Intrinsic Information-Theoretic Models.

With this follow-up paper, we continue developing a mathematical framework based on information geometry for representing physical objects. The long-term goal is to lay down informational foundations for physics, especially quantum physics. We assume that we can now model information sources as univariate normal probability distributions N (µ, σ0), as before, but with a constant σ0 not necessarily equal to 1. Then, we also relaxed the independence condition when modeling m sources of information. Now, we model m sources with a multivariate normal probability distribution Nm(µ,Σ0) with a constant variance-covariance matrix Σ0 not necessarily diagonal, i.e., with covariance values different to 0, which leads to the concept of modes rather than sources. Invoking Schrödinger's equation, we can still break the information into m quantum harmonic oscillators, one for each mode, and with energy levels independent of the values of σ0, altogether leading to the concept of "intrinsic". Similarly, as in our previous work with the estimator's variance, we found that the expectation of the quadratic Mahalanobis distance to the sample mean equals the energy levels of the quantum harmonic oscillator, being the minimum quadratic Mahalanobis distance at the minimum energy level of the oscillator and reaching the "intrinsic" Cramér-Rao lower bound at the lowest energy level. Also, we demonstrate that the global probability density function of the collective mode of a set of m quantum harmonic oscillators at the lowest energy level still equals the posterior probability distribution calculated using Bayes' theorem from the sources of information for all data values, taking as a prior the Riemannian volume of the informative metric. While these new assumptions certainly add complexity to the mathematical framework, the results proven are invariant under transformations, leading to the concept of "intrinsic" information-theoretic models, which are essential for developing physics.

Information-Theoretic Models for Physical Observables.

This work addresses J.A. Wheeler's critical idea that all things physical are information-theoretic in origin. In this paper, we introduce a novel mathematical framework based on information geometry, using the Fisher information metric as a particular Riemannian metric, defined in the parameter space of a smooth statistical manifold of normal probability distributions. Following this approach, we study the stationary states with the time-independent Schrödinger's equation to discover that the information could be represented and distributed over a set of quantum harmonic oscillators, one for each independent source of data, whose coordinate for each oscillator is a parameter of the smooth statistical manifold to estimate. We observe that the estimator's variance equals the energy levels of the quantum harmonic oscillator, proving that the estimator's variance is definitively quantized, being the minimum variance at the minimum energy level of the oscillator. Interestingly, we demonstrate that quantum harmonic oscillators reach the Cramér-Rao lower bound on the estimator's variance at the lowest energy level. In parallel, we find that the global probability density function of the collective mode of a set of quantum harmonic oscillators at the lowest energy level equals the posterior probability distribution calculated using Bayes' theorem from the sources of information for all data values, taking as a prior the Riemannian volume of the informative metric. Interestingly, the opposite is also true, as the prior is constant. Altogether, these results suggest that we can break the sources of information into little elements: quantum harmonic oscillators, with the square modulus of the collective mode at the lowest energy representing the most likely reality, supporting A. Zeilinger's recent statement that the world is not broken into physical but informational parts.

Evaluated electron scattering cross section dataset for gaseous benzene in the energy range 0.1-1000 eV.

In this study, a complete and self-consistent cross section dataset for electron transport simulations through gaseous benzene in the energy range 0.1-1000 eV has been critically compiled. Its reliability has been evaluated through a joint experimental and computational procedure. To accomplish this, the compiled dataset has been used as input for event-by-event Monte Carlo simulations of the magnetically confined electron transport through gaseous benzene, and the simulated transmitted intensity has been compared with the experimental one for different incident energies and benzene gas pressures.

Does previous history of cancer or atypia predict histologic upgrade for pure intraductal papillomas diagnosed via core biopsy? A study of 490 cases at a single institution.

