'PartBreCon' study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps

Background: Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes.Methods: STROBE-compliant protocol ascertained CWPF outcomes between March 2011-March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis.Results: Across 15 centres, 507 patients with median age (54 years, IQR; 48-62), body mass index (25.4 kg/m2, IQR; 22.5-29), tumour size (26 mm, IQR; 18-35), and specimen weight (62 g, IQR; 40-92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11-39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%).Conclusions: This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.</p

Combined Point-of-Care Nucleic Acid and Antibody Testing for SARS-CoV-2 following Emergence of D614G Spike Variant

Rapid COVID-19 diagnosis in the hospital is essential, although this is complicated by 30%-50% of nose/throat swabs being negative by SARS-CoV-2 nucleic acid amplification testing (NAAT). Furthermore, the D614G spike mutant dominates the pandemic and it is unclear how serological tests designed to detect anti-spike antibodies perform against this variant. We assess the diagnostic accuracy of combined rapid antibody point of care (POC) and nucleic acid assays for suspected COVID-19 disease due to either wild-type or the D614G spike mutant SARS-CoV-2. The overall detection rate for COVID-19 is 79.2% (95% CI 57.8-92.9) by rapid NAAT alone. The combined point of care antibody test and rapid NAAT is not affected by D614G and results in very high sensitivity for COVID-19 diagnosis with very high specificity

Combined Point-of-Care Nucleic Acid and Antibody Testing for SARS-CoV-2 following Emergence of D614G Spike Variant

Rapid COVID-19 diagnosis in the hospital is essential, although this is complicated by 30%–50% of nose/throat swabs being negative by SARS-CoV-2 nucleic acid amplification testing (NAAT). Furthermore, the D614G spike mutant dominates the pandemic and it is unclear how serological tests designed to detect anti-spike antibodies perform against this variant. We assess the diagnostic accuracy of combined rapid antibody point of care (POC) and nucleic acid assays for suspected COVID-19 disease due to either wild-type or the D614G spike mutant SARS-CoV-2. The overall detection rate for COVID-19 is 79.2% (95% CI 57.8–92.9) by rapid NAAT alone. The combined point of care antibody test and rapid NAAT is not affected by D614G and results in very high sensitivity for COVID-19 diagnosis with very high specificity

D4.3 Final Report on Network-Level Solutions

Research activities in METIS reported in this document focus on proposing solutions to the network-level challenges of future wireless communication networks. Thereby, a large variety of scenarios is considered and a set of technical concepts is proposed to serve the needs envisioned for the 2020 and beyond. This document provides the final findings on several network-level aspects and groups of solutions that are considered essential for designing future 5G solutions. Specifically, it elaborates on: -Interference management and resource allocation schemes -Mobility management and robustness enhancements -Context aware approaches -D2D and V2X mechanisms -Technology components focused on clustering -Dynamic reconfiguration enablers These novel network-level technology concepts are evaluated against requirements defined by METIS for future 5G systems. Moreover, functional enablers which can support the solutions mentioned aboveare proposed. We find that the network level solutions and technology components developed during the course of METIS complement the lower layer technology components and thereby effectively contribute to meeting 5G requirements and targets.Aydin, O.; Valentin, S.; Ren, Z.; Botsov, M.; Lakshmana, TR.; Sui, Y.; Sun, W.... (2015). D4.3 Final Report on Network-Level Solutions. http://hdl.handle.net/10251/7675

Combined point of care nucleic acid and antibody testing for SARS-CoV-2 following emergence of D614G Spike Variant

Rapid COVID-19 diagnosis in hospital is essential, though complicated by 30-50% of nose/throat swabs being negative by SARS-CoV-2 nucleic acid amplification testing (NAAT). Furthermore, the D614G spike mutant now dominates the pandemic and it is unclear how serological tests designed to detect anti-Spike antibodies perform against this variant. We assess the diagnostic accuracy of combined rapid antibody point of care (POC) and nucleic acid assays for suspected COVID-19 disease due to either wild type or the D614G spike mutant SARS-CoV-2. The overall detection rate for COVID-19 is 79.2% (95CI 57.8-92.9%) by rapid NAAT alone. Combined point of care antibody test and rapid NAAT is not impacted by D614G and results in very high sensitivity for COVID-19 diagnosis with very high specificity

Evaluating the effects of second-dose vaccine-delay policies in European countries: A simulation study based on data from Greece

The results of a simulation-based evaluation of several policies for vaccine rollout are reported, particularly focusing on the effects of delaying the second dose of two-dose vaccines. In the presence of limited vaccine supply, the specific policy choice is a pressing issue for several countries worldwide, and the adopted course of action will affect the extension or easing of non-pharmaceutical interventions in the next months. We employ a suitably generalised, age-structure, stochastic SEIR (Susceptible ! Exposed ! Infectious ! Removed) epidemic model that can accommodate quantitative descriptions of the major effects resulting from distinct vaccination strategies. The different rates of social contacts among distinct age-groups (as well as some other model parameters) are informed by a recent survey conducted in Greece, but the conclusions are much more widely applicable. The results are summarised and evaluated in terms of the total number of deaths and infections as well as life years lost. The optimal strategy is found to be one based on fully vaccinating the elderly/at risk as quickly as possible, while extending the time-interval between the two vaccine doses to 12 weeks for all individuals below 75 years old, in agreement with epidemic theory which suggests targeting a combination of susceptibility and infectivity. This policy, which is similar to the approaches adopted in the UK and in Canada, is found to be effective in reducing deaths and life years lost in the period while vaccination is still being carried out. This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication

