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The objective of this research was to understand key levers that enabled city, regional, and national governments to improve non-motorized transport (NMT) infrastructure during the lockdowns necessitated by the COVID-19 pandemic. The research focused primarily on cycling and adopted a case study approach focusing on three cities: Bengaluru (India), Bogota (Colombia), and London (UK). The selected cities were chosen for diversity across geographies, country income levels, and the scale of interventions. Eight key levers were identified to understand how cycling interventions can be supported, implemented, sustained, and scaled up. These included institutional and organizational arrangements; technical capacity; financing; leadership; policy and regulatory framework; plans, strategies, and technical resources; role of civil society; and communications, messaging, and outreach. The research used secondary literature reviews and key informant interviews, which were validated through an online round table. Research revealed that certain levers were necessary in initiating and continuing successful NMT interventions. These included supportive leadership, participative civil society, and adequate financial and technical capacity. Communications and outreach helped bring behavioral change amongst residents while a coordinated institutional framework and plans and strategies were necessary to sustain momentum. This research contributes to urban mobility and public administration literature in understanding processes and enablers of sustainable mobility interventions. It is relevant for cities in low- and middle-income countries beginning to focus on NMT interventions to combat climate change and public health challenges. more...

This research examines the impacts of COVID-19 on the mobility of resource-poor women and its linkage with livelihoods in urban South Asia, and how gender-responsive transport measures could be adopted. The study, conducted in Delhi between October 2020 and May 2021, used a mixed methods, multi-stakeholder, and reflexive approach. A literature review was conducted on the gender and mobility context in Delhi, India. Quantitative data were collected through surveys with resource-poor women, while qualitative research methods consisted of in-depth interviews with them. Different stakeholders were engaged through round tables and key informant interviews before and after data collection to share the findings and recommendations. The sample survey (n = 800) revealed that only 1.8% of working resource-poor women have access to a personal vehicle, making them dependent on public transport. While 81% of their trips are by bus, 57% of their peak hour trips are by paratransit, despite free travel on buses. Only 10% of the sample have access to a smart phone, which restricts their access to digital initiatives based on smart phone applications. The women expressed concerns such as poor bus frequencies and buses not stopping for them under the free ride scheme. These were consistent with issues faced before the COVID-19 pandemic. These findings highlight the need for targeted strategies for resource-poor women to achieve equity in gender-responsive transport. These include a multimodal subsidy, short messaging service to obtain real-time information, increased awareness on filing complaints, and an effective grievance redressal system. more...

Skin is the largest organ of human body. Its size and external location makes it susceptible to various disorders. Skin diseases are mostly caused by infections like bacteria, fungi etc. All the skin diseases in Ayurveda have been classified under the broad heading of Kushtawhich are further classified into Mahakushtaand Kshudrakushta. Ayurveda has its own unique principles of diagnosis and treatment of various skin diseases under the heading of Kuṣṭha. A review was conducted from the relevant texts of Ayurvedic and contemporary science to collect information about the skin diseases and their treatment through Ayurveda. The review concluded that Ayurveda management through Shodhanaand Shamana Chikitsa(with Ayurvedic herbs) is beneficial in skin diseases. more...

Nucleus drop during cataract surgery is a dreaded complication and requires urgent vitreo-retinal intervention which is managed commonly using a fragmatome. However, a fragmatome is not readily available in routine ophthalmology set-ups because its use is very limited. On the other hand, a phaco-probe is commonly available with all surgeons and makes it cost-effective.The purpose is to demonstrate the utility of a phaco-probe as an alternative to a fragmatome in managing nucleus drop during cataract surgery, making it cost-effective and less time-consuming and simple.The video shows two cases of complicated cataract surgery in which a nucleus is dropped in the vitreous cavity. The sleeve of the phaco-probe was removed, and infusion was disconnected to make it function as a fragmatome. We noted reduced lenticular repulsion from the phaco-handpiece tip as compared to the fragmatome, and no scleral burns were observed. The cases were completed by secondary placement of an intra-ocular lens in the sulcus in the same sitting. Thus, the phaco-probe can be considered to manage nucleus drop in the absence of a fragmatome.A phaco-probe can be used as an alternative to a framgamtome, which is a cost-effective and simple technique.https://youtu.be/6c-40Bcijrc. more...

