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Course Hero, a Learneo business, is an online learning platform with over 60 million course-specific study resources contributed by our community of students and educators, and produced by our team of educational content specialists in collaboration with subject experts. You’ll find practice problems, study guides, videos, class notes, and step-by-step explanations for every subject you’re studying—from economics to literature, biology to history, accounting to psychology, and everything in between. Through Course Hero, you can quickly find what you need to learn deeply. We work closely with educators to help support student learning and complement what’s happening in the classroom. We want to see more students walking up to the podium on graduation day, proud of what they’ve accomplished, and ready to build great lives for themselves. We aim to help them get there.

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In the latest feature by Government Technology , our very own Sean Michael Morris , Vice President of Academics, shares exciting insights on what's to come for Ed Tech in 2025. Sean emphasizes the crucial role of educators in shaping the future of AI tools and advocates for a model where teaching with AI remains a collaborative journey. 🔗 Read more about his thoughts and other expert opinions in the full article below. #EdTech #AIinEducation #FutureOfTeaching

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Feeling stretched too thin? Faculty burnout is more common than you think, but it’s not permanent. This article breaks down 5 key signs of burnout and practical ways to address them. From physical fatigue to emotional exhaustion, these insights can help you protect your well-being and reignite your passion for teaching! #facultyburnout #teacherselfcare #takeabreak

💭 "You can’t pour from an empty cup." With research, curriculum planning, and student support on your plate, self-care can feel out of reach. That’s why we’re sharing 5 quick, practical self-care tips from educators who’ve learned how to prioritize their well-being. What’s your go-to self-care tip? Drop it in the comments ⬇️ #educatorselfcare #selfcareforteachers

In our latest Faculty Club newsletter, Sean Michael Morris , Course Hero’s VP of Academics, answers the question, "How can we position AI as an aid that enhances learning?" From amplifying student voices to critical AI literacy, this column is packed with ideas you can use today.💡 #AIInEducation #WritingWithAI #EducatorTools

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🚨 New Issue Alert from Faculty Club! 🚨 As AI continues to reshape the job market, educators face a pivotal question: How can we prepare students to stand out in a world where AI is everywhere? In this latest issue of Faculty Club, Vice President of Academics Sean Michael Morris discusses the unique human skills that remain critical for career success—and how teachers can help students cultivate them. #StudentSuccess #Education #TeachingWithAI

“We’re thrilled that Course Hero's AI Academy is nominated for The Anthem Awards ,” says Lead Events Manager Irina Matvienko . “Our faculty had voiced concerns and curiosity about AI, and I wanted to create a safe, supportive environment for them to share ideas and inspiration. We're proud to say that, to date, hundreds of teachers have earned a professional certification through AI Academy." You can vote for Course Hero here: https://lnkd.in/g8pBVrN9 Learn more: https://lnkd.in/dEQAgyjT

Thrilled to share that Course Hero has been recognized with three amazing awards from Comparably this year in the Small & Midsize Companies category! • Best Company Work-Life Balance 2024 • Best Company Perks & Benefits 2024 • Happiest Employees 2024 It’s a huge honor to see our efforts to create a supportive, balanced, and fulfilling workplace reflected in these awards. We are grateful to our incredible team for making Course Hero a truly special place to work! 💙 #BestPlacesToWork

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Excited to announce our partnership with Bharti AXA Life Insurance ! BHARTI AXA Life Insurance continues to provide security and peace of mind to millions across India. As they expand their services, they’re seeking professionals for roles such as Insurance Sales Executive, Relationship Manager, Office Assistant, Senior Business Manager and more to deliver personalized financial solutions. apna’s recruitment platform will help BHARTI AXA find the right talent to continue building trust and protection for families across the nation. Here’s to a partnership that secures the future, one policy at a time! Transform your recruitment with apna: https://lnkd.in/gmuTRhxK #apna #acceleratingindia #BHARTIAXA

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🚨Attention Tech Enthusiasts! Ninjacart is on the lookout for the sharpest minds to join India’s leading agri-tech platform. 💻 Work at the forefront of technology and agricultural innovation. ⌛ Registrations are open now! Don’t miss out! Application link: https://lnkd.in/gd4qBKmk #Ninjacart #HiringChallenge #InternshipOpportunity #TechCareers #AgriTech

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We know you’ve got a lot to manage because we’ve been there. There is so much tech, from AI tools to planning software. What’s right and what’s worth it? That’s where Springboard comes in. With our monthly memberships, you can offload the busy-work, the stress, and the questions to our team, so you can focus on, well, whatever you want. That’s why you got into this business right?

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We are hiring at Springboard ! Looking for a junior full-stack developer to help build a sleek, data-driven web app to power smarter dashboards for our clients. Please share with anyone who might be a good fit!

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We are excited to announce that Springboard is now a proud partner of Clio - Cloud-Based Legal Technology ! Clio is the leading practice management software and we're excited to work alongside them to contribute to the future of legal tech! Find out more here: https://lnkd.in/gXsevFjH

Michael G. Roitman, Esq.

I’m excited to share that we’ve reached the point where we’re not taking on any new clients for now. But let's begin at the beginning... A little over a year ago I started looking for a new problem to solve. My friend, Michael G. Roitman, Esq. , had recently left Big Law to start his own firm and asked if I could help getting a few operational things off the ground - a range of things I’d handled as a small business operator like insurance, payroll, accounting, IT, etc. So I started pitching in so he could focus on getting new clients and supporting them, the lifeblood of any firm. It’s been exciting to be a part of helping Michael’s new company grow! I wasn’t sure I was building a company until I pitched the service to a managing partner of a different firm. When I explained what we were doing they replied with an immediate “yes, please, we need this,” and became client number two. Running a law firm takes a ton of work and the road to scaling from 1 or 2 attorneys to 10-20 is full of operational headaches that can slow growth or stall it completely. Successful growth requires a strong operational environment growing in tandem - keeping an eye on the pitfalls and opportunities while providing support in the increments needed. And in answering these challenges Springboard was born! Springboard’s contribution is critical to the firms we serve, and our full focus will be on our current roster of outstanding clients before considering any new additions. Maybe at some point we’ll “scale” or build a product but until then we’re heads down. In the meantime, I plan to share what we know about legal operations so that everyone in this space can benefit from our experience. Stay tuned : )

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Every day, millions of people use software Belzabar has created. Belzabar Software creates Web and mobile-based products on behalf of a remarkable client base - including Fortune 500 companies, government agencies, Web startup ventures. We excel at creating high-performance systems that solve an organization's challenges optimally, from performance and mathematical optimization perspectives. We do what it takes to meet even challenging deadlines. Headquartered in the US, Belzabar Software Design is a world-class software boutique with an impressive development record. What we work on: We work on prominent, high-performance projects for prominent organizations as well as innovative startups. Office: Level 18, One Horizon Center Golf Course Road, DLF Phase-5 Sector 43, Gurgaon 122002 India

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NeoGen Labs screens infants for over 60 metabolic disorders, 24 hours after birth. If these disorders are identified soon after birth and treated, the child will lead a normal healthy life. Consequences of not identifying and treating can be serious.

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Case Study (PART 2): Disorders within Disorders – MADD has some look-alikes Dr. RC said in his reply to Dr. VJ that the IEM MADD detected by TMS screening had a classic spectrum for the disorder in this baby’s sample and was likely due to the malfunction of any one of three proteins (ETFA, ETFB and ETF DH), coded by three discrete genes, and mutations in any one of them were responsible for MADD. These proteins were all involved in electron transfer in the mitochondria (beta-oxidation centers), and they were all electron transport flavoproteins. Seeing a mention of ‘flavoproteins’, Dr. VJ called Dr. RC to inform that there was another pathological homozygous mutation reported (that he had not mentioned earlier as it was quite obscure) in the genetic report - it was in the gene SLC52A3 coding for a riboflavin transporter that is highly expressed in the intestine and several other tissues. The genetic report stated that mutations in this gene are associated with Brown-Vialetto-Van Laere syndrome and Fazio-Londe disease. Although these disorders did not ring a bell, a quick literature search revealed an editorial paper by M.J. Bennett titled “Brown-Vialetto-Van Laere and Fazio Londe syndromes: defects of riboflavin transport with biochemical similarities in multiple acyl-CoA dehydrogenation defects (MADD)” - J Inherit Metab Dis (2012) 35:941-942). All the confusing/interesting pieces fell into place for Dr. VJ and Dr. RC! Dr. Bennett writes in his paper, “BVVLS should theoretically be a diagnosable condition via acylcarnitine measurement in newborn screening programs as there is a characteristic TMS spectrum profile (i.e. same as MADD). However, at this time it is not known if newborns with this condition are initially protected by transfer of maternally-derived riboflavin.” The above paper is available online free of charge. Note: BVVLS is treatable with high dose riboflavin therapy to prevent an otherwise relentless neurological decline.

