Inverse deep learning methods and benchmarks for artificial electromagnetic material design

In this work we investigate the use of deep inverse models (DIMs) for designing artificial electromagnetic materials (AEMs) - such as metamaterials, photonic crystals, and plasmonics - to achieve some desired scattering properties (e.g., transmission or reflection spectrum). DIMs are deep neural networks (i.e., deep learning models) that are specially-designed to solve ill-posed inverse problems. There has recently been tremendous growth in the use of DIMs for solving AEM design problems however there has been little comparison of these approaches to examine their absolute and relative performance capabilities. In this work we compare eight state-of-the-art DIMs on three unique AEM design problems, including two models that are novel to the AEM community. Our results indicate that DIMs can rapidly produce accurate designs to achieve a custom desired scattering on all three problems. Although no single model always performs best, the Neural-Adjoint approach achieves the best overall performance across all problem settings. As a final contribution we show that not all AEM design problems are ill-posed, and in such cases a conventional deep neural network can perform better than DIMs. We recommend that a deep neural network is always employed as a simple baseline approach when addressing AEM design problems. We publish python code for our AEM simulators and our DIMs to enable easy replication of our results, and benchmarking of new DIMs by the AEM community.

Radiographic evaluation of humeral head reconstruction with stemmed and stemless spherical implants compared with stemless elliptical head implants

Background

The purpose of this study was to compare the accuracy of anatomic reconstruction of three different humeral head designs after anatomic total shoulder arthroplasty.

Methods

Postoperative radiographs of 117 patients who underwent anatomic total shoulder arthroplasty with three different implant designs (stemmed spherical, stemless spherical, and stemless elliptical) were analyzed for landmarks that represented the prearthritic state and final implant position. We assessed the change in center of rotati7on and humeral head height on the anteroposterior view and the percentage of prosthesis overhang on the axillary lateral view. A modified anatomic reconstruction index, a compound score that rated each of the 3 parameters from 0 to 2, was created to determine the overall accuracy of the reconstruction.

Results

Excellent modified anatomic reconstruction index scores (5 or 6 points) were achieved by 68.1% of the cases in the stemless elliptical group compared with 33.3% of the cases in the stemless spherical group and by 28.3% of the cases in the stemmed spherical group (P = .001).The mean difference in restoration of humeral head height (P < .001) and percentage of prosthesis overhang (P < .001) was superior for the stemless elliptical group compared with the two other spherical head groups. There was no difference between groups for the shift in center of rotation (P = .060).

Conclusions

In this radiographic investigation comparing three different humeral head designs with respect to anatomic restoration parameters, the stemless elliptical implant more closely restored the geometry of the prearthritic humeral head as assessed by humeral head height, prosthesis overhang, and a compound reconstruction score.

Metabolic Syndrome Associated with Tobacco and Caffeine Products Use Among Refugee Adolescents: Risk of Dyslipidemia

INTRODUCTION

Due to their stressful lives, Palestinian refugees are prone to use cognitive enhancers (CE) and psychostimulant substances (PS). Recognising health problems associated with CE/PS use can indicate how preventive programs should be directed towards adolescents. Unfortunately, research has not thoroughly investigated the health problems related to tobacco and caffeine products, the most socially acceptable CE/PS among Palestinian refugee adolescents.

METHODOLOGY

In 2021, schoolchildren from five Palestinian refugee camps (N=271) aged 12-<16 years agreed to give blood samples and to be interviewed to address the association between metabolic syndrome (MetS) and tobacco smoking, coffee, energy drinks (ED), black tea, and chocolate consumption. MetS was diagnosed based on International Diabetic Federation Criteria. To address the association, we used binary logistic regression models adjusted to age, gender, BMI, and central obesity.

RESULTS

The prevalence of MetS was [17 (6.3%)]; (7.4%) in males, (5.1%) in females. The prevalence of substance use was as follows: ED [163 (48.9%)], coffee [255 (76.6%)], black tea [295 (89.1%)], cigarette [35 (10.5%)], waterpipe [59 (17.7%)], and chocolate [309 (93.6%)], with male predominance. Cigarette smokers have increased central obesity (p-value=0.024), and decreased HDL-cholesterol (p-value=0.015) than non-smokers. Similar results were observed for waterpipe smokers besides the increased levels of triglycerides (p-value=0.01). ED consumers have increased central obesity (p-value=0.03) and fast blood sugar (p-value=0.003) than non-consumers. Chocolate consumers have decreased central obesity (p-value=0.008) and increased HDL levels (p-value=0.04) than non-consumers. ED consumers were significantly at higher risk of MetS (OR=9.97, p-value=0.019) than non-consumers and chocolate consumers were at lower risk of MetS (OR=0.14, p-value=0.046) than non-consumers. Waterpipe smokers were at a higher risk of having increased plasma triglycerides than non-consumers (OR=3.4, p-value=0.03).

