111111112in"} **EM News**

**Volume 3 Issue 2 August 1997**

EM Program National VANTS Teleconference

We invite participation by the EM Director, EM technical staff, Lab
Chief or Laboratory Manager/ Chief Medical Technologist on a scheduled
VANTS system teleconference call on Tuesday, **[Sept. 2nd, 1997 -
scheduled between 1:00PM - 1:50PM EASTERN time]{.underline}**. To join
the teleconference session, participants will need to **dial
1-800-230-2250** shortly before the 1:00PM Eastern time and state to the
VANTS operator that you are joining the **ELECTRON MICROSCOPY PROGRAM**
teleconference call. A few topics proposed for the teleconference agenda
are:

EM Program sharing agreements - changes in rules/legislation, some ideas
contributed by Programs which currently have successful EM sharing
agreements Hopefully, some of those sites will share information on
their experiences.

Changes in Annual EM report letter and EM case review process - general
discussion on changes proposed by the EM Ad Hoc Review Group - including
revisions to M-2 Standard handbook related to EM quality assurance
review and EM case material retention requirements.

Discussion about scientific studies that compare the "sensitivity and
specificity" of electron microscopy versus immunocytochemistry. Recent
publications by **Orenstein** ([*A comparison of the Usefulness of
Electron Microscopy and Immunohistochemistry* - *Arch Pathol Lab Med.
1994;118:922-926*]{.underline}) and **Mierau** (*[Appraisal of the
Comparative Utility of Immunohistochemistry and Electron Microscopy in
the Diagnosis of Childhood Round Cell Tumors - Ultrastructural
Pathology, 20:507-517, 1996]{.underline}*) will be mentioned. We should
consider the possibility of conducting similar studies in our
laboratories.

Discussion about the usual turnaround time for diagnostic electron
microscopy, and how this can be decreased (improved) by using microwave
fixation and digital cameras.

Discussion about methods to disseminate EM Program information more
timely and effectively - via additional teleconferences specific to EM,
via national or regional meetings or conferences for EM Directors and
staff

Question & Answer time available to discuss any additional questions or
concerns related to EM Program activities. (Please submit any other
suggested topics for this call and for any future teleconf. calls by
calling Dr. John Shelburne at Durham VAMC 919-286-6925, 700-671-6925 or
Alex Tuszynski 919-286-0411x5218 or 700-671-5218, FAX 919-286-6818.)

Please mark your calendar for this teleconference call. If the EM
Director or technical staff is unable to participate due to scheduling
conflicts, please arrange to have someone from P&LMS Administrative
staff attend this call in your place.

**Annual EM report packet**

The Annual EM Program report packet has been mailed to your station
routed via the Medical Center Director's office. Another (CC:) duplicate
packet was also mailed directly to each EM Program Director in case the
other copy is not forwarded to you. You should have received an annual
EM reporting packet by the time you receive this newsletter. If not,
please contact Alex Tuszynski (919) -286-0411x5218 or FTS (700)-671-5218
for another copy.

Please pay close attention to the packet cover letter which describes
several changes from previous year's reporting format. These changes
will also be covered during the teleconference call mentioned in the
previous article.

**Enhanced Health Care Resources Sharing Authority**

The current VHA goal of "30, 20, 10", urges medical centers to earn 10%
of their annual operating budget. For laboratories, one way is doing
tests for DoD and/or the private sector in addition to their own
workload. A few months ago we mailed to each EM Program a packet
containing information on the enhanced health care resources sharing
authority. Also included were attachments explaining the costing
methodology to be used according to VHA Directives. Included with the
mailing of this Newsletter is a copy of a very recent change made to the
VHA Handbook, #1660.1 titled "**[VA-DOD HEALTH CARE RESOURCES
SHARING]{.underline}**" signed by Under Secretary for Health, Kenneth
Kizer, M.D., M.P.H. in July 1997. Please share this information with
your P&LMS administrative staff if they are not yet aware of these
recent changes.

