Challenges to smartphone applications for melanoma detection

This commentary addresses the emerging market for health-related smartphone applications. Specific to dermatology, there has been a significant increase not only in applications that promote skin cancer awareness and education but also in those meant for detection. With evidence showing that 365 dermatology-related applications were available in 2014--up from 230 in 2012--and that 1 in 5 patients under the age of 50 have used a smartphone to help diagnose a skin problem, there is clearly a large subset of patients participating in this growing trend. Therefore, we are obligated to take a closer look into this phenomenon. Studies have shown that applications are inferior to in-person consultations with one study showing that 3 out of 4 applications incorrectly classified 30% or more melanomas as low-risk lesions. Although the FDA gained regulatory oversight over mobile health applications in 2012 and recently released their statement in 2015, their reach only extends to cover a selected portion of these applications, leaving many unregulated as they continue to be marketed toward our patients. Dermatologists should be updated on our current situation in order to properly counsel patients on the risks and benefits of these applications and whether they are acceptable for use. © 2016 by the article author(s)

Trends in unsolicited dermatologic opinions: A national survey

In dermatology, a particularly common ethical dilemma can arise when the skin lesions of bystanders are inadvertently viewed in public settings. Dermatology is a unique field, where a person’s organ of interest is readily visible to others. When lesions are suspicious for skin disease, unsolicited medical opinions may or may not be given depending on several factors. This study examined the actions and attitudes of dermatologists with different levels of experience through the use of case scenarios with various settings and skin lesions. © 2017, Dermatology Online Journal. All rights reserved

RISE, a Tool for Holistic Sustainability Assessment at the Farm Level

Sustainability must be adopted as a key principle in global markets. Numerous studies have been conducted to evaluate the degree of sustainability on a national and local level. However, only little information for single farm assessment is currently available. The present paper introduces a tool, the "Response-Inducing Sustainability Evaluation" (RISE), which allows an easy assessment at the farm level. It is system-oriented and offers a holistic approach for advice, education and planning. The model covers ecological, economical and social aspects by defining 12 indicators for Energy, Water, Soil, Biodiversity, Emission Potential, Plant Protection, Waste and Residues, Cash Flow, Farm Income, Investments, Local Economy and Social Situation. For each indicator a "State" (S) and a "Driving force" (D) are determined from direct measures of a number of parameters. The "State" indicates the current condition of the specific indicator, higher values are more desirable, and the "Driving force" is a measure of the estimated pressure the farming system places on the specific indicator; in this case lower values are desirable. D and S are standardized on a 0 to 100 scale; a perfect indicator would be identified by S=100 and D=0, whereas significant challenges would be captured by a combination of a low S and a high D. The degree of sustainability (DS) of each indicator is defined as DS= (S-D), bound by construction to the -100 to +100 range. The overall results are summarized and displayed in a sustainability polygon. In addition to this polygon a strength/weakness profile is determined for 1) the stability of the social, economic and ecological framework, 2) farmer's risk awareness and risk management measures, 3) grey energy in machines, buildings and external inputs, 4) animal health and welfare. RISE has been tested and used to evaluate very different farms in Brazil, Canada, China and Switzerland. Results are considered relevant with regard to the objective stated. Further testing, adaptation and fine-tuning is under way. A similar model covering the supply chain to the factory gate is also under development.Sustainability assessment, Sustainability at the farm and crop level, Indicators of sustainability, Driving Force - State - Response (DSR) - model, Environmental Economics and Policy, Farm Management,

Collapse and Revival of an Artificial Atom Coupled to a Structured Photonic Reservoir

A structured electromagnetic reservoir can result in novel dynamics of quantum emitters. In particular, the reservoir can be tailored to have a memory of past interactions with emitters, in contrast to memory-less Markovian dynamics of typical open systems. In this Article, we investigate the non-Markovian dynamics of a superconducting qubit strongly coupled to a superconducting slow-light waveguide reservoir. Tuning the qubit into the spectral vicinity of the passband of this waveguide, we find non-exponential energy relaxation as well as substantial changes to the qubit emission rate. Further, upon addition of a reflective boundary to one end of the waveguide, we observe revivals in the qubit population on a timescale 30 times longer than the inverse of the qubit's emission rate, corresponding to the round-trip travel time of an emitted photon. By tuning of the qubit-waveguide interaction strength, we probe a crossover between Markovian and non-Markovian qubit emission dynamics. These attributes allow for future studies of multi-qubit circuits coupled to structured reservoirs, in addition to constituting the necessary resources for generation of multiphoton highly entangled states

Collapse and Revival of an Artificial Atom Coupled to a Structured Photonic Reservoir

