Beyond the pandemic? Exploring the impact of COVID-19 on spectrum use and management

COVID-19 has influenced the way we utilise the radio spectrum in terms of increasing data rates, the localisation of usage, and the transfer of traffic from urban to rural areas. Most regulators have shown sympathy towards operator requirements, stipulating a range of mitigation actions including allowing technology neutrality and temporary assignments. Internationally, the ITU-R suspended all physical meetings and launched a new global network resiliency platform named 'REG4COVID' to share experiences including those related to spectrum management. It is argued in this chapter that the pandemic has supported the calls for additional unlicensed spectrum for Wi-Fi in the 6 GHz and accelerated the rollout of 5G. Moreover, despite of increasing use of streaming, it is quite difficult to assume that traditional linear TV will be replaced, at least in the near future for a variety of reasons. The pandemic has also raised the question as to whether an innovative assignment model could be used to assign the spectrum instead of auctions, and whether, in some countries where temporary assignments were made, frequencies are kept unutilised or reserved. Concerning international spectrum management, it is expected that WRC-23 will be held on time though there will be some implications for issues such as the regulatory time-limits for bringing into use satellite networks frequency assignments. Finally, it is argued that the pandemic has also demonstrated the importance of flexibility and agility in national spectrum management, and placed spectrum managers in a new position where they were forced to be proactive instead of their traditional reactive role. © 2023 the authors.

Trials using deferred consent in the emergency setting: a systematic review and narrative synthesis of stakeholders' attitudes.

BACKGROUND: Patients with acute conditions often lack the capacity to provide informed consent, and narrow therapeutic windows mean there is no time to seek consent from surrogates prior to treatment being commenced. One method to enable the inclusion of this study population in emergency research is through recruitment without prior consent, often known as 'deferred consent'. However, empirical studies have shown a large disparity in stakeholders' opinions regarding this enrolment method. This systematic review aimed to understand different stakeholder groups' attitudes to deferred consent, particularly in relation to the context in which deferred consent might occur. METHODS: Databases including MEDLINE, EMCare, PsychINFO, Scopus, and HMIC were searched from 1996 to January 2021. Eligible studies focussed on deferred consent processes for adults only, in the English language, and reported empirical primary research. Studies of all designs were included. Relevant data were extracted and thematically coded using a narrative approach to 'tell a story' of the findings. RESULTS: Twenty-seven studies were included in the narrative synthesis. The majority examined patient views (n = 19). Data from the members of the public (n = 5) and health care professionals (n =5) were also reported. Four overarching themes were identified: level of acceptability of deferred consent, research-related factors influencing acceptability, personal characteristics influencing views on deferred consent, and data use after refusal of consent or participant death. CONCLUSIONS: This review indicates that the use of deferred consent would be most acceptable to stakeholders during low-risk emergency research with a narrow therapeutic window and where there is potential for patients to benefit from their inclusion. While the use of narrative synthesis allowed assessment of the included studies, heterogeneous outcome measures meant that variations in study results could not be reliably attributed to the different trial characteristics. Future research should aim to develop guidance for research ethics committees when reviewing trials using deferred consent in emergency research and investigate more fully the views of healthcare professionals which to date have been explored less than patients and members of the public. Trial registration PROSPERO CRD42020223623.

New ITU-T Study Group 5 Structure and Deliberations

The NTT Group is participating in the international standardization activities in the International Telecommunication Union - Telecommunication Standardization Sector (ITU-T) Study Group (SG) 5 to protect telecommunication facilities from electromagnetic interference and lightning surges, assess the impact of information and communication technologies on climate change, address the issue of a circular economy that enables sustainable development, and contribute to improving the reliability of telecommunication services and reducing the environmental impact of its business activities. In this article, we introduce the study structure of ITU-T SG5 for the new study period (2022–2024), which has finally started due to the COVID-19 pandemic, as well as the latest discussion trends at the first meeting held in June 2022. © 2022 Nippon Telegraph and Telephone Corp.. All rights reserved.

Report on WTSA-20 (World Telecommunication Standardization Assembly)

Due to the impact of COVID-19, the World Telecommunication Standardization Assembly (WTSA-20), which was scheduled to be held in 2020, was held locally and online in Geneva, Switzerland, from March 1 to 9, 2022. This article provides an overview of WTSA-20 and the main deliberations. © 2022 Nippon Telegraph and Telephone Corp.. All rights reserved.

Interprofessional practice in the Intensive Treatment Unit during the Covid-19 pandemic; the reflections of an Advanced Practitioner Radiographer.

Background: The onset of the Covid-19 pandemic in March 2020 posed significant challenges to the National Health Service (NHS) in the United Kingdom (UK). Existing workforce shortages were further exacerbated with staff absence, and the need to redeploy staff into frontline clinical areas became a necessity. Purpose: The exploration of the experiences of an Advanced Practitioner Radiographer volunteering in the Intensive Treatment Unit (ITU) during the Covid-19 pandemic. Method: Interview using Microsoft Teams© involving one participant facilitated by two researchers using a semi-structured interview schedule. Discussion: Redeployment to ITU has allowed individuals to work outside of their normal scope of practice. The non-hierarchical structure within teams, focussed minds and demonstrated interprofessional collaboration at its best, ensuring the best patient care was delivered to those critically affected by the virus. Conclusion: The interprofessional practice demonstrated in ITU during the pandemic should be applied to future learning and training opportunities, to develop individuals and prepare for future pandemics.

