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January 24, 2013

Research Notes

Smartphone diagnosis apps may delay cancer treatment

Smartphone applications that claim to evaluate a user’s photographs of skin lesions for the likelihood of cancer provide highly variable and often inaccurate feedback, according to a study led by Laura Ferris, dermatology faculty member in the School of Medicine.

The findings suggest that relying on these apps instead of consulting with a physician may delay the diagnosis of melanoma and timely, life-saving treatment.

Said Ferris: “These tools may help patients be more mindful about their health care and improve communication between themselves and their physicians, but it’s important that users don’t allow their apps to take the place of medical advice and physician diagnosis.”

The study found that three of the four smartphone applications tested incorrectly diagnosed 30 percent or more melanomas as “unconcerning.”

Ferris and colleagues reviewed applications available in the two most popular smartphone platforms and found that such tools often are marketed to nonclinical users to help them decide, using a digital image for analysis, whether or not their skin lesions are potential melanomas or otherwise of concern, or if they are likely to be benign. Researchers uploaded 188 images of skin lesions to each of the four applications, each of which analyzes images in different ways, including the use of automated algorithms and a review by an anonymous board-certified dermatologist. The applications often are available for free or at a very low cost, and are not subject to any regulatory oversight or validation.

Only the application that used dermatologists for a personal review of user images, essentially functioning as a tool to facilitate teledermatology, provided a high degree of sensitivity in diagnosis: Just one of the 53 melanomas was diagnosed as “benign” by the experts reading the images. This application also was the most expensive, costing users $5 per image evaluation. Although the tools included disclaimers stating they were providing information for educational purposes only, researchers noted the risk that patients might rely on the applications’ evaluations rather than seek the advice of a medical professional.

The likelihood of relying on the application’s free or low-cost evaluation is particularly troubling for the uninsured or economically disadvantaged, especially because many melanomas are detected first by patients. “If they see a concerning lesion but the smartphone app incorrectly judges it to be benign, they may not follow up with a physician,” said Ferris. “Technologies that decrease the mortality rate by improving self- and early-detection of melanomas would be a welcome addition to dermatology. But we have to make sure patients aren’t being harmed by tools that deliver inaccurate results.”

Pitt co-authors were Oleg Akilov, Timothy Patton, Joseph C. English III, Jonhan Ho, Joel A. Wolf and Jacqueline Moreau.

The study was funded by the National Institutes of Health (NIH) and Pitt’s Clinical and Translational Science Institute.

Results were published in JAMA (Journal of the American Medical Association) Dermatology.

Pharmacy faculty named bioengineering fellow

Shilpa Sant, faculty member in the School of Pharmacy’s pharmaceutical sciences and bioengineering department, has been named a 2013 Rising Star/Fellow in the Biomedical Engineering Society’s cellular and molecular bioengineering special-interest group.

This professional society for biomedical engineering and bioengineering, founded in 1968, has almost 6,000 members.

Social networks hike confidence, but also debt & weight

Users of Facebook and other social networks should beware of allowing their self-esteem — boosted by “likes” or positive comments from close friends — to influence their behavior: It could reduce their self-control both on- and offline.

A study coauthored by Andrew T. Stephen, business administration faculty member in the Katz Graduate School of Business and College of Business Administration, demonstrates that users who are focused on close friends tend to experience an increase in self-esteem while browsing their social networks; afterward, these users display less self-control. Greater social network use among this category of users with strong ties to their friends also is associated with individuals having higher body-mass indexes and higher levels of credit-card debt.

Stephen said, “To our knowledge, this is the first research to show that using online social networks can affect self-control.”

In the researchers’ initial study, participants completed surveys about how closely they’re connected to friends on Facebook. They were split into two groups: one group that wrote about the experience of browsing Facebook and another group that actually browsed Facebook. Both groups then completed a self-esteem survey. Regardless of whether the participants wrote about Facebook browsing or actually browsed the site, the participants with weak ties to Facebook friends did not experience an increase in self-esteem, but those with strong ties to friends had an enhanced sense of self-esteem.

The researchers concluded that browsing Facebook only increased participants’ self-esteem when they were focused on the information they were presenting to others —  especially information presented to those with whom they have strong social-network ties.

Participants in another part of the study were instructed to check Facebook or read news articles on, then choose between eating a granola bar or a chocolate-chip cookie. Those who had browsed Facebook were more likely to choose the cookie. Other participants were given anagram word puzzles to solve after either checking Facebook or reading, a celebrity news and gossip website. The Facebook browsers were more likely to give up on the puzzles.