A structured electromagnetic reservoir can result in novel dynamics of quantum emitters. In particular, the reservoir can be tailored to have a memory of past interactions with emitters, in contrast to memory-less Markovian dynamics of typical open systems. In this Article, we investigate the non-Markovian dynamics of a superconducting qubit strongly coupled to a superconducting slow-light waveguide reservoir. Tuning the qubit into the spectral vicinity of the passband of this waveguide, we find non-exponential energy relaxation as well as substantial changes to the qubit emission rate. Further, upon addition of a reflective boundary to one end of the waveguide, we observe revivals in the qubit population on a timescale 30 times longer than the inverse of the qubit's emission rate, corresponding to the round-trip travel time of an emitted photon. By tuning of the qubit-waveguide interaction strength, we probe a crossover between Markovian and non-Markovian qubit emission dynamics. These attributes allow for future studies of multi-qubit circuits coupled to structured reservoirs, in addition to constituting the necessary resources for generation of multiphoton highly entangled states

Potential missed opportunities for diagnosis of cryptococcosis and the association with mortality: A cohort study

BACKGROUND: Cryptococcosis is one of the most common life-threatening opportunistic mycoses worldwide. Insidious presentation and slow onset of symptoms make it difficult to recognize, complicating the diagnostic process. Delays in diagnosis may lead to increased mortality. We aim to determine the frequency of missed opportunities for diagnosis of cryptococcosis and its effects on mortality. METHODS: To estimate the proportion of individuals with a potentially missed diagnosis for cryptococcosis in hospitalized patients, we conducted a retrospective cohort study using the Healthcare Cost and Utilization Project State Inpatient Databases from 2005 to 2015 from eight states. All hospitalized adult patients diagnosed with cryptococcal infection or cryptococcal meningitis were included. Potentially missed diagnoses were defined as admissions coded for a procedure or diagnosis suggestive of cryptococcosis in the 90-days prior to the initial cryptococcosis admission. Generalized estimating equations models were used to evaluate the association between underlying comorbidities and potential missed diagnosis of cryptococcosis and 90-day all-cause in-hospital mortality. FINDINGS: Of 5,354 patients with cryptococcosis, 2,445 (45·7%) were people living with HIV (PLWH). Among PLWH, 493/2,445 (20·2%) had a potentially missed diagnosis, of which 83/493 (16·8%) died while hospitalized compared with 265/1,952 (13·6%) of those without a potentially missed diagnosis (relative risk [RR] 1·04, 95% CI 0·99-1·09). Among HIV-negative patients, 977/2,909 (33·6%) had a potentially missed diagnosis, of which 236/977 (24·2%) died while hospitalized compared with 298/1,932 (15·4%) of those not missed (RR 1·12, 95% CI 1·07-1·16). INTERPRETATION: Missed opportunities to diagnose cryptococcosis are common despite highly efficacious diagnostic tests and are associated with increased risk of 90-day mortality in HIV-negative patients. A high index of clinical suspicion is paramount to promptly diagnose, treat, and improve cryptococcosis-related mortality. FUNDING: National Center for Advancing Translational Sciences, Washington University Institute of Clinical and Translational Sciences, and the Agency for Healthcare Research and Quality

Association of different adverse life events with distinct patterns of depressive symptoms

