Predictors of adherence and the role of primary non-adherence in antihormonal treatment of breast cancer.

BACKGROUND: Antihormonal treatment for hormone receptor (HR) positive breast cancer has highly beneficial effects on both recurrence rates and survival. We investigate adherence and persistence in this group of patients. METHODS: The study population comprised 1192 patients with HR-positive breast cancer who were prescribed adjuvant antihormonal treatment from 2004 to 2013. Adherence was defined as a medical possession ratio (MPR) of ≥80. RESULTS: Of the 1192 included patients, 903 (75.8%) were adherent and 289 (24.2%) were non-adherent. Primary non-adherence was seen in 101 (8.5%) patients. The extremes of age (< 40 and ≥ 80 years) were associated with poor adherence. Patients with metastasis to axillary lymph nodes and those who received radiotherapy and/or chemotherapy were more likely to be adherent. Better adherence was also shown for those who switched medication at 2 years after diagnosis. Primary non-adherence seems to be associated with cancers with a good prognosis. CONCLUSION: Adherence to antihormonal therapy for breast cancer is suboptimal. Primary non-adherence occurs among patients with a relatively good prognosis. Non-adherent patients tend to terminate their antihormonal therapy in the initial part of the treatment period. Targeted interventions to improve adherence should be focused on the first part of the treatment period.

How to measure community tolerance levels for noise.

Relationships between noise exposure and transportation noise induced annoyance have been studied extensively for several decades. The annoyance due to aircraft noise exposure is in the present paper assumed to be influenced by the day-night yearly average sound level (DNL). It has long been recognized that the annoyance also depends on non-DNL factors, but this is complicated-resulting in a variety of different modeling strategies. Motivated by this, the community tolerance level (CTL) was introduced in 2011 for a loudness-based psychometric function. It is a single parameter that accounts for the aggregate influence of other factors. This paper suggests and investigates different methods for the measurement of the CTL. The methods are illustrated on data found in the literature, on recent surveys around two Norwegian airports, and on simulated data. The results from the presented methods differ significantly. An elementary method is shown to give a measurement of the CTL with smaller uncertainty, and is recommended as a replacement for the originally suggested least-squares method. Methods for evaluating the measurement uncertainty are also presented.

Uncertainty of decibel levels.

The mean sound exposure level from a source is routinely estimated by the mean of the observed sound exposures from repeated measurements. A formula for the standard uncertainty based on the Guide to the expression of Uncertainty in Measurement (GUM) is derived. An alternative formula is derived for the case where the GUM method fails. The formulas are applied on several examples, and compared with a Monte Carlo calculation of the standard uncertainty. The recommended formula can be seen simply as a convenient translation of the uncertainty on an energy scale into the decibel level scale, but with a theoretical foundation.

Estimation of aircraft angular coordinates using a directional-microphone array--An experimental study.

Ground reflections cause problems when estimating the direction of arrival of aircraft noise. In traditional methods, based on the time differences between the microphones of a compact array, they may cause a significant loss of accuracy in the vertical direction. This study evaluates the use of first-order directional microphones, instead of omnidirectional, with the aim of reducing the amplitude of the reflected sound. Such a modification allows the problem to be treated as in free field conditions. Although further tests are needed for a complete evaluation of the method, the experimental results presented here show that under the particular conditions tested the vertical angle error is reduced ∼10° for both jet and propeller aircraft by selecting an appropriate directivity pattern. It is also shown that the final level of error depends on the vertical angle of arrival of the sound, and that the estimates of the horizontal angle of arrival are not influenced by the directivity pattern of the microphones nor by the reflective properties of the ground.

Aspects of ground effect modeling.