NeoGen Labs Pvt Ltd

Case Study (PART 1): Disorders within Disorders – MADD has some look-alikes Dr. VJ a seasoned, brilliant neonatologist called Dr. Rohit Cariappa (Lab Director, NeoGen) (henceforth referred to as Dr. RC) to request a discounted cost TMS screen for a sick baby from an economically disadvantaged family. At the time of dried blood specimen collection, the female baby was 62 days old. Born of a consanguineous marriage she presented with multiple episodes of vomiting, decreased feed intake, respiratory distress, hypoglycemia, late onset sepsis, pneumonia, hepatomegaly, high anion gap and hyperlipidemia. There was a previous sibling death. The TMS screen result was strongly positive for the fatty acid oxidation disorder MADD (Multiple Acyl-CoA dehydrogenase Deficiency - also known as Glutaric acidemia type 2 (GA-2)). The acylcarnitines C4, C5, C6, C8, C10:1, C10, C12, C12:1, C14:1 and C14 were all “above normal” limits. NeoGen Labs recommended an organic acid analysis of urine to confirm the positive screening test for MADD (GA-2). Two weeks later Dr. VJ informed Dr. RC that the child’s genetic report had no gene variant identified for MADD (GA-2) but the baby had a heterozygous pathological mutation for Glycogen storage deficiency type 1b (GSD1b deficiency). He wanted to know if the acylcarnitine elevations seen in the TMS report for MADD (GA-2) would be elevated in GSD1b deficiency? Dr. RC wrote back that, no, TMS does not pick up GSDs. It had to be MADD! But Dr. RC was thinking of other possibilities - the hypoglycemia was a common symptom between the GSD and MADD. What else could be connecting the two seemingly disparate results – one by TMS and another by genetic analysis? Stay tuned for PART 2!

Observed Interferences in Amino Acid and Acylcarnitine (Tandem Mass Spectrometry) analysis from different sources At NeoGen Labs we use LC-MS/MS method to screen for amino acid, organic acid and fatty acid disorders. The method uses, flow injection, positive electrospray ionization and tandem mass spectrometry. 40-50 amino acids and acylcarnitines are multiplexed and quantified in one test in approximately 2-3 minutes. One 3/16” dried blood spot punch is required for analysis. Over the years we have seen several interferences arising from different sources that can give rise to false positive results. This is one reason why abnormal results may not be specific for a particular disorder and needs to be evaluated by confirmatory testing. In this newsletter we have briefly listed the different sources of interferences that give rise to false positive screening results (described in the literature and from our experience over the course of 18 years). Prematurity Tyrosine is elevated as well as a generalized amino acid elevation may be observed Free Carnitine is decreased Liver diseases Tyrosine and Methionine are elevated Ketosis or Starvation Leucine, Isoleucine and Valine are elevated Alanine is decreased C2 and C4-OH are elevated Hemolysis Asparagine, Glycine and Glutamic acid are elevated TPN Non-specific (mild, moderate) elevation of several amino acids Intra-lipid C18:2 and C18:1 elevation Prolonged storage of sample at room temperature Ornithine, Glutamic acid are elevated Arginine and Glutamine are decreased Free carnitine is elevated Short chain acylcarnitines (C2, C3) are decreased Hyperbilirubinemia (&gt; 12 mg/dL) or B12 deficiency C3 is elevated Medium-chain triglyceride (MCT) Oil The concentration in the order of C10 &gt; C8 &gt; C6 will all be elevated L-Carnitine supplementation Free carnitine, C2, C3, C4, C8, C14 all will be non-specifically elevated Sepsis C4, C6, C8, C5DC(C8-OH), C10 will be non-specifically elevated. Bacterial contamination No effect on Amino Acid or acylcarnitine concentration Fungal contamination Phenylalanine will be very low (single digit micromolar concentration) Post-Mortem sample Non-specific increase in Amino Acids and Acylcarnitines Significant increase in C4 and C4-OH Drug interferences Valproic acid cause an increase in Glycine and C8 and a decrease in Free Carnitine Pivalic acid containing antibiotics cause an increase in C5 Paracetamol gives an interfering peak in the spectrum for Phenylalanine Conclusion: Confirmation of abnormal NBS results require assaying plasma amino acids and acylcarnitines, urine organic acids and in some cases enzyme and mutation studies. All TMS results should be interpreted taking cognizance of dietary history, nutritional status, medical history and sample condition. A recommendation for further testing should always be given for abnormal reports. Feel free to call the Laboratory Director at any time to discuss NBS results.

