Squamous cell carcinoma of the dorsal hands and feet after repeated exposure to ultraviolet nail lamps

Gel nails are a common artificial nail option. Ultraviolet (UV) nail lamps are commonly used to cure gel nails. Ultraviolet A radiation is a known mutagen that penetrates into the nail bed. Although previously reported, the role of UV nail lamps in the carcinogenesis of both keratinocyte carcinoma and melanoma remains controversial. Herein, we report a patient taking the photosensitizing agent hydrochlorothiazide who developed numerous squamous cell carcinomas on the dorsal hands and feet with a 10-year history of UV nail light exposure every 2-3 weeks

Evidence-based deprescribing: reversing the tide of potentially inappropriate polypharmacy

• Objective: To review the adverse drug events (ADEs) risk of polypharmacy; the process of deprescribing and evidence of efficacy in reducing inappropriate polypharmacy; the enablers and barriers to deprescribing; and patient and system of care level strategies that can be employed to enhance deprescribing. • Methods: Literature review. • Results: Inappropriate polypharmacy, especially in older people, imposes a significant burden of ADEs, ill health, disability, hospitalization and even death. The single most important predictor of inappropriate prescribing and risk of ADEs in older patients is the number of prescribed medicines. Deprescribing is the process of systematically reviewing, identifying, and discontinuing potentially inappropriate medicines (PIMs), aimed at minimizing polypharmacy and improving patient outcomes. Evidence of efficacy for deprescribing is emerging from randomized trials and observational studies, and deprescribing protocols have been developed and validated for clinical use. Barriers and enablers to deprescribing by individual prescribers center on 4 themes: (1) raising awareness of the prevalence and characteristics of PIMs; (2) overcoming clinical inertia whereby discontinuing medicines is seen as being a low value proposition compared to maintaining the status quo; (3) increasing skills and competence (self-efficacy) in deprescribing; and (4) countering external and logistical factors that impede the process. • Conclusion: In optimizing the scale and effects of deprescribing in clinical practice, strategies that promote depresribing will need to be applied at both the level of individual patient-prescriber encounters and systems of care

« Malthus in, Malthus out? »

In this paper, we analyse the world model which represents the most ambitious attempt yet to bring together six great forecasts comprising population, resource depletion, food supply, capital investment, pollution and space. We wish to show on the one hand that the model has serious limitations and, on the other, that many different conclusions can be arrived at with this kind of study.

Hearing through your eyes: neural basis of audiovisual cross-activation, revealed by transcranial alternating current stimulation

Some people experience auditory sensations when seeing visual flashes or movements. This prevalent synaesthesia-like ‘visual-evoked auditory response’ (vEAR) could result either from over-exuberant cross-activation between brain areas, and/or reduced inhibition of normally-occurring cross-activation. We have used transcranial alternating current stimulation (tACS) to test these theories. We applied tACS at 10Hz (alpha-band frequency) or 40Hz (gamma-band), bilaterally either to temporal or occipital sites, while measuring same/different discrimination of paired auditory (A) versus visual (V) 'Morse code' sequences. At debriefing, participants were classified as vEAR or non-vEAR depending on whether they reported 'hearing' the silent flashes. In non-vEAR participants, temporal 10Hz tACS caused impairment of A performance, which correlated with improved V; conversely under occipital tACS, poorer V performance correlated with improved A. This reciprocal pattern suggests that sensory cortices are normally mutually inhibitory, and that alpha-frequency tACS may bias the balance of competition between them. vEAR participants showed no tACS effects, consistent with reduced inhibition, or enhanced cooperation between modalities. In addition, temporal 40Hz tACS impaired V performance, specifically in individuals who showed a performance advantage for V (relative to A). Gamma-frequency tACS may therefore modulate the ability of these individuals to benefit from recoding flashes into the auditory modality, possibly by disrupting cross-activation of auditory areas by visual stimulation. Our results support both theories, suggesting that vEAR may depend on disinhibition of normally-occurring sensory cross-activation, which may be expressed more strongly in some individuals. Furthermore, endogenous alpha and gamma-frequency oscillations may function respectively to inhibit or promote this cross-activation

Nonparametric 3D map of the IGM using the Lyman-alpha forest

Visualizing the high-redshift Universe is difficult due to the dearth of available data; however, the Lyman-alpha forest provides a means to map the intergalactic medium at redshifts not accessible to large galaxy surveys. Large-scale structure surveys, such as the Baryon Oscillation Spectroscopic Survey (BOSS), have collected quasar (QSO) spectra that enable the reconstruction of HI density fluctuations. The data fall on a collection of lines defined by the lines-of-sight (LOS) of the QSO, and a major issue with producing a 3D reconstruction is determining how to model the regions between the LOS. We present a method that produces a 3D map of this relatively uncharted portion of the Universe by employing local polynomial smoothing, a nonparametric methodology. The performance of the method is analyzed on simulated data that mimics the varying number of LOS expected in real data, and then is applied to a sample region selected from BOSS. Evaluation of the reconstruction is assessed by considering various features of the predicted 3D maps including visual comparison of slices, PDFs, counts of local minima and maxima, and standardized correlation functions. This 3D reconstruction allows for an initial investigation of the topology of this portion of the Universe using persistent homology