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Treatment of dermatofibromas, beyond surgical excision, has remained inadequate and elusive. Nonsurgical treatment options are desired by both patients and physicians. Erbium glass lasers are known for targeting and remodeling the dermis but have not yet been studied for the treatment of dermatofibromas.To evaluate the efficacy and safety of the fractional 1540-nm erbium glass laser for treatment of dermatofibromas.Thirty-five patients representing 44 dermatofibromas completed 2 consecutive monthly treatments with a non-ablative, fractional 1540-nm erbium glass laser and were evaluated at 4, 8, and 12 weeks after the initial treatment. Dermatofibromas were evaluated using patient surveys given before and after the treatments.By week 4, patients reported improvement in color and texture of the dermatofibromas. These improvements were durable through week 12. No complications were reported.This study demonstrates that the fractional 1540-nm erbium glass laser may be used to improve the color and texture of dermatofibromas and achieve positive patient reported outcomes after only 2 treatments. J Drugs Dermatol. 2022;21(11):1201-1205. doi:10.36849/JDD.6287.

Purpose This study aims to evaluate the effect of Alpha-Stim Anxiety, Insomnia and Depression (AID) cranial electrotherapy stimulation (CES) on anxiety, depression and health-related quality of life for primary care social prescribing service patients with anxiety symptoms. Design/methodology/approach Open-label patient cohort design with no control group. A total of 33 adult patients (average age 42 years) completed six weeks of Alpha-Stim AID use. Pre- and post-intervention assessment with participant self-report measures: Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7) and European Quality of Life Five Dimension (EQ-5D-5L). Findings Reliable improvement and remission rates, respectively, were 53.39% and 33.3% for GAD-7; 46.7% and 29.5% for PHQ-9. There was a significant improvement in GAD-7 and PHQ-9 with large effect sizes. EQ-5D-5L results showed significant improvements in health-related quality of life. Perceived quality of life increased by 0.17 on the health index score, with the intervention adding 1.68 quality-adjusted life years (QALYs). Practical implications Alpha-Stim AID can be delivered through a primary health-care social prescribing service and most patients will use as prescribed and complete treatment course. Alpha-Stim AID CES may be an effective anxiety and depression treatment for people with anxiety symptoms. The widespread roll-out of Alpha-Stim AID in health-care systems should be considered. Originality/value To the best of the authors’ knowledge, this is the first study to respond to the UK’s National Institute for Health and Care (NICE) request for the collection of real-world data to understand better Alpha-Stim AID in relation to people’s treatment uptake, response rates and treatment completion rates (NICE, 2021).

One of the largest climate forcing eruptions of the nineteenth century was, until recently, believed to have taken place at the Babuyan Claro volcano, in the Philippines, in 1831. However, a recent investigation found no reliable evidence of such an eruption, suggesting that the 1831 eruption must have taken place elsewhere. We here present our newly compiled dataset of reported observations of a blue, purple and green sun in August 1831, which we use to reconstruct the transport of a stratospheric aerosol plume from that eruption. The source of the aerosol plume is identified as the eruption of Ferdinandea, which took place about 50 km off the south-west coast of Sicily (37.1∘ N, 12.7∘ E), in July and August 1831. The modest magnitude of this eruption, assigned a volcanic explosivity index (VEI) of 3, has commonly caused it to be discounted or overlooked when identifying the likely source of the stratospheric sulfate aerosol in 1831. It is proposed, however, that convective instability in the troposphere contributed to aerosol reaching the stratosphere and that the aerosol load was enhanced by addition of a sedimentary sulfur component to the volcanic plume. Thus, one of the largest climate forcing volcanic eruptions of the nineteenth century would effectively have been hiding in plain sight, arguably “lowering the bar” for the types of eruptions capable of having a substantial climate forcing impact. Prior estimates of the mass of stratospheric sulfate aerosol responsible for the 1831 Greenland ice core sulfate deposition peaks which have assumed a source eruption at a low-latitude site will, therefore, have been overstated. The example presented in this paper serves as a useful reminder that VEI values were not intended to be reliably correlated with eruption sulfur yields unless supplemented with compositional analyses. It also underlines that eye-witness accounts of historical geophysical events should not be neglected as a source of valuable scientific data.

Goblet cell hyperplasia and overproduction of airway mucin are characteristic features of the lung epithelium of smokers and COPD patients. Tobacco heating products (THPs) are a potentially less risky alternative to combustible cigarettes, and through continued use solus THPs may reduce smoking-related disease risk. Using the MucilAir™ in vitro lung model, a 6-week feasibility study was conducted investigating the effect of repeated cigarette smoke (1R6F), THP aerosol and air exposure. Tissues were exposed to nicotine-matched whole aerosol doses 3 times/week. Endpoints assessed were dosimetry, tight-junction integrity, cilia beat frequency (CBF) and active area (AA), cytokine secretion and airway mucin MUC5AC expression. Comparison of incubator and air exposed controls indicated exposures did not have a significant effect on the transepithelial electrical resistance (TEER), CBF and AA of the tissues. Cytokine secretion indicated clear differences in secretion patterns in response to 1R6F and THP exposure. 1R6F exposure resulted in a significant decrease in the TEER and AA (p=0.000 and p=0.000, respectively), and an increase in MUC5AC positive cells (p=0.002). Repeated THP exposure did not result in a significant change in MUC5AC positive cells. This study demonstrates repeated cigarette smoke whole aerosol exposure can induce these morphological changes in vitro.

Background: Anxiety disorders are the most common mental disorders, typically treated with psychotherapy and medication. These treatments are not suitable for, acceptable to, or effective for everyone. Alpha-Stim AID is a Cranial Electrotherapy Stimulation (CES) treatment with evidence of effectiveness in treating anxiety disorders. Objective: The aim of this paper is to present outcomes on anxiety, depression, and quality of life of Alpha-Stim use in primary care patients in the United Kingdom’s (UK) National Health Service (NHS) who reported symptoms of anxiety. Methods: Open label patient cohort design. Self-report measures: PHQ-9 (depression), GAD-7 (anxiety) and EQ-5D-5L (health related quality of life). Twenty-three patients with symptoms of anxiety completed a six-week course of Alpha-Stim intervention. Results: Reliable improvement and remission rates respectively were 60.9% and 17.4% for the GAD-7; 42.9% and 22.7% for the PHQ-9. Significant improvement and medium/large effect sizes (n2 = 0.59 and 0.56 respectively). EQ-5D-5L results showed significant improvements in quality of life. Perceived quality of life doubled with an improvement of 0.36 on the health index score, this intervention adds 3.64 Quality Adjusted Life Years (QALYs). Limitations: The study was not an RCT, there was no control group. Conclusions: Alpha-Stim AID CES can be delivered through a UK primary care practice, and can have a significant impact on symptoms of anxiety and depression, and improve quality of life in primary care patients with anxiety symptoms. Further feasibility studies in primary care and sufficiently powered RCT are required.

Introduction: This study reviews diving deaths that occurred in Tasmanian waters over a 20-year period. Methods: Detailed analysis was undertaken of deaths that occurred from 01 January 1995 to 31 December 2014. The cases were collated from numerous sources. Utilising a chain of events analysis, factors were identified and assigned to predisposing factors, triggers, disabling agents, disabling injuries and cause of death. These were then scrutinised to ascertain regional variables, remediable factors and linkages which may benefit from targeted risk mitigation strategies. Results: Seventeen deaths were identified across this 20-year period, which included one additional case not previously recorded. All were recreational divers and 15 were male. Five were hookah divers, 12 were scuba divers. Important predisposing factors identified included equipment (condition and maintenance), pre-existing health conditions, diver experience and training. These factors can now be used to promote public health messages for divers. Conclusions: This 20-year study highlighted regional variations for Tasmanian deaths and presents opportunities for strategies to prevent diving deaths in the future. Of particular concern was the diving practice of 'hookah' diving, which has no governing regulations. The study highlighted the importance of applying a structured methodology such as chain of events analysis to scrutinise diving deaths.