On the interaction between Autonomous Mobility-on-Demand systems and the power network: models and coordination algorithms

We study the interaction between a fleet of electric, self-driving vehicles servicing on-demand transportation requests (referred to as Autonomous Mobility-on-Demand, or AMoD, system) and the electric power network. We propose a model that captures the coupling between the two systems stemming from the vehicles' charging requirements and captures time-varying customer demand and power generation costs, road congestion, battery depreciation, and power transmission and distribution constraints. We then leverage the model to jointly optimize the operation of both systems. We devise an algorithmic procedure to losslessly reduce the problem size by bundling customer requests, allowing it to be efficiently solved by off-the-shelf linear programming solvers. Next, we show that the socially optimal solution to the joint problem can be enforced as a general equilibrium, and we provide a dual decomposition algorithm that allows self-interested agents to compute the market clearing prices without sharing private information. We assess the performance of the mode by studying a hypothetical AMoD system in Dallas-Fort Worth and its impact on the Texas power network. Lack of coordination between the AMoD system and the power network can cause a 4.4% increase in the price of electricity in Dallas-Fort Worth; conversely, coordination between the AMoD system and the power network could reduce electricity expenditure compared to the case where no cars are present (despite the increased demand for electricity) and yield savings of up $147M/year. Finally, we provide a receding-horizon implementation and assess its performance with agent-based simulations. Collectively, the results of this paper provide a first-of-a-kind characterization of the interaction between electric-powered AMoD systems and the power network, and shed additional light on the economic and societal value of AMoD.Comment: Extended version of the paper presented at Robotics: Science and Systems XIV, in prep. for journal submission. In V3, we add a proof that the socially-optimal solution can be enforced as a general equilibrium, a privacy-preserving distributed optimization algorithm, a description of the receding-horizon implementation and additional numerical results, and proofs of all theorem

Variation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals

Introduction: Elderly breast cancer patients have been shown to be managed less aggressively than younger patients. There is evidence that their management varies between institutions. We audited the management of elderly patients in two neighboring units in Glasgow and aimed to identify reasons for any differences in practice found. Methods: Patients aged ≥70 years, who were managed for a new diagnosis of breast cancer in the two units between 2009 and 2013, were identified from a prospectively maintained database. Tumor pathology, treatment details, postcode and consultant in charge of care were obtained from the same database. Comorbidities were obtained from each patient’s electronic clinical record. Questionnaires were distributed to members of each multidisciplinary teams. Results: 487 elderly patients in Unit 1 and 467 in Unit 2 were identified. 76.2% patients in Unit 1 were managed surgically compared to 63.7% in Unit 2 (p<0.0001). There was no difference between the two units in patient age, tumor pathology, deprivation or comorbidity. 16.2% patients managed surgically in Unit 1 had a comorbidity score of 6 and above compared to 11% of surgically managed patients in Unit 2 (p=0.036). Responses to questionnaires suggested that staff at Unit 1 were more confident of the safety of general anesthetic in elderly patients and were more willing to consider local anesthetic procedures. Conclusion: A higher proportion of patients aged >70 years with breast cancer were managed surgically in Unit 1 compared to Unit 2. Reasons for variation in practice seem to be related to attitudes of medical professionals toward surgery in the elderly, rather than patient or pathological factors

A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland – an analysis of 589 patients

Introduction: Current evidence for oncoplastic breast conservation (OBC) is based on single institutional series. Therefore, we carried out a population-based audit of OBC practice and outcomes in Scotland. Methods: A predefined database of patients treated with OBC was completed retrospectively in all breast units practicing OBC in Scotland. Results: 589 patients were included from 11 units. Patients were diagnosed between September 2005 and March 2017. High volume units performed a mean of 19.3 OBCs per year vs. low volume units who did 11.1 (p = 0.012). 23 different surgical techniques were used. High volume units offered a wider range of techniques (8–14) than low volume units (3–6) (p = 0.004). OBC was carried out as a joint operation involving a breast and a plastic surgeon in 389 patients. Immediate contralateral symmetrisation rate was significantly higher when OBC was performed as a joint operation (70.7% vs. not joint operations: 29.8%; p < 0.001). The incomplete excision rate was 10.4% and was significantly higher after surgery for invasive lobular carcinoma (18.9%; p = 0.0292), but was significantly lower after neoadjuvant chemotherapy (3%; p = 0.031). 9.2% of patients developed major complications requiring hospital admission. Overall the complication rate was significantly lower after neoadjuvant chemotherapy (p = 0.035). The 5 year local recurrence rate was 2.7%, which was higher after OBC for DCIS (8.3%) than invasive ductal cancer (1.6%; p = 0.026). 5-year disease-free survival was 91.7%, overall survival was 93.8%, and cancer-specific survival was 96.1%. Conclusion: This study demonstrated that measured outcomes of OBC in a population-based multi-centre setting can be comparable to the outcomes of large volume single centre series

