T-cell large granular lymphocytic leukemia in Vietnam: Using microscope-to-screen videoconferencing to improve diagnosis

OBJECTIVES

Leukemia diagnosis in Vietnam is limited by a lack of hematopathology training and expert consultation as well as the cost of high-magnification digitization of hematology slides. Screen-sharing software allows international collaboration with experienced hematopathologists for improved diagnostic accuracy.

METHODS

A hematopathology education and consultation program was proposed for Vietnam hospitals. By appointment, pathologists in Vietnam with access to a microscope camera, imaging software, and high-speed internet were invited to review slides and data with a volunteer board-certified hematopathologist in the United States using secure videoconferencing software. A single hospital in southern Vietnam assigned a pathologist proficient in English to access this service. All consultations from this site with clinicopathologic information were logged. After a 2-year period of online consultation, case slides for selected diagnoses were reviewed under the microscope in Vietnam to assess concordance.

RESULTS

In total, 135 consultations were logged, 53 of which were for blood and bone marrow. T-cell large granular lymphocytic leukemia (T-LGLL) was 1 of the most frequent bone marrow consultation-related diagnoses; all diagnoses of this entity were confirmed by in-person microscopy (100% concordance). A records search and physician surveys found no prior documented diagnoses of T-LGLL made in Vietnam before this education and consultation program.

CONCLUSIONS

Our virtual consultation model has improved patient care in Vietnam by providing correct diagnoses to inform best practices in treatment. As a result of our program, the first Vietnam diagnoses of T-LGLL were made and may help expand on the literature in this area. This model could provide cost-effective, real-time consultation and education services for pathologists in underserved communities.

Four-decades evolutionary development of municipal solid waste management in China: Implications for sustainable waste management and circular economy

This study collected data on waste generation and management in China between 1979 and 2020 from government statistics and literature and reviewed the development of municipal solid waste (MSW) management in China. The extended stochastic impact by regression on population, affluence and technology (STIRPAT) model was employed to identify the driving forces of MSW generation, and the cointegration analysis showed that economy (0.35, t = -3.47), industrial structure (3.34, t = -20.77) and urbanization (-1.5, t = 5.678) were the significant socioeconomic driving forces in the long run. By employing the framework of evolutionary economics, this study then investigated the internal rules of long-term interaction between socioeconomic factors and MSW management. The results indicate that, in the long run, MSW management development can be viewed as an evolutionary process that includes a continuous adaptation to external socioeconomic factors and the co-evolution of internal institutions and technologies. Adaptation and diversity of institutions and technologies play an important role in achieving sustainable waste management and circular economy (CE). This study offers a novel evolutionary perspective for explaining dynamic changes of MSW management in China, as well as recommendations for emerging economies to achieve sustainable waste management and CE goals.

The heterogeneous driving forces behind carbon emissions change in 30 selective emerging economies

Emerging economies are predicted to be future emission hotspots due to expected levels of urbanization and industrialization, and their CO₂ emissions are receiving more scrutiny. However, the driving forces underlying dynamic change in emissions are poorly understood, despite their crucial role in developing targeted mitigating pathways. We firstly compile energy-related emissions of 30 selective emerging economies from 2010 to 2018. Then, three growth patterns of emissions in these economies have been identified through emission data, which imply different low-carbon pathways. Most emerging economies saw an increase of varying degrees in emissions, driven by economic growth and partly offset by better energy efficiency and improvements in energy mixes. Furthermore, the industrial structure was another factor that slowed emissions, especially in Latin America and the Caribbean. Our research contributes to the heterogeneous exploration of CO₂ emissions produced by energy among sectors and the creation of low-carbon development pathways in emerging economies.

