Patients' preferences for adjuvant endocrine therapy in early breast cancer: what makes it worthwhile?

Adjuvant endocrine therapy improves recurrence and survival rates, but has side effects and is inconvenient. The aim of this study was to determine the preferences of premenopausal women who had adjuvant endocrine therapy in a randomised trial. In all, 85 (or eighty-five) women completed semistructured interviews 6–30 months after finishing adjuvant endocrine therapy. Hypothetical scenarios based on known potential survival times (5 or 15 years) and rates (60% or 80% at 5 years) without adjuvant endocrine therapy were used to determine the smallest gains women judged necessary to make their adjuvant endocrine therapy worthwhile. Although a third of the women considered gains of 1% in survival rates or 6 months in survival times sufficient to make their adjuvant endocrine therapy worthwhile, more than half the women required gains of at least 5% in survival rates or 3 years in survival time as necessary to make adjuvant endocrine therapy worthwhile. Larger benefits were required by women who had longer treatment, worse side effects, and by those who were treated with goserelin alone. The route of administration (tablet vs injection) did not affect preferences and some women judged small benefits sufficient to make their adjuvant endocrine therapy worthwhile, but many women required larger benefits than their counterparts in similar studies of preferences for adjuvant chemotherapy

Spatially-resolved Thermal Continuum Absorption against the Supernova Remnant W49B

We present sub-arcminute resolution imaging of the Galactic supernova remnant W49B at 74 MHz (25") and 327 MHz (6"), the former being the lowest frequency at which the source has been resolved. While the 327 MHz image shows a shell-like morphology similar to that seen at higher frequencies, the 74 MHz image is considerably different, with the southwest region of the remnant almost completely attenuated. The implied 74 MHz optical depth (~ 1.6) is much higher than the intrinsic absorption levels seen inside two other relatively young remnants, Cas A and the Crab Nebula, nor are natural variations in the relativistic electron energy spectra expected at such levels. The geometry of the absorption is also inconsistent with intrinsic absorption. We attribute the absorption to extrinsic free-free absorption by a intervening cloud of thermal electrons. Its presence has already been inferred from the low-frequency turnover in the integrated continuum spectrum and from the detection of radio recombination lines toward the remnant. Our observations confirm the basic conclusions of those measurements, and our observations have resolved the absorber into a complex of classical HII regions surrounded either partially or fully by low-density HII gas. We identify this low-density gas as an extended HII region envelope (EHE), whose statistical properties were inferred from low resolution meter- and centimeter-wavelength recombination line observations. Comparison of our radio images with HI and H_2CO observations show that the intervening thermal gas is likely associated with neutral and molecular material as well.Comment: 18 pages, LaTeX with AASTeX-5, 5 figures in 7 PostScript files; accepted for publication in the Ap

6.7 GHz methanol absorption toward the Seyfert 2 galaxy NGC 3079

The detection of the 6.7 GHz line of methanol (CH3OH) is reported for the first time toward an object beyond the Magellanic Clouds. Using the Effelsberg 100 m telescope, two absorption features were identified toward the Seyfert 2 galaxy NGC 3079. Both components probably originated on lines-of-sight toward the central region, presumably absorbing the radio continuum of the nuclear sources A, B, and E of NGC 3079. One absorption feature, at the systemic velocity, is narrow and may arise from gas not related to the nuclear environment of the galaxy. The weaker blue-shifted component is wider and may trace outflowing gas. Total A-type CH3OH column densities are estimated to be between a few times 10^13 and a few times 10^15 cm^-2. Because of a highly frequency-dependent continuum background, the overall similarity of HI, OH, and CH3OH absorption profiles hints at molecular clouds that cover the entire area occupied by the nuclear radio continuum sources ~ 4 pc.Comment: 4 pages, 1 figure, accepted for publication in A&A Letter

Chemotherapy-Response Monitoring of Breast Cancer Patients Using Quantitative Ultrasound-Based Intra-Tumour Heterogeneities