New provisions of "The Veterans Health Care Eligibility Reform Act of
1996" or Public Law 104-262 significantly expand the VA health care
resources sharing authority in current regulations (Title 38 U.S.C.
sections 8151-8153)

-   **These Provisions include eliminating some existing barriers and
    disincentives to the sharing of health care resources with non-VA
    entities**

-   **The types of resources that can be shared and who qualifies as a
    sharing partner, are expanded with this new directive**

-   **VA will publish regulations establishing simplified competitive
    procurement procedures applicable to sharing contracts as permitted
    under the provisions of the Reform Act of 1996**

-   **The statue expands the opportunity for VA health care facilities
    to sell services and generate revenue, thereby maintaining and
    expanding services to veterans. One effect of such measures could be
    the preservation of jobs that otherwise would have to be eliminated
    to meet budget reductions and cost efficiency targets**

-   **Under this authority, "[health care providers]{.underline}" with
    whom VHA may enter into sharing contracts include health care plans
    and insurers, and any organization, institution or other entity or
    individual who furnishes [health care resources]{.underline}**

-   **The term "health care resources" includes hospital and ambulatory
    care, mental health services, medical and surgical services, exams,
    treatments, rehab services and appliances, preventive health care,
    prosthetics and other services and supplies**

-   **The term also includes any health care support services (e.g.
    biomedical equipment repair) and administrative services, as well as
    use of medical equipment or space**

-   **VA may enter into non-competitive sharing contracts with
    affiliated health professional schools, practice groups and other
    entities associated with an affiliate (e.g., another hospital which
    has a residency training program with the VA affiliate), blood
    banks, organ banks, and research centers for health care resources
    consisting of commercial services. The term "commercial services"
    includes medical or professional services as well as other services.
    For these non-competitive contracts a simple justification, citing
    the use of the sharing authority established in the Reform act and
    stating that the sharing partner meets the criteria is required**

-   **Sharing authority may be used to provide or "sell" health care
    resources to any eligible sharing partner. Contracts to provide or
    sell health care resources to other than eligible veterans may only
    be executed if specific determination is made (1) that veterans will
    receive priority for the services provided and (2) the agreement is
    either necessary to maintain an acceptable level and quality of
    service to veterans, or will result in the improvement of services
    to eligible veterans. Certification that these conditions have been
    met are required by either the VISN or the medical center director.
    [Proceeds from providing or selling services are credited to the
    appropriate medical appropriation at the facility providing the
    service]{.underline}.**

-   **Threshold limits will also be changed so that "competitive"
    sharing agreement contracts which are less than \$100,000 can be
    approved locally with written justification by a "simplified"
    contracting procedure (this is kept at the local level as long as a
    higher contracting approving official at the local site approves the
    contract). An important point in this threshold level is that it is
    the NET total flow of dollars which cannot exceed the limit, i.e.,
    as long the shared services dollar net "flow" does not exceed the
    threshold limit**

-   **Sole source contract of less than \$100,000 with an
    [affiliate]{.underline} do not require justification under the
    simplified contract procedures. (previous limit - \$50,000)**

-   **Simplified contracting procedures with appropriate justifications
    may be used for "commercial services" contracts for up to 5 million
    dollars with affiliates which provide or sell health care
    resources**

-   **Examples of innovative programs at VAMC's include: One VAMC is
    renting space on its roof for a commercial microwave tower. Another
    VAMC is renting or leasing one entire ward to its affiliate, who
    uses this ward for its own patients.**

-   **In other words, the old barriers to more efficient and productive
    use of our EM laboratories have now been removed. We strongly
    encourage each of you to be creative and to take advantage of these
    new regulations.**

**To facilitate VAMC and VISN implementation of the enhanced sharing
authority a "Rapid Response Team" has been established to assist
Contracting Officers and Program Officials with application of this new
authority.**

***Katherine Galos, Office of A&MM (202) 273-8823, Phil Kauffman, Office
of General Council (202) 273-8622, Karen Walters, Medical Sharing Office
(202) 273-8404.***

**M-2 handbook still being revised**

Revisions to M-2 standards related to diagnostic EM Program activities
have been approved and recommended by the EM Ad Hoc Review Group and
submitted for inclusion for the next version of the M-2 handbook, as
noted in comments in the previous issue of this newsletter. The
revisions would include doing away with designating numerical standards
for EM Program levels, and emphasizing the quality assessment section to
be primarily a review of five [clinically justified]{.underline} EM
cases. The main emphasis in making changes to the M-2 handbook for all
P&LMS sections, including EM, is to simplify those regulations as much
as possible as long as the appropriate accreditation agency regulations
are followed.

**E-Mail, Web sites**

**[MicroWorld News]{.underline}** is an e-mail newsletter for
microscopists and microanalysts. The issue lists a large number of web
sites, resources, meetings and conferences in the area of EM, imaging,
etc. To subscribe to the e-mail newsletter send an e-mail message to
MWN@mwrn.com

To subscribe to the e-mail Microscopy newsgroup or discussion group send
an e-mail message containing the message "Subscribe Microscopy
YourUserID@YourDomain" to Listserver@MSA.Microscopy.com

An example message from John Doe in FORUM might be:

Subscribe Microscopy doe.john@forum.va.gov

A few sample entries from the e-mail discussions and the Microworld
newsletter are provided in the meetings calendar section and in the
following web site listings.

**[From MicroWorld Resources, your guide to microscopy on the Internet
at]{.underline}**

http://www.mwrn.com/

http://www.mwrn.com/guide.htm

(the above location contains articles on electron microscopy, laser and
confocal microscopy, light microscopy, job postings, etc,)

**[University of Washington]{.underline}**

http://www.pathology.washington.edu./

**[University of Pittsburgh]{.underline}**

http://path.upmc.edu/

**[Uniformed Services University]{.underline}**

http://wwwpath.usuf2.usuhs/mil/

**[Virgil's Web]{.underline}**

http://virgil.mc.vanderbilt.edu/

**[GI and Liver Pathology]{.underline}**

http://www.pds.med.umich.edu/users/ greenson/

**[Osaka Medical College]{.underline}**

http://www.osaka-med.ac.jp/

**[Microscopy Society of America]{.underline}**

http://www.msa.microscopy.com/

***[MSA - FTP site address]{.underline}***

ftp.msa.microscopy.com

**[Emory University School of Medicine]{.underline} just developed a Web
page for the residency program**

http://www.emory.edu/PATHOLOGY/ RESIDENT/

**Government sites of possible interest**:

***[Armed Forces Institute of Pathology]{.underline}***

http://www.afip.mil

**[CancerNet]{.underline}**

gopher.nih.gov:70/11/clin/cancernet

**[National Cancer Institute]{.underline}**

http://www.nci.nih.gov

**[National Library of Medicine]{.underline}**

http://www.nlm.nih.gov

**[Institute of Medicine]{.underline}**

http://www2.nas.edu/iom

**[Morbidity and Mortality Weekly Review]{.underline}**

http://www.cdc.gov/epo/mmwr/mmwr.html

**[National Institutes of Health]{.underline}**

http://www.nih.gov

**[Visible Human Project]{.underline}**

http://www.nlm.gov/research/visible/visible_human.html

**[Cumulative Survey or Histopathological and Cytological Findings
1989-1996]{.underline}** (more than 55,000 aspiration biopsy findings
and more than 90,000 histopathological findings) is available on the
internet on:

http://www.mpt.com.mk/stavric/survey96.zip

For additional information on internet resources for pathologists and
laboratory professionals see "***A full menu for labs that navigate the
NET***" by Carl Graziano in **[CAP TODAY]{.underline}** (Vol. 9, No. 8,
August 1995). On page 40 of that issue, a table lists many additional
internet site addresses including details about signing up for pathology
related "mailing lists" on the internet.

**Future**![](media/image2.emf){width="0.2791666666666667in"
height="0.16944444444444445in"} **EM Newsletters:**

If you have any comments, suggestions, article submissions for use in a
future Newsletter, please send to: Alex Tuszynski (EM-QA/QM) Coordinator
via FAX 919-286-6818 or call 700-671-6925x5218 or E-Mail
tuszynski.a@forum.va.gov

**Microscopy Calendar**

**FOR INFORMATION** on specialty and regional meeting and links to
additional meeting information, **visit** the MicroWorld Resource\'s
Meetings and Conference at **www.mwrn.com/feature/meeting.htm**