Dengue virus (DENV) causes repeated outbreaks of disease in endemic areas, with patterns of local transmission strongly influenced by seasonality, importation via human movement, immunity, and vector control efforts. An understanding of how each of these interacts to enable endemic transmission (continual circulation of local virus strains) is largely unknown. There are times of the year when no cases are reported, often for extended periods of time, perhaps wrongly implying the successful eradication of a local strain from that area. Individuals who presented at a clinic or hospital in four communes in Nha Trang, Vietnam, were initially tested for DENV antigen presence. Enrolled positive individuals then had their corresponding household members invited to participate, and those who enrolled were tested for DENV. The presence of viral nucleic acid in all samples was confirmed using quantitative polymerase chain reaction, and positive samples were then whole-genome sequenced using an amplicon and target enrichment library preparation techniques and Illumina MiSeq sequencing technology. Generated consensus genome sequences were then analysed using phylogenetic tree reconstruction to categorise sequences into clades with a common ancestor, enabling investigations of both viral clade persistence and introductions. Hypothetical introduction dates were additionally assessed using a molecular clock model that calculated the time to the most recent common ancestor (TMRCA). We obtained 511 DENV whole-genome sequences covering four serotypes and more than ten distinct viral clades. For five of these clades, we had sufficient data to show that the same viral lineage persisted for at least several months. We noted that some clades persisted longer than others during the sampling time, and by comparison with other published sequences from elsewhere in Vietnam and around the world, we saw that at least two different viral lineages were introduced into the population during the study period (April 2017–2019). Next, by inferring the TMRCA from the construction of molecular clock phylogenies, we predicted that two of the viral lineages had been present in the study population for over a decade. We observed five viral lineages co-circulating in Nha Trang from three DENV serotypes, with two likely to have remained as uninterrupted transmission chains for a decade. This suggests clade cryptic persistence in the area, even during periods of low reported incidence. more...

Objectives Wound healing is an integral part of any surgical procedure. Appropriate wound closure is critical to any successful surgical procedure, especially intraoral procedures. Various factors aid in wound healing, both pharmacological and non-pharmacological. Dehydrated human amniotic/chorionic membrane (dHACM) is an emerging bioinert material that contains anti-inflammatory properties, angiogenetic properties, osteogenic potential, and various growth factors. The purpose of this study was to evaluate the efficacy of wound healing properties of dHACM in bilateral alveoloplasty patients. Materials and Methods A prospective split-mouth study was conducted on 10 patients. Site A received sutures with dHACM and site B was sutured without dHACM. Wound healing was assessed with the Landry, Turnbull, and Howley Index. Results Sites A and site B were compared. A P more...

Background: The outbreak of Covid-19 has led to a health emergency and economic crisis worldwide. Mortality in productive age further worsens the crisis, so it is important to understand reasons for death in productive age group. Objective: To identify predictors of mortality and to compare the intensity of rise in inflammatory markers of amongst young Covid-19 decedents in comparison with elder Covid-19 decedents. Method: Record based study of Covid-19 infected admitted patients was conducted in tertiary care hospital. Information of all (n=3131, 209 deceased and 2922 recovered patients) Covid-19 positive patient assessed . Their clinico epidemiological markers were compared between younger (18-45 years) decedents in comparision with elder decedents (>45 years). Mann–Whitney U-test and the Chi-square test for significance were used. Bivariate Multiple logistic regression was used to identify predictors in younger and elder decedents. Results: Case Fatality Rate (CFR) in Covid-19 infected patients was 2.4% and 9.7% amongst younger and elder group respectively. (OR 8.83 : 95% CI 5.9-13.2; p < 0.001). Biomarkers were raised and similar in both groups except Neutrophil Lymphocyte Ratio (NLR) was significantly higher in elder decedent while LDH was significantly higher in younger decedents. Conclusions: Males had higher CFR than females after 45 years of age, which was due to co-morbidity. Reaching late to the health care facility and high LDH were predictors in younger decedent, while male gender, co morbidities and high NLR were more important predictors in elder group. more...

Chemotherapies often cause side effects of the skin, nails, and mucosal surfaces. These mucocutaneous toxicities contribute to morbidity and affect quality of life. Identification and management of these drug-induced eruptions is vital to allow for continuation of essential therapies. This review demonstrates the wide range of chemotherapy-induced cutaneous toxicities in children and includes clues for diagnosis as well as tips for counseling and management. more...