© 2017 The Author(s). Anti-cancer therapies including chemotherapy aim to induce tumour cell death. Cell death introduces alterations in cell morphology and tissue micro-structures that cause measurable changes in tissue echogenicity. This study investigated the effectiveness of quantitative ultrasound (QUS) parametric imaging to characterize intra-tumour heterogeneity and monitor the pathological response of breast cancer to chemotherapy in a large cohort of patients (n = 100). Results demonstrated that QUS imaging can non-invasively monitor pathological response and outcome of breast cancer patients to chemotherapy early following treatment initiation. Specifically, QUS biomarkers quantifying spatial heterogeneities in size, concentration and spacing of acoustic scatterers could predict treatment responses of patients with cross-validated accuracies of 82 ± 0.7%, 86 ± 0.7% and 85 ± 0.9% and areas under the receiver operating characteristic (ROC) curve of 0.75 ± 0.1, 0.80 ± 0.1 and 0.89 ± 0.1 at 1, 4 and 8 weeks after the start of treatment, respectively. The patients classified as responders and non-responders using QUS biomarkers demonstrated significantly different survivals, in good agreement with clinical and pathological endpoints. The results form a basis for using early predictive information on survival-linked patient response to facilitate adapting standard anti-cancer treatments on an individual patient basis

Breast-Lesion Characterization using Textural Features of Quantitative Ultrasound Parametric Maps

© 2017 The Author(s). This study evaluated, for the first time, the efficacy of quantitative ultrasound (QUS) spectral parametric maps in conjunction with texture-analysis techniques to differentiate non-invasively benign versus malignant breast lesions. Ultrasound B-mode images and radiofrequency data were acquired from 78 patients with suspicious breast lesions. QUS spectral-analysis techniques were performed on radiofrequency data to generate parametric maps of mid-band fit, spectral slope, spectral intercept, spacing among scatterers, average scatterer diameter, and average acoustic concentration. Texture-analysis techniques were applied to determine imaging biomarkers consisting of mean, contrast, correlation, energy and homogeneity features of parametric maps. These biomarkers were utilized to classify benign versus malignant lesions with leave-one-patient-out cross-validation. Results were compared to histopathology findings from biopsy specimens and radiology reports on MR images to evaluate the accuracy of technique. Among the biomarkers investigated, one mean-value parameter and 14 textural features demonstrated statistically significant differences (p < 0.05) between the two lesion types. A hybrid biomarker developed using a stepwise feature selection method could classify the legions with a sensitivity of 96%, a specificity of 84%, and an AUC of 0.97. Findings from this study pave the way towards adapting novel QUS-based frameworks for breast cancer screening and rapid diagnosis in clinic

Attenuation Imaging with Pulse-Echo Ultrasound based on an Acoustic Reflector

Ultrasound attenuation is caused by absorption and scattering in tissue and is thus a function of tissue composition, hence its imaging offers great potential for screening and differential diagnosis. In this paper we propose a novel method that allows to reconstruct spatial attenuation distribution in tissue based on computed tomography, using reflections from a passive acoustic reflector. This requires a standard ultrasound transducer operating in pulse-echo mode, thus it can be implemented on conventional ultrasound systems with minor modifications. We use calibration with water measurements in order to normalize measurements for quantitative imaging of attenuation. In contrast to earlier techniques, we herein show that attenuation reconstructions are possible without any geometric prior on the inclusion location or shape. We present a quantitative evaluation of reconstructions based on simulations, gelatin phantoms, and ex-vivo bovine skeletal muscle tissue, achieving contrast-to-noise ratio of up to 2.3 for an inclusion in ex-vivo tissue.Comment: Accepted at MICCAI 2019 (International Conference on Medical Image Computing and Computer Assisted Intervention

Scenario analysis report with policy recommendations: An assessment of sustainability, resilience, efficiency and fairness and effective chain relationships in VALUMICS case studies : Deliverable 8.4