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

Bőrkímélő (skin-sparing) mastectomia és azonnali emlőrekonstrukció onkológiai biztonságossága a recidívaarány, recidívalokalizáció és a rekonstrukciós technika függvényében | Oncologic safety of skin-sparing mastectomy followed by immediate breast reconstruction: rate and localization of recurrences, and impact of reconstruction techniques

Bevezetés: A bőrkímélő mastectomia és az azonnali emlőrekonstrukció onkosebészeti biztonságossága megkérdőjelezhető. A rendelkezésre álló evidencia a legtöbb esetben szelektált betegcsoportok rövid távú utánkövetésén alapul. Cél: A szerzők tanulmányukban egy nem szelektált betegcsoport 10 éves onkológiai utánkövetésének adatait elemzik. Módszerek: 253, bőrkímélő mastectomiával és azonnali emlőrekonstrukcióval kezelt beteg utánkövetési adatainak retrospektív elemezését végezték. Minden, emlőcarcinomával diagnosztizált betegnek felajánlották az azonnali emlőrekonstrukciót a tumor stádiumától függetlenül („all-comers” módszer). Eredmények: Az „all-comers” módszer eredményeképp a betegek viszonylag nagy hányada előrehaladott emlőrákkal került műtétre. 119 hónapos átlagos utánkövetési idő alatt a lokoregionális recidíva aránya 8,2%, a distalis kiújulás 10,6% volt. A betegek emlőrák-specifikus túlélése 90,9% volt. Autológ szövettel végzett emlőrekonstrukciót gyakrabban alkalmaztak magasabb tumorstádium esetén, ezért a recidívák gyakorisága magasabb volt, mint implantátummal végzett emlőrekonstrukciók után. Következtetés: A hosszú távú utánkövetésen alapuló eredmények szerint a bőrkímélő mastectomia és az azonnali emlőrekonstrukció onkológiailag megbízható kezelési módszer. Mivel az „all-comers” módszer alkalmazása onkológiailag biztonságosnak bizonyult, ezért azonnali emlőrekonstrukció a tumorstádiumtól függetlenül felajánlható. Orv. Hetil., 2013, 154, 163–171. | Introduction: Oncological safety of skin-sparing mastectomy followed by immediate breast reconstruction is widely debated. Current evidence is relatively poor since it is based mostly on short-term follow-up data of highly selected patient populations. Aim: Recurrence rates of a large cohort of non-selected patients, i. e. “all-comers” were analyzed during a 10-year follow up. Methods: Patient records and follow-up data of 253 consecutive cases treated with of skin-sparing mastectomy and immediate breast reconstruction between 1995 and 2000 were studied. During this time period “all-comers” policy was applied, which meant that all patients treated with mastectomy were offered immediate breast reconstruction regardless of tumour stage. Results: “All-comers” approach resulted in a large proportion of patients with more advanced disease. During the 112 months mean follow-up 8.2% locoregional, 2.9% local, 10.6% distal and 18.8% overall recurrence rates were detected. Breast cancer specific survival rate was 90.9%. Autologous breast reconstruction was applied more frequently in patients with higher tumour stage; therefore recurrence rate was higher compared to patients undergoing implant-based reconstruction. Conclusion: Based on these long-term follow-up data skin-sparing mastectomy combined with immediate breast reconstruction is an oncologically safe treatment option. Therefore, application of “all-comers” policy for breast cancer patients treated with skin-sparing mastectomy followed by immediate breast reconstruction is feasible. Orv. Hetil., 2013, 154, 163–171

