Smartphone applications for melanoma detection by community, patient and generalist clinician users: a review.

Smartphone health applications ('apps') are widely available but experts remain cautious about their utility and safety. We reviewed currently available apps for the detection of melanoma (July 2014), aimed at general community, patient and generalist clinician users. A proforma was used to extract and assess each app that met the inclusion criteria, and we undertook content analysis to evaluate their content and the evidence applied in their development. Thirty-nine apps were identified with the majority available only for Apple users. Over half (n = 22) provided information or education about melanoma, ultraviolet radiation exposure prevention advice, and skin self-examination strategies, mainly using the ABCDE (A, Asymmetry; B, Border; C, Colour; D, Diameter; E, Evolving) method. Half (n = 19) helped users take and store images of their skin lesions either for review by a dermatologist or for self-monitoring to identify change, an important predictor of melanoma; a similar number (n = 18) used reminders to help users monitor their skin lesions. A few (n = 9) offered expert review of images. Four apps provided a risk assessment to patients about the probability that a lesion was malignant or benign, and one app calculated users' future risk of melanoma. None of the apps appeared to have been validated for diagnostic accuracy or utility using established research methods. Smartphone apps for detecting melanoma by nonspecialist users have a range of functions including information, education, classification, risk assessment and monitoring change. Despite their potential usefulness, and while clinicians may choose to use apps that provide information to educate their patients, apps for melanoma detection require further validation of their utility and safety.This is the final published version. It first appeared at http://dx.doi.org/10.1111/bjd.13665

Multiwavelength observations of nova SMCN 2016-10a — one of the brightest novae ever observed

We report on multiwavelength observations of nova SMCN 2016-10a. The present observational set is one of the most comprehensive for any nova in the Small Magellanic Cloud, including: low, medium, and high resolution optical spectroscopy and spectropolarimetry from SALT, FLOYDS, and SOAR; long-term OGLE V- and I- bands photometry dating back to six years before eruption; SMARTS optical and near-IR photometry from ∼ 11 days until over 280 days post-eruption; Swift satellite X-ray and ultraviolet observations from ∼ 6 days until 319 days post-eruption. The progenitor system contains a bright disk and a main sequence or a sub-giant secondary. The nova is very fast with t2 ≃ 4.0 ± 1.0 d and t3 ≃ 7.8 ± 2.0 d in the V-band. If the nova is in the SMC, at a distance of ∼ 61 ± 10 kpc, we derive MV, max ≃ −10.5 ± 0.5, making it the brightest nova ever discovered in the SMC and one of the brightest on record. At day 5 post-eruption the spectral lines show a He/N spectroscopic class and a FWHM of ∼ 3500 km s−1 indicating moderately high ejection velocities. The nova entered the nebular phase ∼ 20 days post-eruption, predicting the imminent super-soft source turn-on in the X-rays, which started ∼ 28 days post-eruption. The super-soft source properties indicate a white dwarf mass between 1.2 M⊙ and 1.3 M⊙ in good agreement with the optical conclusions

Symptom Signatures and Diagnostic Timeliness in Cancer Patients: A Review of Current Evidence

Early diagnosis is an important aspect of contemporary cancer prevention and control strategies, as the majority of patients are diagnosed following symptomatic presentation. The nature of presenting symptoms can critically influence the length of the diagnostic intervals from symptom onset to presentation (the patient interval), and from first presentation to specialist referral (the primary care interval). Understanding which symptoms are associated with longer diagnostic intervals to help the targeting of early diagnosis initiatives is an area of emerging research. In this Review, we consider the methodological challenges in studying the presenting symptoms and intervals to diagnosis of cancer patients, and summarize current evidence on presenting symptoms associated with a range of common and rarer cancer sites. We propose a taxonomy of cancer sites considering their symptom signature and the predictive value of common presenting symptoms. Finally, we consider evidence on associations between symptomatic presentations and intervals to diagnosis before discussing implications for the design, implementation, and evaluation of public health or health system interventions to achieve the earlier detection of cancer