BACKGROUND: Management of pure intraductal papillomas (IDP) without atypia diagnosed on core needle biopsy (CNB) remains controversial given highly variable rates of upgrade in the literature. AIM: We sought to identify clinical and histologic factors that predict upgrade to atypia or malignancy in a large population. METHODS AND RESULTS: A retrospective review was performed of all cases of pure IDP diagnosed on CNB and then surgically excised at a single institution from 2008 to 2018. Clinical, radiologic, and pathologic factors were compared in the no upgrade, upgrade to atypia, or upgrade to cancer groups. Univariate analysis was performed comparing no upgrade and upgrade to cancer or atypia. Four hundred and thirty nine patients were identified with a total of 490 IDP and a median age of 50 years (range 16-85). Of these patients, 54 (12.3%) were upgraded to atypia after surgical excision and five (1.1%) were upgraded to cancer. The presence of multiple papillomas in a single patient was a significant predictor of upgrade to cancer or atypia (p < .01), as well as age over ≥55 years (p < .01) and a prior history of cancer (p < .01). No other clinical, radiologic and histologic factors were found to be significant predictors of upgrade. 40/439 (9.1%) patients in the total cohort had prior history of cancer, and of these, 2/40 (5%) were found to have a new cancer after excision. CONCLUSIONS: In patients with pure IDP on CNB, the upgrade rate to malignancy was 1.1%, while 12.3% were upgraded to atypia. The clinical significance of identifying atypia in a papilloma is unknown, especially in a patient with a prior history of atypia or cancer. However, the majority of patients who were upgraded to either atypia or cancer had no prior history of high-risk or malignant breast disease and are therefore considered true clinical upgrades. As such excision for IDP should be considered.

Trends in neoadjuvant chemotherapy versus surgery-first in stage I HER2-positive breast cancer patients in the National Cancer DataBase (NCDB).

BACKGROUND: Neoadjuvant chemotherapy (NAC) is the standard of care for locally advanced HER2 + breast cancer (BC). Optimal sequencing of treatment (NAC vs. surgery first) is less clear cut in stage I (T1N0) HER2 + BC, where information from surgical pathology could impact adjuvant treatment decisions. Utilizing the NCDB, we evaluated the trend of NAC use compared to upfront surgery in patients with small HER2 + BC. METHODS: We identified NCDB female patients diagnosed with T1 N0 HER2 + BC from 2010 through 2015. Prevalence ratios (PR) using multivariable robust Poisson regression models were calculated to measure the association between baseline characteristics and the receipt of NAC. Analysis of trends over time was denoted by annual percent change (APC) of NAC versus surgery upfront. RESULTS: Of the 14,949 that received chemotherapy and anti-HER2 therapy during the study period, overall 1281 (8.6%) received NAC and 13,668 (91.4%) received adjuvant treatment. Patients receiving NAC increased annually from 4.2% in 2010 to 17.3% in 2015, with the most rapid increase occurring between years 2013 (8.5%) and 2014 (14.2%). The greatest increase was seen in patients with cT1c tumors with an APC of 37.8% over the study period (95% CI 29.0, 47.3%, p < 0.01), although a significant trend was likewise seen in patients with cT1a (APC = 26.1%,95% CI 1.59, 56.6%), and cT1b (APC = 27.4%, 95% CI 18.0, 37.7%) tumors. Predictors of neoadjuvant therapy receipt were age younger than 50 (PR = 1.69, 95% CI 1.52, 1.89), Mountain/Pacific area (PR = 1.24, 95% CI 1.05, 1.46), and estrogen receptor negativity (ER- PR + : PR = 2.01, 95% CI 1.51, 2.68; ER- PR- : PR = 1.49, 95% CI 1.32, 1.69). CONCLUSIONS: Neoadjuvant therapy for T1 N0 HER2 + BC increased over the study period and was mostly due increased use in clinical T1c tumors. This may be consistent with secular change in Pertuzumab treatment following FDA approval in 2013.

Adherence to NCCN Guidelines for Genetic Testing in Breast Cancer Patients: Who Are We Missing?

