Using big data to gauge effectiveness of breast cancer awareness month.

Breast Cancer Awareness Month (BCAM) has been used for decades to increase awareness and screening for breast cancer, but its geographic reach and effectiveness is difficult to judge. Using Internet Search Interest (ISI) could allow for better evaluation of BCAM effects. Using Google Trends, we evaluated the ISI for "breast cancer" and "mammogram" for each state and metropolitan area from 2006 to 2019. The ISI represents population level Google internet searches relative to the highest number of searches for the United States over a given period, with a max number of 100. The ISI for each term in October (BCAM) was compared against all other months during this period, across states and across major metropolitan regions. ISI was 2.34 times higher (95% Confidence Interval [CI]: 2.10-2.61, P < .001) in BCAM than the average for all other months combined. Geographically categorized data revealed that there were significant differences in the ISI for "breast cancer" and for "mammogram" among the 50 states, and among major metropolitan areas (P < .001for each). ISI suggests that BCAM is effective at increasing breast cancer related internet searches, with significant heterogeneity across states and metro areas. Google Trends is a publicly available free tool that can be used to assess penetrance of awareness campaigns in a time sensitive and location specific manner for future targeting of populations with low breast cancer awareness. Future research is needed to assess relationships between preventive outcomes and ISI scores.

A new method to measure nasal impedance in spontaneously breathing adults.

As an alternative to standard rhinomanometric methods, we applied forced oscillations at the mouth in five normal subjects and determined their nasal impedance with a novel method involving flow subtraction. Pressure oscillations of constant amplitude were applied at the mouth of a subject both when the nostrils were open and when they were closed with a noseclip. The airflows measured under the two conditions were subtracted to yield the oscillating nasal airflow at the imposed pressure. The resultant pressure-flow relation defined the nasal impedance of the subject. For frequencies between 3 and 15 Hz, the transnasal pressure-flow relation was well described by a linear lumped parameter model consisting of a resistive and inertial element. Nasal resistance obtained with flow subtraction did not differ significantly from control measurements obtained while the subjects performed the Valsalva maneuver. In contrast, nasal inertance obtained with flow subtraction was approximately twice that obtained with the Valsalva method. The difference between inertances may reflect structural changes in nasopharyngeal dimensions that occur with the Valsalva maneuver. We conclude that the mechanical impedance of the nasal passage may be determined during spontaneous breathing from the response to imposed forced oscillations at the mouth. The noninvasive nature of this method suggests that it may be simpler to implement than traditional rhinomanometric methods.

Nonlinear parameter estimation by linear association: application to a five-parameter passive neuron model.

Linear associative memories (LAM) have been intensely used in the areas of pattern recognition and parallel processing for the past two decades. Application of LAM to nonlinear parameter estimation, however, has only been recently attempted. The process consists in converting the nonlinear function in the parameters into a set of linear algebraic equations. The nature of the linearized system and the factors influencing the accuracy of the parameter estimates have not yet been fully investigated. In this paper, LAM is applied to a nonlinear five-parameter model of the neuron. Ill-conditioning, which is often exhibited in LAM, is treated with the method of regularization as well as by the singular value decomposition (SVD). Simulation results indicate that the parameters estimated by LAM exhibit a remarkable robustness against additive white noise in comparison with the classical gradient optimization technique. Moreover, it is shown that regularization can be superior to SVD under certain conditions. Our results suggest that LAM can be used both as a noise reduction technique and as a stand-alone nonlinear parameter estimation algorithm. The comparison between LAM and a gradient technique show that, for this estimation problem, the LAM method can give more reliable estimates. Further improvements in estimation quality may still be achieved by the use of other forms of regularizing functions.

Parameter estimation by reduced-order linear associative memory (ROLAM).

In a series of papers we have shown that nonlinear parameter estimation by linear association provides accurate estimates of the parameters in complex systems described by nonlinear differential equations even in the presence of additive white noise of considerable power. The technique is based on linearly associating the system's output with a set of parameter values spanning the region of interest. When an actual output is measured, the system's unknown parameters could be estimated by a matrix inversion. The size of the inverted matrix, being equal to the length of the output vector, poses a limiting factor upon the generalization of the technique. In this paper we propose a modification which requires the inversion of a matrix whose dimension equals the number of model parameters. The modified version is called reduced-order associative memory (ROLAM). The technique is applied to two complex lumped-parameter nonlinear models: the Van der Pol relaxation oscillator and the passive neuron model of the granule cells. Results validate ROLAM as a parameter-estimation tool which is especially suited in cases where the number of parameters is large, the number of samples in the observation signal is high, or when on-line parameter estimation is required. It is also shown that ROLAM provides an optimal parameter estimate in the special case of single-parameter nonlinear models.

Hemangioma of the nasal bones: radiographic appearance.

