PECULIARITIES OF EXPANDED NEWBORN SCREENING FOR THE INHERITED METABOLIC DISORDERS IN PREMATURE NEWBORNS

Occurrence of the premature birth in Ukraine is about 6%. Premature newborns are the highest risk group of developing chronic pathology of the nervous system, sensory organs, and respiratory system, causing neonatal mortality and disability; the latter is 22 times higher in premature newborns than in full-term ones. Besides, there is a large group of rare metabolic disorders that significantly disrupt the adaptation and nursing of newborns with signs of morpho-functional and enzymes immaturity. The efficacy of medical care of premature newborns to a great extent relates to prompt diagnosis as common somatic, as rare metabolic disorders.In view of the absence of specific symptoms, it is almost impossible to establish a diagnosis of inherited metabolic disordersduring the clinical examination of a neonate.Expanded newborn screening (ENBS) for inborn errors of metabolism (IEMs) proved to be an effective tool to single out newborns with genetic deficiency of certain metabolic enzymes.The practical experience of performingENBS indicates a problematic issue is the interpretation of results for preterm babies.This article is discussed the key factors affecting the predictive value of ENBS results in premature newborns, like peculiarities of blood sampling based on time intervals from delivery for certain nosologies, repeated sample taking for lab examination considering the basic principles of 2-nd Edition of CLSI "Guideline "Newborn Screening for Preterm, Low Birth Weight, and Sick Newborns, 2019". The CLSI Guideline presents the consensus solutions of a global team of neonatologists, metabolic paediatricians and medical geneticists regarding the accuracy, reliability and timing of laboratory determinations of IEM markers in the blood, as well as a set of factors to consider interpreting ENBS results for premature, low birth weight and newborns with perinatal pathology.The current procedure for neonatal screening for premature babies in Ukraine should be updated to modern requirements of the relevant clinical recommendations of world-recognized medical institutions, including CLSI. The critical issue in improving the quality and reliability of neonatal screening for preterm babies is multiple (repeated) blood sampling for laboratory determination of levels of biochemical IEM markers.A properly established and well- functioning system of expanded neonatal screening proved to be a highly effective tool for reducing early infant mortality and disability associated with inherited metabolic diseases.

Endogenous Streptococcus mitis panophthalmitis in a patient visiting the Dominican Republic

A 67-year-old woman presented with painful, acute vision loss after 5 days of fever and muscle aches while visiting the Dominican Republic. She had no recent history of ocular surgery, dental work or recent trauma. Anterior chamber aspiration confirmed an initial diagnosis of endogenous endophthalmitis, positive for Streptococcus mitis that progressed to panophthalmitis on return to Canada. Treatment included systemic antibiotics, intravitreal antibiotics and intravitreal dexamethasone. Despite the best medical treatment, the left eye progressed to corneal perforation 5 weeks after presentation. An evisceration with fitted orbital implant was successful in alleviating pain following the surgery. S. mitis is a rare, but possible cause of endogenous endophthalmitis and panophthalmitis. It was important to work with a multidisciplinary and global team to coordinate and offer appropriate treatment measures. Although vision was lost, evisceration of the left eye provided ocular comfort and good cosmetic outcomes for the patient.

Navigating a Pandemic: The Unique Role of the Medical Director

The sudden emergence of the COVID-19 pandemic in early 2020 presented a unique challenge for medical directors of life insurance companies. Company leadership required quick answers about many issues, but two in particular: 1) the magnitude of the pandemic's impact on the insured lives portfolio and 2) the underwriting of new applicants during a pandemic. This article will describe the experiences of a global team of reinsurance medical directors during a pandemic. It may also serve to provide guidance for medical directors facing a similar challenge in the future.