All you need to know about G6PD Deficiency: (Q) In the NeoGen Newborn Screening Panel of disorders which is the most common screen positive disorder among newborn babies in India? The answer is G6PD deficiency. (Q) What is G6PD deficiency? G6PD deficiency is a hereditary, X-linked disorder, and therefore seen mostly in males. The enzyme, Glucose-6-phosphate dehydrogenase, is involved in the pentose phosphate pathway that metabolizes glucose. The deficiency (zero to low activity of the enzyme) adversely affects the stability of RBC membranes and makes them susceptible to destruction by strong oxidizing agents. Affected patients are at risk for hemolytic anemia, which could be induced by exposure to certain drugs and foods. (Q) What are the drugs to avoid if a baby has G6PD deficiency? · Antimalarial medicines such as quinine · Aspirin (high doses) · Nonsteroidal anti-inflammatory drugs (NSAIDs) · Quinidine · Sulfa medicines · Antibiotics such as quinolones, nitrofurantoin (Q) What are the 3 easily treatable and absolutely essential disorders to be screened for in India? As India does not have a newborn screening program the nationwide incidence of G6PD deficiency has not been thoroughly documented. Every Indian neonatologist/pediatrician is aware of the disorder and has seen/diagnosed and treated the disorder. For this reason the following 3 easily treatable disorders must be part of any routine screening program in any Indian hospital, Indian city or Indian state program: 1) Congenital Hypothyroidism (CH) 2) Congenital Adrenal Hyperplasia (CAH) 3) G6PD deficiency (G6PD) Taking data from Indian physicians and hospitals who send us routine newborn screening samples, the percentage of samples that screen positive for G6PD deficiency are about 1.7% to 2% of samples. It is slightly higher in routine samples received from the middle east. Treatment is straight forward and easy - mainly avoidance of certain drugs and food items. Another caution is many of these drugs can enter the breast milk if taken by the mother and have the potential to cause harm to the affected baby. Worldwide, G6PD is one of the most common hereditary enzyme disorders, affecting over 200 million people. Data from other countries reveal that 10% of all African American males inherit mild forms of G6PD deficiency. Some people of Mediterranean origin inherit severe forms of the disease. The ingestion of fava beans may also elicit hemolytic episodes in some affected Caucasians. NeoGen Labs, based in Bangalore, uses a Fluorometric Enzyme Assay for the detection of G6PD deficiency. The normal cut off has been set at > 2 U/gHb. We recommend confirmatory testing on fresh whole blood for G6PD enzyme activity when the NeoGen Labs dried blood specimen screening result is < 2 U/gHb.

Newborn Screening for SMA (Spinal Muscular Atrophy) NeoGen Labs is the first lab in India to introduce SMA genetic testing as part of Newborn Screening (NBS) using Dried Blood Spot (DBS) as the sample matrix. This enables a seamless integration of this test into the existing FirstStep™ NBS panel tests offered by NeoGen Labs. The screening test offers the treating physician as well as the parents of an affected baby a head start in planning out a future course of timely action. The inexpensive screening test can identify infants impacted by SMA. NeoGen labs is also the first lab in India to have launched the SMA screening test service using DBS after having successfully cleared an International EQA (external quality assurance) program, the NSQAP – PT (Newborn Screening Quality Assurance Program - Proficiency Testing, administered by the Centre for Disease Control, Atlanta, Georgia, USA). The NSQAP-PT results for SMA genetic NBS test has a greater significance because in this PT program, a thorough evaluation of every component of the genetic testing process is carried out,including – the assay method used, the sample extraction method, reference gene expression, and assessment of the probe and primer sequence. Based on these inputs provided by the lab, the PT provider evaluates the lab on their performance. Of the 109 labs worldwide that participated in the First Quarter PT program for 2024, NeoGen Labs was one of the labs that successfully cleared the PT evaluation for SMA. The PT result gives an assurance that the SMA genetic screening test service for the identification of SMN1 Exon 7 gene deletion is robust and reliable. NeoGen Labs is working on bringing this assay under the scope of NABL. For any queries on SMA screening or requirement please contact, Dr. Siva Adarsh (+91 93412 62986, siva@neogenlabs.com ).

