ALMOST INTERCONNECTED—How Sweden’s 50 Largest Companies Apply a Systems Approach to Sustainability

A new complex and global society demands new approaches to solving our shared challenges and making businesses thrive. As a result, applying a systems approach is becoming more important for businesses when forming strategies for the future. The Inter Business Index is a measurement tool to understand a company’s holistic value creation, and one part of the index is a specific measurement focused on a company’s ability to adapt a systems approach to core strategy and operations. By qualitative analysis of annual and sustainability reports of Sweden’s 50 biggest companies, looking at how the companies relate to future needs and requirements, their own sense of responsibility and place in the system, ability to analyze complex problems and ability to make strategic priorities thereafter, the index ranks the companies by ability to apply a systems approach. Our findings show that companies are better at analyzing what needs to be done, but are having a hard time prioritizing their actions to fit. In discussion, we argue that short sightedness of profits companies traditionally has might make this process harder, albeit necessary

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Maternal immunization country readiness: a checklist approach

Prior to the addition of a maternal vaccine onto the National Immunization Programme, it is important for a country to evaluate their capacity and readiness. This checklist has been developed that is deliberately not restricted to any particular vaccine so it can be applied by national-level stakeholders during the decision-making stage for the introduction of any additional or new maternal vaccine. It is suggested that a team consisting of representatives from the Ministry of Health, including the National Immunization Programme (NIP) and Maternal, Newborn and Child Health (MNCH) programs complete and review the checklist together. This checklist enables countries to assess their capacity, strengths and weaknesses and identify a list of priorities to allow for smooth implementation of maternal vaccines

Maternal Immunization and Antenatal Care Situation Analysis (MIACSA) study protocol: a multiregional, cross-sectional analysis of maternal immunization delivery strategies to reduce maternal and neonatal morbidity and mortality

Introduction Maternal immunization (MI) with tetanus toxoid containing vaccine, is a safe and cost-effective way of preventing neonatal tetanus. Given the prospect of introducing new maternal vaccines in the near future, it is essential to identify and understand current policies, practices and unmet needs for introducing and/or scaling up MI in low-income and middle-income countries (LMICs). Methods and analysis The Maternal Immunization and Antenatal Care Situation Analysis (MIACSA) is a mixed methods, cross-sectional study that will collect data in four phases: (1) a review of global databases for selected health indicators in 136 LMICs; (2) a structured online survey directed at Maternal, Newborn and Child Health and Expanded Programme on Immunization focal points in all 136 LMICs; (3) semistructured telephone interviews of 30 selected LMICs and (4) 10 week-long country visits, including key informant interviews, health facility visits and focus group discussions. The principal analyses will assess correlations between the various aspects of MI delivery strategies and proxy measures of health systems performance related to vaccine-preventable disease control. The primary outcome will be a typology of existing MI delivery models, and secondary outcomes will include country profiles of child and maternal health indicators, and a MI gaps and needs analysis. Ethics and dissemination The protocol was approved by the WHO Ethics Review Committee (ERC.0002908). The results will be made available in a project report and submitted for publication in peer-reviewed journals that will be shared broadly among global health decisionmakers, researchers, product developers and country-level stakeholders.Peer Reviewe

Regulatory scientific advice on non-inferiority drug trials.

The active-controlled trial with a non-inferiority design has gained popularity in recent years. However, non-inferiority trials present some methodological challenges, especially in determining the non-inferiority margin. Regulatory guidelines provide some general statements on how a non-inferiority trial should be conducted. Moreover, in a scientific advice procedure, regulators give companies the opportunity to discuss critical trial issues prior to the start of the trial. The aim of this study was to identify potential issues that may benefit from more explicit guidance by regulators. To achieve this, we collected and analyzed questions about non-inferiority trials posed by applicants for scientific advice in Europe in 2008 and 2009, as well as the responses given by the European Medicines Agency (EMA). In our analysis we included 156 final letters of advice from 2008 and 2009, addressed to 94 different applicants (manufacturers). Our analysis yielded two major findings: (1) applicants frequently asked questions 'whether' and 'how' to conduct a non-inferiority trial, 26% and 74%, respectively, and (2) the EMA regulators seem mainly concerned about the choice of the non-inferiority margin in non-inferiority trials (36% of total regulatory answers). In 40% of the answers, the EMA recommended using a stricter margin, and in 10% of the answers regarding non-inferiority margins, the EMA questioned the justification of the proposed non-inferiority margin. We conclude that there are still difficulties in selecting the appropriate methodology for non-inferiority trials. Straightforward and harmonized guidance regarding non-inferiority trials is required, for example on whether it is necessary to conduct such a trial and how the non-inferiority margin is determined. It is unlikely that regulatory guidelines can cover all therapeutic areas; therefore, in some cases regulatory scientific advice may be used as an opportunity for tailored advice

SoHo Story

Formed by the London Community Foundation (LCF), the Vision SoHo Alliance is a partnership between six non-profit housing developers, which includes Chelsea Green Home Society, Homes Unlimited, Indwell, Residenza Affordable Housing, London Affordable Housing Foundation, and Zerin Development Corporation. Vision SoHo Alliance will create 650-unit apartments, of which 30-60% will be affordable units, in seven buildings on the former South Street Victoria Hospital property. Most buildings will be located on the block bounded by Waterloo, South, Colborne, and Hill streets. Another building will be constructed at the northeast corner of South and Colborne. Indwell purchased the former Faculty of Medicine building and War Memorial Children’s Hospital to be redeveloped as housing and designated as heritage buildings under the Ontario Heritage Act. The Vision SoHo Alliance tasked Western’s MA Public History Program with researching and compiling stories of St. David’s Ward, now known as the South of Horton, or SoHo neighbourhood (bounded by the Canadian National Railway and Adelaide Street with the Thames River acting as a natural south-west barrier), the former Western Faculty of Medicine building (1921), and the War Memorial Children’s Hospital (1922). This research included orally interviewing Londoners who had or have ties to the SoHo area. This is in effort to preserve the history of one of the oldest and most culturally diverse area in London, and which changed demographically following the medical school moving to Western’s main campus in 1965, the closing of War Memorial in 1985, and of Victoria Hospital in 2013. Western’s MA Public History Program plans to use the compiled research and recordings to curate a digitally interactive outdoor exhibit installed in the green spaces of the Alliance’s property, which will highlight the significance of the neighbourhood and the area’s medical history. The goals of this report are to: • Document the history of the SoHo area, including Indigenous presence, immigration, and neighbourhood culture; • Create a thematic historical overview of the neighbourhood, the medical school, and War Memorial Children’s Hospital; • Compile associated stories, memories, and photographs provided by the public. This is the final two-year research report which revises and extend the first-year report called Echoes of SoHo