Long-term topical corticosteroid use and risk of skin cancer: a systematic review protocol

Review question/objective: The objective of this systematic review is to synthesize the best available research evidence to determine the risk of skin cancer in patients on long-term use of topical corticosteroids. Specifically the review question is: In people using long-term (regular use over one month) topical corticosteroids, what is the risk of developing skin cancer (clinically or histologically confirmed basal cell carcinoma, squamous cell carcinoma or melanoma)

Machine learning algorithms can predict tail biting outbreaks in pigs using feeding behaviour records

Tail biting is a damaging behaviour that impacts the welfare and health of pigs. Early detection of precursor signs of tail biting provides the opportunity to take preventive measures, thus avoiding the occurrence of the tail biting event. This study aimed to build a machine-learning algorithm for real-time detection of upcoming tail biting outbreaks, using feeding behaviour data recorded by an electronic feeder. Prediction capacities of seven machine learning algorithms (Generalized Linear Model with Stepwise Feature Selection, random forest, Support Vector Machines with Radial Basis Function Kernel, Bayesian Generalized Linear Model, Neural network, K-nearest neighbour, and Partial Least Squares Discriminant Analysis) were evaluated from daily feeding data collected from 65 pens originating from two herds of grower-finisher pigs (25-100kg), in which 27 tail biting events occurred. Data were divided into training and testing data in two different ways, either by randomly splitting data into 75% (training set) and 25% (testing set), or by randomly selecting pens to constitute the testing set. In the first data splitting, the model is regularly updated with previous data from the pen, whereas in the second data splitting, the model tries to predict for a pen that it has never seen before. The K-nearest neighbour algorithm was able to predict 78% of the upcoming events with an accuracy of 96%, when predicting events in pens for which it had previous data. Our results indicate that machine learning models can be considered for implementation into automatic feeder systems for real-time prediction of tail biting events

Creation of a national landslide domain map to aid susceptibility mapping in Great Britain

The need to develop a national map that characterises landslides across Gr eat Britain has long been recognised by the British Geological Survey as part of its strategic role providing hazard information to stakeholders. Hierarchical landslide domains represent areas of similar physiographic , meteorological, climatic and geologi cal characteristics that shaped the style of landsliding. Developed to underpin current research into how different types of landslides and terrains will be affected by changing environmental conditions , the map further assists development of a national l andslide susceptibility map with conditioning factors tailored to a specific domain. This paper considers the role of national - scale land systems mapping to create a Landslide Domain Map , the refinement of a national model using landslide inventories to b etter reflect the spatial extent and characteristics of landslides within domain s . The distribution of landsliding in Great Britain is a product of the complex range of lithologies and geomorphological processes active under a range of climatic conditions. The domain s represent landslides across a series of unstable slopes ranging from very large, ancient landslides formed under periglacial climate conditions to small, modern failures , particularly along transport infrastructure corridors . Although analysis of the National Landslide Database broadly informed the nature of landsliding within a specific domain, expert knowledge was needed to supplement it especially in areas where recent mapping had not taken place. Targeted data collection is planned in data - poor domains to supplement the database . Further domain - specific research is ongoing and includes development of semi - empirical process - specific models involving the weighting of critical factors in order to refine the current national landslide susceptibi lity map, GeoSure. As a n example of this refinement , this paper discusses an improved debris flow model for the Scottish Highlands

Affective interactive narrative in the CALLAS Project

This full text version, available on TeesRep, is the post-print (final version prior to publication) of

Cruise passengers’ perception of key quality attributes of cruise lines in North America

This study identified cruise passengers’ perceived importance and performance of quality attributes for cruise lines in North America by utilizing an importance–performance analysis tool. The results concluded that: (a) room temperature, behavior of other passengers, food and beverages, and accommodation require immediate attention from cruise line operators; (b) the cruise lines are succeeding in providing excellent services for their customers, as well as maintaining a high level of overall shipboard cleanliness; and (c) cruise marketing efforts should promote the attractiveness of onboard activities and facilities, including entertainment, recreation and sports facilities, fitness and health facilities, supplementary facilities, and facilities for children. Overall, the results of this study help cruise lines identify which onboard attributes need more attention and determine the areas that may be consuming too many resources

Long-term topical corticosteroid use and risk of skin cancer: a systematic review