Argininemia - An Inborn Error of Metabolism Tandem Mass Spectrometry (TMS) is a powerful tool for the detection of metabolic disorders. Its use during the newborn period (~ first month of life) is well established for the detection of metabolic disorders. This is a period of time when the baby may present as completely normal (asymptomatic) and there are absolutely no signs of an underlying metabolic disorder (IEM). Of course, some metabolic disorders present with severe fulminant symptoms immediately after birth (examples being Propionic Acidemia and Citrullinemia), necessitating the admission of newborns to the NICU and critical care from day 1, until a diagnosis is made and, if available, treatment is started. In this communication we would like to highlight one insidious metabolic disorder that presents in a very mild and subtle manner in its symptoms during the first few months of life and is often missed by the clinician. However, it is always deadly in the longer term, if not detected early. Surprisingly, this asymptomatic or mild presenting metabolic disorder is a Urea Cycle Disorder (UCD - which are generally known to present early and aggressively), called Argininemia. It is caused by the deficiency of the enzyme Arginase in liver and erythrocytes (tissue specific) which catalyzes the breakdown of arginine to ornithine and urea. Most of the cases we detect in our laboratory by TMS are unfortunately in older children, 2 - 9 years of age who have developmental delay and the treating physician is searching for a diagnosis. It is always a sad moment for thought and reflection that the mild but persistent elevation we observe in the concentration of arginine detected from the proffered dried blood specimen by TMS could have been picked up 24 hours after birth itself, had a routine screening program been in place at the birthing centre. Early detection and treatment would have prevented the onset of brain damage leading to a normal and healthy life for the affected child. “The symptoms of Argininemia are progressive spastic paraplegia, failure to thrive, delayed milestones, hyperactivity and irritability, with episodic vomiting, hyperammonemia and seizures. Mental retardation is a result of cerebral atrophy which leads to macroccephaly. Hepatomegaly may be present” (reference: PerkinElmer Handbook of IEMs). Dietary restriction of protein is the basic treatment along with additional support to prevent and control the hyperammonemia. The gene for Arginase is on Chromosome 6 and several pathological mutations have been identified. Heterozygous (carrier) individuals are clinically unaffected although they may have partial Arginase activity. This article is prompted by the detection of elevated Arginine levels in a 11-day old baby, following routine newborn screening which included TMS. Upon confirmation of Argininemia, this early result will give the baby a chance for normal development with the appropriate treatment and therapy.

Insights on Tandem Mass Spectrometry (TMS) - part 2 One of the most powerful and helpful results of TMS is a NORMAL TMS screening result. Think of the scenario. The baby is sick after birth with multiple symptoms which may range from metabolic acidosis to sepsis to vomiting etc. A normal TMS screen with its ~100% sensitivity, rules out a metabolic cause for the overlapping symptoms seen in bacterial or viral infection. In most cases the baby returns to health after treating the associated infection. In the rare case where the baby is chronically sick even after treatment for infection but the TMS result was normal, the way ahead is clear: perform genetic testing (with consent). The ability to rule out a metabolic disorder early in a baby’s life by obtaining a normal TMS result gives a certain peace of mind (doubly so, if the baby is sick). In fact, The case for performing TMS is amplified when the baby is in the NICU. It the most efficient, and cheap way to find the proverbial needle in the haystack, i.e., if an Inborn Error of Metabolism is present/lurking. In Newborn Screening, QUALITY of the result is of utmost importance. Invest money in producing high quality results, be it in people, instruments, maintenance, training, etc. to provide a results that a treating physician can trust. They are willing to pay for a quality result, a result they can base medical decisions on. They will take a stand with the finance directors (if there is one), who will always ask why not pay for a cheaper result offered by a competing lab. To summarize: There are no shortcuts to a quality result, and it has been a very gratifying part of my job to see that so many doctors understand this.

Insights on Tandem Mass Spectrometry (TMS) TMS is a powerful method to detect Inborn errors of metabolism (IEMs). In developed countries it is routinely used for newborn screening of fatty acid oxidation disorders (FAODs), Organic acid disorders (OADs) and Amino Acid disorders (AADs) including the urea cycle disorders (UCDs). A well-tuned and maintained instrument has close to 100% sensitivity and specificity. However it takes significant cost and expertise to maintain the instrument properly. Preanalytical factors can affect the screening result. A baby given TPN or hyperalimentation will show a generalized elevation of specific amino acids. As amino acids turn over quickly a repeat specimen collected 48 hours after amino acid administration will suffice to measure the true concentrations of amino acids in the blood. L-carnitine is another supplement that can confound the interpretation of acylcarnitines. Cessation of L-carnitine a week prior to dried blood specimen collection will yield the physiological levels of acylcarnitines suitable for interpretation. Transfusion is another pre-analytical event that can dramatically alter the TMS result. We recommend waiting 96 hours after an exchange transfusion before collecting a dried blood specimen (DBS) for TMS screening and analysis. We recommend waiting 72 hours for a small volume whole blood transfusion, before collecting a DBS. TMS is sensitive enough to detect an IEM even when a baby has not been fed (NPO). This is because endogenous catabolism of muscle, protein and fat will reveal any defects in the metabolic pathways. However if the treating physician has a continued suspicion of a metabolic disorder (after the first normal TMS analysis) we will repeat the screen 48 hours after regular feeding has been established (free of charge). Ideally a sample for TMS should be collected a minimum of 24 hours after birth when the baby has had 3-6 feeds. TMS screening should be done in the first month of life for its full benefit to be realized (a positive health outcome for an affected baby, achieved by early treatment). After the first month of life TMS becomes more like a diagnostic tool even though we still insist on confirmation of any positive results by other suggested and appropriate technologies.