A recently published one-parameter ground model based on Darcy's law is here generalized into a two-parameter model which depends on an effective flow resistivity and an effective layer depth. Extensive field measurements of the acoustic impedance of various ground types have been carried out for frequencies in the range from 200 Hz to 2.5 kHz. The model based on Darcy's law gives an improved fit to the measurements compared to the Delany-Bazley model. It is, in addition, argued on purely theoretical grounds that the suggested model is preferable. In contrast to the Delany-Bazley model it corresponds to a proper causal time-domain model. This is particularly relevant for extrapolation of the models to lower frequencies and for the recently developed harmonized methods intended for use in the implementation of the European Union directive on the assessment and management of environmental noise. The harmonized methods include frequencies down to the 25 Hz third octave band and have the Delany-Bazley ground impedance model as the default choice. The arguments presented here suggest that this default choice should be replaced by the more physically based model from the law of Darcy.

Gender differences in subjective well-being, self-esteem and psychosocial functioning in adolescents with symptoms of anxiety and depression: findings from the Nord-Trøndelag Health Study.

Gender differences in the prevalence of symptoms of anxiety and depression during adolescence are well documented. However, little attention has been given to differences in subjective well-being, self-esteem and psychosocial functioning between boys and girls with symptoms of anxiety and depression. The aim of this study was to investigate gender differences in the associations between such symptoms and subjective well-being, self-esteem, school functioning and social relations in adolescents. Data were taken from a major population-based Norwegian study, the Nord-Trøndelag Health study (HUNT), in which 8984 (91% of all invited) adolescents, aged 13-19 years, completed an extensive self-report questionnaire. Although prevalence rates of symptoms of anxiety and depression were higher in girls than in boys, a significant interaction between gender and symptoms of anxiety and depression was found in respect of each of the following outcome variables: subjective well-being, self-esteem, academic problems, frequency of meeting friends and the feeling of not having enough friends. These interactions indicate that the associations between symptoms of anxiety and depression and lower subjective well-being and self-esteem, more academic problems in school and lower social functioning were stronger for boys than for girls. Our findings may contribute to an earlier assessment and more efficient treatment of male adolescent anxiety and depression.

Perinatal risk and psychiatric outcome in adolescents born preterm with very low birth weight or term small for gestational age.

OBJECTIVE: To study perinatal risk factors for psychiatric symptoms in adolescents born preterm with very low birth weight or at term, but small for gestational age (GA). METHOD: Mental health was assessed in 65 adolescents born with very low birth weight (VLBW) (birth weight < or = 1500 g), 59 born term small for GA (birth weight <10th centile) and 81 control adolescents using Schedule for Affective Disorders and Schizophrenia for School-Age Children, Children's Global Assessment Scale, Autism Spectrum Screening Questionnaire, Attention-Deficit Hyperactivity Disorder-Rating Scale IV and Achenbach System of Empirically Based Assessment. Perinatal data included birth weight, GA, head circumference, Apgar scores, intraventricular hemorrhage, days in neonatal intensive care unit, and days on mechanical ventilation. RESULTS: In the very low birth weight group, lower birth weight was associated with inattention (p < .01), psychiatric diagnoses, and reduced psychosocial function (p < or = .05). Intraventricular hemorrhage increased the risk for a high inattention score (odds ratio = 7.5; 95% confidence intervals: 1.2-46.8). Lower Apgar score at 1 min was associated with a high Autism Spectrum Screening Questionnaire score and lower Apgar score at 5 min with a high internalizing score (p < or = .05). In the subgroup born appropriate for GA, internalizing symptoms were also associated with lower GA. In the term small for GA group, perinatal events were not associated with psychiatric problems. In contrast, low socioeconomic status was associated with externalizing symptoms. CONCLUSION: Lower birth weight, shorter gestation, and intraventricular hemorrhage were risk factors for psychiatric problems in the very low birth weight group. Lower Apgar score increased the risk for autism spectrum symptoms and internalizing symptoms. Among adolescents born term small for GA, the main risk factor for psychiatric symptoms was low socioeconomic status.

Early prediction of cerebral palsy by computer-based video analysis of general movements: a feasibility study.