Objective: The objective of this systematic review was to synthesize available research evidence to determine the risk of skin cancer in patients with long-term use of topical corticosteroids (TCS). Introduction: Topical corticosteroids are one of the most commonly prescribed medicines in dermatology and the mainstay of the treatment of atopic dermatitis and other skin conditions such as psoriasis. They are often required for months or years to control the disease and ultimately restore patients’ quality of life. In some patients, TCS may have a local immunosuppressive effect and theoretically increase the risk of skin cancer, whilst on the other hand TCS may decrease the risk of skin cancer in patients where TCS are used to treat inflammatory skin disease. To date, no systematic review has been performed to collate evidence on the effect of long-term TCS use on the risk of skin cancer. Inclusion criteria: This review considered studies that included people of all ages, genders and ethnicities, including HIV and transplant participants or participants with genetic diseases (for example, Gorlin-Goltz syndrome) This review considered studies that evaluated long-term use of topical corticosteroids. “Long-term” was defined as using TCS more than once a week for a month or longer. The review included cohort, cross-sectional and case-control observational studies exploring the association between the stated intervention and outcomes. The primary outcome measures of interest were: non-melanoma skin cancer (keratinocyte carcinoma), cutaneous squamous cell carcinoma (cSSC), basal cell carcinoma (BCC) or melanoma skin cancer. Genital and oral skin cancers are considered to be slightly different so we did not include them in this review. Methods: We performed a comprehensive search of MEDLINE, Embase and LILACS on November 9, 2017 to identify observational epidemiological studies assessing the association between long-term TCS use and skin cancer. We also searched EThOS at the British Library and three drug safety databases to identify unpublished work. The titles, abstracts and full text identified from the search were assessed independently by two authors against pre-specified inclusion/exclusion criteria. Methodological quality was not assessed as no articles were found which met the inclusion criteria. Data extraction was not possible as no articles were found which met the inclusion criteria. It was not possible to complete data synthesis as no articles were found which met the inclusion criteria. Results: A total of 1703 potentially relevant studies were identified following a comprehensive electronic search. After abstract and title screening, 51 full texts were assessed for eligibility criteria. Of these, no study met the inclusion criteria. No additional records were identified from searching unpublished literature. Conclusions: We did not find any studies that could help us establish if long-term TCS use is associated with skin cancer. Future research using primary care databases might give a better understanding regarding long-term use of TCS and skin cancer

Obsessive Compulsive Treatment Efficacy Trial (OCTET) comparing the clinical and cost effectiveness of self-managed therapies: study protocol for a randomised controlled trial

Background: UK National Institute of Health and Clinical Excellence guidelines for obsessive compulsive disorder (OCD) specify recommendations for the treatment and management of OCD using a stepped care approach. Steps three to six of this model recommend treatment options for people with OCD that range from low-intensity guided self-help (GSH) to more intensive psychological and pharmacological interventions. Cognitive behavioural therapy (CBT), including exposure and response prevention, is the recommended psychological treatment. However, whilst there is some preliminary evidence that self-managed therapy packages for OCD can be effective, a more robust evidence base of their clinical and cost effectiveness and acceptability is required. Methods/Design: Our proposed study will test two different self-help treatments for OCD: 1) computerised CBT (cCBT) using OCFighter, an internet-delivered OCD treatment package; and 2) GSH using a book. Both treatments will be accompanied by email or telephone support from a mental health professional. We will evaluate the effectiveness, cost and patient and health professional acceptability of the treatments. Discussion: This study will provide more robust evidence of efficacy, cost effectiveness and acceptability of self-help treatments for OCD. If cCBT and/or GSH prove effective, it will provide additional, more accessible treatment options for people with OCD

Out of Pocket Expenses in Obsessive Compulsive Disorder

Background: Despite anecdotal evidence that the out of pocket costs of OCD can be substantial in some cases, there is no evidence on how many people they affect, or the magnitude of these costs. Aims: This paper explores the type and quantity of out of pocket expenses reported by a large sample of adults with OCD. Methods: Data on out of pocket expenses were collected from participants taking part in the OCTET multi-centre randomised controlled trial. Participants were aged 18+, meeting DSM-IV criteria for OCD, and scoring 16+ on the Yale Brown Obsessive Compulsive Scale. Individual-level resource use data including a description and estimated cost of out of pocket expenses were measured using an adapted version of the Adult Service Use Schedule (AD-SUS): a questionnaire used to collect data on resource use. Results: Forty-five percent (208/465) reported out of pocket expenses due to their OCD. The mean cost of out of pocket expenses was £19.19 per week (SD £27.56 SD), range £0.06–£224.00. Conclusions: Future economic evaluations involving participants with OCD should include out of pocket expenses, but careful consideration of alternative approaches to the collection and costing of this data is needed