Background Pediatric melanoma is rare and diagnostically challenging. Objective To characterize clinical and histopathologic features of fatal pediatric melanomas. Methods Multicenter retrospective study of fatal melanoma cases in patients younger than 20 years diagnosed between 1994 and 2017. Results Of 38 cases of fatal pediatric melanoma identified, 57% presented in white patients and 19% in Hispanic patients. The average age at diagnosis was 12.7 years (range, 0.0-19.9 y), and the average age at death was 15.6 years (range, 1.2-26.2 y). Among cases with known identifiable subtypes, 50% were nodular (8/16), 31% were superficial spreading (5/16), and 19% were spitzoid melanoma (3/16). One fourth (10/38) of melanomas arose in association with congenital melanocytic nevi. Limitations Retrospective nature, cohort size, and potential referral bias. Conclusions Pediatric melanoma can be fatal in diverse clinical presentations, including a striking prevalence of Hispanic patients compared to adult disease, and with a range of clinical subtypes, although no fatal cases of spitzoid melanoma were diagnosed during childhood. more...

Background/objectives The COVID-19 pandemic has raised questions about the approach to management of systemic immunosuppressive therapies for dermatologic indications in children. Change to: Given the absence of data to address concerns related to SARS-CoV-2 infection and systemic immunosuppressive therapies in an evidence-based manner, a Pediatric Dermatology COVID-19 Response Task Force (PDCRTF) was assembled to offer time-sensitive guidance for clinicians. Methods A survey was distributed to an expert panel of 37 pediatric dermatologists on the PDCRTF to assess expert opinion and current practice related to three primary domains of systemic therapy: initiation, continuation, and laboratory monitoring. Results Nearly all respondents (97%) reported that the COVID-19 pandemic had impacted their decision to initiate immunosuppressive medications. The majority of pediatric dermatologists (87%) reported that they were pausing or reducing the frequency of laboratory monitoring for certain immunosuppressive medications. In asymptomatic patients, continuing therapy was the most popular choice across all medications queried. The majority agreed that patients on immunosuppressive medications who have a household exposure to COVID-19 or test positive for new infection should temporarily discontinue systemic and biologic medications, with the exception of systemic steroids, which may require tapering. Conclusions The ultimate decision regarding initiation, continuation, and laboratory monitoring of immunosuppressive therapy during the pandemic requires careful deliberation, consideration of the little evidence available, and discussion with families. Consideration of an individual's adherence to COVID-19 preventive measures, risk of exposure, and the potential severity if infected must be weighed against the dermatological disease, medication, and risks to the patient of tapering or discontinuing therapies. more...

Background: Type1 Diabetes Mellitus (T1DM) is the most common endocrine metabolic disorder of childhood casing significant mortality and morbidity in childhood. Home Monitoring of Blood Glucose (HMBG) and Supplements of insulin as required depending on the blood glucose level at that time is a very important aspect of management in T1DM. The Goal of this study was to determine whether frequent checking of home base blood glucose (HMBG) levels accompanied with insulin self dose adjustment, will lead to improved metabolic control as assessed by reduction in the Glycosylated hemoglobin values (HbA1c).Subject and Method:This study was conducted in G.G.Hospital,,M.P.Shah Medical college,Jamanagar between October 2012 to September 2013 for a period of 1 year including OPD and ward patients. Retrospective analysis of clinical profile of 37patients with T1DM attending our OPD between the age group of 2 to 16 years.A detailed clinical and family history, educational level of parents and insulin regime and insulin dose was recorded. Result:Age distribution in our study showed that 62% cases in the age of more than 10 years, 32% cases in the age group 5-10years and 2 % cases falling in the age group 0-2 years, with male to female ratio of a 1:1.7. The most frequently seen symptoms were polyuria (53%), breathlessness (48%),polydipsia (46%), vomiting (29%) of cases and 82%of the patients were ketotic at the time of presentation. In family members most common associated co-morbidity is type 2 DM(21% ) , hypertension(21%) & thyroid dysfunction (19%). split regimen was observed in (70%)and basal bolus regime in (30%). split mix regime 11(42%) had good( more...