The final investigation, an online field study, examined the relationship between online social network use and offline behaviors associated with poor self-control. Participants completed a survey asking about their height and weight, the number of credit cards they own and the amount of their credit-card debt, and how many friends they have offline, among other questions.

Researchers said the results suggest that greater social network use is associated with a higher body-mass index, increased binge eating, a lower credit score and higher levels of credit-card debt for individuals with strong ties to their social network. Stephen and a colleague from Columbia University concluded that the studies have implications for policymakers because self-control is an important mechanism for maintaining social order and well-being.

The paper is scheduled to be published in June’s Journal of Consumer Research.

Education prof wins national research award

John Jakicic, head of the School of Education’s Department of Health and Physical Activity, has received the Albert J. Stunkard Founders Award for Outstanding Scientific Achievement in Obesity Research from the University of Pennsylvania’s Center for Weight and Eating Disorders.

The national award honors his obesity research, including three papers in JAMA for which he was first author. Previously, Jakicic’s work has focused on the use of technology, such as text messaging, to support weight-loss efforts.

Synthetic material rebuilds itself

Self-moving gels can give synthetic materials the ability to act alive and mimic primitive biological communication, according to Anna Balazs, principal investigator of a new study and faculty member in the Swanson School of Engineering’s chemical and petroleum engineering department. Her team demonstrated that a synthetic system can reconfigure itself through a combination of chemical communication and interaction with light.

Balazs long has studied the properties of the Belousov-Zhabotinsky (BZ) gel, a material first fabricated in the late 1990s and shown to pulsate in the absence of any external stimuli. In a previous study, she and colleagues noticed that long pieces of gel attached to a surface by one end bent toward one another, almost as if they were trying to communicate by sending signals. This hint that communication might be taking place led the team to detach the fixed ends of the gels and allow them to move freely.

They developed a 3-D gel model to test the effects of the chemical signaling and light on the material. They found that when the gel pieces were moved far apart, they would automatically come back together, exhibiting autochemotaxis — the ability to both emit and sense a chemical, and to move in response to that signal.

Said Balazs: “This study demonstrates the ability of a synthetic material to actually ‘talk to itself’ and follow out a given action or command, similar to such biological species as amoeba and termites. Imagine a LEGO set that could, by itself, unsnap its parts and then put itself back together again in different shapes but also allow you to control those shapes through chemical reaction and light.”

The study was published in the Proceedings of the National Academy of Sciences and partially supported by the National Science Foundation, the Army Research Office and the Air Force Office of Scientific Research.

Better TB tests may result from enzyme discovery

Led by Anil Ojha, infectious diseases and microbiology faculty member in the Graduate School of Public Health, researchers have identified an enzyme that will trigger the rapid breakdown of several mycobacteria species, including the bacteria known to cause tuberculosis.

Tuberculosis is one of the most deadly global bacterial infections, killing more than two million people annually. Doctors see nine million new cases every year, mostly in Africa and Southeast Asian countries, although small outbreaks of the disease have been reported in urban areas of the United States. Tuberculosis is caused by Mycobacterium tuberculosis attacking the lungs and is spread through the air.

Ojha said, “Clearly, controlling the infection is heavily dependent upon an effective diagnosis.”

The current bacterial culture test for TB infections is highly accurate but time-consuming, taking up to several weeks. “That’s why our process is so important,” said Ojha. “It can obtain results that are both rapid and accurate.”

The existing diagnostic technique has difficulty in breaking open, or lysing, bacteria to access nucleic acids, while Ojha’s team found that exposure to an esterase, an enzyme that targets fatty acids on the surface of the mycobacterial envelope, led to rapid lysis of the bacilli. They also demonstrated that this quick lysis improved detection of the bacteria at lower density.

Study collaborators included Pitt’s Yong Yang, Alexandra Bhatti, Danxia Ke and Peijun Zhang, as well as researchers from Colorado State University, the University of Montpellier and the French National Center for Scientific Research.

The study, funded by NIH, was published in the Journal of Biological Chemistry.

Pregnant women lack physician help to quit smoking

Many obstetric-care providers could benefit from additional communication training to address smoking cessation effectively with their pregnant patients.