Environmental Regulation, Corporate Social Responsibility (CSR) Disclosure and Enterprise Green Innovation: Evidence from Listed Companies in China

The resource and environmental constraints on China's economic development have become more prominent; thus there is an urgent need for enterprises to achieve green innovation transformation to promote high-quality economic development. We obtained data on 655 on Chinese A-share companies listed on the Shanghai and Shenzhen Stock Exchanges from 2010 to 2020, a total of 7205 samples, and explored the influencing mechanism of environmental regulation on corporate green innovation and the moderating mechanism of CSR disclosure by constructing a nonlinear fixed-effect regression model. The results showed: (1) the overall level of green innovation of listed companies is low, and the relationship between environmental regulation and enterprise green innovation presents the U-shaped characteristic of changing from cost effect to innovation compensation effect; (2) non-state-owned enterprises have less tolerance and more sensitive response to environmental regulation than state-owned enterprises; (3) social responsibility information disclosure has a positive regulatory effect on environmental regulation and enterprise green innovation, and non-state-owned enterprises are more significant. It provides references for the government to adjust the intensity of environmental regulation, and, meanwhile, for enterprises to improve the level of environmental protection and the CSR disclosure, and enhance the green innovation ability of enterprises in emerging market.

Current Regulatory Requirements for Biosimilars in Six Member Countries of BRICS-TM: Challenges and Opportunities

Background: The aim of the study was to identify, interpret, and compare the current perspectives of regulatory agencies in six member countries of BRICS-TM (Brazil, Russia, India, China, South Africa, Turkey, and Mexico) on the different criteria used for biosimilar development and marketing authorisation process.

Methods: A semi-quantitative questionnaire was developed covering the organisation of agency, biosimilar development criteria and marketing authorisation process and sent to seven regulatory agencies covering the BRICS-TM countries. All data was kept anonymous and confidential. Data processing and analysis was carried out; descriptive statistics were used for quantitative data and content analysis was employed to generate themes for qualitative data.

Results: Out of the seven regulatory agencies included in the study, six representatives provided the responses. The perspectives of these six regulatory agencies varied on a number of aspects relating to the review criteria for biosimilar development and licencing process. The most prevalent model for data assessment is the “full review” of a marketing authorisation application. There is lack of a standard approach across the agencies on sourcing of the reference biological product, in vivo toxicity studies and confirmatory clinical studies. Most agencies restrict interaction with biosimilar developers and any scientific advice is non-binding. The marketing authorisation approval depends on scientific assessment of the dossier, sample analysis and GMP certification. The agencies do not issue any public assessment report specifying the summary basis of biosimilar approval.

Conclusion: Regulatory agencies across the six emerging economies are steadily improving the regulatory mechanism in the area of biosimilars. However, there remains scope for increasing the effectiveness and efficiency of the processes by encouraging open and transparent interaction with developers, adopting a flexible approach toward accepting advanced analytical data in lieu of clinical studies and enhancing regulatory reliance amongst agencies. This will help to simplify the new biosimilar development programmes and make them more cost-effective.

Science Diplomacy in Emerging Economies: A Phenomenological Analysis of the Colombian Case

Little has been investigated about Science Diplomacy (SD) in emerging economies, more specifically on governance schemes useful for organizing intersecting actors, practices, conceptions and suggestions of the future in foreign affairs and Science, Technology and Innovation (STI) in public administration sectors. This paper contributes to a better understanding of the “texture and nature” of SD initiatives in emerging economies through the eyes of relevant actors involved or reflecting about them in Colombia. The aim of this paper is to propose a general governance scheme for SD in emerging economies and its potential instrumentation for a policy-mix. In Colombia, SD initiatives are very fragmented, and are not part of the priorities of the Colombian state, however the increasing interest of an embryonic practitioner and scholar community working in the topic make necessary this work. A phenomenological perspective combined with a single case study research methodology is used to gain a very accurate description of the state of the situation of SD in Colombia. Policy document review and semi-structured interviews were conducted with 18 relevant actors to understand the conceptions, practices, and suggestions for the future of SD in Colombia. The study results show that SD actors in Colombia are scattered, practices strongly related to traditional cooperation diplomatic activities and the need to give a function to SD for capacity building, better global intermediation and the development of new knowledge, in particular promoting SD abilities in the scientific community. In addition, data expresses the need to cultivate a multi-stakeholder working group for such a purpose. The study reflects on the need of a policy mix for SD in emerging economies. It proposes a general governance scheme for it, a potential instrumentation founded on research participant future suggestions, and a set of practical recommendations and policy implications. Conclusions and further research questions are set, pointing out the importance of including non-conventional diplomacy actors and knowledge, and the need to inquire rationales behind possible SD policy mixes in the southern world.