CONCLUSION

The high prevalence of ED consumption and waterpipe smoking in Palestinian refugee adolescents is problematic. Their use was associated with higher odds of MetS, dyslipidemia, and central obesity, which justifies greater attention.

Vibrational exciton nanoimaging of phases and domains in porphyrin nanocrystals

Much of the electronic transport, photophysical, or biological functions of molecular materials emerge from intermolecular interactions and associated nanoscale structure and morphology. However, competing phases, defects, and disorder give rise to confinement and many-body localization of the associated wavefunction, disturbing the performance of the material. Here, we employ vibrational excitons as a sensitive local probe of intermolecular coupling in hyperspectral infrared scattering scanning near-field optical microscopy (IR s-SNOM) with complementary small-angle X-ray scattering to map multiscale structure from molecular coupling to long-range order. In the model organic electronic material octaethyl porphyrin ruthenium(II) carbonyl (RuOEP), we observe the evolution of competing ordered and disordered phases, in nucleation, growth, and ripening of porphyrin nanocrystals. From measurement of vibrational exciton delocalization, we identify coexistence of ordered and disordered phases in RuOEP that extend down to the molecular scale. Even when reaching a high degree of macroscopic crystallinity, identify significant local disorder with correlation lengths of only a few nanometers. This minimally invasive approach of vibrational exciton nanospectroscopy and -imaging is generally applicable to provide the molecular-level insight into photoresponse and energy transport in organic photovoltaics, electronics, or proteins.

Robots in Human Environments: Basic Autonomous Capabilities

This article discusses the basic capabilities needed to enable robots to operate in human-populated environments for accomplishing both autonomous tasks and human-guided tasks. These capabilities are key to many new emerging robotic applications in service, construction, field, underwater, and space. An important characteristic of these robots is the “assistance” ability they can bring to humans in performing various physical tasks. To interact with humans and operate in their environments, these robots must be provided with the functionality of mobility and manipulation. The article presents developments of models, strategies, and algorithms concerned with a number of autonomous capabilities that are essential for robot operations in human environments. These capabilities include: integrated mobility and manipulation, cooperative skills between multiple robots, interaction ability with humans, and efficient techniques for real-time modification of collision-free path. These capabilities are demonstrated on two holonomic mobile platforms designed and built at Stanford University in collaboration with Oak Ridge National Laboratories and Nomadic Technologies.

Can Flexible Instruments Create Adequate Femoral Tunnel Lengths at 90° of Knee Flexion in Anterior Cruciate Ligament Reconstruction?

PURPOSE

This study aims to study femoral tunnel lengths drilled with a flexible reamer and the distance to important lateral structures obtained by flexing the knee at various angles and by drilling the guide pins arthroscopically to resemble clinical practice. The purpose of this cadaveric study was twofold: 1. to determine whether femoral tunnel lengths of greater than 20 mm can be created with a flexible reamer system at 90 ° of knee flexion and 2. to determine whether the lateral structures of the knee are safe with this technique.

METHODS

Ten fresh cadaveric knees were utilized. The intra-osseous length can be measured with a specially de - signed flexible guide pin. Flexible pins were inserted with the knee at 70°, 90°, and 120° of flexion. The intra-osseous length was measured with the measuring device. Each speci - men was dissected around the lateral aspect of the knee to identify the critical structures, the common peroneal nerve, and the LCL. The distance from the guide pins to the com - mon peroneal nerve and femoral attachment of the LCL were measured with a standard flexible paper ruler to the nearest millimeter.