AIM: The aim of this study was to investigate the predictive value of a computer-based video analysis of the development of cerebral palsy (CP) in young infants. METHOD: A prospective study of general movements used recordings from 30 high-risk infants (13 males, 17 females; mean gestational age 31wks, SD 6wks; range 23-42wks) between 10 and 15 weeks post term when fidgety movements should be present. Recordings were analysed using computer vision software. Movement variables, derived from differences between subsequent video frames, were used for quantitative analyses. CP status was reported at 5 years. RESULTS: Thirteen infants developed CP (eight hemiparetic, four quadriparetic, one dyskinetic; seven ambulatory, three non-ambulatory, and three unknown function), of whom one had fidgety movements. Variability of the centroid of motion had a sensitivity of 85% and a specificity of 71% in identifying CP. By combining this with variables reflecting the amount of motion, specificity increased to 88%. Nine out of 10 children with CP, and for whom information about functional level was available, were correctly predicted with regard to ambulatory and non-ambulatory function. INTERPRETATION: Prediction of CP can be provided by computer-based video analysis in young infants. The method may serve as an objective and feasible tool for early prediction of CP in high-risk infants.

Using computer-based video analysis in the study of fidgety movements.

OBJECTIVE: Absence of fidgety movements (FM) in high-risk infants is a strong marker for later cerebral palsy (CP). FMs can be classified by the General Movement Assessment (GMA), based on Gestalt perception of the infant's movement pattern. More objective movement analysis may be provided by computer-based technology. The aim of this study was to explore the feasibility of a computer-based video analysis of infants' spontaneous movements in classifying non-fidgety versus fidgety movements. METHOD: GMA was performed from video material of the fidgety period in 82 term and preterm infants at low and high risks of developing CP. The same videos were analysed using the developed software called General Movement Toolbox (GMT) with visualisation of the infant's movements for qualitative analyses. Variables derived from the calculation of displacement of pixels from one video frame to the next were used for quantitative analyses. RESULTS: Visual representations from GMT showed easily recognisable patterns of FMs. Of the eight quantitative variables derived, the variability in displacement of a spatial centre of active pixels in the image had the highest sensitivity (81.5) and specificity (70.0) in classifying FMs. By setting triage thresholds at 90% sensitivity and specificity for FM, the need for further referral was reduced by 70%. CONCLUSION: Video recordings can be used for qualitative and quantitative analyses of FMs provided by GMT. GMT is easy to implement in clinical practice, and may provide assistance in detecting infants without FMs.

Computer simulation of forward wave propagation in soft tissue.

A method for simulating forward wavefront propagation in heterogeneous tissue is discussed. The intended application of this method is for the study of aberration produced when performing ultrasound imaging through a layer of soft tissue. A one-way wave equation that permits smooth variation in all acoustically important variables is derived. This equation also describes tissue exhibiting nonlinear elasticity and arbitrary frequency-dependent relaxation. A numerical solution to this equation is found by means of operator splitting and propagation along the spatial depth coordinate. The numerical solution is accurate when compared to analytical solutions for special cases, and when compared to numerical solutions of the full wave equation by other methods. The presented implementation provides a fast numerical method for studying the impact of aberration in medical ultrasound imaging through soft tissue--both on the transmitted beam and the nonlinearly generated harmonic beam.

A note on reflection of spherical waves.

In 1909 Sommerfeld gave an exact solution for the reflection of a spherical wave from a plane surface in terms of an oscillatory integral and also presented an asymptotic solution for the case where both source and receiver are at the boundary. Weyl (1919) presented an alternative solution and also an asymptotic solution for the case where the source is at the boundary. It is known that the general case is solved if a general solution for the case where the source is at the boundary is known. Here it is demonstrated that it is sufficient to have the general solution for the case where both source and receiver are at the boundary. This is mainly of theoretical interest, but may have practical applications. As an example it is demonstrated that Sommerfeld's approximate solution gives Ingard's (1951) approximate solution which is valid for arbitrary source and receiver heights.