Gamma (30–80 Hz) rhythms in hippocampus and neocortex resulting from the interaction of excitatory and inhibitory cells (E- and I-cells), called Pyramidal-Interneuronal Network Gamma (PING), require that the I-cells respond to the E-cells, but don't fire on their own. In idealized models, there is a sharp boundary between a parameter regime where the I-cells have weak-enough drive for PING, and one where they have so much drive that they fire without being prompted by the E-cells. In the latter regime, they often de-synchronize and suppress the E-cells; the boundary was therefore called the “suppression boundary” by Börgers and Kopell (2005). The model I-cells used in the earlier work by Börgers and Kopell have a “type 1” phase response, i.e., excitatory input always advances them. However, fast-spiking inhibitory basket cells often have a “type 2” phase response: Excitatory input arriving soon after they fire delays them. We study the effect of the phase response type on the suppression transition, under the additional assumption that the I-cells are kept synchronous by gap junctions. When many E-cells participate on a given cycle, the resulting excitation advances the I-cells on the next cycle if their phase response is of type 1, and this can result in suppression of more E-cells on the next cycle. Therefore, strong E-cell spike volleys tend to be followed by weaker ones, and vice versa. This often results in erratic fluctuations in the strengths of the E-cell spike volleys. When the phase response of the I-cells is of type 2, the opposite happens: strong E-cell spike volleys delay the inhibition on the next cycle, therefore tend to be followed by yet stronger ones. The strengths of the E-cell spike volleys don't oscillate, and there is a nearly abrupt transition from PING to ING (a rhythm involving I-cells only).

The incidence of surgical intervention for non-lung cancer diagnosis was low (0.30%) and is comparable to the rate reported in the National Lung Screening Trial (0.62%). Surgical intervention for benign disease was rare (0.24%) in our experience.

Background: Primary care providers (PCPs) frequently address dermatologic concerns and perform skin examinations during clinical encounters. For PCPs who evaluate concerning skin lesions, dermoscopy (a noninvasive skin visualization technique) has been shown to increase the sensitivity for skin cancer diagnosis compared with unassisted clinical examinations. Because no formal consensus existed on the fundamental knowledge and skills that PCPs should have with respect to dermoscopy for skin cancer detection, the objective of this study was to develop an expert consensus statement on proficiency standards for PCPs learning or using dermoscopy.Methods: A 2-phase modified Delphi method was used to develop 2 proficiency standards. In the study's first phase, a focus group of PCPs and dermatologists generated a list of dermoscopic diagnoses and associated features. In the second phase, a larger panel evaluated the proposed list and determined whether each diagnosis was reflective of a foundational or intermediate proficiency or neither.Results: Of the 35 initial panelists, 5 PCPs were lost to follow-up or withdrew; 30 completed the fifth and last round. The final consensus-based list contained 39 dermoscopic diagnoses and associated features.Conclusions: This consensus statement will inform the development of PCP-targeted dermoscopy training initiatives designed to support early cancer detection.