Context-aware, user-driven, network-controlled RAT selection for 5G networks

It is expected that in the very near future, cellular networks will have to deal with a massive data traffic increase, as well as a vast number of devices. Optimal placement of the end devices to the most suitable access network is expected to provide the best Quality of Service (QoS) experience to the users but also the maximum utilization of the scarce wireless resources by the operators. Several on-going proposals attempt to overcome the existing barriers by enabling the use of Wi-Fis and femto-cells to cater for part of the load generated by the end devices. The evolution of the Access Network Discovery and Selection Function (ANDSF) for the core part of the cellular network, as well as the Hotspot 2.0 approach, are currently being subject to thorough discussions and studies and are expected to facilitate a seamless 3GPP-WiFi interworking. During the past years, several Radio Access Technology (RAT) selection schemes have been proposed. However, these schemes do not take into consideration the opportunities offered by these new standardized approaches. Our paper acts in a manifold way: Firstly, it proposes COmpAsS, a Context-Aware RAT Selection mechanism, the main part of which operates on the User Equipment (UE)-side, minimizing signaling overhead over the air interface and computation load on the base stations. Secondly, we discuss in detail the architectural perspective; i.e., the extensions needed in the network interfaces that enable the exchange of the required context information among the respective network entities and in accordance with the 3GPP trends in relation to the context-aggregating entities. Furthermore, we quantify the signaling overhead of the proposed mechanism by linking it to the current 3GPP specifications and performing a comprehensive per-parameter analysis. Finally, we evaluate the novel scheme via extensive simulations in a complex and realistic 5G use case, illustrating the clear advantages of our approach in terms of key QoS metrics, i.e. the user-experienced throughput and delay, both in the uplink and the downlink. © 2016 Elsevier B.V

Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort study

Background Gallbladder cancer (GBC) is rare but aggressive. The extent of surgical intervention for different GBC stages is non-uniform, ranging from cholecystectomy alone to extended resections including major hepatectomy, resection of adjacent organs and routine extrahepatic bile duct resection (EBDR). Robust evidence here is lacking, however, and survival benefit poorly defined. This study assesses factors associated with recurrence-free survival (RFS), overall survival (OS) and morbidity and mortality following GBC surgery in high income countries (HIC) and low and middle income countries (LMIC). Methods The multicentre, retrospective Operative Management of Gallbladder Cancer (OMEGA) cohort study included all patients who underwent GBC resection across 133 centres between 1st January 2010 and 31st December 2020. Regression analyses assessed factors associated with OS, RFS and morbidity. Findings On multivariable analysis of all 3676 patients, wedge resection and segment IVb/V resection failed to improve RFS (HR 1.04 [0.84–1.29], p = 0.711 and HR 1.18 [0.95–1.46], p = 0.13 respectively) or OS (HR 0.96 [0.79–1.17], p = 0.67 and HR 1.48 [1.16–1.88], p = 0.49 respectively), while major hepatectomy was associated with worse RFS (HR 1.33 [1.02–1.74], p = 0.037) and OS (HR 1.26 [1.03–1.53], p = 0.022). Furthermore, EBDR (OR 2.86 [2.3–3.52], p &lt; 0.0010), resection of additional organs (OR 2.22 [1.62–3.02], p &lt; 0.0010) and major hepatectomy (OR 3.81 [2.55–5.73], p &lt; 0.0010) were all associated with increased morbidity and mortality. Compared to LMIC, patients in HIC were associated with poorer RFS (HR 1.18 [1.02–1.37], p = 0.031) but not OS (HR 1.05 [0.91–1.22], p = 0.48). Adjuvant and neoadjuvant treatments were infrequently used. Interpretation In this large, multicentre analysis of GBC surgical outcomes, liver resection was not conclusively associated with improved survival, and extended resections were associated with greater morbidity and mortality without oncological benefit. Aggressive upfront resections do not benefit higher stage GBC, and international col&#x2;laborations are needed to develop evidence-based neoadjuvant and adjuvant treatment strategies to minimise surgical morbidity and prioritise prognostic benefit

A context extraction and profiling engine for 5G network resource mapping

Future 5G network ecosystems comprise a plethora of 3GPP and non 3GGP Radio Access Technologies - RATs. Deployment scenarios envision a multi-layer use of macro, micro and femto-cells where multi-mode end devices, supporting different applications, are served by different technologies. The association of end devices to the most appropriate RAT/layer will therefore become a tantalizing process necessitating the introduction of mechanisms that decide and execute an optimal mapping. The latter is of paramount importance since sub-optimal configuration of network components will affect overall network performance. Towards this end, we introduce the Context Extraction and Profiling Engine (CEPE), a knowledge discovery (KDD) framework catering for the extraction and exploitation of user behavioral patterns from network and service information. An eNB exploits the knowledge scheme derived by CEPE in order to improve the placement of end devices to RATs/layers. In the context of this paper, we provide a thorough analysis of existing standards, research papers and patents, discuss the main innovation of our proposal and highlight the differences with existing schemes. Building on use cases involving mobility management mechanisms that typically affect device to technology mapping (i.e. cell (re)selection, handover) we provide an extensive set of experiments that demonstrate the validity and viability of our idea. Overall evaluation showcases that CEPE achieves high quality results thus emerging as a viable approach for network optimization in future 5G environments. © 2017 Elsevier B.V