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ImportanceLaser-assisted drug delivery (LADD) is used for various medical and cosmetic applications. However, there is insufficient evidence-based guidance to assist clinicians performing LADD.ObjectiveTo develop recommendations for the safe and effective use of LADD.Evidence reviewA systematic literature review of Cochrane Central Register of Controlled Trials, Embase, and MEDLINE was conducted in December 2019 to identify publications reporting research on LADD. A multidisciplinary panel was convened to draft recommendations informed by the systematic review; they were refined through 2 rounds of Delphi survey, 2 consensus meetings, and iterative review by all panelists until unanimous consensus was achieved.FindingsOf the 48 published studies of ablative fractional LADD that met inclusion criteria, 4 were cosmetic studies; 21, oncologic; and 23, medical (not cosmetic/oncologic), and 6 publications of nonablative fractional LADD were included at the request of the expert panel, producing a total of 54 studies. Thirty-four studies (63.0%) were deemed to have low risk of bias, 17 studies (31.5%) had moderate risk, and 3 (5.5%) had serious risk. The key findings that informed the guidelines developed by the expert panel were as follows: LADD is safe in adults and adolescents (≥12 years) with all Fitzpatrick skin types and in patients with immunosuppression; it is an effective treatment for actinic keratosis, cutaneous squamous cell carcinoma in situ, actinic cheilitis, hypertrophic scars, and keloids; it is useful for epidermal and dermal analgesia; drug delivery may be increased through the application of heat, pressure, or occlusion, or by using an aqueous drug solution; laser settings should be selected to ensure that channel diameter is greater than the delivered molecule; antibiotic prophylaxis is not recommended, except with impaired wound healing; antiviral prophylaxis is recommended when treating the face and genitalia; and antifungal prophylaxis is not recommended. The guideline's 15 recommendations address 5 areas of LADD use: (I) indications and contraindications; (II) parameters to report; (III) optimization of drug delivery; (IV) safety considerations; and (V) prophylaxis for bacterial, viral, and fungal infections.Conclusions and relevanceThis systematic review and Delphi consensus approach culminated in an evidence-based clinical practice guideline for safe and effective use of LADD in a variety of applications. Future research will further improve our understanding of this novel treatment technique.

The article criticizes the failure of the United Nations (UN) security council to transcend state interests in the name of humanitarianism. The council had failed to either authorize or stop the U.S.-led invasion of Iraq. The obligation to protect has yet to be matched by a willingness to intervene to protect. The member states of the UN have been incapable of bringing the political will, resources, and organization capacity to bear at the right place and at the right time in places like Afghanistan, Chechnya, Iraq and the Democratic Republic of the Congo.

We present a 'focal window' procedure for estimating associations between non - focal animals, based on focal data. The estimate is based on the time that two non - focal animals spend simultaneously proximal to a third, focal animal, relative to the time that would be expected given their independent attraction to this animal. Simulations showed that the error of the estimate was low when at least one of the three associations in the triad was high. [ABSTRACT FROM AUTHOR]

International policy and law have long sought to ensure that states regulate the negative impacts of production processes on people and the planet. Sustainable Development Goal (SDG) 12 targets sustainable production and consumption; international conventions, such as the Basel Convention, or the Convention on Biological Diversity (CBD), and the International Labour Organisation Conventions, all seek to regulate toxic or labour-related impacts associated with industrial production. However, there is ample evidence that such impacts continue. At a time of increasing pressure to develop sustainable systems of production and consumption, we asked whether the existing legal frameworks are appropriate to the task of regulating for sustainability in consumer products. Drawing on research conducted into sustainability in the mobile phone lifecycle, this paper examines the regulatory ecology of hotspots of unsustainability in the product lifecycle of electronics. This paper finds that the interaction of regulatory disjunctures, business models, design of technology, and marginalisation combine to ensure that our systems of production and consumption are predisposed to resist regulation aimed at sustainability. [ABSTRACT FROM AUTHOR]