BACKGROUND: Genetic predisposition accounts for 5-10% of all breast cancers (BC) diagnosed. NCCN guidelines help providers identify appropriate candidates for counseling and testing. Concerns about underutilization of genetic testing have spurred interest in broader peri-diagnostic testing. We evaluated surgeon adherence to NCCN guidelines and studied patterns of testing in newly diagnosed BC patients. METHODS: A total of 397 patients were identified with newly diagnosed BC treated at our institution between 2016 and 2017 with no prior genetic testing. Eligibility for genetic testing based on NCCN criteria, referral, and patient compliance were recorded. RESULTS: In total, 212 of 397 (53%) met NCCN testing criteria. Fifty-nine of 212 (28%) patients went untested despite meeting one or more criteria. Fourteen of 59 (24%) of these were referred but did not comply. Most common criteria for meeting eligibility for testing both in the overall cohort and among missed patients were family history-based. Age > 45 years old and non-Ashkenazi Jewish descent were predictive of missed referral (p < 0.01). We identified pathogenic mutations in 16 of 153 (10%) patients who did undergo testing (11 (7%) BRCA1 or 2 and 5 (3%) with other predisposition gene mutations) or 16 of 397 (4%) among the overall group. CONCLUSIONS: Our data highlight the underutilization of genetic testing. Even in the setting of a full-service breast center with readily available genetic counseling, there is a substantial miss rate for identifying eligible patients, related to assessment of family history, patient age, and ethnicity, as well as patient compliance. Broader peri-diagnostic testing should be considered, and higher compliance rates with patients referred should be sought.

Use of neoadjuvant versus adjuvant chemotherapy for hormone receptor-positive breast cancer: a National Cancer Database (NCDB) study.

INTRODUCTION: Neoadjuvant chemotherapy (NAC) is a well-established therapeutic option for patients with locally advanced disease often allowing downstaging and facilitation of breast conserving therapy. With evolution of better targeted treatment regimens and awareness of improved outcomes for significant responders, use of NAC has expanded particularly for triple negative and HER2-positive (HER2+) breast cancer. In this study, we explore utility of neoadjuvant chemotherapy for hormone receptor-positive HER2-negative (HR+ HER2-) patients. METHODS: Patients with HR+ HER2- breast cancer treated with chemotherapy before or after surgery were identified from 2010 to 2015 in the NCDB. Multivariable regression models adjusted for covariates were used to determine associations within these groups. RESULTS: Among 134,574 patients (clinical stage 2A, 64%; 2B, 21%; 3, 15%), 105,324 (78%) had adjuvant chemotherapy (AC) and 29,250 (22%) received NAC. Use of NAC increased over time (2010-2015; 13.2-19.4% and PR = 1.34 for 2015; p < 0.0001). Patients were more likely to receive NAC with cT3, cT4, and cN+ disease. Patients less likely to receive NAC were age ≥ 50, lobular carcinoma, increased Charlson-Deyo score, and government insurance. Complete response (pCR) was noted in 8.3% of NAC patients. Axillary downstaging occurred in 21% of patients, and predictors included age < 50 years, black race, poorly differentiated grade, invasive ductal histology, and either ER or PR negativity. CONCLUSIONS: NAC use among HR+ HER2- breast cancer patients has expanded over time and offers downstaging of disease for some patients, with pCR seen in only a small subset, but downstaging of the axilla in 21%. Further analysis is warranted to determine the subgroup of patients with HR+ HER2- disease who benefit from this approach.

Electron scattering cross sections from nitrobenzene in the energy range 0.4-1000 eV: the role of dipole interactions in measurements and calculations.

