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

Economic Development and Housing Policy In the Asian Pacific Rim: A Comparative Study of Hong Kong, Singapore, And Shenzhen Special Economic Zone

At the origins of the research presented here lie a dramatic dilemma and a striking paradox.The dilemma concerns teh apparent contradiction between the use of resources to foster economic growth and the necessity to provide public expenses to cover elementary human needs. In most of the developing world, the housing situation has continued to deteriorate in the largest metropolitan areas. This has been true even when the areas were experiencing periods of sustained economic growth, as was the case for most of Asia, and for Latin America until the 1980s. The growing proportion of squatters among urban dwellers all over the world is evidence of this dilemma. thus, housing appears to be a burden for development and a need almost impossible to satisfy for the majority of the population until much later stages of development, which may never be reached by a given country.The paradox is that Singapore and Hong Kong, the two countries with the highest rate of economic growth of the last 25 years, are also the countries that have built the two largest public housing systems in the world during that period. Their public housing systems are the largest in terms of the proportion of the population housed by the government (in 1987, 46 percent for Hong Kong, 86 percent for Singapore). It may be argued that it is precisely their economic growth that has made it affordable for the government to spend so much for public goods. However, the public housing programs actually preceded the process of economic growth and went hand-in-hand with it throughout the period when the growth occurred. It can be reasonably proposed that there is a meaningful relationship -- and not just a historical coincidence -- between these two processes: namely, a high rate of economic growth and the building of a comprehensive public housing program. At least, such is the thesis that we put forward and that we will try to prove and to document in this monograph. To be sure, both countries are very specific. Both are city states and tiny in their physical dimension, but other developing countries have similar or smaller populations. For example, Hong Kong is more populated than all Central American countries with the exception of Guatemala. While size is an important factor, it does not determine the extent or even the form of a housing program: all the public housing estates of Singapore (which house 86 percent of the 2.6 million population) still occupy only less than 5 percent of the island's surface. However, we will not argue against the obvious specificity of the urban situations studied here. What we are concerned with are the economic, social, and political mechanisms that made possible these public housing programs and their positive interaction with the process of economic development. These mechanisms are what could be considered as potential elements for the formulation of housing policies in other contexts, not the actual forms and institutions of the public housing progress in the two city-states.By way of contrast, we have studied the connection between housing policy and industrial development in Shenzhen, which lies across teh border from Hong Kong and is the most important of the Chinese Special Economic Zones. These economic zones have been set up by a socialist state, China, as a deliberate counterpoint to the successful Asian newly industrialized countries (three of them of primarily Chinese ethnic composition). In these zones, China is trying to reproduce the mechanism of participation in the international economy as the key for economic success. Interestingly enough, housing policy is the one element that the Chinese government has NOT replicated in Shenzhen. Instead, it has actually used housing as a profit-making mechanism whose benefits go to real estate companies, public or private, and through them, to the government revenues. Thus, in an approximate manner, we can shift the terms of our paradox (the connection between capitalist industrialization and nonprofit housing in Hong Kong and Singapore): Shenzhen provides us with the opportunity too analyze the effects of profit-making housing on socialist industrialization.For our analysis, we conducted research over a period of four years, from 1983 to 1987, although with varying intensity during this time span. Manuel Castells conducted a pilot study in Hong Kong in 1983, supported by the Center of Urban Studies of the University of Hong Kong. Reginald Kwok started a study in 1985 of economic and spatial development in Shenzhen. Lee Goh combined professional work and reflection upon it as an architect at the Singapore Housing Development Board in 1979-82 and 1984-86. In 1986, the University of California's Pacific Rim Research Program, the Institute of International Studies, and the Institute of Urban and Regional Development at Berkeley provided their full financial and institutional support to the project. At this time the study became a full-fledged research program that engaged most of the time and the effort of the three researchers from the Fall of 1986 to the end of 1987. Manuel Castells in Hong Kong, with the cooperation of Reginald Kwok and the research assistance of To Lap-kee; renewed field work research by Reginald Kwok and To Lap-kee in Shenzhen; and field work in Singapore by Manuel Castells and Lee Goh. Data analysis and elaboration of the research proceeded throughout the whole period in Hong Kong, Singapore, and Berkeley, with the researchers moving around the Pacific in a truly international cooperative venture.The work relied on data collected by three different procedures: (1) Personal observation and acquaintance with the subject; (2) a systematic search of secondary sources, in terms of monographs, statistics, and documents (the theses materials produced and deposited in the Universities of Hong Kong and Singapore proved precious in that sense); (3) in-depth interviews of key actors of economic development, housing policy, and policy-making in general. The interviews provided the main materials for the analysis. We conducted interviews in Hong Kong, Singapore, and Shenzhen, and even in London, where Reginald Kwok had to go to meet Hong Kong's retired governor, Sir Murray MacLehose. In total, nearly 100 focused interviews were conducted, with written notes taken in all cases. Interviews lasted between 45 minutes and two hours, with an average time of one and one-quarter hours. In addition to the interviews, about 40 planned visits to housing estates, neighborhoods, offices, and factories were also performed. A list of interviews for each city is presented in appendices to the corresponding chapters.The result of this data-gathering enterprise is an extraordinary documentation that could have easily overwhelmed the analytical purpose of our research. We have made an effort to be succinct and focused in our analysis, but the courageous reader may find it useful to skip through the pages of this monograph and focus on those themes and propositions that are really at the core of our endeavour: that economic growth and the quality of urban life not only are compatible aspects of the development process but that they can be synergistic in their contribution to such process

Selective Equatorial Sclera Crosslinking in the Orbit Using a Metal-Coated Polymer Waveguide.

Purpose Photochemical crosslinking of the sclera is an emerging technique that may prevent excessive eye elongation in pathologic myopia by stiffening the scleral tissue. To overcome the challenge of uniform light delivery in an anatomically restricted space, we previously introduced the use of flexible polymer waveguides. We presently demonstrate advanced waveguides that are optimized to deliver light selectively to equatorial sclera in the intact orbit. Methods Our waveguides consist of a polydimethylsiloxane cladding and a polyurethane core, coupled to an optical fiber. A reflective silver coating deposited on the top and side surfaces of the waveguide prevents light leakage to nontarget, periorbital tissue. Postmortem rabbits were used to test the feasibility of in situ equatorial sclera crosslinking. Tensometry measurements were performed on ex vivo rabbit eyes to confirm a biomechanical stiffening effect. Results Metal-coated waveguides enabled efficient light delivery to the entire circumference of the equatorial sclera with minimal light leakage to the periorbital tissues. Blue light was delivered to the intact orbit with a coefficient of variation in intensity of 22%, resulting in a 45 ± 11% bleaching of riboflavin fluorescence. A 2-fold increase in the Young's modulus at 5% strain (increase of 92% P < 0.05, at 25 J/cm2) was achieved for ex vivo crosslinked eyes. Conclusions Flexible polymer waveguides with reflective, biocompatible surfaces are useful for sclera crosslinking to achieve targeted light delivery. We anticipate that our demonstrated procedure will be applicable to sclera crosslinking in live animal models and, potentially, humans in vivo

Design of a device for simultaneous particle size and electrostatic charge measurement of inhalation drugs

10.1007/s11095-008-9660-xPharmaceutical Research25112488-2496PHRE