BackgroundLight microscopy remains a standard method for the detection of malaria parasites in clinical cases but training of staff to a WHO level 2 or higher requires considerable time. Moreover, excessive workflow can rapidly lead to fatigue and impact performance, even for a highly skilled technician. An automated microscopy tool that can perform consistent, accurate diagnoses could be an effective aid in clinics with limited access to highly skilled microscopists, where the daily number of cases are excessively high for the number of available technicians or in multi-site studies where consistency between sites is essential. The EasyScan GO is an automated scanning microscope combined with machine learning software designed to detect malaria parasites in field-prepared Giemsa-stained blood films. This study evaluates the performance of the EasyScan GO to determine its ability to detect, quantify and identify the species of parasite present in Giemsa-stained blood films compared with expert light microscopy.MethodsTravelers returning to the UK and testing positive for malaria parasite infection were screened for eligibility and enrolled into the study. Surplus blood samples from enrolled patients were subsequently used to make Giemsa-stained thick and thin slide smears that were assessed by expert light microscopy and the EasyScan GO to determine parasite density and species. Blood samples were also assessed by real time PCR and nested PCR (Snounou) to confirm parasite density and species present and to resolve any discrepancy between manual microscopy and the EasyScan GO.ResultsWhen compared to light microscopy, the EasyScan GO exhibited a sensitivity of 90% (95% CI: 82–95%) and a specificity of 89% (95% CI: 86–90%). Of the 95 samples labelled positive by both light microscopy and the EasyScan GO, manual microscopy identified 83 as Plasmodium falciparum (P. falciparum) and 12 as non-P. falciparum. The EasyScan GO correctly reported P. falciparum for 82 out of the 83 P. falciparum samples and non-P. falciparum for 11 out of 12 non-P. falciparum samples. However, it failed to distinguish between non-P. falciparum species, reporting all non-P. falciparum samples as P. vivax. EasyScan GO calculated parasite densities were within +/-25% of the light microscopy densities for 33% of samples between 200 and 2000 p/µL, falling short of WHO level 1 (expert) manual microscopy competency (50% of samples should be within +/-25% of the true parasitaemia).ConclusionsThis study shows that the EasyScan GO can be proficient in detecting malaria parasites in Giemsa-stained blood films relative to expert manual light microscopy and can accurately distinguish between P. falciparum and non-P. falciparum species. Performance of the device at low parasite densities, distinguishing between non-P. falciparum species and accurate quantitation of parasitaemias require further development and evaluation. Nonetheless, the data shown here suggests that the EasyScan GO could provide assistance as a tool for malaria diagnosis in settings where work load is frequently higher than manageable or where access to expert microscopy is difficult. more...

Background Ageratum conyzoides is an aromatic plant. It is considered as an invasive and cosmopolite weed, widely spread in tropical and subtropical regions. Phytochemicals such as benzopyrenes, flavonoids, and terpenoids are reported from A. conyzoides. Objective Development and validation of a reversed-phase HPLC-photodiode array (PDA) detection method for simultaneous identification and quantification of coumarin, precocene-I, β-caryophyllene oxide, α-humulene, and β-caryophyllene in extracts of A. conyzoides and essential oils was carried out. Methods Separation of analytes was achieved on a RP-18 (250 mm × 4.6 mm, 5 µm) column using a solvent system comprising of a mixture of acetonitrile and water with 0.05% trifluoroacetic acid in gradient elution mode at ambient temperature with flow rate of 1 mL/min. Results The retention time of coumarin, precocene-I, β-caryophyllene oxide, α-humulene, and β-caryophyllene was 4.38, 12.86, 20.10, 33.34, and 35.11 min, respectively. Limits of detection for coumarin, precocene-I, β-caryophyllene oxide, α-humulene, and β-caryophyllene were 2.5, 2.5, 2.5, 0.025, and 2.5 µg/mL, respectively. Similarly, LOQ were 10, 10, 10, 0.10, and 10 µg/mL for coumarin, precocene-I, β-caryophyllene oxide, α-humulene, and β- caryophyllene, respectively. Repeatabilities (RSD, %) values for intraday and interday precision for coumarin, precocene-I, β-caryophyllene oxide, α-humulene, and β-caryophyllene was 0.765–2.086 and 0.886–2.128; 0.879–1.672 and 0.979–1.825; 0.696–2.418 and 0.768–2.592; 1.728–2.362 and 1.965–2.378; 1.615–2.897 and 1.658–2.906, respectively. Conclusions The separation of five analytes was achieved within 50 min. The developed and validated HPLC-PDA method was successfully applied for identification and quantification of above five analytes in A. conyzoides extracts and essential oils. The method could be used for meeting the characterization criteria of phytoformulations. more...