A DETAILED PHOTOMETRIC AND SPECTROSCOPIC STUDY OF THE 2011 OUTBURST OF THE RECURRENT NOVA T Pyxidis FROM 0.8 TO 250 DAYS AFTER DISCOVERY

We investigated the optical light curve of T Pyx during its 2011 outburst through compiling a database of Solar Mass Ejection Imager (SMEI) and AAVSO observations. The SMEI light curve, providing unprecedented detail covering t=1.5-49 days post-discovery, was divided into four phases based on the idealised nova optical light curve; the initial rise (1.5-3.3 days), the pre-maximum halt (3.3-13.3 days), the final rise (14.7-27.9 days), and the early decline (27.9 days - -). The SMEI light curve contains a strongly detected period of 1.44_0.05 days during the pre-maximum halt phase. These oscillations resemble those found in recent TNR models arising from instabilities in the expanding envelope. No spectral variations that mirror the light curve periodicity were found however. The marked dip at t_22-24 days just before light curve maximum at t=27.9 days may represent the same (shorter duration) phenomenon seen in other novae observed by SMEI and present in some model light curves. The spectra from the 2m Liverpool Telescope and SMARTS 1.5m telescope were obtained from t=0.8-80.7 and 155.1-249.9 days, covering the major phases of development. The nova was observed very early in its rise where a distinct high velocity ejection phase was evident with derived Vej_4000 km

Risk prediction tools for cancer in primary care.

This is the final version of the article. Available from the publisher via the DOI in this record.Numerous risk tools are now available, which predict either current or future risk of a cancer diagnosis. In theory, these tools have the potential to improve patient outcomes through enhancing the consistency and quality of clinical decision-making, facilitating equitable and cost-effective distribution of finite resources such as screening tests or preventive interventions, and encouraging behaviour change. These potential uses have been recognised by the National Cancer Institute as an 'area of extraordinary opportunity' and an increasing number of risk prediction models continue to be developed. The data on predictive utility (discrimination and calibration) of these models suggest that some have potential for clinical application; however, the focus on implementation and impact is much more recent and there remains considerable uncertainty about their clinical utility and how to implement them in order to maximise benefits and minimise harms such as over-medicalisation, anxiety and false reassurance. If the potential benefits of risk prediction models are to be realised in clinical practice, further validation of the underlying risk models and research to assess the acceptability, clinical impact and economic implications of incorporating them in practice are needed

The risk of oesophago-gastric cancer in symptomatic patients in primary care: a large case-control study using electronic records

ArticleBACKGROUND: Over 15 000 new oesophago-gastric cancers are diagnosed annually in the United Kingdom, with most being advanced disease. We identified and quantified features of this cancer in primary care. METHODS: Case-control study using electronic primary-care records of the UK patients aged ≥40 years was performed. Cases with primary oesophago-gastric cancer were matched to controls on age, sex and practice. Putative features of cancer were identified in the year before diagnosis. Odds ratios (ORs) were calculated for these features using conditional logistic regression, and positive predictive values (PPVs) were calculated. RESULTS: A total of 7471 cases and 32 877 controls were studied. Sixteen features were independently associated with oesophago-gastric cancer (all P5% in patients ≥55 years was for dysphagia. In patients <55 years, all PPVs were <1%. CONCLUSION: Symptoms of oesophago-gastric cancer reported in secondary care were also important in primary care. The results should inform guidance and commissioning policy for upper GI endoscopy

The use of teledermatology for the diagnosis of skin cancer in adults

Background Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high risk skin cancers which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised with potential to infiltrate and damage surrounding tissue. Anxiety around missing early curable cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Teledermatology provides a way for generalist clinicians to access the opinion of a specialist dermatologist for skin lesions that they consider to be suspicious without referring the patients concerned through the normal referral pathway. Teledermatology consultations can be ‘store-and-forward’ with electronic digital images of a lesion sent to a dermatologist for review at a later time, or can be live and interactive consultations using video conferencing to connect the patient, referrer and dermatologist in real time. Objectives To determine the diagnostic accuracy of teledermatology for the detection of any skin cancer (melanoma, BCC or cSCC) inNIH