Flood forecast skill for Early Action: Results and Learnings from the development of the Early-Action Protocol for Floods in Uganda

<p>Global flood forecasting systems are helpful in complementing local resources and in-country data to support humanitarians and trigger early action before an impactful flood occurs. Freely available global flood forecast information from the European Commission’s Global Flood Awareness System (GloFAS, a Copernicus EMS service) is being used by the Uganda Red Cross Society (URCS) alongside in-country knowledge to develop appropriate triggers for early actions for flood preparedness, within the Forecast-based Financing (FbF) initiative. To scale up the first FbF pilot to a national level, in 2020 URCS collaborated with several partners including the Red Cross Red Crescent Climate Centre (RCCC), the Uganda’s Ministry of Water and Environment, through the Directorate of Water Resources Management (DWRM), the Uganda National Meteorological Authority (UNMA), the 510 Global team and the University of Reading, through the UK-supported project Forecasts for Anticipatory Humanitarian Action (FATHUM). The new Early Action Protocol (EAP) for floods, submitted to the IFRC’s validation committee in September 2020, is now under review.</p><p>One of the aims of an EAP is to set the triggers for early action, based on forecast skill information, alongside providing a local risk analysis, and describing the early actions, operational procedures, and responsibilities. Working alongside our partners and practitioners in Uganda, we developed a methodology to tailor flood forecast skill analysis to EAP development, that could be potentially useful for humanitarians in other Countries and forecasters engaging with them. The key aim of the analysis is to identify skilful lead times and appropriate triggers for early action based on available operational forecasts, considering action parameters, such as an Action Lifetime of 30 days, and focusing on relevant flood thresholds and skill scores. We analysed the skill of probabilistic flood forecasts from the operational GloFAS (v2.1) system across Uganda against river flow observations and reanalysis data. One of the challenges was to combine operational needs with statistical robustness requirements, using relevant flood thresholds for action. Here we present the results from the analysis carried out for Uganda and the verification workflow, that we plan to make openly available to all practitioners and scientists working on the implementation of forecast-based actions.</p>

Safe Bicycle Lane Design Principles: Responding to Cycling Needs in Cities during COVID and Beyond

Cycling has become a popular, resilient and reliable travel option during the pandemic in cities around the globe. The implementation of emergent, or pop-up, bike lanes has received an overwhelming response since early 2020 and has also created a growing desire for safe and efficient bicycle infrastructure. Between March and July 2020, 394 cities, states and countries reported interventions that reallocated street space for people to cycle and walk more easily, directly and safely. This shift to cycling comes at a perfect time when cities have been making efforts to meet greenhouse gas emissions reduction targets. Pop-up bike lanes are typically implemented with temporary materials to segregate a traffic lane for the use of cyclists only. Despite this initial temporary condition, any new cycling infrastructure must be designed and implemented thoughtfully and to the highest standards to reduce or eliminate risks that cyclists face during trips, especially novice cyclists who might be biking in the city for the first time. When a crash occurs between a vehicle and a bicycle, it’s the cyclist who is most likely to be injured. According to the WHO, every year 41,000 cyclists die in road traffic-related incidents worldwide, representing 3% of global road traffic deaths. Temporary and quickly designed bike lanes should not compromise on safety. Bike lanes that are deployed now may have a significant impact on travel patterns and safety in cities for years to come, especially as the broad range of temporary materials available can be rapidly installed yet offer a semipermanent solution. For this reason, it is important to get the design and planning right. And right means safe. This guidance equips government agencies, designers, and civil society organizations that are participating in the health crisis response with an understanding of how to protect cyclists through safe and appropriate design. Cities are investing considerable effort and resources to implement safe cycling lanes under very challenging conditions, and this energy should not be wasted. The guidance provided here is based on the broad experience of the global team of authors, led by the WRI Ross Center for Sustainable Cities in collaboration with the Dutch Cycling Embassy, the League of American Bicyclists, Urban Cycle Planning (Denmark), and Asplan Viak (Norway).