Absolute total electron scattering cross sections (TCS) for nitrobenzene molecules with impact energies from 0.4 to 1000 eV have been measured by means of two different electron-transmission experimental arrangements. For the lower energies (0.4-250 eV) a magnetically confined electron beam system has been used, while for energies above 100 eV a linear beam transmission technique with high angular resolution allowed accurate measurements up to 1000 eV impact energy. In both cases random uncertainties were maintained below 5-8%. Systematic errors arising from the angular and energy resolution limits of each apparatus are analysed in detail and quantified with the help of our theoretical calculations. Differential elastic and integral elastic, excitation and ionisation as well as momentum transfer cross sections have been calculated, for the whole energy range considered here, by using an independent atom model in combination with the screening corrected additivity rule method including interference effects (IAM-SCARI). Due to the significant permanent dipole moment of nitrobenzene, additional differential and integral rotational excitation cross sections have been calculated in the framework of the Born approximation. If we ignore the rotational excitations, our calculated total cross section agrees well with our experimental results for impact energies above 15 eV. Additionally, they overlap at 10 eV with the low energy Schwinger Multichannel method with Pseudo Potentials (SMCPP) calculation available in the literature (L. S. Maioli and M. H. F. Bettega, J. Chem. Phys., 2017, 147, 164305). We find a broad feature in the experimental TCS at around 1.0 eV, which has been related to the formation of the NO2- anion and assigned to the π*(b1) resonance, according to previous mass spectra available in the literature. Other local maxima in the TCSs are found at 4.0 ± 0.2 and 5.0 ± 0.2 eV and are assigned to core excited resonances leading to the formation of the NO2- and O2- anions, respectively. Finally, for energies below 10 eV, differences found between the present measurements, the SMCPP calculation and our previous data for non-polar benzene have revealed the importance of accurately calculating the rotational excitation contribution to the TCS before comparing theoretical and experimental data. This comparison suggests that our dipole-Born calculation for nitrobenzene overestimates the magnitude of the rotational excitation cross sections below 10 eV.

Experimental and theoretical analysis for total electron scattering cross sections of benzene.

Measurements of the total electron scattering cross sections (TCSs) from benzene, in the impact energy range of 1-1000 eV, are presented here by combining two different experimental systems. The first utilizes a magnetically confined electron transmission beam for the lower energies (1-300 eV), while the second utilizes a linear transmission beam apparatus for the higher energies (100-1000 eV). These cross sections have also been calculated by means of two different theoretical methods, the Schwinger Multichannel with Pseudo Potential (SMCPP) procedure, employing two different approaches to account for the polarization of the target for impact energies between 0.1 and 15 eV, and the Independent Atom Model with the Screening Corrected Additivity Rule including Interference effect (IAM-SCAR+I) paradigm to cover the 10-10 000 eV impact energy range. The present results are compared with available theoretical and experimental data, with the level of accord being good in some cases and less satisfactory in others, and some predicted resonances have been identified. In particular, we found a π* shape resonance at 1.4 eV and another feature in the energy region 4.6-4.9 eV interpreted as a π* resonance (2B2g symmetry), which is a mixture of shape and a core excited resonance, as well as a Feshbach resonance at 5.87 eV associated with the 3s (a1g) Rydberg state. A Born-type formula to extrapolate TCS values for energies above 10 000 eV is also given. This study provides a complete set of TCS data, with uncertainty limits within 10%, ready to be used for modeling electron transport applications.

Breast Imaging During Pregnancy and Lactation.

Breast imaging during pregnancy and lactation is important in order to avoid delays in the diagnosis and treatment of pregnancy-associated breast cancers. Radiologists have an opportunity to improve breast cancer detection by becoming familiar with appropriate breast imaging and providing recommendations to women and their referring physicians. Importantly, during pregnancy and lactation, both screening and diagnostic breast imaging can be safely performed. Here we describe when and how to screen, how to work up palpable masses, and evaluate bloody nipple discharge. The imaging features of common findings in the breasts of pregnant and lactating women are also reviewed. Finally, we address breast cancer staging and provide a brief primer on treatment options for pregnancy-associated breast cancers.

Total electron scattering cross sections from para-benzoquinone in the energy range 1-200 eV.

