AbstractIntroductionDomestic hand hygiene could prevent over 500,000 attributable deaths per year, but 6 in 10 people in least developed countries (LDCs) do not have a handwashing facility with soap and water available at home. We estimated the economic costs of universal access to basic hand hygiene services in household settings in 46 LDCs.MethodsOur model combines quantities of households with no handwashing facility (HWF) and prices of promotion campaigns, HWFs, soap, and water. For quantities, we used estimates from the WHO/UNICEF Joint Monitoring Programme. For prices, we collated data from recent impact evaluations and electronic searches. Accounting for inflation and purchasing power, we calculated costs over 2021-2030, and estimated total cost probabilistically using Monte Carlo simulation.ResultsAn estimated US$ 12.2 - 15.3 billion over 10 years is needed for universal hand hygiene in household settings in 46 LDCs. The average annual cost of hand hygiene promotion is $334 million (24% of annual total), with a further $233 million for ‘top-up’ promotion (17%). Together, these promotion costs represent $0.47 annually per head of LDC population. The annual cost of HWFs, a purpose-built drum with tap and stand, is $174 million (13%). The annual cost of soap is $497 million (36%), and water $127 million (9%).ConclusionThe annual cost of behaviour change promotion to those with no handwashing facility represents 4.7% of median government health expenditure in LDCs, and 1% of their annual aid receipts. These costs could be covered by mobilising resources from across government and partners, and could be reduced by harnessing economies of scale and integrating hand hygiene with other behaviour change campaigns where appropriate. Innovation is required to make soap more affordable and available for the poorest households.Summary boxWhat is already known?Understanding resource requirements is important for planning, but data on the costs of improving domestic hand hygiene are scarce.While a 2016 study estimated the global cost of drinking water, sanitation and hygiene, it did not report hygiene-specific estimates of recurrent or total cost, nor did it describe the assumed promotion intervention and handwashing facility or consider alternatives to them.What are the new findings?The total economic cost over 10 years is US$ 12.2 – 15.3 billion, of which $4.9 – 6.6 billion (42%) is for behaviour change promotion interventions.The remainder is for facilities and supplies, with soap the biggest cost category (36%) followed by handwashing facilities (13%) and water (9%).The facility and supply costs per household comprise an initial investment in a handwashing facility (lasting 5 years) at a median of US$ 17, accompanied by an annual cost of $17 for soap and $5 for water.What do the new findings imply?The annual cost of behaviour change promotion to those with no handwashing facility represents 4.7% of median government health expenditure in LDCs.On top of this, investments in infrastructure and supplies are required. Soap in particular is a substantial and recurrent cost, which may be unaffordable for the poorest households.Promotion costs could be covered by mobilising resources from across government and partners, and could be reduced by harnessing economies of scale and integrating hand hygiene with other behaviour change campaigns where appropriate.

Kikuchi-FujimotoDisease (KFD), also known ashistiocyticnecrotizinglymphadenitis, is a rare cause of cervical lymphadenopathy. Patients usually present with localized lymphadenopathy, fever and fatigue. Because of the poorly understood etiology, it can be mistaken for an infectious disease or even malignance. Here we discuss a case of KFD that initially presented with left sided cervical lymphadenopathy that later progressed to left supraclavicular lymph nodes. Due to its characteristic overlap with other disorders like tuberculous lymphadenitis and lymphoma, KFD remains an arduous diagnosis for physicians. Therefore, one should be made aware of symptoms that can lead to misdiagnosis in patients.

Objective: To characterize dietary supplements marketed online as "ephedra-containing or ephedra-like products" for weight management and to assess labeling/marketing compliance with the ban on the sale of ephedrine alkaloids. Materials and Methods: This cross-sectional study assessed websites selling ephedra-like supplements using the search term "buy ephedra." For each website, the first three featured products were characterized by evaluating the label for (1) Ephedra sp. or its alkaloid content, (2) serving size, (3) other ingredients, (4) directions, (5) side effects, (6) reported interactions, (7) recommendation to consult a health care provider, (8) recommendation to use with diet and exercise, and (9) Food and Drug Administration (FDA) disclaimer. Results: Thirty-six (71%) of the first 51 websites evaluated sold at least one weight loss product. A total of 105 products were assessed, 93 had labeling with 10 (11%) in possible violation of the ephedra ban. Five were labeled as containing ephedrine or ephedrine hydrochloride, two reported containing ephedrine alkaloids, and two reported containing unidentified Ephedra sp. not formulated as an extract; one reported containing Ma Huang. Sixty-seven (72%) products listed caffeine with a daily serving size averaging 400 mg. Other ingredients with stimulant properties include green tea, yohimbe, and phenylethylamine. Conclusions: Nearly 20% of websites sold weight loss products that potentially violated the 2004 ban of ephedra alkaloids. Ephedrine, unidentified Ephedra sp. not formulated as an extract, and Ma Huang were labeled as present in 11% of products evaluated. Incomplete reporting of adverse effects and drug interactions was common.