Objective: Patients with transfusion-dependent thalassemia (TDT) are susceptible to osteopenia and osteoporosis, the mechanism is multi-factorial. Transfusion-related iron overload in endocrine organs leads to impaired hormonal secretion, all contributing to bone loss. The aim is the assessment of bone loss frequency and related parameters affecting it in TDT patients in tertiary care Centre, Jamnagar. Design: Observational cross-sectional study. Subjects: 33. Methods: The study is conducted over 1 year in TDT patients attending G.G.G. hospital for blood transfusion. After clearance from the ethical committee and consent from parents, patients selected according to inclusion criteria and scanned for Bone Mineral Density (BMD) and biochemical tests. Results analyzed with the help of standard statistical tests. Results: Out of 33 patients, 36% (12) patients had osteopenia while 45% (15) patients had osteoporosis. 84% (16) of 19 male patients and 78% (11) of 14 female patients had low BMD. 80% (4) of 5 patients with high S.TSH levels and all patients with low calcium levels, were detected with low BMD.11% (3) of 27 patients having low BMD, had high S. Alkaline phosphatase level. 85% (6) of 7 patients with low S.FSH levels and 73% (8) of 11 patients with low S.L.H. levels have low BMD. 87% (14) of 16 patients with short stature have low bone mass. Conclusion: Evaluating BMD annually in TDT patients helps prevent and intervene timely. Administration of bisphosphonates, calcium, vitamin-D supplements, hormone replacement therapy, bone-forming agents and newer therapies will help improve bone mass. Changing lifestyle with appropriate diet and exercise, iron chelation therapy, early diagnosis and treatment of endocrine insufficiency and regular blood transfusions help achieve optimal bone density. more...

We are reporting a case of torpedo maculopathy (TM) over a long term follow up with the aid of multimodal imagingof Optical coherence tomography (OCT), Fundus Autofluorescence, En Face OCT, and recent OCT angiography (OCTA)findings. An asymptomatic 18 years old female was clinically found to be having a whitish spindle shaped lesion in theright eye with classic findings of TM. OCT imaging at baseline and at 2 and 4 years follow up did not reveal any changein the retinal structures. A focal excavation of the choroid along with a small subretinal cleft was also seen. Fundusautofluorescence imaging exhibits a central hypofluorescence along with a hyperfluorescent border corresponding tothe lesion. OCTA segmentation of the choriocapillaris vasculature showed increased density of the choroidalvasculature suggestive of its role in the pathogenesis of this lesion. Enigma behind the pathogenesis of this rare lesionis still unsolved. Recently introduced imaging techniques can help us understand this lesion and its pathogenesis indetail. more...

This article reviews existing literature on scaling social impact and proposes a new theoretical framework to understand the ecosystem of scaling social impact beyond organizational growth. By sear... more...

Macronutrients and micronutrients are the key elements of a healthy diet. The correct balance of protein, carbohydrates and fats, along with vitamins and minerals, ensures that all of the body's nutritional requirements are met. Specific daily requirements vary from individual to individual, based on a wide range of factors including age, gender, weight, activity level and general health status. Gram for gram, proteins and carbohydrates contain the same number of calories, whereas fat and alcohol contain more. Proteins have multiple functions in the body, acting as an energy source, in tissue growth and repair and for cell signaling. Carbohydrates primarily provide energy but have additional roles including the regulation of satiety. Highly processed carbohydrates are often digested more easily, can cause rapid fluctuations in blood glucose levels and have been implicated in the increasing incidence of various chronic diseases such as obesity and type 2 diabetes. There are several different types of fat which form part of the human diet. Fat consumption is a controversial topic, with polarising views on the types and quantities of fat required. However, on the basis of the most recent available evidence, a balanced diet should include healthy fats from a variety of natural sources. Vitamins and minerals are the micronutrients required by the body. They have multiple functions and often work synergistically. Micronutrient deficiencies are rare in the developed world, and there is no consistent evidence to suggest that empirical supplementation improves health outcomes, other than in specific circumstances. more...

Health literacy is a key determinant of health. Health literacy is defined as ‘the personal characteristics and social resources needed for individuals and communities to access, understand and use information about health’. Poor health literacy is associated with a greater risk of life limiting conditions, premature death and increased mortality, which comes with a significant economic cost. Many countries are motivated to develop multifaceted approaches to tackle the issues associated with disparities in health literacy. Evidence suggests that health literacy interventions at both system and practitioner level can impact positively upon health behaviours and health outcomes in those with low levels of health literacy. All healthcare professionals should be familiar with the challenges associated with health literacy and the simple steps that can be taken to improve patient care. more...