Total electron scattering cross sections, from para-benzoquinone, for impact energies ranging between 1 to 200 eV, have been obtained by measuring the attenuation of a linear electron beam under magnetic confinement conditions. Random uncertainty limits on these values have been found to be within 5%. Systematic errors, due to the axial magnetic beam conditions in combination with the acceptance angle of the detector, have been evaluated by integrating our calculated independent atom model with the screening corrected additivity rule and interference term elastic differential cross sections over that detection acceptance angle. Our previous calculations and measurements on this molecule (Jones et al., J. Chem. Phys., 2018, 148, 124312 and J. Chem. Phys., 2018, 148, 204305), have been compiled and complemented with new elastic and inelastic scattering cross section calculations in order to obtain a comprehensive cross section data base, within the considered energy range, for modelling purposes. The self-consistency of the present data set has been evaluated by simulating the electron transport of 15 eV electrons in para-benzoquinone, and comparing those results with the observed transmitted intensity distribution.

Magnetically confined electron beam system for high resolution electron transmission-beam experiments.

A novel experimental setup has been implemented to provide accurate electron scattering cross sections from molecules at low and intermediate impact energies (1-300 eV) by measuring the attenuation of a magnetically confined linear electron beam from a molecular target. High-resolution electron energy is achieved through confinement in a magnetic gas trap where electrons are cooled by successive collisions with N2. Additionally, we developed and present a method to correct systematic errors arising from energy and angular resolution limitations. The accuracy of the entire measurement procedure is validated by comparing the N2 total scattering cross section in the considered energy range with benchmark values available in the literature.

Novel experimental setup for time-of-flight mass spectrometry ion detection in collisions of anionic species with neutral gas-phase molecular targets.

We report a novel experimental setup for studying collision induced products resulting from the interaction of anionic beams with a neutral gas-phase molecular target. The precursor projectile was admitted into vacuum through a commercial pulsed valve, with the anionic beam produced in a hollow cathode discharge-induced plasma, and guided to the interaction region by a set of deflecting plates where it was made to interact with the target beam. Depending on the collision energy regime, negative and positive species can be formed in the collision region and ions were time-of-flight (TOF) mass-analysed. Here, we present data on O2 precursor projectile, where we show clear evidence of O- and O2- formation from the hollow cathode source as well as preliminary results on the interaction of these anions with nitromethane, CH3NO2. The negative ions formed in such collisions were analysed using time-of-flight mass spectrometry. The five most dominant product anions were assigned to H-, O-, NO-, CNO- and CH3NO2-.

Energy deposition by a 106Ru/106Rh eye applicator simulated using LEPTS, a low-energy particle track simulation.

The present study introduces LEPTS, an event-by-event Monte Carlo programme, for simulating an ophthalmic (106)Ru/(106)Rh applicator relevant in brachytherapy of ocular tumours. The distinctive characteristics of this code are the underlying radiation-matter interaction models that distinguish elastic and several kinds of inelastic collisions, as well as the use of mostly experimental input data. Special emphasis is placed on the treatment of low-energy electrons for generally being responsible for the deposition of a large portion of the total energy imparted to matter.

Identification of a scalar glueball.

We perform a coupled channel study of the meson-meson S waves with isospin (I) 0 and 1/2 up to 2 GeV. A new approach is derived that allows one to include the many channels pipi, KK[over ], etaeta, sigmasigma, etaeta; eta; eta; , rhorho, omegaomega, omegavarphi, varphivarphi, a(1)pi, and pipi with still few free parameters. It follows that coupled channel dynamics is strong and cannot be neglected in order to study resonance properties in the region 1.4-1.6 GeV. All the resonances with masses below 2 GeV and I=0 and 1/2 are generated. We identify the f(0)(1710) and an important contribution to the f (0)(1500) as an unmixed glueball. This is based on an accurate agreement of our results with predictions of lattice QCD and the chiral suppression of the coupling of a scalar glueball to q[over ]q. Another pole, mainly corresponding to the f_{0}(1370), is a pure octet state.

