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

The ticking clock: does actively making an enhanced care team aware of the passage of time improve pre-hospital scene time following traumatic incidents

Introduction:Pre-hospital enhanced care teams like Helicopter Emergency Medical Services (HEMS) are often dispatched to major trauma patients, including patients with traumatic brain injuries and those with major haemorrhage. For these patients, minimizing the time to definitive care is vital. The aim of this study was to determine whether increased awareness of elapsed on scene time produces a relevant time performance improvement for major trauma patients attended by HEMS, and weather introducing such a timer was feasible and acceptable to clinicians. Methods: We performed a prospective cohort study of all single casualty traumatic incidents attended by Air Ambulance Kent Surrey Sussex (AAKSS) between 15 October 2016 and 23 May 2017 to test if introduction of a prompting scene timer within the service resulted in a reduction in pre-hospital scene times. Results: The majority of the patients attended were male (74%) and sustained blunt trauma (92%). Overall, median scene time was 25.5 [IQR16.3] minutes before introduction of the scene timer and 23.0 [11.0] minutes after introduction, p = 0.13). Scene times for patients with a GCS < 8 and for patients requiring prehospital anaesthesia were significantly lower after introduction of the timer (28 [IQR 14] vs 25 [1], p = 0.017 and 34 [IQR 13] vs 28 [IQR11] minutes, p = 0.007 respectively). The majority of clinicians felt the timer made them more aware of passing time (91%) but that this had not made a difference to scene time (62%) or their practice (57%). Conclusion: Audible scene timers may have the potential to reduce pre-hospital scene time for certain single casualty trauma patients treated by a HEMS team, particularly for those patients needing pre-hospital anaesthesia. Regular use of on-scene timers may improve outcomes by reducing time to definitive care for certain subgroups of trauma patientsPeer reviewe

ChIPing the cistrome of PXR in mouse liver

The pregnane X receptor (PXR) is a key regulator of xenobiotic metabolism and disposition in liver. However, little is known about the PXR DNA-binding signatures in vivo, or how PXR regulates novel direct targets on a genome-wide scale. Therefore, we generated a roadmap of hepatic PXR bindings in the entire mouse genome [chromatin immunoprecipitation (ChIP)-Seq]. The most frequent PXR DNA-binding motif is the AGTTCA-like direct repeat with a 4bp spacer [direct repeat (DR)-4)]. Surprisingly, there are also high motif occurrences with spacers of a periodicity of 5 bp, forming a novel DR-(5n + 4) pattern for PXR binding. PXR-binding overlaps with the epigenetic mark for gene activation (histone-H3K4-di-methylation), but not with epigenetic marks for gene suppression (DNA methylation or histone-H3K27-tri-methylation) (ChIP-on-chip). After administering a PXR agonist, changes in mRNA of most PXR-direct target genes correlate with increased PXR binding. Specifically, increased PXR binding triggers the trans-activation of critical drug-metabolizing enzymes and transporters. The mRNA induction of these genes is absent in PXR-null mice. The current work provides the first in vivo evidence of PXR DNA-binding signatures in the mouse genome, paving the path for predicting and further understanding the multifaceted roles of PXR in liver

GPER/GPR30, a Membrane Estrogen Receptor, is Expressed in the Brain and Retina of a Social Fish (Carassius auratus) and Colocalizes with Isotocin

Estradiol rapidly (within 30 minutes) influences a variety of sociosexual behaviors in both mammalian and nonmammalian vertebrates, including goldfish, in which it rapidly stimulates approach responses to the visual cues of females. Such rapid neuromodulatory effects are likely mediated via membrane-associated estrogen receptors; however, the localization and distribution of such receptors within the nervous system is not well described. To begin to address this gap, we identified GPER/GPR30, a G-protein-coupled estrogen receptor, in goldfish (Carassius auratus) neural tissue and used reverse-transcription polymerase chain reaction (RT-PCR) and in situ hybridization to test if GPR30 is expressed in the brain regions that might mediate visually guided social behaviors in males. We then used immunohistochemistry to determine whether GPR30 colocalizes with isotocin-producing cells in the preoptic area, a critical node in the highly conserved vertebrate social behavior network. We used quantitative (q)PCR to test whether GPR30 mRNA levels differ in males in breeding vs. nonbreeding condition and in males that were socially interacting with a female vs. a rival male. Our results show that GPR30 is expressed in the retina and in many brain regions that receive input from the retina and/or optic tectum, as well as in a few nodes in the social behavior network, including cell populations that produce isotocin. J. Comp. Neurol. 525:252–270, 2017

The past, present and future of health geography: An exchange with three long standing participants in the Geographies of Health and Wellbeing Research Group