This is an open access article distributed under the Creative Commons Attribution License, to view a copy of the license, see: https://creativecommons.org/licenses/by/4.0/. The final version of this report is available at https://doi.org/10.5281/zenodo.6534011The functioning of food value chains entails a complex organisation from farm to fork which is characterised by various governance forms and externalities which have shaped the overall food system. VALUMICS food value chain case studies: wheat to bread, dairy cows to milk, beef cattle to steak, farmed salmon to fillets and tomato to processed tomato were selected to enable explorative and empirical analysis to better understand the functioning of the food system and, to identify the main challenges that need to be addressed to improve sustainability, integrity, resilience, and fairness of European food chains. The VALUMICS system analysis was executed through four operational phases starting with Groundwork & analysis including mapping specific attributes and impacts of food value chains and their externalities. This was followed by Case study baseline analysis, which provided input to the third phase on Modelling and exploration of future scenarios and finally Policy and synthesis of the overall work. This report is an overall synthesis of the VALUMICS results as follows: • Key findings from the VALUMICS project on the functioning of European food value chains and their impacts on more sustainable, resilient, fairer, and transparent food system are summarised through a compilation of 25 Research Findings and Policy Briefs. • By highlighting the major contributions from the research activities throughout the four phases of the VALUMICS project, this report delivers an assessment of various factors influencing sustainability, resilience, efficiency and fairness and effective chain relationships of different food value chains, and their determinants. • The synthesis of the outcome allows the identification of opportunities and challenges characterising the functioning of food supply chains, and thus, the prospects and potentials for strengthening the EU food sector

Astrobiological Complexity with Probabilistic Cellular Automata

Search for extraterrestrial life and intelligence constitutes one of the major endeavors in science, but has yet been quantitatively modeled only rarely and in a cursory and superficial fashion. We argue that probabilistic cellular automata (PCA) represent the best quantitative framework for modeling astrobiological history of the Milky Way and its Galactic Habitable Zone. The relevant astrobiological parameters are to be modeled as the elements of the input probability matrix for the PCA kernel. With the underlying simplicity of the cellular automata constructs, this approach enables a quick analysis of large and ambiguous input parameters' space. We perform a simple clustering analysis of typical astrobiological histories and discuss the relevant boundary conditions of practical importance for planning and guiding actual empirical astrobiological and SETI projects. In addition to showing how the present framework is adaptable to more complex situations and updated observational databases from current and near-future space missions, we demonstrate how numerical results could offer a cautious rationale for continuation of practical SETI searches.Comment: 37 pages, 11 figures, 2 tables; added journal reference belo

Computerized Ultrasound Risk Evaluation (CURE) System: Development of Combined Transmission and Reflection Ultrasound with New Reconstruction Algorithms for Breast Imaging

Our Computerized Ultrasound Risk Evaluation (CURE) system has been developed to the engineering prototype stage and generated unique data sets of both transmission and reflection ultrasound (US). This paper will help define the clinical underpinnings of the developmental process and interpret the imaging results from a similar perspective. The CURE project was designed to incorporate numerous diagnostic parameters to improve upon two major areas of early breast cancer detection. CURE may provide improved tissue characterization of breast masses and reliable detection of abnormal microcalcifications found in some breast cancers and ductal carcinoma in situ (DCIS). Current breast US is limited to mass evaluation, whereas mammography also detects and guides biopsy of malignant calcifications. Screening with CURE remains a distant goal, but improved follow-up of mammographic abnormalities may represent a feasible breakthrough. Improved tissue characterization could result in reduction of the estimated one million benign biopsies each year in the United States, costing up to several billion dollars. Most breast calcifications are benign and comprise-80% of stereotactic biopsies guided by mammography. Ultrasound has the capability of finding some groups of calcifications, but further improvements in resolution should also address tissue characterization to define the soft tissue filling of ducts by DCIS. In this manner, CURE may be able to more accurately identify the malignant calcifications associated with progression of DCIS or early cancers. Currently, high-resolution US images of the breast are performed in the reflection mode at higher frequencies, which also limits depth of penetration. Reconstruction of reflection ultrasound images relies upon acoustic impedance differences in the tissue and includes only direct backscatter of the ultrasound signal. Resolution and tissue contrast of current US continues to improve with denser transducer arrays and image processing, but the operator dependent nature of using a moveable transducer head remains a significant problem for thorough coverage of the entire breast. We have therefore undertaken the development of a whole breast (i.e., including auxiliary tail) system, with improved resolution and tissue characterization abilities. The extensive ultrasound physics considerations, engineering, materials process development and subsequent algorithm reconstruction are beyond the scope of this initial paper. The proprietary nature of these processes will be forthcoming as the intellectual property is fully secured. We will focus here on the imaging outcomes as they apply to eventual expansion into clinical use