An AI based digital-twin for prioritising pneumonia patient treatment.

A digital-twin based three-tiered system is proposed to prioritise patients for urgent intensive care and ventilator support. The deep learning methods are used to build patient-specific digital-twins to identify and prioritise critical cases amongst severe pneumonia patients. The three-tiered strategy is proposed to generate severity indices to: (1) identify urgent cases, (2) assign critical care and mechanical ventilation, and (3) discontinue mechanical ventilation and critical care at the optimal time. The severity indices calculated in the present study are the probability of death and the probability of requiring mechanical ventilation. These enable the generation of patient prioritisation lists and facilitates the smooth flow of patients in and out of Intensive Therapy Units (ITUs). The proposed digital-twin is built on pre-trained deep learning models using data from more than 1895 pneumonia patients. The severity indices calculated in the present study are assessed using the standard benchmark of Area Under Receiving Operating Characteristic Curve (AUROC). The results indicate that the ITU and mechanical ventilation can be prioritised correctly to an AUROC value as high as 0.89. This model may be employed in its current form to COVID-19 patients, but transfer learning with COVID-19 patient data will improve the predictions. The digital-twin model developed and tested is available via accompanying Supplemental material.

Haematological and biochemical pathology markers for a predictive model for ITU admission and death from COVID-19: A retrospective study.

Coronavirus disease (COVID-19) caused by SARS-CoV-2 has affected over 227 countries. Changes in haematological and biochemical characteristics in patients with COVID-19 are emerging as important features of the disease. This study aims to identify the pathological findings of COVID-19 patients at Bedford Hospital by analysing laboratory parameters that were identified as significant potential markers of COVID-19. Patients who were admitted to Bedford Hospital from March-July 2020 and had a positive swab for COVID were selected for this study. Clinical and laboratory data were collected using ICE system. Multiple haematological and biochemistry biomarkers were analysed using univariate and multivariate logistic regression to predict intensive therapy unit (ITU) admission and/or survival based on admission tests. Neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein were elevated in most patients, irrespective of ITU status, representing a common outcome of COVID-19. This was driven by lymphopenia in 80% and neutrophilia in 42% of all patients. Multivariate logistic regression identified an increase in mortality associated with greater age, elevated NLR, alkaline phosphatase activity and hyperkalaemia. With the area under the receiver operating characteristic (ROC) curve of 0.706 +/- 0.04117, negative predictive value (NPV) 66.7% and positive predictive value (PPV) 64.9%. Analysis also revealed an association between increases in serum albumin and potassium concentrations and decreases in serum calcium, sodium and in prothrombin time, with admission to ITU. The area under the ROC curve of 0.8162 +/- 0.0403, NPV 63.3% and PPV 80.5%. These data suggest that using admission (within 4 days) measurements for haematological and biochemical markers, that we are able to predict outcome, whether that is survival or ITU admission.

Cardiothoracic surgery in the midst of a pandemic: Operative outcomes and maintaining a coronavirus disease 2019 (COVID-19)-free environment.

OBJECTIVE: In the United Kingdom, the coronavirus disease 2019 (COVID-19) pandemic has led to the cessation of elective surgery. However, there remains a need to provide urgent and emergency cardiac and thoracic surgery as well as to continue time-critical thoracic cancer surgery. This study describes our early experience of implementing a protocol to safely deliver major cardiac and thoracic surgery in the midst of the pandemic. METHODS: Data on all patients undergoing cardiothoracic surgery at a single tertiary referral center in London were prospectively collated during the first 7 weeks of lockdown in the United Kingdom. A comprehensive protocol was implemented to maintain a COVID-19-free environment including the preoperative screening of all patients, the use of full personal protective equipment in areas with aerosol-generating procedures, and separate treatment pathways for patients with and without the virus. RESULTS: A total of 156 patients underwent major cardiac and thoracic surgery over the study period. Operative mortality was 9% in the cardiac patients and 1.4% in thoracic patients. The preoperative COVID-19 protocol implemented resulted in 18 patients testing positive for COVID-19 infection and 13 patients having their surgery delayed. No patients who were negative for COVID-19 infection on preoperative screening tested positive postoperatively. However, 1 thoracic patient tested positive on intraoperative bronchoalveolar lavage. CONCLUSIONS: Our early experience demonstrates that it is possible to perform major cardiac and thoracic surgery with low operative mortality and zero development of postoperative COVID-19 infection.

Communication in the time of COVID.

The risk of infection precluded normal visiting by relatives of COVID-19 patients in an intensive therapy unit (ITU). Instead, a team of medical students and retired consultants telephoned next of kin with a daily update. A categorised selection of the students' reflections on their experiences is presented and discussed.

Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis.

BACKGROUND: Patients from ethnic minority groups are disproportionately affected by Coronavirus disease (COVID-19). We performed a systematic review and meta-analysis to explore the relationship between ethnicity and clinical outcomes in COVID-19. METHODS: Databases (MEDLINE, EMBASE, PROSPERO, Cochrane library and MedRxiv) were searched up to 31st August 2020, for studies reporting COVID-19 data disaggregated by ethnicity. Outcomes were: risk of infection; intensive therapy unit (ITU) admission and death. PROSPERO ID: 180654. FINDINGS: 18,728,893 patients from 50 studies were included; 26 were peer-reviewed; 42 were from the United States of America and 8 from the United Kingdom. Individuals from Black and Asian ethnicities had a higher risk of COVID-19 infection compared to White individuals. This was consistent in both the main analysis (pooled adjusted RR for Black: 2.02, 95% CI 1.67-2.44; pooled adjusted RR for Asian: 1.50, 95% CI 1.24-1.83) and sensitivity analyses examining peer-reviewed studies only (pooled adjusted RR for Black: 1.85, 95%CI: 1.46-2.35; pooled adjusted RR for Asian: 1.51, 95% CI 1.22-1.88). Individuals of Asian ethnicity may also be at higher risk of ITU admission (pooled adjusted RR 1.97 95% CI 1.34-2.89) (but no studies had yet been peer-reviewed) and death (pooled adjusted RR/HR 1.22 [0.99-1.50]). INTERPRETATION: Individuals of Black and Asian ethnicity are at increased risk of COVID-19 infection compared to White individuals; Asians may be at higher risk of ITU admission and death. These findings are of critical public health importance in informing interventions to reduce morbidity and mortality amongst ethnic minority groups.

Bickerstaff's brainstem encephalitis associated with anti-GM1 and anti-GD1a antibodies.

Bickerstaff's brainstem encephalitis (BBE) is a Guillain-Barré syndrome (GBS) spectrum disorder associated with predominantly central nervous system predilection. Patients exhibit a variable constellation of depressed consciousness, bilateral external ophthalmoplegia, ataxia and long tract signs. Although the pathophysiology is not fully understood, it has been associated with anti-GQ1b antibodies in two-thirds of patients. We present a patient with clinical features consistent with BBE and positive anti-GM1 and anti-GD1a antibodies. A diagnostic approach to the acutely unwell patient with brainstem encephalitis is explored in this clinical context with a literature review of the aforementioned ganglioside antibody significance. Intravenous immunoglobulin therapy is highlighted in BBE using up-to-date evidence-based extrapolation from GBS.

Coronavirus Disease Model to Inform Transmission-Reducing Measures and Health System Preparedness, Australia.

The ability of health systems to cope with coronavirus disease (COVID-19) cases is of major concern. In preparation, we used clinical pathway models to estimate healthcare requirements for COVID-19 patients in the context of broader public health measures in Australia. An age- and risk-stratified transmission model of COVID-19 demonstrated that an unmitigated epidemic would dramatically exceed the capacity of the health system of Australia over a prolonged period. Case isolation and contact quarantine alone are insufficient to constrain healthcare needs within feasible levels of expansion of health sector capacity. Overlaid social restrictions must be applied over the course of the epidemic to ensure systems do not become overwhelmed and essential health sector functions, including care of COVID-19 patients, can be maintained. Attention to the full pathway of clinical care is needed, along with ongoing strengthening of capacity.

Point of care and intensive care lung ultrasound: A reference guide for practitioners during COVID-19.

Objectives: Current events with the recent COVID-19 outbreak are necessitating steep learning curves for the NHS workforce. Ultrasound, although not used in the diagnosis of COVID-19 may be utilised by practitioners at the point of care (POC) or on the intensive care units (ITUs) where rapid assessment of the lung condition may be required. The aim of this article was to review current literature surrounding the use of lung ultrasound in relation to COVID-19 and provide Sonographers with a quick and digestible reference guide for lung pathologies. Key findings: Ultrasound is being used in Italy and China to help review lung condition during the COVID-19 outbreak however not strictly as a diagnostic tool as Computed Tomography (CT) of the chest and chest radiographs are currently gold standard. Ultrasound is highly sensitive in the detection of multiple lung pathologies which can be demonstrated in conjunction with COVID-19 however to date there are no specific, nor pathognomonic findings which relate to COVID-19 on ultrasound. Conclusion: Lung ultrasound is highly sensitive and can quickly and accurately review lung condition creating potential to assess for changes or resolution over time, especially in the ITU and POC setting. However it should not be used as a diagnostic tool for COVID-19 due to low specificity in relation to the virus. Implications for practice: The adoption of lung ultrasound to monitor lung condition during the COVID-19 outbreak may reduce the need for serial exposure to ionising radiation on the wards and in turn reduce the number of radiographers required to attend infected wards and bays, protecting both patients and the workforce.