Medical Marijuana and the Healthcare System

Many individuals in America suffer from chronic diseases (Glaucoma, Cancer, PTSD, HIV/AIDS, and multiple sclerosis) and medical marijuana can alleviate the side effects associated with these conditions. The federal government should legalize marijuana in order to give individuals with chronic diseases the organic medication they need to manage their symptoms. The current literature discusses how this topic is a national and community healthcare issue due to the large numbers of individuals with chronic conditions who could benefit from access to medical marijuana. Medical marijuana has the ability to improve the cost, access, and quality of healthcare in the United States for persons living with chronic diseases. This paper explores how cannabis impacts the delivery of healthcare as well as populations who are impacted. Additionally, this paper explores how this topic applies to occupational science, the future role of healthcare providers, and current healthcare policies

Focus on Basal Cell Carcinoma

Nonmelanoma skin cancers (NMSCs), which include basal and squamous cell cancers are the most common human cancers. BCCs have a relatively low metastatic rate and slow growth and are frequently underreported. Whilst there is a definite role of sunexposure in the pathogenesis of BCC, several additional complex genotypic, phenotypic and environmental factors are contributory. The high prevalence and the frequent occurrence of multiple primary BCC in affected individuals make them an important public health problem. This has led to a substantial increase in search for newer noninvasive treatments for BCC. Surgical excision with predetermined margins remains the mainstay treatment for most BCC. Of the newer non-invasive treatments only photodynamic therapy and topical imiquimod have become established in the treatment of certain BCC subtypes, while the search for other more effective and tissue salvaging therapies continues. This paper focuses on the pathogenesis and management of BCC

Actinic Keratosis, a Chronic, Progressive Disease: Understanding Clinical Gaps to Optimise Patient Management

Actinic keratosis (AK) is a chronic, progressive disease of the skin that has undergone long-term sun exposure. The affected areas contain visible and subclinical nonvisible sun damage resulting in epidermal keratinocyte dysplasia, known by many as ‘field cancerisation’ (1), which is prone to AKs and sun-related skin cancer (2). Thus, visible AKs are clinical biomarkers for a photo-damaged field with subclinical damage associated with the unpredictable risk of progression to invasive squamous cell carcinoma (iSCC) (3). The aim of this multiexpert opinion article is to provide a discussion succinctly highlighting the clinical gaps for optimal management of AK: the lack of a universal definition and the need for a standardised grade assessment of AK/field cancerisation that also takes into account individual risk

Apparent preservation of primary foraminiferal Mg/Ca ratios and Mg-banding in recrystallized foraminifera

Trace element and δ18O values of foraminifera are widely used to reconstruct oceanic temperatures throughout the Cenozoic and beyond. Previous work evaluating the geochemistry of foraminifera with differing degrees of physical preservation have shown that Mg/Ca and δ18O paleothermometers give discrepant values in recrystallized tests, with planktonic oxygen isotopes often yielding significantly lower temperatures than Mg/Ca ratios. To study the mobility of elements during diagenesis, we performed microspatial trace element analyses in Eocene Morozovella. Element maps show that trace element banding is readily identifiable and preserved, to an extent, in texturally recrystallized tests. A reaction-diffusion model was used to test whether the preservation of Mg-banding and the decoupling of δ18O and Mg/Ca values could be the result of diffusively limited “closed-system” recrystallization. Results show that, in a closed system, internal features (such as Mg-banding) will dissipate prior to changes in bulk Mg/Ca composition, while the bulk δ18O value will typically change faster than Mg/Ca. This is observed regardless of what partitioning coefficient is used for Mg and demonstrates that the planktonic Mg/Ca proxy is more diagenetically robust than the δ18O proxy. Thus, this model can explain the observed decoupling of these two proxies. Furthermore, the preservation of intra-test Mg-banding shows potential for use in evaluating the preservation of primary Mg/Ca values and hence the accuracy of paleotemperature reconstructions

Electron backscatter diffraction analysis unveils foraminiferal calcite microstructure and processes of diagenetic alteration

Electron backscatter diffraction (EBSD) analysis enables a unique perspective of the internal microstructure of foraminiferal calcite. Specifically, EBSD provides crystallographic data from within the test, highlighting the highly organised “mesocrystal” structure of crystallographically aligned domains throughout the test, formed by sequential deposits of microgranular calcite. We compared EBSD maps across the test walls of both poorly preserved and well-preserved specimens of the planktonic foraminifera species Globigerinoides ruber and Morozovella crater. The EBSD maps, paired with information about intra-test distributions of Mg/Ca ratios, allowed us to examine the effects of different diagenetic processes on the foraminifera test. In poorly preserved specimens EBSD data show extensive reorganisation of the biogenic crystal microstructure, indicating differing phases of dissolution, re-precipitation and overgrowth. The specimens with the greatest degree of microstructural reorganisation also show an absence of higher concentration magnesium bands, which are typical features of well-preserved specimens. These findings provide important insights into the extent of post-depositional changes, in both microstructure and geochemical signals that must be considered when utilising foraminifera to generate proxy archive data

