William Carey University

Blended oxygen has been shown to reduce severe retinopathy of prematurity (ROP) incidence worldwide, and more recently in Uganda. Although it has been established that ROP-driven visual impairment has a substantial societal burden and that screening and treatment programs are cost-effective in low- and middle-income countries, there is limited evidence for the economic impact of prevention with appropriate oxygen management equipment (OME) in these regions. We performed a cost-utility analysis of OME implementation comparing variations ranging between most and least favorable values. Disability-adjusted life years (DALYs) were calculated with a 3% discount rate. Calculations assumed a 62.1% incidence of visual impairment in untreated severe ROP and a disability weight of 0.184 for severe visual impairment due to ROP. One set of OME costs between $677.50-$1,844.11 USD in Uganda. We found that the cost to prevent one case of ROP-driven severe visual impairment in Uganda ranges from $25.55-$543.99, with a base case (best estimate) of $168.92 per case averted. This reflects 5.18 DALYs averted over the 58-year average Ugandan lifespan and a cost of $4.97-$104.98 to avert one DALY, with a base case of $32.60 per DALY averted. In comparison, prevention of malaria via mosquito net distribution was estimated in a 2020 meta-analysis to cost $50 for every DALY averted. The high-end estimate is roughly 10% of the annual gross domestic product per capita ($1,002.30). Therefore, OME is a cost-effective means to prevent severe visual impairment among infants in Uganda. Implementation of OME in Uganda would also reflect a clear ethical and humanitarian success.

Leadership has become an essential component of medical professionalism; yet, China lacks leadership competency models grounded in physicians' clinical realities. This study aimed to develop a context-specific leadership competency model for Chinese oncologists, aligning international frameworks with local healthcare priorities. A three-round modified Delphi study was conducted between June and October 2024. The process began with a preliminary model comprising 6 domains and 30 competency items, derived from a scoping review and the National Health Service Medical Leadership Competency Framework. 40 oncology-related experts evaluated both the six proposed domains and the 30 competency items in round 1 using 9-point Likert scales and open-ended feedback. In round 2, experts screened the suggestions from round 1 through binary (yes/no) evaluations. The resulting refined list was subjected to a final rating in round 3, again using 9-point Likert scales to establish consensus. Quantitative data (mean scores, SD, percentage agreement) and thematic analysis of qualitative feedback were used to iteratively refine the model across rounds. Experts reached consensus on a final leadership competency model comprising 6 domains and 40 specific competencies. The highest-rated competencies included integrity, continuous personal development, healthcare quality management, learn and apply new technologies and ensur patient safety. New competencies, not present in the initial model, also emerged-such as clear expression, empathy, influence on the public, familiarity with end-of-life care, health economics evaluation and vision building-capturing the evolving expectations of oncologists as communicators, collaborators and system improvers in a rapidly changing healthcare environment. The resulting competency model reflects the multidimensional nature of oncologist leadership, encompassing professionalism, teamwork, service improvement and social responsibility. It offers a practical framework for leadership development and assessment in oncology and provides methodological guidance for building physician leadership competency models in other medical fields.

PurposeTo present a case of type II oculocutaneous albinism (OCA2) diagnosed in infancy following the finding of nystagmus, and to review the diagnostic process and the management of this disorder.ObservationA 4‐month‐old female presented with subtle, roving eyes that were initially attributed to normal development. A subsequent evaluation by a pediatric ophthalmologist, prompted by a high index of suspicion, confirmed the findings of nystagmus, mild foveal hypoplasia, and astigmatism. Genetic testing confirmed the presence of pathological variants of the OCA2 gene, leading to a diagnosis of oculocutaneous albinism.Conclusion and ImportanceThis case highlights the importance of a meticulous ophthalmologic examination and a high index of suspicion in pediatric care. The early finding of nystagmus can be the key to a timely diagnosis of OCA2. This allows for early intervention to optimize visual development and allows for multidisciplinary management and genetic counseling for the family. This case underscores the need for ongoing education in enhancing the early detection of OCA.

<title>Abstract</title> Uveal melanoma is a rare and refractory subtype of melanoma. ¹ Approximately 50% of patients diagnosed with uveal melanoma die within one year, and an effective standard of care treatment has yet to be established. ² It affects men and women equally but primarily affects middle-aged individuals. ³ Metastatic uveal melanoma predominantly spreads to the liver, often with fatal outcomes. ⁴ Treatments successful in cutaneous melanoma have been trialed in uveal melanoma patients but have not achieved similar efficacy. ⁵ Over the past decade, significant research has focused on understanding tumor biology, immune evasion, and molecular signaling pathways unique to uveal melanoma. Genetic markers of this disease have been identified and evaluated for their roles in progression, therapeutic resistance, and long-term prognosis. ⁶ A novel immunotherapy, tebentafusp, has recently demonstrated effectiveness in treating this challenging and historically treatment-resistant malignancy. ⁷ This thesis examines key genetic mutations and their molecular products in uveal melanoma, alongside immunotherapeutic advancements, to guide the development of effective, innovative, and sustainable treatment strategies for patients.