Nuevas formas de gestión en un Servicio de Cirugía General comarcal / New forms of management in a regional General Surgery Unit

El objetivo principal de este trabajo es demostrar una mejora en la asistencia sanitaria con el nuevo modelo de Unidad de Gestión Clínica (UGC) en comparación con el tradicional, a través de variables económicas, asistenciales y de calidad/ eficiencia. Entre los resultados destaca que han disminuido los ingresos totales en un 4,2% a expensas de los programados (-10,3%), así como las estancias totales (-7,8%), produciéndose un ahorro en estancias por la Cirugía Mayor Ambulatoria (CMA) del 331,1%. Ha aumentado el total de intervenciones en un 10,7%, debido fundamentalmente a la CMA (341%). Se ha conseguido un ahorro en gasto por CMA de 387,5%. El índice de intervenciones suspendidas descendió (-27,8%), así como el de infecciones nosocomiales (-8,3%). También descendió el número de pacientes en lista de espera (-30,9%), y la media de días de lista espera (-22,4%). La satisfacción global del usurario experimentó un aumento del 9,3%. Como conclusión se establece que desde la constitución de la UGC se han mejorado la casi totalidad de los parámetros asistenciales, económico y de calidad, en relación al modelo previo con el que se compara (AU)

The main objective of this article is to demonstrate an improvement in health care with the new model of the Clinical Management Unit (UGC) in comparison with the traditional one, using financial, nursing and quality/efficiency variables. Finally, it is also mentioned that since setting up the Clinical Management Unit, almost all the nursing, financial and quality parameters have improved in relation to the previous model it is compared with (AU)

CASANDRA: a prototype implementation of a system of network progressive transmission of medical digital images.

In this paper, a prototype for progressive transmission of medical digital 2D images through the network, called CASANDRA, is presented. The prototype consists of the server part and the client part. In the server part, the images are acquired, stored, computed their wavelet transform and the wavelet coefficients stored, then transmitted progressively, when required, via TCP to the client. In the client part, with the inverse wavelet transform, the received wavelet coefficients are used to build successive improved reconstructions of the image. This prototype has been implemented and is being tested in the Radiotherapy Service of the Valencia University Hospital (Valencia, Spain).

Effectiveness of virosomal subunit influenza vaccine in preventing influenza-related illnesses and its social and economic consequences in children aged 3-14 years: a prospective cohort study.

To evaluate the effectiveness of a virosomal subunit influenza vaccine in preventing influenza-related illnesses and its social and economic consequences in children aged 3-14 years, a prospective cohort study was carried out during the 2004-2005 influenza season in 11 private pediatric clinics in the Barcelona metropolitan area. One dose of a virosomal subunit inactivated influenza vaccine (Inflexal V Berna) was given during September and October 2004 to healthy children aged 3-14 years attended in 5 of the 11 clinics. Who comprised the vaccinated cohort (n=966). The non-vaccinated cohort (n=985) was comprised of children attended in the other six clinics. Informed consent was obtained from all parents. The follow up was performed between 1 November 2004 and 31 March 2005. Using a self-administered questionnaire, information was collected from parents or guardians on any type of acute, febrile respiratory illness suffered by their children during the study period, including antibiotic use, and absence from school or work-loss of parents as a result of the illness. RT-PCR (influenza A+B+C) was carried out on pharyngeal and nasal samples obtained from children attended by pediatricians during this period in these clinics with the following symptoms: fever> or =38.5 degrees lasting at least 72h, cough or sore throat (influenza-like illness). Adjusted vaccination effectiveness was 58.6% (95% CI 49.2-66.3) in preventing acute febrile respiratory illnesses, 75.1% (95% CI 61.0-84.1) in preventing cases of influenza-like illnesses and 88.4% (95% CI 49.2-97.3) in preventing laboratory-confirmed cases of influenza A. The adjusted vaccination effectiveness in reducing antibiotic use (18.6%, 95% CI -4.2 to 3.64), absence from school (57.8%, 95% CI 47.9-65.9) and work-loss of parents (33.3%, 95% CI 8.9-51.2) in children affected by an acute febrile respiratory illness was somewhat lower. Vaccination of children aged 3-14 years in pediatric practices with one dose of virosomal subunit inactivated influenza vaccine has the potential to considerably reduce the health and social burdens caused by influenza-related illnesses.