A Novel Actinic Keratosis Field Assessment Scale For Grading Actinic Keratosis Disease Severity

Actinic keratosis (AK) lesions are surrounded by field cancerization (areas of subclinical, non-visible sun damage). Existing AK grading tools rely on AK counts, which are not reproducible. An Actinic Keratosis Field Assessment Scale (AK-FAS) for grading the severity of AK/field was developed. Standardized photographs of patients representing the full range of AK severity were collected. Six investigators independently rated each photograph according to 3 criteria: AK area (total skin area affected by AK lesions), hyperkeratosis and sun damage. Inter-rater reproducibility was good for all 3 criteria. Validation of the AK-FAS showed good reproducibility for AK area and hyperkeratosis, even for dermatologists untrained on use of the scale. In conclusion, the AK-FAS is objective, easy to use and implement, and reproducible. It incorporates assessment of the entire field affected by AK instead of relying on lesion counts. Use of the AK-FAS may standardize AK diagnosis, making it relevant to routine clinical practice

Revealing their true stripes: Mg/Ca banding in the Paleogene planktonic foraminifera genus Morozovella and implications for paleothermometry

The Mg/Ca ratio of foraminiferal calcite is a widely used empirical proxy for ocean temperature. Foraminiferal Mg/Ca-temperature relationships are based on extant species and are species-specific, introducing uncertainty when applying them to the fossil tests of extinct groups. Many modern species show remarkable heterogeneity in their intra-test Mg distributions, typically due to the presence of high Mg bands, which have a biological origin. Importantly, banding patterns differ between species, which could affect Mg/Ca-temperature relationships. Few studies have looked at intra-test variability in Mg/Ca ratios in extinct species of foraminifera, despite the obvious implications for paleothermometry. We used electron probe microanalysis (EPMA) to investigate intra-test Mg distributions in the fossil tests of two species of planktonic foraminifera from the extinct muricate mixed-layer-dwelling genus Morozovella, commonly used in Paleogene sea surface temperature reconstructions. Both M. aragonensis and M. crater show striking Mg banding patterns with multiple high and low Mg/Ca band pairs throughout the test wall in all chambers. The intra-test Mg variability in M. aragonensis and M. crater is similar to that in modern species widely used in paleoclimate reconstructions and banding patterns are consistent with published growth models for modern forms, albeit with subtle differences. The presence of Mg bands supports the application of Mg/Ca-palaeothermometry in extinct Morozovella species as well as the utility of EPMA for examining preservation of foraminifera tests in paleoclimatological studies. However, we emphasize the importance of rigorous assessments of inter- and intra-test Mg variability when using microanalytical techniques for foraminiferal Mg/Ca paleothermometry

Comparison of ALitretinoin with PUVA as the first-line treatment in patients with severe chronic HAnd eczema (ALPHA):study protocol for a randomised controlled trial

Introduction Hand eczema (HE) is one of the most common skin disorders and an important cause for morbidity and occupational disability. The 1-year prevalence of HE is estimated to be up to 10% and it is estimated that 5%–7% of those develop severe chronic HE. However, current clinical evidence is not compelling enough to guide clinical practice. In a survey among 194 UK dermatologists the most frequent first choice approaches were psoralen combined with ultraviolet A (UVA) treatment (PUVA), oral steroids and alitretinoin (AL). When asked which strategy was most efficient for long-term outcome 20% of clinicians indicated they did not know; 43% of clinicians reported AL and 30% reported PUVA. Methods and analysis ALPHA is a multicentre, open, prospective, two-arm parallel group, randomised controlled trial comparing PUVA and AL with a planned sample size re-estimation. Between 500 and 780 participants will be randomised on a 1:1 basis. The physician’s global assessment (PGA) will direct treatment after randomisation, non-responders will be treated according to usual clinical practice; providing valuable pilot data on second line therapeutic approaches to inform future trials. Assessments will be conducted up to 52 weeks post randomisation. The primary outcome measure is the Hand Eczema Severity Index at 12 weeks. Secondary outcome measures include modified Total Lesion Symptom Score, PGA, time to relapse, patient reported outcome measures and DNA extraction and assessment of genetic variants. A substudy on molecular inflammatory mediators will provide information on subgroup specific treatment responses. Photographs will be taken and HE severity assessed by a central review panel