RESULTS

There is a trend for progressively increasing mean intra-osseous length associated with increased flexion of the knee. The mean intra-osseous length for 70° flexion was 25.2 mm (20 mm to 32 mm), which was statistically significant when compared to mean intra-osseous lengths of 32.1 mm (22 mm to 45 mm) and 38.0 mm (34 mm to 45 mm) in the 90° and 120° flexion groups, respectively (p < 0.05). There were no significant differences among the groups with respect to distance to the LCL. There is a trend toward longer distances to the common peroneal nerve with increased flexion. There was a statistically significant dif - ference when comparing 120° versus 70° (p < 0.05).

CONCLUSIONS

This study that shows that adequate femoral tunnel lengths can be safely created without knee hyperflex - ion using flexible instruments via an anteromedial portal.

Ultrafast Nanoimaging of the Photoinduced Phase Transition Dynamics in VO2

Many phase transitions in correlated matter exhibit spatial inhomogeneities with expected yet unexplored effects on the associated ultrafast dynamics. Here we demonstrate the combination of ultrafast nondegenerate pump-probe spectroscopy with far from equilibrium excitation, and scattering scanning near-field optical microscopy (s-SNOM) for ultrafast nanoimaging. In a femtosecond near-field near-IR (NIR) pump and mid-IR (MIR) probe study, we investigate the photoinduced insulator-to-metal (IMT) transition in nominally homogeneous VO2 microcrystals. With pump fluences as high as 5 mJ/cm(2), we can reach three distinct excitation regimes. We observe a spatial heterogeneity on ∼50-100 nm length scales in the fluence-dependent IMT dynamics ranging from <100 fs to ∼1 ps. These results suggest a high sensitivity of the IMT with respect to small local variations in strain, doping, or defects that are difficult to discern microscopically. We provide a perspective with the distinct requirements and considerations of ultrafast spatiotemporal nanoimaging of phase transitions in quantum materials.

Hybrid Tip-Enhanced Nanospectroscopy and Nanoimaging of Monolayer WSe2 with Local Strain Control

Many classes of two-dimensional (2D) materials have emerged as potential platforms for novel electronic and optical devices. However, their physical properties are strongly influenced by nanoscale heterogeneities in the form of edges, twin boundaries, and nucleation sites. Using combined tip-enhanced Raman scattering and photoluminescence (PL) nanospectroscopy and nanoimaging, we study the associated effects on the excitonic properties in monolayer WSe2 grown by physical vapor deposition. With ∼15 nm spatial resolution, we resolve nanoscale correlations of PL spectral intensity and shifts with crystal edges and internal twin boundaries associated with the expected exciton diffusion length. Through an active atomic force tip interaction we can control the crystal strain on the nanoscale and tune the local bandgap in reversible (up to 24 meV shift) and irreversible (up to 48 meV shift) fashion. This allows us to distinguish the effect of strain from the dominant influence of defects on the PL modification at the different structural heterogeneities. Hybrid nano-optical spectroscopy and imaging with nanomechanical strain control thus enables the systematic study of the coupling of structural and mechanical degrees of freedom to the nanoscale electronic and optical properties in layered 2D materials.

The Effect of Platelet-rich Fibrin Matrix on Rotator Cuff Healing in a Rat Model

The purpose of the current study was to determine if the application of platelet-rich fibrin matrix could improve regeneration of the tendon-bone insertion site in a rat rotator cuff repair model. 25 Lewis syngeneic rats underwent bilateral tenotomy and repair of the supraspinatus tendon. 10 separate rats were used for PRFM harvest. All left (control) shoulders underwent transosseous rotator cuff repair, while all right (treatment) shoulders were repaired similarly with PRFM augmentation. 9 rats were sacrificed at 2-weeks and ten at 4-weeks for biomechanical testing. 3 separate rats were sacrificed at 2-weeks and 4-weeks each for histologic analysis of the insertion site. At 2 weeks, the experimental group repairs were significantly stronger in ultimate load to failure (P=0.01), stress (P=0.03), and stiffness (P=0.03). Differences in biomechanical testing were not found between the groups at 4 weeks. Histological analysis revealed less collagen organization and cartilage formation at the insertion site in the experimental group. Semiquantitative histologic analysis confirmed our qualitative assessment of the specimens. PRFM does not recapitulate the native enthesis, but rather induces an exuberant and disordered healing response that is characterized by fibrovascular scar tissue.

Shoulder arthroplasty in New York State, 1991 to 2010: changing patterns of utilization

BACKGROUND

Shoulder arthroplasty is now used to treat an expanding variety of glenohumeral disorders.