Oncological Outcomes and Complications after Volume Replacement Oncoplastic Breast Conservations—The Glasgow Experience

Introduction Oncoplastic breast conservation surgery (OBCS) combines the principles of surgical oncology and plastic surgery. OBCS has now become a growing option for the treatment of breast cancer and forms a part of breast-conserving therapy (BCT). We sought to investigate and report our experience in two breast units in Glasgow (Victoria Infirmary and Western Infirmary) on volume replacement OBCS. Materials and Methods Details of patients treated with volume replacement OBCS were identified from a prospectively recorded database from November 2010 to October 2015. The clinical records included in the oncoplastic dataset were analyzed for demographics, tumor, treatment characteristics, and recurrences. The data were analyzed for follow-up to determine the pattern and timing of recurrence up to April 2016. The primary outcome of this study was tumor-free margin resection rates, and the secondary outcomes were locoregional and distant recurrence rates as these correlate with the overall oncological safety of volume replacement oncoplastic breast surgery (OPBS). Results A total of 30 volume replacement oncoplastic breast conservation procedures have been carried out in this time period. The mean age of the former group was 51 years. Twice as many patients presented symptomatically than had tumors detected on screening. The mean preoperative tumor size on radiology was 25.4 mm. Patients underwent 13 thoracoepigastric flaps, 5 lateral intercostal artery perforator (LICAP) flaps, 2 thoracodorsal artery perforator (TDAP) flaps, 1 lateral thoracic artery perforator (LTAP) flap, 1 crescent flap volume replacement surgery, and 8 matrix rotations. Two patients had neoadjuvant chemotherapy. Fourteen patients had adjuvant chemotherapy, and all patients were treated with adjuvant radiotherapy. Twenty-two patients were treated with hormonal therapy and four patients were treated with Herceptin. The rate of incomplete excision was 10%. Median follow-up time was 48.5 months. Only one regional recurrence was detected. Eight patients encountered some form of complication. Conclusion This study continues to show the relative oncological safety of volume replacement oncoplastic conservations as an option for reconstruction in breast cancer patients. Further research is urgently needed to build robust evidence supporting the long-term oncological safety

Terápiás emlőplasztika intraoperatív, közvetlen posztoperatív és hosszú távú onkosebészeti biztonsága | Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty

Bevezetés: Az onkoplasztikai emlősebészeti módszerek alkalmazásával a hagyományosan mastectomiával kezelt (pre)malignus emlőelváltozások is eltávolíthatók emlőmegtartó műtéttel (terápiás emlőplasztika). A módszer onkosebészeti megbízhatóságára ugyanakkor nincsenek megfelelő adatok. Célkitűzés: A szerzők célul tűzték ki a terápiás emlőplasztika onkosebészeti biztonságának meghatározását. Módszer: 99 beteget kezeltek terápiás emlőplasztikával és az eredményeket folyamatosan vezetett emlősebészeti adatbázis alapján elemezték. Az intraoperatív, a közvetlen posztoperatív, illetve a hosszú távú onkológiai biztonságot vizsgálták. Eredmények: A betegek 14,1%-ában voltak a reszekciós szélek inkomplettek, amelyek korreláltak a tumormérettel (p = 0,023) és a multifokális elváltozásokkal (p = 0,012). A terápiás emlőplasztika és a kemoterápia megkezdése közötti időintervallum hasonló volt a mastectomiával, egyszerű széles excisióval, vagy mastectomiával és azonnali rekonstrukcióval kezelt betegekéhez (átlagosan 29–31 nap; p<0,05). 27 hónapos (1–88) átlagos utánkövetési idő alatt a recidíva aránya 6,1%, ebből a lokális recidíva aránya 2% volt. Következtetések: Mivel az irodalmi adatok is hasonlóan rövid utánkövetési időszakon és alacsony betegszámon alapulnak, kulcsfontosságú, hogy minden emlőcentrum, ahol terápiás emlőplasztikát végeznek, folyamatosan vezetett adatbázist készítsen a hosszú távú recidívaarány meghatározása céljából. Orv. Hetil., 2013, 154, 1291–1296. | Introduction: (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. Aim: The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. Method: 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. Results: Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29–31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1–88) mean follow-up. Conclusions: Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up. Orv. Hetil., 2013, 154, 1291–1296