Emerging and advanced economies markets behaviour during the COVID‐19 crisis era

This article examines the consequences of the COVID‐19 crisis on the interdependencies between emerging and advanced economies. Using daily market index data from 22 developed and emerging markets, we develop a combination of statistical methods based on Diebold and Yilmaz spillover index and Toda–Yamamoto and Dolado and Lütkepohl causality approach. The results substantiate an increase in the interdependence between emerging and advances economies, which suggests an increase in the transmission of the stress and uncertainty between financial markets during the pandemic period. Our findings show that the emerging countries are affected by the financial markets of advanced economies during the COVID‐19 crisis and, in particular, by European markets, which appear to be the primary driver of contagion and transmission of stress and uncertainty to all other regional markets.

Causal Relationship Between the Spread of the COVID-19 and Geopolitical Risks in Emerging Economies

This study investigates the causality between the spread of the COVID-19 pandemic (measured by new cases per million and new deaths per million) and geopolitical risks (measured by the index of geopolitical risks). We use the balanced panel data framework in 18 emerging economies from January 2020 to August 2020. We run the initial tests of cross-sectional dependence and the panel unit root tests with capturing cross-sectional dependence. Then, we utilize the panel Granger non-causality tests for heterogeneous stationary panel datasets. According to the findings, there is a significant causality from both measures of spreading the COVID-19 pandemic to geopolitical risks. Further tests are performed, and potential implications are also discussed.

trends a barometer of future cancer transitions in emerging economies?

The currently high cancer incidence rates in the U.S. and other high-income countries have been strongly affected by the acquisition of environmental and lifestyle risk factors that accompanied socioeconomic growth in the second half of the last century. The very same factors are now operating in many low- and middle-income countries (LMIC) undergoing rapid socioeconomic transition. A parallel is drawn between the past cancer trends in the U.S. and those anticipated in LMIC transitioning towards higher levels of socioeconomic development. We expect to see a major upsurge in the (still low to intermediate) cancer incidence and mortality rates in LMIC over the next decades, which coupled with population aging and growth, would translate to a scale of individuals diagnosed with, living and dying from cancer unparalleled in history. On account of resource constraints and organizational limitations, prevention strategies need to be prioritized in LMIC.

Are Air Pollution, Economic and Non-Economic Factors Associated with Per Capita Health Expenditures? Evidence from Emerging Economies

Environmental pollution, rapid economic growth, and other social factors have adverse effects on public health, which have consequently increased the burden of health expenditures during the last two decades. This paper provides a comprehensive analysis of carbon dioxide (CO₂) emissions and the environment index, as well as economic and non-economic factors such as Gross Domestic Product (GDP) growth, foreign direct investment, population aging, and secondary education impacts on per capita government and private health expenditures in 13 emerging economies for the time period of 1994-2017. We employ robust econometric techniques in this endeavor of panel data analysis to account for the issues of heterogeneity and cross-sectional dependence. This study applies the Lagrange Multiplier (LM) bootstrap approach to investigate the presence of panel cointegration and empirical results underscore the existence of cointegration among variables. For the execution of long-run analysis, we incorporate the two latest estimators, i.e., continuously updated-fully modified (CUP-FM) and continuously updated- bias corrected (CUP-BC). Findings of long-run elasticities have documented that the air-pollution indicators, i.e., CO₂ emissions and the environment index, have a positive and significant influence on government health expenditures, while in contrast, both factors negatively influence private health expenditures in emerging economies. We find that economic factors such as GDP growth consistently show a positive impact on both government and private health expenditures, whereas, foreign direct investment exhibits a significant negative and positive impact on government and private health expenditures respectively. Findings of non-economic factors can be used to argue that population aging increases health expenditures while secondary education lowers private health spending in emerging markets. Furthermore, empirical analysis of heterogeneous causality indicates that CO₂ emissions, the environment index, GDP growth, foreign direct investment, and secondary education have a unidirectional causal relationship with government and private health expenditures. Population aging has a strong relationship of bidirectional causality with government health expenditures and unidirectional causal relationship with private health expenditures. Findings of this paper put forward key suggestions for policy makers which can be used as valuable instruments for better understanding and aiming to maximize public healthcare and environmental quality gains which are highly connected with sustainable GDP growth and developments in emerging economies.