Collaborative Model for International Telehealth: High Dose Rate Brachytherapy Training for Emerging Radiation Oncology Centers in Lower- and Middle-Income Countries

PURPOSE High dose rate (HDR) brachytherapy is a critical treatment modality—both palliative and curative—for gynecologic malignancies that significantly burden low- and middle-income countries (LMICs). Many of these countries currently have limited capacity to provide necessary brachytherapy treatment. To bridge this gap in LMICs in North Africa and the Middle East, nonprofits Rayos Contra Cancer and Radiating Hope evaluated the efficacy, cost, and feasibility of a pilot HDR brachytherapy continuing medical education curriculum to selected regional cancer centers via videoconferencing. METHODS Rayos Contra Cancer and Radiating Hope recruited a global team of HDR brachytherapy content experts. They developed a 16-week curriculum and recruited 10 regional cancer center partners in LMICs throughout the Middle East, Africa, and Nepal. The curriculum included 17 sessions shared via live Zoom videoconferences. A lead correspondent was assigned for communication at each center. Attendance was taken during each call, and pre- and postsession Likert-scale (1 to 5 points) surveys were collected from participants that assessed their confidence in 15 practical competencies in HDR brachytherapy and overall confidence in their ability to provide services and teach others. RESULTS A total of 326 attendance hours was recorded during the curriculum. Among 46 participants, the average paired confidence scores increased pre- versus postcurriculum in all 15 practical competencies, with an average improvement of 1.2 out of 5 and significant P values in all 15 topics. Absolute improvements were largest for confidence in applicator commissioning (2.3 to 3.8, P = .0015), TPS commissioning (2.2 to 3.7, P = .0010), and commissioning an HDR machine (2.2 to 4.0, P = .00096). Participant confidence significantly increased in ability to provide services (3.5 to 4.2, P = .0023) and teach others (3.4 to 3.9, P = .013). There was no cost to provide this training, and more than 4,300 patients are treated annually with HDR brachytherapy at participating centers. CONCLUSION This novel low-cost telehealth model for HDR brachytherapy training is a promising vehicle for advancing cancer care in LMICs. Postcourse surveys demonstrated increased confidence in both providing care and teaching in HDR brachytherapy, and sessions were well attended. A video-based telehealth teaching platform enabled expert HDR brachytherapy providers and physicists to reach growing cancer centers worldwide.

The Birth, Growth and Future of Systems Approach

The Beyond Compliance Global team held an interview by video link with Dr Eric Jang, United States Department of Agriculture, Agricultural Research Service (USDA/ARS), now retired. His lab was based in Hawaii, where he continues to reside. Eric was an early advocate and one of the originators of the concepts for Systems Approach.

Global Teams

Global teams have become a basic building block for organizing work that crosses geographic boundaries. They are an alternative to more traditional forms of hierarchy-based organizing and form the foundation of what is becoming known as the global networked organization. Global teams connect people who are geographically dispersed and work together on specific projects or tasks, crossing national, cultural, organizational, and linguistic boundaries. While global teams hold promise for organizing global work, they face conditions of complexity: (1) a multiplicity of different cultural contexts, governmental requirements, and multiple diverse stakeholders; (2) interdependence brought about by global flows of capital, information, and value chains; and, (3) ambiguity of meanings despite the fact that there is plenty of information. Management scholars have conducted most of the research about global teams from 1990 to 2018. These studies have shed light on global teaming processes, including communication and collaboration, facilitation and brokerage, leadership, language and identity, shared meaning, trust, power, national and organizational culture, distance, time, and technology. Some of the factors shown to improve global team effectiveness are as follows: a clear mission and objectives, explicit expectations for members’ roles and responsibilities, facilitating relationships among team members that leads to shared knowledge and a team identity, managing cultural, language and other contextual challenges, and monitoring and managing changing environmental conditions. While knowledge has grown about how global teams function, there is still much to learn about the complexity of multilevel cultural interactions in global teams and how different influence factors interact to affect performance. In-depth, longitudinal studies by anthropologists can provide such insights. The role of anthropologists is to assist the development of global teams by bringing nuance to the ways culture manifests in team member interactions and how social relationships are enacted and understood. Anthropologists can help build a richer understanding of contextual influences and the perceptions embedded in culture that shape sense-making across multiple contexts.