© 2024 The Authors. This is an open access article distributed under the Creative Commons Attribution License, to view a copy of the license, see: https://creativecommons.org/licenses/by/4.0/This article traces the past, present and future of health geography through the career journeys of three notable academics, Sarah Curtis (SC), Julia Jones (JJ) and Graham Moon (GM). All three of these scholars have had entanglements with the Geographies of Health and Wellbeing Research Group (GHWRG) of the Royal Geographical Society (with the Institute of British Geographers) (RGS‐IBG) throughout their careers, enabling them to shape health geography into the contemporary sub‐discipline that we know today. GHWRG has, for the last 50 years, offered a lively and supportive network for all those interested in the geographies of health and health care, medical geography and all other areas of scholarship related to health and wellbeing that engage with geographical concerns.Peer reviewe

Aseptic meningitis in a patient taking etanercept for rheumatoid arthritis: a case report

Background \ud We report a case of a 53 year old lady recently commenced on etanercept, an anti-TNF (tumour necrosis factor) therapy for rheumatoid arthritis presenting with \ud confusion, pyrexia and an erythematous rash. \ud \ud Case presentation \ud A lumbar puncture was highly suggestive of bacterial meningitis, but CSF cultures produced no growth, and polymerase chain reactions (PCR) for all previously reported bacterial, fungal and viral causes of meningitis were negative. \ud \ud Conclusions \ud This case report describes aseptic meningitis as a previously unreported complication of etanercept therapy, and serves as a reminder of the rare but potentially lifethreatening risk of serious infections in patients taking anti-TNF therapy for a variety of conditions

Achieving Behavioral Health Care Integration in Rural America

Integrating primary care services and treatment for mental health and substance use conditions not only enhances patients' access to needed care but also improves health outcomes in a cost-effective way. Yet the barriers to integrated care are substantial, and it is even more difficult to achieve in rural and frontier communities, which are home to 1 in 7 Americans.Our current work focuses on breaking down the barriers to integration in rural America, where the health care infrastructure and provider composition vary in distinct ways from urban and suburban areas. Americans in rural areas face significant shortages of psychiatrists, psychologists, clinical social workers, and other behavioral health specialists. More than 60% of nonmetropolitan counties lack a psychiatrist, and almost half of nonmetropolitan counties do not have a psychologist, compared with 27% and 19% of urban counties, respectively. These gaps in specialty care force rural residents to rely heavily on primary providers for much of their care

Developing and using a toolkit for cultivating compassion in healthcare: an appreciative inquiry approach

This article describes the process of developing and evaluating a ‘cultivating compassionate care’ toolkit of evidence-based training resources designed to be cascaded through a ‘train-the-trainer’ approach in three healthcare organisations in Southern England. The purpose of the project was to develop an awareness of compassion, and to investigate how compassion can be recognised, developed, and sustained within the healthcare workforce. The study was based on appreciative inquiry and a train-the-trainer model, using focus groups to generate evidence-based training tools designed with the staff in the participating organisations. Questionnaires evaluated the first wave of Cultivating Compassion workshops delivered by trainers, while semi-structured interviews and focus groups evaluated the experiences of those using the toolkit. The findings demonstrated that a cultivating compassion toolkit, co-created with the healthcare workforce, can develop confidence in engaging in discourse on the meaning of compassionate care, and provoke a focus on self-compassion and compassion towards colleagues. Thematic analysis of interviews and focus group data with participants involved in cascading the toolkit activities revealed the value and usability of the toolkit resource, and the leadership factors influencing its implementation. We conclude that cultivating compassionate practices requires leadership to clearly articulate their values and vision for compassion, ensuring these are clearly supported and integrated throughout the organisation as part of changing culture and practices to support compassionate care. The limitation of the study was that we were unable, due to the project timeline, to measure impact of the project on patients, their families, and carers. Keywordsappreciative inquiry; compassion; healthcare workforce; train-the-traine

Model-based Robotic Dynamic Motion Control for the Robonaut 2 Humanoid Robot

Robonaut 2 (R2), an upper-body dexterous humanoid robot, has been undergoing experimental trials on board the International Space Station (ISS) for more than a year. R2 will soon be upgraded with two climbing appendages, or legs, as well as a new integrated model-based control system. This control system satisfies two important requirements; first, that the robot can allow humans to enter its workspace during operation and second, that the robot can move its large inertia with enough precision to attach to handrails and seat track while climbing around the ISS. This is achieved by a novel control architecture that features an embedded impedance control law on the motor drivers called Multi-Loop control which is tightly interfaced with a kinematic and dynamic coordinated control system nicknamed RoboDyn that resides on centralized processors. This paper presents the integrated control algorithm as well as several test results that illustrate R2's safety features and performance