A study, conducted by researchers from the School of Medicine and the Magee-Womens Research Institute (MWRI), reviewed audio-recorded discussions between obstetric-care providers and their pregnant patients to assess whether providers adhered to the “Five A’s” for smoking cessation communication. Previous studies have shown that patients are more likely to quit smoking when care providers ask whether the patient smokes, advise cessation, assess the patient’s willingness and challenges to explore cessation, assist the patient with strategies and resources for cessation, and arrange follow-up to address patients’ specific progress and efforts to quit.

According to Judy Chang, faculty member in obstetrics, gynecology and reproductive sciences, physician-researcher with MWRI and lead investigator of the study: “Very few of the providers we observed performed the recommended Five A’s. Instead, providers seemed more likely to give patients some general information on smoking and smoking cessation.”

Chang and her colleagues recruited 301 pregnant women who agreed to have their first obstetric visit audio-recorded. A total of 139 reported being current smokers. While health-care providers regularly asked about smoking (in 98 percent of visits), only a third of the visits contained either advice to quit or assistance with cessation approaches or resources. In only 22 percent of the visits did providers assess motivations or barriers to quitting and in none of the visits did the providers arrange specific follow-up regarding the cessation progress. None of the care providers adhered to all of the Five A’s; the average amount of time spent talking about smoking cessation was 47 seconds.

Chang said, “We need to bridge the gap in provider-patient communication so that obstetricians, nurse practitioners and other providers who interact with patients can more effectively address cessation with their pregnant smokers.”

The study was funded by the Scaife Family Foundation, an American Professors of Gynecology and Obstetrics/Abbot Medical Education Foundation award, the Building Interdisciplinary Research Careers in Women’s Health Award, the Agency for Healthcare Research and Quality and NIH.

Results were published in the American Journal of Health Promotion.

Vaccine may provide colon cancer immunity

A vaccine developed by the University of Pittsburgh Cancer Institute (UPCI) researchers successfully prompted the immune system to respond to early indications of colon cancer in people at high risk for the disease.

Olivera Finn, head of the Department of Immunology in the School of Medicine, who developed the vaccine, said: “This prophylactic colon cancer vaccine boosts the patient’s natural immune surveillance, which potentially could lead to the elimination of premalignant lesions before their progression to cancer. This might spare patients the risk and inconvenience of repeated invasive surveillance tests.”

Colon cancer takes years to develop and typically starts with a polyp, which is a benign but abnormal growth in the intestinal lining. Polyps that could become cancerous are called adenomas and typically are removed before cancer develops.

The study involved people with a history of advanced adenoma, which places them at higher risk for subsequent colorectal cancer.

Robert E. Schoen, faculty member in the Division of Gastroenterology, Hepatology and Nutrition and clinical leader of the study, noted: “Around 30-40 percent of these patients will develop a new polyp within three years. We demonstrated the ability of the vaccine to boost immunity. Subsequent trials need to evaluate the vaccine for its ability to lower or prevent polyp recurrence and thus progression to colon cancer.”

The Pitt vaccine is directed against an abnormal variant of a self-made cell protein called MUC1, which is altered and produced in excess in advanced adenomas and cancer.

MUC1 also is abnormally present in pancreatic, breast, lung and prostate cancer and will be tested in the future in patients with premalignant lesions leading to some of those cancers.

To date, no vaccine based on cell proteins made by tumors has been tested in humans to prevent cancer. Preclinical models show the vaccine works by targeting the abnormal cells that grow the cancer.

The Pitt vaccine was tested in 39 patients, ages 40-70, without cancer but with a history of advanced adenomas. The vaccine was well-tolerated and safe, researchers said. It produced a strong protective response in 17 of the patients, or 44 percent.

Researchers said the lack of response in the other 22 patients likely was due to already high levels of cells that suppress the immune system’s ability to fight cancer.

“This suggests that it might be better to vaccinate people against colon cancer at an even earlier stage, or vaccinate only people who do not already have suppressed immune systems,” Finn said.

Colorectal cancer is the third-leading cause of cancer death in the United States.

Co-authors included medical school faculty Takashi Kimura, John R. McKolanis, Lynda A. Dzubinski and Kazi Islam, as well as public health’s Douglas M. Potter, and a researcher from Oncovir.

The study, which was published in Cancer Prevention Research, was funded in part by the National Cancer Institute and NIH.


The University Times Research Notes column reports on funding awarded to Pitt researchers as well as findings arising from University research.

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