Objective: The authors sought to determine whether, in a general population sample, different categories of adverse life events were associated with different patterns of depressive symptoms. Method: A total of 4,856 individuals (53% female) who experienced depressive symptoms in the previous year were assessed in up to four waves over a maximum of 12 years. At each wave, participants reported the severity of 12 symptoms disaggregated from the nine DSM-III-R criteria for major depression and the self-identified cause of these symptoms, which were classified into nine categories of adverse life events. Results: The patterns of de pressive symptoms associated with the nine categories of adverse life events differed significantly. Deaths of loved ones and romantic breakups were marked by high levels of sadness, anhedonia, appetite loss, and (for romantic breakups) guilt. Chronic stress and, to a lesser degree, failures were associated with fatigue and hypersomnia, but less so with sadness, anhedonia, and appetite loss. Those who reported that no adverse life events caused their dysphoric episodes reported fatigue, appetite gain, and thoughts of self-harm, but less sadness or trouble concentrating. These symptom patterns were found in a between-persons analysis of participants who had a single dysphoric episode, and they were replicated in an independent within-persons analysis of episode-specific symptom deviations among individuals with multiple episodes. Similar results were obtained when the sample was restricted to those meeting DSM-III-R diagnostic criteria for major depression. Conclusions: Depression is a pathoplastic syndrome. Different types of life events are related to different depressive symptom profiles. The results from the withinpersons analysis suggest that these relationships are causal. A central question in psychiatry has been whether variation in causal factors is related to variation in clinical presentation. While aspects of a syndrome may be central or core (pathogenic), other aspects may be pathoplastic, differing as a function of personal or precipitating factors (1). Much of the debate over the nosology of major depression-the "unitary" (2) versus "pluralistic" (3) viewpoints-can be seen as attempts to understand the pathogenic and pathoplastic nature of depression. What aspects of depression are invariant across individuals and across episodes within individuals, and what, if any, aspects depend on factors specific to the individual or episode? Attempts to understand this latter issue generally focus on differences in symptom profiles, precipitating causes, or both (4). The two most common subdivisions of major depression, melancholic (or endogenous) depression and atypical depression, are based on depressive symptom profiles that are thought to reflect stable interpersonal differences in how depression is manifested in different people. Similarly, diathesis-stress models suggest that distinct symptom profiles arise from interactions between specific cognitive styles and adverse life events (ALEs) to which people with the predisposing cognitive style are particularly vulnerable (5, 6). Both approaches predict that differences in depressive symptoms between episodes are due to stable interpersonal differences and that the symptom profiles of multiple episodes in an individual should be similar. However, several recent studies have found only modest stability in symptom profiles across episodes in the same individual (7-9), which raises the possibility that some of the differences in depressive symptoms across episodes are caused by situational factors. Research on college students (10, 11) has shown relationships between broad ALE categories and distinct depressive symptom patterns. Social losses, such as deaths of loved ones and romantic breakups, were associated with more emotional pain, crying, desire for social support, and appetite loss. Wintertime blues were associated with symptoms typical of seasonal affective disorder. Failures and chronic stress were associated with more guilt, hopelessness, and fatigue

Panoramic Views of the Cygnus Loop

We present a complete atlas of the Cygnus Loop supernova remnant in the light of [O III] (5007), H alpha, and [S II] (6717, 6731). Despite its shell-like appearance, the Cygnus Loop is not a current example of a Sedov-Taylor blast wave. Rather, the optical emission traces interactions of the supernova blast wave with clumps of gas. The surrounding interstellar medium forms the walls of a cavity through which the blast wave now propagates, including a nearly complete shell in which non-radiative filaments are detected. The Cygnus Loop blast wave is not breaking out of a dense cloud, but is instead running into confining walls. The interstellar medium dominates not only the appearance of the Cygnus Loop but also the continued evolution of the blast wave. If this is a typical example of a supernova remnant, then global models of the interstellar medium must account for such significant blast wave deceleration.Comment: 28 pages AAS Latex, 28 black+white figures, 6 color figures. To be published in The Astrophysical Journal Supplement Serie

Hypohidrotic Ectodermal Dysplasia and Immunodeficiency with Coincident NEMO and EDA Mutations

Ectodermal dysplasias (ED) are uncommon genetic disorders resulting in abnormalities in ectodermally derived structures. Many ED-associated genes have been described, of which ectodysplasin-A (EDA) is one of the more common. The NF-κB essential modulator (NEMO encoded by the IKBKG gene) is unique in that mutations result in severe humoral and cellular immunologic defects in addition to ED. We describe three unrelated kindreds with defects in both EDA and IKBKG resulting from X-chromosome crossover. This demonstrates the importance of thorough immunologic consideration of patients with ED even when an EDA etiology is confirmed, and raises the possibility of a specific phenotype arising from coincident mutations in EDA and IKBKG

Varying whole body vibration amplitude differentially affects tendon and ligament structural and material properties

Whole Body Vibration (WBV) is becoming increasingly popular for helping to maintain bone mass and strengthening muscle. Vibration regimens optimized for bone maintenance often operate at hypogravity levels (1 G) vibrations. The effect of vibratory loads on tendon and ligament properties is unclear though excessive vibrations may be injurious. Our objective was to evaluate how tendon gene expression and the mechanical/histological properties of tendon and ligament were affected in response to WBV in the following groups: no vibration, low vibration (0.3 G peak-to-peak), and high vibration (2 G peak-to-peak). Rats were vibrated for 20 min a day, 5 days a week, for 5 weeks. Upon sacrifice, the medial collateral ligament (MCL), patellar tendon (PT), and the Achilles Tendon (AT) were isolated with insertion sites intact. All tissues were tensile tested to determine structural and material properties or used for histology. Patellar tendon was also subjected to quantitative RT-PCR to evaluate expression of anabolic and catabolic genes. No differences in biomechanical data between the control and the low vibration groups were found. There was evidence of significant weakness in the MCL with high vibration, but no significant effect on the PT or AT. Histology of the MCL and PT showed a hypercellular tissue response and some fiber disorganization with high vibration. High vibration caused an increase in collagen expression and a trend for an increase in IGF-1 expression suggesting a potential anabolic response to prevent tendon overuse injury