Noncoding RNA (ncRNA) transcripts that did not code proteins but regulate their functions were extensively studied for the last two decades and the plethora of discoveries have instigated scientists to investigate their dynamic roles in several diseases especially in cancer. However, there is much more to learn about the role of ncRNAs as drivers of malignant cell evolution in relation to macrophage polarization in the tumor microenvironment. At the initial stage of tumor development, macrophages have an important role in directing Go/No-go decisions to the promotion of tumor growth, immunosuppression, and angiogenesis. Tumor-associated macrophages behave differently as they are predominantly induced to be polarized into M2, a pro-tumorigenic type when recruited with the tumor tissue and thereby favoring the tumorigenesis. Polarization of macrophages into M1 or M2 subtypes plays a vital role in regulating tumor progression, metastasis, and clinical outcome, highlighting the importance of studying the factors driving this process. A substantial number of studies have demonstrated that ncRNAs are involved in the macrophage polarization based on their ability to drive M1 or M2 polarization and in this review we have described their functions and categorized them into oncogenes, tumor suppressors, Juggling tumor suppressors, and Juggling oncogenes.

ContributorsThe following document and appendices represent the third edition of the Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy. These guidelines were developed by the Diabetic Retinopathy Telehealth Practice Guidelines Working Group. This working group consisted of a large number of subject matter experts in clinical applications for telehealth in ophthalmology.The editorial committee consisted of Mark B. Horton, OD, MD, who served as working group chair and Christopher J. Brady, MD, MHS, and Jerry Cavallerano, OD, PhD, who served as cochairs. The writing committees were separated into seven different categories. They are as follows: 1.Clinical/operational: Jerry Cavallerano, OD, PhD (Chair), Gail Barker, PhD, MBA, Christopher J. Brady, MD, MHS, Yao Liu, MD, MS, Siddarth Rathi, MD, MBA, Veeral Sheth, MD, MBA, Paolo Silva, MD, and Ingrid Zimmer-Galler, MD.2.Equipment: Veeral Sheth, MD (Chair), Mark B. Horton, OD, MD, Siddarth Rathi, MD, MBA, Paolo Silva, MD, and Kristen Stebbins, MSPH.3.Quality assurance: Mark B. Horton, OD, MD (Chair), Seema Garg, MD, PhD, Yao Liu, MD, MS, and Ingrid Zimmer-Galler, MD.4.Glaucoma: Yao Liu, MD, MS (Chair) and Siddarth Rathi, MD, MBA.5.Retinopathy of prematurity: Christopher J. Brady, MD, MHS (Chair) and Ingrid Zimmer-Galler, MD.6.Age-related macular degeneration: Christopher J. Brady, MD, MHS (Chair) and Ingrid Zimmer-Galler, MD.7.Autonomous and computer assisted detection, classification and diagnosis of diabetic retinopathy: Michael Abramoff, MD, PhD (Chair), Michael F. Chiang, MD, and Paolo Silva, MD.

Safety training in the United States construction industry commonly employs classroom-based lecture and storytelling techniques to transfer knowledge to workers and professionals. However, low levels of engagement and low-fidelity representations of the construction jobsites have posed limitations for learners to easily visualize and understand hazard conditions. One emerging technology that has the potential to increase engagement and provide high-fidelity visualizations of construction jobsites is 360-degree panorama virtual environments. This study concentrates on using immersive storytelling within digital 360-degree panoramas to improve hazard recognition and risk perception. A proof-of-concept platform was developed to assess the produced virtual training environment in terms of hazard identification, risk perception, and sense of presence. The platform was conceptualized within the visual and narrative context of electrical trade fall hazards, as this trade often perform complex work at elevated surfaces making them especially susceptible to fall related injuries and fatalities. A between-subject pilot study was conducted with forty construction management student subjects, comparatively evaluating safety immersive storytelling and Occupational Safety and Health Administration (OSHA) trained participants (e.g., OSHA 10-hr, OSHA 30-hr). It was found that no statistical differences are present in the average Hazard Identification Index (HII) scores for both approaches, suggesting that the outcomes of the training techniques are equivalent for the narrow scope of fall hazards evaluated in this study (scissor/aerial lifts, scaffolds, roofs/unprotected edges). Nevertheless, time savings in hazard identification training were found; safety immersive storytelling required 15 min of training in contrast 10 or 30 h of OSHA training. Furthermore, it was detected that subjects assigned more or equal risk to ladders, scaffolds, and scissor/aerial lifts hazards for safety immersive storytelling compared to the OSHA condition. Although the subject risk perception scores demonstrate these trends, a statistical analysis performed showed no significant differences between the two experimental groups. All participants perceived that the immersive experience provided a high sense of presence. Based on the experimental results, it was concluded that safety immersive storytelling provides an analogous outcome to OSHA interventions for the studied fall hazards while reducing the required training time.

Ganglioneuroblastoma is a neural tissue neoplasm, which is derived from the neural crest cells. It is mostly seen in the pediatric population but is very rarely found in the lower thoracic spine. Here, we report a rare case of ganglioneuroblstoma occurrence in the lower thoracic spine. A 2.5-year-old boy presented with spinal compression symptoms and on magnetic resonance imaging, a mass was identified over T10 to L1. The tumor showed round blue cells and mature ganglion cells with hypermitotic activity. Immunohistochemical synaptophysin and neurofilament staining was positive, confirming the diagnosis. The patient showed significant improvement after surgical excision of the tumor. This is the first reported case of ganglioneuroblastoma in the lower thoracic spine that was successfully treated in Pakistan.

The isotope-enriched h-BN films exhibited a dielectrics dispersion with low dielectric loss, below 1.3%. Their optical band gaps depend on isotopic composition (5.54 to 5.79 eV). Thermal conductivity of pure B10/11N are enhanced by around 231%.

Novel Cs-containing triple cation perovskite nanocrystals produce high-performance LEDs as a result of improved surface passivation and environmental stability.

Layered transition metal dichalcogenides (TMDCs) within two dimension (2D) have been gaining widespread consideration due to their exclusive optoelectronic properties.