Does the histopathological subtype of primary basal cell carcinoma predict the subtype of secondary tumours? What role do genetic mutations play?

Background: Basal cell carcinoma (BCC) is one of the most common malignancies in the world. The frequency of histopathological subtypes and the distribution on the body of BCC has been well documented. Less has been written on the nature of secondary tumours. The genetics of BCC is starting to be understood, particularly with the advent of newer medical treatments (hedgehog inhibitors). Objectives: To determine if primary basal cell carcinoma histopathological subtype predicts secondary tumour subtype, as well as their anatomical distribution. Methods: A retrospective case series of patients over the age of 18 was performed from 2009 to 2014, with at least two separate diagnoses of BCC. Results: In 394 identified patients, a total of 1355 BCCs arose in the cohort over the 6-year study period. The number of secondary BCCs per patient ranged from 2 to 19 tumours. Nodular BCC was the most likely to reoccur in secondary tumours (53.3%), followed by mixed subtypes (45.7%). Conclusions: Within our study, we did find a predisposition for secondary BCCs to be of the same histopathological subtype as the primary, particularly with respect to nodular and mixed tumours. Furthermore, we found that secondary tumours were also more likely to occur on the same anatomical site as the primary tumour. We are only just beginning to under the genetic mutations involved in subtype formation.

Temporal patterns in vital sign recording within and across general hospital wards.

Introduction: The use of mobile devices on hospital wards to record patient vital signs and Early Warning Scores provides opportunity for secondary analysis of the data collected. This research investigated how such analysis can contribute to the understanding of the complexities of managing clinical care in hospital environments. Methods: The influence of ward type and the distribution of patient observation intervals was evaluated in relation to the timing of vital signs observation patterns in data collected from eight adult in-patient wards over a 12-month period. Actual and projected observation times were compared across patients with higher and lower National Early Warning Scores (NEWS). Results: Both ward type and the distribution of patient observation intervals were significant predictors of temporal observation patterns. Observation patterns showed evidence of grouping of observation recordings. This was, however, not found for observations of patients with higher NEWS scores (3 or more). Conclusions: Secondary analysis of vital signs observation data can reveal insights into how ward operate. The patterns of observation recordings within a ward are a reflection of ward type and the distribution of patient observation intervals. The grouping of observation recordings of patients with low NEWS (<3) result in late or early observations to fit activity peaks characteristic of the ward culture.

Correction to: Timing rather than user traits mediates mood sampling on smartphones.

An amendment to this paper has been published and can be accessed via the original article.

Identifying Indicators of Smartphone Addiction Through User-App Interaction.

We introduce a new approach to monitoring the activity of smartphone users based on their physical interactions with the interface. Typical events are taps, scrolling and typing, carried out to interact with apps. As compared to other measures, this directly encapsulates potential problematic physical smartphone behaviour as a signal. The approach contrasts against conventions such as self-reporting or timing activity sessions, and it focusses on active rather than passive smartphone activity. Using this alternative method, we collected all user interface interaction events from a sample of 64 participants over a period of 8 weeks, using a bespoke monitoring app called Tymer. User Smartphone Addiction was seen to significantly correlate with high levels of interaction with Lifestyle apps, particularly for female users. Interactions with Social apps in general were also associated with Smartphone Addiction. In particular, user interactions with Snapchat correlated with Smartphone Addiction, represented across all types of interface interaction. This is significant given the widespread usage of Snapchat by teenagers, and we hypothesise that the app's design provides a particularly strong pathway in support of Smartphone Addiction.

Evidence to support common application switching behaviour on smartphones.

We find evidence to support common behaviour in smartphone usage based on analysis of application (app) switching. This is an overlooked aspect of smartphone usage that gives additional insight beyond screen time and the particular apps that are accessed. Using a dataset of usage behaviour from 53 participants over a six-week period, we find strong similarity in the structure of networks built from app switching, despite diversity in the apps used, and the volume of app switching. App switch networks exhibit small-world, broad-scale network features, with a rapid popularity decay, suggesting that preferential attachment may drive next-app decision-making.

Timing rather than user traits mediates mood sampling on smartphones.

OBJECTIVE: Recent years have seen an increasing number of studies using smartphones to sample participants' mood states. Moods are usually collected by asking participants for their current mood or for a recollection of their mood states over a specific period of time. The current study investigates the reasons to favour collecting mood through current or daily mood surveys and outlines design recommendations for mood sampling using smartphones based on these findings. These recommendations are also relevant to more general smartphone sampling procedures. RESULTS: N=64 participants completed a series of surveys at the beginning and end of the study providing information such as gender, personality, or smartphone addiction score. Through a smartphone application, they reported their current mood 3 times and daily mood once per day for 8 weeks. We found that none of the examined intrinsic individual qualities had an effect on matches of current and daily mood reports. However timing played a significant role: the last followed by the first reported current mood of the day were more likely to match the daily mood. Current mood surveys should be preferred for a higher sampling accuracy, while daily mood surveys are more suitable if compliance is more important.

The versatility of the temporoparietal fascial graft (TPFG) in orbital implant exposure.

BACKGROUND: The use of TPFGs for hydroxyapatite, porous polyethylene and silicone implant exposure has been described previously. To the authors' knowledge, this is the first description of this technique for acrylic implant exposure and paediatric patients. PURPOSE: To demonstrate the versatility of the TPFG in orbital implant exposures of varying duration, implant types and patient age as well as for recurrent exposure. METHODS: Retrospective, interventional, non-comparative case series. RESULTS: Twelve patients (13 grafts) are presented with a mean follow-up of 9.5 months. The duration of exposure prior to grafting ranged from 1-11 months occurring in bioceramic, hydroxyapatite, porous polyethylene and acrylic implant types. There were 2 graft failures (success rate 84.6%), one of which was treated with a 2nd TPFG. Two of the cases were from the paediatric age group. CONCLUSION: This study provides further supporting evidence for the safety and efficacy of the TPFG and demonstrates the use of this graft in a variety of different clinical situations.

Bilateral optic disc oedema and associated optic neuropathy in the setting of FOLFOX chemotherapy.

BACKGROUND: To report a case of bilateral optic disc oedema and associated optic neuropathy in the setting of FOLFOX chemotherapy. CASE PRESENTATION: A case of a 57-year-old male being treated with FOLFOX chemotherapy for stage 3B colorectal cancer, who developed bilateral optic disc oedema and associated left sided optic neuropathy is described. The patient presented following cycles 7, 8 and 9 of chemotherapy with a history of bilateral simultaneous intermittent inferior altitudinal field defects. These episodes progressed to bilateral optic nerve oedema and a subsequent left sided optic neuropathy. The patient's symptoms and oedema regressed with discontinuation of chemotherapy. CONCLUSION: This is the first report suggesting a vasospastic role of 5-fluoruracil in 5-FU associated optic neuropathy. It highlights that 5-FU may have the potential to cause arterial vasospasm outside the cardiac vasculature, resulting in end-organ optic nerve ischaemia.