Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Self-configuration Concept to Solve Physical Cell ID Conflict for SON LTE-based Femtocell Environment

and Self-healing functions are the most important concepts for self-managing heterogeneous network. However, the concept of self-configuration can be used to solve various challenges in the femtocell deployment phase and also in the PCIs confusion and collision problems. However, the proposed solutions for interference mitigation are not satisfying and need further improvement. Two main reasons identified for this unsatisfactory, firstly the small number of femtocells used in the simulation scenario which can lead to high failure probability if applied under real enterprise environment, secondly; the provided solutions discussed only part of the problem,i.e. either in co-tier interference or cross-tier interference but not both. Thus the need arises for stable solution which can resolve the interference problem for both inter and intra scenarios. In addition among the tree types of approaches used to solve collision and confusion problems the Nokia Siemens approach was the best. Index Terms — Self-configuration, cross-tire and co-tier interference, SON, LTE-femtocell, interference. I

New graph colouring algorithm for resource allocation in large-scale wireless networks

The vertex-colouring problem is a well-known classical problem in graph theory in which a colour is assigned to each vertex of the graph such that no two adjacent vertices have the same colour. The minimum vertex-colouring problem is known as NP-hard problem in an arbitrary graph. In this paper a graph colouring algorithm based on modified incidence matrix is proposed for resolving Physical Cell ID (PCI) allocation for largescale femtocell deployment in LTE Telecommunication Networks. The proposed algorithm is not specified for neighbours only, but additionally can deal with neighbours of neighbours’ objects due to telecommunication requirements. Our results show that by applying proper searching and assigning methods it is possible to achieve satisfactory results for resource allocation in large and complex networks such as resolving PCI allocation and conflict for large femtocells deployment in LTE Networks

Femtocell geo-location challenge DSL approach as solution

Femtocell or Home eNode cell in LTE is a home base station that anticipated to be deployed in very large numbers with fully automated manner. Femtocell provides enhanced coverage for in‐building cellular services. The enhanced data rates enable new multimedia services which in turn generate new revenue. However, with all the convenience such device can provide, locating the user’s geographic location represents a great deal of challenge for law enforcement and operators alike. In this work we propose a simple and direct approach that does not require any changes in the network or in the femtocell standard design by exploiting the connection between the femtocell and the network operator through the DSL backhaul. Result shows the proposed approach has achieved successfully the goal of locating the geographic location of the femtocell user precisely

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)