METHODS

This study assessed the demographic patterns and utilization rates of shoulder hemiarthroplasty (HA) and anatomic or reverse total shoulder arthroplasty (TSA) within New York State (NYS) from 1991 to 2010. Using the New York Statewide Planning and Research Cooperative System database, all shoulder arthroplasty procedures that occurred within NYS during the study period were retrospectively identified and analyzed.

RESULTS

During the 20-year period, 24,040 shoulder arthroplasty procedures were performed. During the second decade (2001-2010), there was a 393% increase in utilization of TSA with a 98% increase in HA. This disproportionate increase is likely due to the introduction and expanding indications of reverse TSA as an effective procedure in place of HA for the treatment of proximal humerus fractures and rotator cuff arthropathy, as rotator cuff arthropathy as a primary indication for HA was significantly less prevalent in period 2. Also notable was an identifiable disparity in race; whites represented approximately 80% of the shoulder arthroplasty procedures in both decades, whereas African Americans made up <5%. This is significantly different from the general racial demographics of NYS during both periods analyzed.

DISCUSSION

It is clear that the volume of shoulder arthroplasty procedures performed in NYS is increasing, mirroring the national experience. This trend reflects the expanding indications, the general success of these procedures, the aging demographic of our population, and a greater desire and willingness of patients to consider operative management to maintain or to improve quality of life.

Graphene-Based Platform for Infrared Near-Field Nanospectroscopy of Water and Biological Materials in an Aqueous Environment

Scattering scanning near-field optical microscopy (s-SNOM) has emerged as a powerful nanoscale spectroscopic tool capable of characterizing individual biomacromolecules and molecular materials. However, applications of scattering-based near-field techniques in the infrared (IR) to native biosystems still await a solution of how to implement the required aqueous environment. In this work, we demonstrate an IR-compatible liquid cell architecture that enables near-field imaging and nanospectroscopy by taking advantage of the unique properties of graphene. Large-area graphene acts as an impermeable monolayer barrier that allows for nano-IR inspection of underlying molecular materials in liquid. Here, we use s-SNOM to investigate the tobacco mosaic virus (TMV) in water underneath graphene. We resolve individual virus particles and register the amide I and II bands of TMV at ca. 1520 and 1660 cm(-1), respectively, using nanoscale Fourier transform infrared spectroscopy (nano-FTIR). We verify the presence of water in the graphene liquid cell by identifying a spectral feature associated with water absorption at 1610 cm(-1).

The utility of plain radiographs in the initial evaluation of knee pain amongst sports medicine patients

PURPOSE

To evaluate whether screening radiographs as part of the initial workup of knee pain impacts clinical decision-making in a sports medicine practice.

METHODS

A questionnaire was completed by the attending orthopaedic surgeon following the initial office visit for 499 consecutive patients presenting to the sports medicine centre with a chief complaint of knee pain. The questionnaire documented patient age, duration of symptoms, location of knee pain, associated mechanical symptoms, history of trauma within the past 2 weeks, positive findings on plain radiographs, whether magnetic resonance imaging was ordered, and whether plain radiographs impacted the management decisions for the patient. Patients were excluded if they had prior X-rays, history of malignancy, ongoing pregnancy, constitutional symptoms as well as those patients with prior knee surgery or intra-articular infections. Statistical analyses were then performed to determine which factors were more likely do correspond with diagnostic radiographs.

RESULTS

Overall, initial screening radiographs did not change management in 72 % of the patients assessed in the office. The mean age of patients in whom radiographs did change management was 57.9 years compared to 37.1 years in those patients where plain radiograph did not change management (p < 0.0001). Plain radiographs had no impact on clinical management in 97.3 % of patients younger than 40. In patients whom radiographs did change management, radiographs were more likely to influence management if patients were over age forty, had pain for over 6 months, had medial or diffuse pain, or had mechanical symptoms. A basic cost analysis revealed that the cost of a clinically useful radiographic series in a patient under 40 years of age was $7,600, in contrast to $413 for a useful series in patients above the age of 40.

CONCLUSION

Data from the current study support the hypothesis that for the younger patient population, routine radiographic imaging as a screening tool may be of little clinical benefit. Factors supporting obtaining screening radiographs include age greater than 40, knee pain for greater than 6 months, the presence of medial or diffuse knee pain, and the presence of mechanical symptoms.