Loneliness is a feeling that may be experienced by individuals of all ages, backgrounds and from countries around the world. Many personal, social and circumstantial factors can play a role in causing someone to feel lonely. Loneliness has neurobiological effects which directly impact an individual's health and well-being, increasing their risk of developing chronic disease and of premature mortality. It is important to identify those at risk of social and psychological isolation, so that health- and social care systems can intervene and offer support as necessary. more...

Gratitude has been described as a human emotion, an attitude or a personality trait. The practice of gratitude was traditionally associated with religious activities, but it has recently gained significant interest from the medical community. The field of positive psychology has been developing over the past three decades and has found that the practice of gratitude has benefits in five key areas: emotional, social, personality, career and health. There is evidence that those who are naturally more ‘grateful’ are happier, healthier, have better overall wellbeing, are more satisfied with life and sleep better. It is proposed that these effects might be mediated through neuroendocrine mechanisms. The potential health benefits of gratitude lead to the possibility that it could be used as an intervention in healthcare or as adjunct to support traditional medical management in a variety of clinical settings. Although the understanding of gratitude is in its infancy, and many of the current studies addressing gratitude are small and are of variable quality, results suggest it is an area that warrants further research and that could have an important future role in clinical medicine. more...

Purpose To investigate the potential of handheld optical coherence tomography (HH-OCT) in assessing the anterior segment of the eye in patients with primary congenital glaucoma. Design A prospective, case-controlled observational study. Participants Twenty-two patients with primary congenital glaucoma (PCG, 9 females and 13 males; mean age 4.36 ± 3.4 years) and age-, gender- and ethnicity-matched healthy participants. Methods Anterior OCT was performed in all participants using a high-resolution HH SD-OCT device (Envisu 2300, Leica Microsystems, Germany) without anaesthesia or sedation. Results Anterior HH-OCT in PCG visualised Haab’s striae in 14.3%, uneven internal cornea in 9.5% and epithelial thickening in 11.9% of patients with central corneal thickening (CCT, p more...

Background The proliferative phase of infantile hemangiomas (IHs) is usually complete by 9 months of life. Late growth beyond age 3 years is rarely reported. Objective To describe the demographic and clinic characteristics of a cohort of patients with late growth of IH, defined as growth in a patient >3 years of age. Methods A multicenter, retrospective cohort study. Results In total, 59 patients, 85% of which were female, met the inclusion criteria. The mean first episode of late growth was 4.3 (range 3-8.5) years. Head and neck location (55/59; 93%) and presence of deep hemangioma (52/59; 88%) were common characteristics. P osterior fossa malformations, h emangiomas, a rterial anomalies, c ardiac defects, e ye abnormalities (PHACE) syndrome was noted in 20 of 38 (53%) children with segmental facial IH. Systemic therapy (corticosteroid or β-blocker) was given during infancy in 58 of 59 (98%) and 24 of 59 (41%) received systemic therapy (β-blockers) for late IH growth. Limitations The retrospective nature and ascertainment by investigator recall are limitations of the study. Conclusion Late IH growth can occur in children after 3 years of age. Risk factors include head and neck location, segmental morphology, and involvement of deep dermal/subcutaneous tissues. more...

The COVID‐19 pandemic has caused significant shifts in patient care including a steep decline in ambulatory visits and a marked increase in the use of telemedicine. Infantile hemangiomas (IH) can require urgent evaluation and risk stratification to determine which infants need treatment and which can be managed with continued observation. For those requiring treatment, prompt initiation decreases morbidity and improves long‐term outcomes. The Hemangioma Investigator Group has created consensus recommendations for management of IH via telemedicine. FDA/EMA‐approved monitoring guidelines, clinical practice guidelines, and relevant, up‐to‐date publications regarding initiation and monitoring of beta‐blocker therapy were used to inform the recommendations. Clinical decision‐making guidelines about when telehealth is an appropriate alternative to in‐office visits, including medication initiation, dosage changes, and ongoing evaluation, are included. The importance of communication with caregivers in the context of telemedicine is discussed, and online resources for both hemangioma education and propranolol therapy are provided. more...