Implementing a Cancer Fast-track programme between primary and specialised care in Catalonia(Spain): amixed methods study

BACKGROUND: The Cancer Fast-track Programme's aim was to reduce the time that elapsed between well-founded suspicion of breast, colorectal and lung cancer and the start of initial treatment in Catalonia (Spain). We sought to analyse its implementation and overall effectiveness. METHODS: A quantitative analysis of the programme was performed using data generated by the hospitals on the basis of seven fast-track monitoring indicators for the period 2006-2009. In addition, we conducted a qualitative study, based on 83 semistructured interviews with primary and specialised health professionals and health administrators, to obtain their perception of the programme's implementation. RESULTS: About half of all new patients with breast, lung or colorectal cancer were diagnosed via the fast track, though the cancer detection rate declined across the period. Mean time from detection of suspected cancer in primary care to start of initial treatment was 32 days for breast, 30 for colorectal and 37 for lung cancer (2009). Professionals associated with the implementation of the programme showed that general practitioners faced with suspicion of cancer had changed their conduct with the aim of preventing lags. Furthermore, hospitals were found to have pursued three specific implementation strategies (top-down, consensus-based and participatory), which made for the cohesion and sustainability of the circuits. CONCLUSION: The programme has contributed to speeding up diagnostic assessment and treatment of patients with suspicion of cancer, and to clarifying the patient pathway between primary and specialised care.

On high-rate full-diversity 2x2 space-time codes with low-complexity optimum detection

The 2×2 MIMO profiles included in Mobile WiMAX specifications are Alamouti’s space-time code (STC) fortransmit diversity and spatial multiplexing (SM). The former hasfull diversity and the latter has full rate, but neither of them hasboth of these desired features. An alternative 2×2 STC, which is both full rate and full diversity, is the Golden code. It is the best known 2×2 STC, but it has a high decoding complexity. Recently, the attention was turned to the decoder complexity, this issue wasincluded in the STC design criteria, and different STCs wereproposed. In this paper, we first present a full-rate full-diversity2×2 STC design leading to substantially lower complexity ofthe optimum detector compared to the Golden code with only a slight performance loss. We provide the general optimized form of this STC and show that this scheme achieves the diversitymultiplexing frontier for square QAM signal constellations. Then, we present a variant of the proposed STC, which provides a further decrease in the detection complexity with a rate reduction of 25% and show that this provides an interesting trade-off between the Alamouti scheme and SM.

Capacity-approaching rate function for layered multiantenna architectures

The simultaneous use of multiple transmit and receive antennas can unleash very large capacity increases in rich multipath environments. Although such capacities can be approached by layered multi-antenna architectures with per-antenna rate control, the need for short-term feedback arises as a potential impediment, in particular as the number of antennas—and thus the number of rates to be controlled—increases. What we show, however, is that the need for short-term feedback in fact vanishes as the number of antennas and/or the diversity order increases. Specifically, the rate supported by each transmit antenna becomes deterministic and a sole function of the signal-to-noise, the ratio of transmit and receive antennas, and the decoding order, all of which are either fixed or slowly varying. More generally, we illustrate -through this specific derivation— the relevance of some established random CDMA results to the single-user multi-antenna problem.

A systolic array for linear MIMO detection based on an all-swap lattice reduction algorithm

A systolic array to implement lattice-reduction-aided lineardetection is proposed for a MIMO receiver. The lattice reductionalgorithm and the ensuing linear detections are operated in the same array, which can be hardware-efficient. All-swap lattice reduction algorithm (ASLR) is considered for the systolic design.ASLR is a variant of the LLL algorithm, which processes all lattice basis vectors within one iteration. Lattice-reduction-aided linear detection based on ASLR and LLL algorithms have very similarbit-error-rate performance, while ASLR is more time efficient inthe systolic array, especially for systems with a large number ofantennas.

Gated Geiger mode avalanche photodiode pixels with integrated readout electronics for low noise photon detection

Avalanche photodiodes operated in the Geiger mode offer a high intrinsic gain as well as an excellent timing accuracy. These qualities make the sensor specially suitable for those applications where detectors with high sensitivity and low timing uncertainty are required. Moreover, they are compatible with standard CMOS technologies, allowing sensor and front-end electronics integration within the pixel cell. However, the sensor suffers from high levels of intrinsic noise, which may lead to erroneous results and limit the range of detectable signals. They also increase the amount of data that has to be stored. In this work, we present a pixel based on a Geiger-mode avalanche photodiode operated in the gated mode to reduce the probability to detect noise counts interfering with photon arrival events. The readout circuit is based on a two grounds scheme to enable low reverse bias overvoltages and consequently lessen the dark count rate. Experimental characterization of the fabricated pixel with the HV-AMS 0.35µm standard technology is also presented in this article.

Contribution of early detection and adjuvant treatments to breast cancer mortality reduction in Catalonia, Spain

Background: Reductions in breast cancer (BC) mortality in Western countries have been attributed to the use of screening mammography and adjuvant treatments. The goal of this work was to analyze the contributions of both interventions to the decrease in BC mortality between 1975 and 2008 in Catalonia. Methodology/Principal Findings: A stochastic model was used to quantify the contribution of each intervention. Age standardized BC mortality rates for calendar years 1975-2008 were estimated in four hypothetical scenarios: 1) Only screening, 2) Only adjuvant treatment, 3) Both interventions, and 4) No intervention. For the 30-69 age group, observed Catalan BC mortality rates per 100,000 women-year rose from 29.4 in 1975 to 38.3 in 1993, and afterwards continuously decreased to 23.2 in 2008. If neither of the two interventions had been used, in 2008 the estimated BC mortality would have been 43.5, which, compared to the observed BC mortality rate, indicates a 46.7% reduction. In 2008 the reduction attributable to screening was 20.4%, to adjuvant treatments was 15.8% and to both interventions 34.1%. Conclusions/Significance: Screening and adjuvant treatments similarly contributed to reducing BC mortality in Catalonia. Mathematical models have been useful to assess the impact of interventions addressed to reduce BC mortality that occurred over nearly the same periods.