LEVEL OF EVIDENCE

II.

The incidence of proximal humeral fractures in New York State from 1990 through 2010 with an emphasis on operative management in patients aged 65 years or older

BACKGROUND

Proximal humeral fractures are commonly encountered injuries. The development of locking plate technology and reverse shoulder arthroplasty may have changed the treatment patterns of these fractures.

METHODS

We used the Statewide Planning and Research Cooperative System database in New York State to determine the incidence of proximal humeral fractures from 1990 through 2010 and the choice of treatment: closed reduction-internal fixation, open reduction-internal fixation (ORIF), hemiarthroplasty (HA), or total shoulder arthroplasty (TSA).

RESULTS

The population-adjusted incidence per 100,000 increased from 15.35 in 1990 to 19.4 in 2010 (P < .0001). In patients aged 65 years or older, the incidence increased from 78.9 in 1990 to 101.0 in 2010 (P < .0001). In 1990, 20.4% of proximal humeral fractures were treated operatively; in 2010, this increased to 28.6% (P < .0001). Closed reduction-internal fixation/ORIF accounted for 58.4% of operative cases in 1990, decreasing to 46.6% in 2001 and increasing to 59.4% in 2010. HA was used in 27.1% of operative cases in 1990, increasing to 41% in 2001 and decreasing to 29.4% in 2010. TSA was used in 6.4% of operative cases in 1990, decreasing to 1.5% in 2001 with an increase to 7.5% in 2010.

DISCUSSION

The incidence of proximal humeral fractures in patients aged 65 or older increased by 28% between 1990 and 2010, and operative management increased by more than 40%. The use of ORIF increased between 2001 and 2010, corresponding with the use of locking plate technology. There was an associated decrease in HA. TSA increased between 2006 and 2010, corresponding to the use of reverse shoulder arthroplasty.

Comparison of ultrasound-guided versus blind glenohumeral injections: a cadaveric study

BACKGROUND

Intra-articular glenohumeral (GH) injections are important for diagnostic and therapeutic purposes. It has been suggested that ultrasound guided injections are more accurate than blind or freehand injections. This study assessed the accuracy of ultrasound-guided GH injections compared with freehand injections in fresh cadavers.

METHODS

The study used 80 shoulder specimens from fresh cadavers. Ultrasound guidance was used to inject radiopaque contrast in 40 shoulders, and freehand technique was used in the remaining 40. All injections were performed by 2 surgeons (A and B) through a posterior approach. After the injections, radiographs were obtained of the specimens to assess the accuracy of the injections.

RESULTS

Sixty-six of 80 (82.5%) injections were accurately administered into the GH joint. Ultrasound-guided injections were accurate in 37 of 40 specimens (92.5%) compared with freehand injections, which were accurate in only 29 of 40 specimens (72.5%; P = .02). Both surgeons independently had higher accuracy using ultrasound-guidance compared with the freehand technique (surgeon A: 90% vs 65%, P = 0.058; surgeon B: 95% vs 80%, P = 0.15). The average time for injections was 52 seconds by the freehand technique and 166 seconds using ultrasound guidance (P < 0.001).

CONCLUSIONS

The data from this cadaveric study suggest that ultrasound-guided injections are more accurate at reaching the GH joint than freehand injections. The ultrasound-guided injections took substantially longer to administer. Once familiar with the technique, surgeons can expect improved accuracy and efficacy of GH joint injections using ultrasound guidance in the clinical setting.

The rising incidence of arthroscopic superior labrum anterior and posterior (SLAP) repairs

BACKGROUND

Superior labrum anterior-posterior (SLAP) lesions of the shoulder that require surgical repair are relatively uncommon. However, recent observations suggest that there may be a rise in the incidence of SLAP lesion repair.

MATERIALS AND METHODS

The Statewide Planning and Research Cooperative Systems (SPARCS) database from the New York State Department of Health was used to acquire data for all outpatient ambulatory surgery procedures that were performed in New York State from 2002 to 2010. The data were reviewed and analyzed to compare the incidence of arthroscopic SLAP lesion repairs relative to other outpatient surgical procedures.