Smartphone applications for triaging adults with skin lesions that are suspicious for melanoma

Background Melanoma accounts for a small proportion of all skin cancer cases but is responsible for the majority of skin cancer-related deaths. Early detection and treatment can improve survival. Smartphone applications are readily accessible and potentially offer an instant risk assessment of the likelihood of malignancy, so that the right people seek further medical attention from a clinician for more detailed assessment of the lesion. There is, however, a risk that melanomas will be missed and treatment delayed if the application reassures the user that their lesion is low risk. Objectives To determine the diagnostic accuracy of smartphone applications to rule out cutaneous invasive melanoma and intraepidermal melanocytic variants in adults with concerns about suspicious skin lesions.NIH

Spectroscopic and Photometric Development of T Pyxidis (2011) from 0.8 to 250 Days After Discovery

We investigated the optical light curve of T Pyx during its 2011 outburst through compiling a database of SMEI and AAVSO observations. The SMEI light curve, providing unprecedented detail with high cadence data during t=1.5-49 days post-discovery, was divided into four phases based on the idealised nova optical light curve; the initial rise, the pre-maximum halt (or the 'plateau'), the final rise, and the early decline. Variation in the SMEI light curve reveals a strongly detected period of 1.44\pm0.04 days before the visual maximum. The spectra from the LT and SMARTS telescopes were investigated during t=0.8-80.7 and 155.1-249.9 days. The nova was observed very early in its rise and a distinct high velocity ejection phase was evident. A marked drop and then gradual increase in derived ejection velocities were present. Here we propose two different stages of mass loss, a short-lived phase occurring immediately after outburst followed by a more steadily evolving and higher mass loss phase. The overall spectral development follows that typical of a Classical Nova and comparison to the photometric behaviour reveals consistencies with the simple evolving pseudo-photosphere model of the nova outburst. The optical spectra are also compared to X-ray and radio light curves. Weak [Fe X] 6375A emission was marginally detected before the rise in X-ray emission. The middle of the plateau in the X-ray light curve is coincident with the appearance of high ionization species detected in optical spectra and the peak of the high frequency radio flux

Concerns, perceived need and competing priorities: a qualitative exploration of decision-making and non-participation in a population-based flexible sigmoidoscopy screening programme to prevent colorectal cancer.

OBJECTIVE: Optimising uptake of colorectal cancer (CRC) screening is important to achieve projected health outcomes. Population-based screening by flexible sigmoidoscopy (FS) was introduced in England in 2013 (NHS Bowel scope screening). Little is known about reactions to the invitation to participate in FS screening, as offered within the context of the Bowel scope programme. We aimed to investigate responses to the screening invitation to inform understanding of decision-making, particularly in relation to non-participation in screening. DESIGN: Qualitative analysis of semistructured in-depth interviews and written accounts. PARTICIPANTS AND SETTING: People from 31 general practices in the North East and East of England invited to attend FS screening as part of NHS Bowel scope screening programme were sent invitations to take part in the study. We purposively sampled interviewees to ensure a range of accounts in terms of beliefs, screening attendance, sex and geographical location. RESULTS: 20 screeners and 25 non-screeners were interviewed. Written responses describing reasons for, and circumstances surrounding, non-participation from a further 28 non-screeners were included in the analysis. Thematic analysis identified a range of reactions to the screening invitation, decision-making processes and barriers to participation. These include a perceived or actual lack of need; inability to attend; anxiety and fear about bowel preparation, procedures or hospital; inability or reluctance to self-administer an enema; beliefs about low susceptibility to bowel cancer or treatment and understanding of harm and benefits. The strength, rather than presence, of concerns about the test and perceived need for reassurance were important in the decision to participate for screeners and non-screeners. Decision-making occurs within the context of previous experiences and day-to-day life. CONCLUSIONS: Understanding the reasons for non-participation in FS screening can help inform strategies to improve uptake and may be transferable to other screening programmes