Tandem Mass Spectometry (MS/MS) vs Gas Chromatography-Mass Spectrometry (GC/MS) There is only one right answer when it comes to deciding between MS/MS and GC/MS as a primary choice for Newborn Screening (NBS). You guessed right! The answer is always MS/MS. Here are some reasons why - 1. Sample Type: NBS typically involves small blood samples from newborns. MS/MS is better suited for analyzing these samples as it can handle small volumes of blood while simultaneously targeting several metabolites crucial for detecting metabolic disorders. 2. Metabolite Range: While MS/MS is designed to analyze a broader range of metabolites relevant to newborn screening, including amino acids and acylcarnitines, GC-MS is more focused on volatile and less polar compounds, which might not cover the full spectrum of metabolites crucial in NBS. 3. Sensitivity and Specificity: MS/MS is very sensitive and selective in identifying specific molecules associated with metabolic disorders. This is critical for accurate and consistent screening, particularly in the context of neonatal health. 4. Throughput: MS/MS enables high-throughput screening, making it useful for assessing a large number of samples fast. This is critical for the timely identification of potential disorders in newborns. 5. Advancements in Technology: MS/MS technology has evolved to address the unique needs of NBS, allowing for the simultaneous analysis of several analytes with greater precision and efficiency. Although GC/MS is a powerful analytical tool, it is better suited to detect and analyse volatile and less polar compounds than the comprehensive and targeted screening required for newborns.

NeoGen's Approach to Newborn Screening (NBS) NeoGen Labs has been providing NBS services for the past 18 years. We have NABL and CAP accreditations for all the screening tests we perform. Our laboratory scientists, managers, quality control personnel, authorized signatories and the lab director have up to the date training and qualifications to provide high quality newborn screening results and appropriate follow-up testing and consultation services. Our goal is to provide the best possible results to ensure that timely medical decisions can be made in case of positive screening results. In spite of excellent and robust cut offs, low number of false positive cases and strict adherence to established protocols there is a one area that is outside the realm of measurement that ensures that the right decision is made by the laboratory. This is the PHONE CALL to the treating physician when there is any doubt about the screening result. The phone call to the treating physician has multiple and rewarding benefits to the outcome of the screening result - 1. It allows the lab and the treating physician to align their expectation of what might be truly happening through a detailed discussion of the case history in conjunction with laboratory testing results. 2. This conversation allows for the appropriate follow -up testing to take place (or it may be deemed not necessary, thus saving unnecessary expenditure of time and money and the associated anxiety). 3. The lab is basing its report on sophisticated testing of a dried blood specimen. The treating physician has direct expert assessment of the baby’s clinical condition. The conversation between the Laboratory and the Treating Physician is a powerful and compelling joining of forces to arrive and the best next steps for care of the baby. The Director of NeoGen, Dr. Rohit Cariappa says, "I have had the privilege of interacting with 1000s of Neonatologists and Pediatricians over the last 18 years. The area that has given me the most satisfaction has been how our Laboratory has approached ambiguous screening results (which happen on a daily basis). The reasons for such results may be due to preanalytical factors like improper blood collection/drying of the sample, drug interactions, L-carnitine supplementation, transfusion, etc. or unmentioned factors that might affect the interpretation of results like consanguinity, special diets, IEM monitoring sample, family history, sick baby with symptoms, etc. It would be easy to make a decision at the laboratory level as to whether a given result is normal or abnormal. But if is there is any doubt in the whole collection/couriering/testing process it is best to be transparent about it and have a conversation with the treating physician utilizing the simple yet all powerful PHONE CALL."

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