Alcohol Consumption at Any Level Increases Risk of Injury Caused by Others: Data from the Study on Global AGEing and Adult Health

BACKGROUND

Alcohol use is a well-known risk factor for injury. However, information is needed about alcohol drinking patterns and the risk of injury among older adults in low- and middle-income countries as this population grows. We aimed to examine the influence of drinking patterns on the burden of injury and investigate factors associated with different types of injury in older populations in six emerging economies.

METHODS

Data from more than 37,000 adults aged 50 years and older were included from the Study on Global AGEing and Adult Health (SAGE) Wave 1 conducted in six emerging economies, namely, China, Ghana, India, Mexico, Russia, and South Africa. We investigated past-year reported injuries from falls, traffic accidents, and being hit or stabbed. Alcohol drinking patterns were measured as lifetime abstinence, ever but not past- week use, and gender-specific past-week low-risk and high-risk use. We stratified by gender and used logistic regression models to observe the association between alcohol drinking pattern and risk of injury by controlling for other factors.

RESULTS

During the year prior to interview, 627 (2.2%) subjects reported bodily injury resulting from a car accident, 1,156 (4.2%) from a fall, and 339 (0.9%) from being hit or stabbed during the past year. For women, only being a high-risk drinker increased the risk of being hit or stabbed, whereas for men, all levels of drinking were associated with an increased risk of being hit or stabbed. We observed a higher risk of being hit or stabbed from past-week high-risk drinking among women (odds ratio [OR] = 6.09, P < 0.01) than among men (OR = 3.57, P < 0.01). We observed no association between alcohol drinking pattern and injury due to car accidents for either women or men.

CONCLUSIONS

The risk of experiencing injury due to violence increased with level of alcohol exposure of the victim. The increase in alcohol use in emerging economies calls for further study into the consequences of alcohol use and for public health initiatives to reduce the risk of violence in older adult populations, with special attention to the experience of older adult women.

The management challenge for household waste in emerging economies like Brazil: realistic source separation and activation of reverse logistics

Business opportunities in the household waste sector in emerging economies still evolve around the activities of bulk collection and tipping with an open material balance. This research, conducted in Brazil, pursued the objective of shifting opportunities from tipping to reverse logistics in order to close the balance. To do this, it illustrated how specific knowledge of sorted waste composition and reverse logistics operations can be used to determine realistic temporal and quantitative landfill diversion targets in an emerging economy context. Experimentation constructed and confirmed the recycling trilogy that consists of source separation, collection infrastructure and reverse logistics. The study on source separation demonstrated the vital difference between raw and sorted waste compositions. Raw waste contained 70% biodegradable and 30% inert matter. Source separation produced 47% biodegradable, 20% inert and 33% mixed material. The study on collection infrastructure developed the necessary receiving facilities. The study on reverse logistics identified private operators capable of collecting and processing all separated inert items. Recycling activities for biodegradable material were scarce and erratic. Only farmers would take the material as animal feed. No composting initiatives existed. The management challenge was identified as stimulating these activities in order to complete the trilogy and divert the 47% source-separated biodegradable discards from the landfills.