Four additional cases of hemangioma involving the nasal bones are presented, bringing the reported cases to 15. The radiographic findings of nasal bone hemangioma are distinctive, permitting easy diagnosis. Hemangioma involving the nasal bones may result in a reticular or "soap bubble" osteoporosis, spiculation, bone thickening, or a channelled appearance of the nasal bone. Treatment is by local excision.

Symmetry and linearity of trunk function in subjects with non-specific low back pain.

Objective. To investigate the effect of a standard rehabilitation program on the symmetry of trunk kinematics in subjects with non-specific low back pain.Design. Assessing lumbar spine kinematics in the cardinal planes using dynamometry.Background. Previous evaluations of trunk symmetry focussed more on anatomical rather than functional symmetry. Correlation of functional symmetry with low back pain was occasionally performed, but only for base line evaluations. To the best of the author's knowledge, there is no study examining the effect of exercise on the functional symmetry of the trunk, especially in non-specific low back pain subjects.Methods. Two groups of young male subjects whose working conditions incurred long daily hours of sitting and standing participated in the study. Muscles of the lumbar spine were initially evaluated in the cardinal planes using dynamometry. The same parameters (maximum isometric torque, dynamic torque, angular velocity and range of motion) were then repeatedly measured throughout a standardized strength protocol lasting for 12 sessions over a four-week period.Results. As pain gradually disappeared over a one-month period of rehabilitation, certain factors of the trunk kinematics exhibited convergence towards perfect symmetry while others showed oscillations. Moreover, global right-left data for certain trunk kinematics exhibited near-perfect linear relationship.Conclusion. Functional symmetry of the trunk in the coronal and transverse planes can be used to assess the progress of rehabilitation programs of non-specific low back pain subjects. RelevanceRehabilitation programs focus on the progress of directly measured trunk kinematics, which do not always exhibit monotonic behavior. This paper alludes to the importance of tracking symmetry of trunk kinematics as it may help clinicians modify the strengthening protocols in order to achieve more rapid relief from back pain.

Atypical fibroxanthoma of the cheek: a case report.

Atypical fibroxanthoma is a cutaneous soft tissue tumor that may mimic squamous cell carcinoma and melanoma on clinical and histologic examination. Immunohistochemical stains for cytokeratin, S100 protein, and vimentin may be helpful in differentiating atypical fibroxanthoma from the latter two diagnoses. We report a patient with atypical fibroxanthoma of the cheek who underwent successful local excision. The clinical and laboratory features of this neoplasm are reviewed.

Error correction of intraocular lens (IOL) power calculation.

Intraocular lens (IOL) power depends mainly on the corneal power and the axial length of the eye. There is a significant error in the estimation of axial length by the usual methods due to the assumption that the ultrasonic speed has a constant value of 1,540 m/sec in the different media of the eye. In-vitro measurements have shown that sound speed in the cataractous lens may vary between 1,580 and 1,690 m/sec. Unlike the original method of accommodation that involves registrations of the eye echography for a period exceeding 30 seconds, modification proposed in this study allows in-vivo estimation of the sound velocity in the lens during only 2 to 3 seconds. Consequently, this modification allows measurements to be performed on subjects with minimal training and cooperation. Using regression analysis, actual axial length of the eye is estimated and the proper IOL power is calculated. Several normal and cataractous cases are examined to test the validity of the method. The resultant estimated IOL power turned out to be less than that obtained by the customary method of 0.4 to 1.0 diopters. It is therefore concluded that improved estimation of the axial length increases the efficacy of those formulas used for calculating the IOL power at different vision states.

A nonlinear model of respiratory mechanics in emphysematous lungs.

Existing mechanical models of chronic obstructive lung disease have failed to explain a number of experimental findings of airway obstruction, e.g., the varying manners of frequency dependence of resistance (FDR). Departing from the parallel-unit concept and attempting to account for the "check-valve" mechanism in the emphysematous lung, we proposed a single-compartment lung model with a nonlinear pressure-flow relationship: P + P* = LV + K1V + K3(V +/- V*)3 + V/c, where P* = K3V*, V* is a constant. The plus and minus signs in the cubic term indicate the expiratory and inspiratory check valves, respectively. The choice of an asymmetric P - V relation reflects several properties of emphysematous lungs such as airflow limitation and higher expiratory resistance. Implementation of the above equation using sine wave, white noise, and step inputs resulted in various forms of FDR at frequencies between 0 and 40 Hz depending on the type of input used. Resistance was most sensitive to changes in input pressure amplitude. The model's results suggest that the P - V nonlinearity can have a significant influence on the impedance construct in obstructed lung disease.

Primary oat cell carcinoma of the larynx: an ultrastructural study.

An extrapulmonary oat cell carcinoma arising in the larynx is described. Ultrastructurally the tumor is identical to the oat cell carcinoma of pulmonary origin. The pressure of neurosecretory granules in our case strongly suggests that the tumor is derived from Kulchitsky-like cells, a histogenesis previously proposed for oat cell carcinoma of the lung.