RESULTS

Within New York State, from 2002 to 2010, the number of all ambulatory surgical procedures increased 55%, from 1,411,633 to 2,189,991. Correspondingly, the number of ambulatory orthopedic procedures increased 135%, from 118,126 to 278,136. In comparison, the number of arthroscopic SLAP repairs increased 464%, from 765 to 4,313 (P < .0001). This represented a population-based incidence of 4.0/100,000 in 2002 and 22.3/100,000 in 2010. The mean age of patients undergoing arthroscopic SLAP repair in 2002 was 37 ± 14 years. The mean age in 2010 was 40 ± 14 years (P < .0001).

CONCLUSIONS

The data suggest a substantial increase in the number of arthroscopic SLAP repairs that is significantly more rapid than the rising rate of outpatient orthopedic surgical procedures. In addition, there is a significant increase in the age of patients who are being treated with arthroscopic SLAP repairs.

Robotics-based synthesis of human motion

The synthesis of human motion is a complex procedure that involves accurate reconstruction of movement sequences, modeling of musculoskeletal kinematics, dynamics and actuation, and characterization of reliable performance criteria. Many of these processes have much in common with the problems found in robotics research. Task-based methods used in robotics may be leveraged to provide novel musculoskeletal modeling methods and physiologically accurate performance predictions. In this paper, we present (i) a new method for the real-time reconstruction of human motion trajectories using direct marker tracking, (ii) a task-driven muscular effort minimization criterion and (iii) new human performance metrics for dynamic characterization of athletic skills. Dynamic motion reconstruction is achieved through the control of a simulated human model to follow the captured marker trajectories in real-time. The operational space control and real-time simulation provide human dynamics at any configuration of the performance. A new criteria of muscular effort minimization has been introduced to analyze human static postures. Extensive motion capture experiments were conducted to validate the new minimization criterion. Finally, new human performance metrics were introduced to study in details an athletic skill. These metrics include the effort expenditure and the feasible set of operational space accelerations during the performance of the skill. The dynamic characterization takes into account skeletal kinematics as well as muscle routing kinematics and force generating capacities. The developments draw upon an advanced musculoskeletal modeling platform and a task-oriented framework for the effective integration of biomechanics and robotics methods.

Electronic fluctuations in nanotube circuits and their sensitivity to gases and liquids

The temperature-dependent noise of individual, single-walled carbon nanotubes is measured here in a variety of different gases and liquids. The ambient environment is found to have only a weak relationship with device noise, even in cases where adsorption significantly changes the dc resistance. Correspondingly, a 450 K degassing procedure typically reduces the device noise by only 1 order of magnitude. An important exception to this finding is a pronounced, 100-fold increase in noise observed near gas-liquid phase transitions of the ambient. Wide-range temperature scans clearly identify the condensation of N(2), H(2), and CH(4) onto metallic nanotubes, but not the sublimation of CO(2). The observations suggest that nanotube devices can directly transduce ambient density fluctuations, though without an inherent gas specificity. Even so, the method is a particularly sensitive characterization of nanotube chemical interactions, one which is successful even for the extreme case of inert gases adsorbed on metallic nanotubes.

Noncommunicable diseases: risk factors and regional strategies for prevention and care

Noncommunicable diseases (NCDs) are a major disease burden in the Region. Many of the risk factors are related to lifestyle and can be controlled. Physical inactivity, low fruit and vegetable intake, high fast food consumption and high cholesterol are predominant causes of cardiovascular disease and some cancers. Overweight and obesity can lead to metabolic changes and raise the risk of NCDs, including heart disease and type 2 diabetes. Three main strategies are proposed to deal with the problem: estimate need and advocate for action; develop national policies, strategies and plans for prevention and care; promote and implement community participation in prevention and care. NCDs are preventable using available knowledge; solutions are effective and highly cost-effective.

Noncommunicable diseases: risk factors and regional strategies for prevention and care

Noncommunicable diseases [NCDs] are a major disease burden in the Region. Many of the risk factors are related to lifestyle and can be controlled. Physical inactivity, low fruit and vegetable intake, high fast food consumption and high cholesterol are predominant causes of cardiovascular disease and some cancers. Overweight and obesity can lead to metabolic changes and raise the risk of NCDs, including heart disease and type 2 diabetes. Three main strategies are proposed to deal with the problem:estimate need and advocate for action; develop national policies, strategies and plans for prevention and care; promote and implement community participation in prevention and care. NCDs are preventable using available knowledge; solutions are effective and highly cost-effective