**[MCEM 97 - Multinational Congress on Electron Microscopy October 5 -
8, 1997]{.underline}** Portoroz, Slovenia - Contact MCEM97 Congress
Secretariat, Ljubljana, Slovenia, 1001 Tel: +386 61 1773341 Fax: +386 61
1263126, e-mail mcem97@ijs.sci or
http://www2.ijs.si/\~k5www/MCEM97/index.html

**[The 15th Australian Conference for Electron Microscopy, Feb 1 - 6,
1998]{.underline}**, Hobart, Tasmania, Australia Contact: Mures
Convention Management, Victoria Dock, Hobart, Tasmania, 7000, Australia
Tel: +61 (0)3 62 31 21 21 Fax: +6 (0)3 62 34 44 64, e-mail
conventions@mures.com.au or http://www.antdiv.gov.au/acem/

**[Microscopy & Microanalysis-98 (Joint Annual Meeting), July 12 -16,
1998]{.underline}**, Atlanta GA, Contact: MSA Business Office
(800)-538-3672 or 508-563-1155 Fax: 508-563-1211, e-mail
BusinessOffice@MSA.Microscopy.com

**[Society for Ultrastructural Pathology - Mar 1, 1998]{.underline}**
meeting in conjunction with **USCAP meeting Feb 28 - Mar 6, 1998** in
Boston, MA at The Sheraton Boston.

**[Society for Ultrastructural Pathology - ULTRAPATH IX August 2 -7,
1998]{.underline}** at Grove Park Inn Resort, Asheville, NC When making
reservations for the hotel, mention **[Society for Ultrastructural
Pathology]{.underline}** for special meeting rates. Contact Hotel
Reservations, The Grove Park Inn Resort, 290 Macon Ave. Asheville, NC
28804-3799 (704) 252-2711 or (800) 438-5800 or FAX (704) 252-6102 For
additional information and to receive a registration application
contact: John D. Shelburne, Dept. of Pathology, Box 3712, Duke
University and Durham VA Medical Centers, Durham, NC 27710 Phone (919)
286-6925 FAX (919) 286-6818 or e-mail shelburne.john@forum.va.gov

Also take a look at the following URL for updates on information
concerning the Ultrapath IX meeting and on the Grove Park Inn Resort
meeting site.

http://sup.ultrakohl.com/ultrapat.htm

**ICEM-14 \-- 14th International Congress on Electron Microscopy August
31 - Sept. 4, 1998** Cancun, Mexico Col. Hipodromo Condesa. C.P. 06100,
Mexico, D.F. MEXICO (525) 553-4507/4509 FAX (525) 553-4500
http://icem.inin.mx

**MSA/MAS Meetings: continued\....**

**[Aug 1/5, 1999]{.underline}** Portland, OR

(***Congratulations to Charles Meshul of the Portland VAMC ! Charles has
been selected by the Microscopy Society of America to be the local area
coordinator for this important and very large meeting***)

**MSA/MAS Meetings: continued\....**

**July 30 - Aug 3, 2000** Philadelphia, PA

**Aug 5/9, 2001** Long Beach, CA

**[Short Courses and Training]{.underline}**

**A list of short courses and consultants that offer on-site training
for microscopists is available in the Products and Services Directory at
http://www.mwrn.com/products.htm**

**LOM/AFM/SEM/TEM Specimen Preparation Workshops -** contact AMC Group,
7620 E. McKellips Rd. No 4109, Scottsdale, AZ 85257-4600 for schedule &
locations.

**[EM Training Schools]{.underline}:**

**Albany VA Medical Center** - Dr. Jaswant K. Singh, Director Electron
Microscopy Program, 113 Holland Avenue, Albany, New York 12208 (518)
462-3311x2291 FAX: (518) 462-1258 e-mail: singh.jaswant@albany.va.gov

**Microscopy Technology Center**, San Joaquin Delta College, 5151
Pacific Avenue, Stockton, CA 95207 (209) 474-5284 FAX: (209) 474-5600
e-mail: murphy@ms.sjdccd.cc.ca.us

**Madison Area Technical College - Electron Microscopy Program**, 3550
Anderson Street, Madison Wisconsin 53704 Glenn Boda (608) 246-6254
Michael Kostrna (608) 246-6762