UV imaging reveals facial areas that are prone to skin cancer are disproportionately missed during sunscreen application.

Application of sunscreen is a widely used mechanism for protecting skin from the harmful effects of UV light. However, protection can only be achieved through effective application, and areas that are routinely missed are likely at increased risk of UV damage. Here we sought to determine if specific areas of the face are missed during routine sunscreen application, and whether provision of public health information is sufficient to improve coverage. To investigate this, 57 participants were imaged with a UV sensitive camera before and after sunscreen application: first visit; minimal pre-instruction, second visit; provided with a public health information statement. Images were scored using a custom automated image analysis process designed to identify areas of high UV reflectance, i.e. missed during sunscreen application, and analysed for 5% significance. Analyses revealed eyelid and periorbital regions to be disproportionately missed during routine sunscreen application (median 14% missed in eyelid region vs 7% in rest of face, p<0.01). Provision of health information caused a significant improvement in coverage to eyelid areas in general however, the medial canthal area was still frequently missed. These data reveal that a public health announcement-type intervention could be effective at improving coverage of high risk areas of the face, however high risk areas are likely to remain unprotected therefore other mechanisms of sun protection should be widely promoted such as UV blocking sunglasses

There is no difference between application of sun cream or sun spray.

<p>a) Box and whisker plot of percentage of region missed as detected by automated image analysis software. Line represents median, boxes represent 25 to 75^th percentile, whiskers 5^th and 95^th percentile, outliers denoted by black dots, n = 57. p>0.05 Mann Whitney test b) Box and whisker plot of participants Likert scale responses regarding ease of sun cream/spray application. Line represents median, boxes represent 25 to 75^th percentile, whiskers 5^th and 95^th percentile, n = 40. c, d and e) pie charts representing participants' responses to indicated questions.</p

UV imaging as a mechanism to identify regions of incomplete sunscreen application.

<p>a) UV images before and after sunscreen application. b) UV images of eyelid region showing the impact of SPF15 makeup compared with SPF50 sun cream. c) UV images analysis steps; top left and middle panels, before and after images from sunscreen application. Top right panel, facial landmarks identified by dlib package: green box; cropped facial region, yellow box; eyelid region, magenta boxes; medial canthal areas. Bottom left, cropped facial region. Bottom middle, hue saturation value (HSV) heat map produced from grayscale image, bottom right binary mask generated from thresholding the HSV heat map.</p

Eyelid regions and medial canthal areas are disproportionately missed during routine sunscreen application.

<p>a) Box and whisker plot of percentage of indicated region missed as detected by automated image analysis software. Line represents median, boxes represent 25 to 75^th percentile, whiskers 5^th and 95^th percentile, outliers denoted by black dots, n = 57. * denote significant difference between bracketed groups p<0.01 Mann Whitney test b) Dot plot of percentage area of rest of face missed versus percentage missed in eyelid region. Each dot represents one individual from the trial, n = 57. Spearman correlation coefficient 0.84, p<0.01. c) Box and whisker plots comparing male and females sunscreen application effectiveness plotted as percentage missed of the indicated regions, plotted as in b), d) box and whisker plot comparing application with self-assessed skin type, grouped as types 1 or 2 (n = 42) compared with types 3 or higher (n = 15), plotted as for b), e) Bar chart of percentage of population that either completely covered or failed to cover medial canthal regions. f) Representative UV images of six participants eyelid regions without sunscreen application. Note the dark spots indicating presence of UV damaged skin i.e, areas of pigmentation deep in the dermis that are invisible to the naked eye but visible to UV photography.</p

Provision of a simple information sheet improves eyelid coverage.

<p>a) Representative images without SPF (left), after SPF50 application during routine application (visit 1), or after receiving cancer risk information sheet (visit 2). b) Box and whisker plot of percentage of region missed as detected by automated image analysis software. Line represents median, boxes represent 25 to 75^th percentile, whiskers 5^th and 95^th percentile, outliers denoted by black dots, n = 57. * denote significant difference between bracketed groups, p<0.01 Wilcoxon Signed Ranks test. c) Dot plot showing percentage coverage change against initial percentage eyelid area missed for all participants (n = 57). Values above 0 on this plot indicate improved coverage. Pearson correlation coefficient 0.66, p<0.01. d) Bar chart showing percentage of study population who failed to cover either >20% of their eyelid regions (white), 10–20% (grey) or 0–10%. e) Bar chart of percentage of population that either completely covered or failed to cover medial canthal regions. f) Bar chart of medial canthal area coverage comparing on an individual basis coverage in visit 1 and visit 2, <i>x</i>² p>0.05.</p

Delivering Endothelial Keratoplasty Grafts: Modern Day Transplant Devices

PURPOSE: To summarize the graft loading, transporting and delivery devices used for endothelial keratoplasty (EK). METHODS: A literature search of electronic databases was performed. RESULTS: New techniques and devices have been introduced and implemented to prepare, load, transport and transplant the grafts for EK. The advantages are not only limited to the surgical theatre but also widely spread across the eye banking field. Investigation of advanced materials and designs have been rapidly growing with continuous evolution in the field of eye banking and corneal transplantation. Innovative techniques and modern devices have been evaluated to reduce the endothelial cell loss and increase the precision of the transplant in order to benefit both surgeons and the patients. CONCLUSIONS: It is extremely important to reduce any potential wastage and optimize the use of every available donor cornea due to the limited availability of healthy cadaveric donor corneas required for transplants. As a result, the use of pre-cut and pre-loaded grafts supplied by the eye banks in calibrated devices have been gaining momentum. Innovation in the field of bioengineering for the development of new devices that facilitate excellent clinical outcomes along with reduction in learning curve has shown promising results

Delivering Endothelial Keratoplasty Grafts: Modern Day Transplant Devices

PURPOSE: To summarize the graft loading, transporting and delivery devices used for endothelial keratoplasty (EK). METHODS: A literature search of electronic databases was performed. RESULTS: New techniques and devices have been introduced and implemented to prepare, load, transport and transplant the grafts for EK. The advantages are not only limited to the surgical theatre but also widely spread across the eye banking field. Investigation of advanced materials and designs have been rapidly growing with continuous evolution in the field of eye banking and corneal transplantation. Innovative techniques and modern devices have been evaluated to reduce the endothelial cell loss and increase the precision of the transplant in order to benefit both surgeons and the patients. CONCLUSIONS: It is extremely important to reduce any potential wastage and optimize the use of every available donor cornea due to the limited availability of healthy cadaveric donor corneas required for transplants. As a result, the use of pre-cut and pre-loaded grafts supplied by the eye banks in calibrated devices have been gaining momentum. Innovation in the field of bioengineering for the development of new devices that facilitate excellent clinical outcomes along with reduction in learning curve has shown promising results

Biomaterials for corneal endothelial cell culture and tissue engineering

The corneal endothelium is the posterior monolayer of cells that are responsible for maintaining overall transparency of the avascular corneal tissue via pump function. These cells are non-regenerative in vivo and therefore, approximately 40% of corneal transplants undertaken worldwide are a result of damage or dysfunction of endothelial cells. The number of available corneal donor tissues is limited worldwide, hence, cultivation of human corneal endothelial cells (hCECs) in vitro has been attempted in order to produce tissue engineered corneal endothelial grafts. Researchers have attempted to recreate the current gold standard treatment of replacing the endothelial layer with accompanying Descemet's membrane or a small portion of stroma as support with tissue engineering strategies using various substrates of both biologically derived and synthetic origin. Here we review the potential biomaterials that are currently in development to support the transplantation of a cultured monolayer of hCECs

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality