5,073 research outputs found

    Comparing accuracy of tomosynthesis plus digital mammography or synthetic 2D mammography in breast cancer screening: baseline results of the MAITA RCT consortium.

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    AIM: The analyses here reported aim to compare the screening performance of digital tomosynthesis (DBT) versus mammography (DM). METHODS: MAITA is a consortium of four Italian trials, REtomo, Proteus, Impeto, and MAITA trial. The trials adopted a two-arm randomised design comparing DBT plus DM (REtomo and Proteus) or synthetic-2D (Impeto and MAITA trial) versus DM; multiple vendors were included. Women aged 45 to 69 years were individually randomised to one round of DBT or DM. FINDINGS: From March 2014 to February 2022, 50,856 and 63,295 women were randomised to the DBT and DM arm, respectively. In the DBT arm, 6656 women were screened with DBT plus synthetic-2D. Recall was higher in the DBT arm (5路84% versus 4路96%), with differences between centres. With DBT, 0路8/1000 (95% CI 0路3 to 1路3) more women received surgical treatment for a benign lesion. The detection rate was 51% higher with DBT, ie. 2路6/1000 (95% CI 1路7 to 3路6) more cancers detected, with a similar relative increase for invasive cancers and ductal carcinoma in situ. The results were similar below and over the age of 50, at first and subsequent rounds, and with DBT plus DM and DBT plus synthetic-2D. No learning curve was appreciable. Detection of cancers >= 20聽mm, with 2 or more positive lymph nodes, grade III, HER2-positive, or triple-negative was similar in the two arms. INTERPRETATION: Results from MAITA confirm that DBT is superior to DM for the detection of cancers, with a possible increase in recall rate. DBT performance in screening should be assessed locally while waiting for long-term follow-up results on the impact of advanced cancer incidence

    Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study

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    Background: The association between volume, complications and pathological outcomes is still under debate regarding colorectal cancer surgery. The aim of the study was to assess the association between centre volume and severe complications, mortality, less-than-radical oncologic surgery, and indications for neoadjuvant therapy.Methods: Retrospective analysis of 16,883 colorectal cancer cases from 80 centres (2018-2021). Outcomes: 30-day mortality; Clavien-Dindo grade >2 complications; removal of >= 12 lymph nodes; non-radical resection; neoadjuvant therapy. Quartiles of hospital volumes were classified as LOW, MEDIUM, HIGH, and VERY HIGH. Independent predictors, both overall and for rectal cancer, were evaluated using logistic regression including age, gender, AJCC stage and cancer site.Results: LOW-volume centres reported a higher rate of severe postoperative complications (OR 1.50, 95% c.i. 1.15-1.096, P = 0.003). The rate of >= 12 lymph nodes removed in LOW-volume (OR 0.68, 95% c.i. 0.56-0.85, P = 12 lymph nodes removed was lower in LOW-volume than in VERY HIGH-volume centres (OR 0.57, 95% c.i. 0.41-0.80, P = 0.001). A lower rate of neoadjuvant chemoradiation was associated with HIGH (OR 0.66, 95% c.i. 0.56-0.77, P < 0.001), MEDIUM (OR 0.75, 95% c.i. 0.60-0.92, P = 0.006), and LOW (OR 0.70, 95% c.i. 0.52-0.94, P = 0.019) volume centres (vs. VERY HIGH).Conclusion: Colorectal cancer surgery in low-volume centres is at higher risk of suboptimal management, poor postoperative outcomes, and less-than-adequate oncologic resections. Centralisation of rectal cancer cases should be taken into consideration to optimise the outcomes

    Fermi-GBM Discovery of GRB 221009A: An Extraordinarily Bright GRB from Onset to Afterglow

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    We report the discovery of GRB 221009A, the highest flux gamma-ray burst ever observed by the Fermi Gamma-ray Burst Monitor (GBM). This GRB has continuous prompt emission lasting more than 600 seconds which smoothly transitions to afterglow visible in the GBM energy range (8 keV--40 MeV), and total energetics higher than any other burst in the GBM sample. By using a variety of new and existing analysis techniques we probe the spectral and temporal evolution of GRB 221009A. We find no emission prior to the GBM trigger time (t0; 2022 October 9 at 13:16:59.99 UTC), indicating that this is the time of prompt emission onset. The triggering pulse exhibits distinct spectral and temporal properties suggestive of the thermal, photospheric emission of shock-breakout, with significant emission up to \sim15 MeV. We characterize the onset of external shock at t0+600 s and find evidence of a plateau region in the early-afterglow phase which transitions to a slope consistent with Swift-XRT afterglow measurements. We place the total energetics of GRB 221009A in context with the rest of the GBM sample and find that this GRB has the highest total isotropic-equivalent energy (E,iso=1.01055\textrm{E}_{\gamma,\textrm{iso}}=1.0\times10^{55} erg) and second highest isotropic-equivalent luminosity (L,iso=9.91053\textrm{L}_{\gamma,\textrm{iso}}=9.9\times10^{53} erg/s) based on redshift of z = 0.151. These extreme energetics are what allowed us to observe the continuously emitting central engine of GBM from the beginning of the prompt emission phase through the onset of early afterglow.Comment: 26 pages 7 figures - accepted for publication in ApJ

    The foreground transfer function for HI intensity mapping signal reconstruction: MeerKLASS and precision cosmology applications

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    Blind cleaning methods are currently the preferred strategy for handling foreground contamination in single-dish HI intensity mapping surveys. Despite the increasing sophistication of blind techniques, some signal loss will be inevitable across all scales. Constructing a corrective transfer function using mock signal injection into the contaminated data has been a practice relied on for HI intensity mapping experiments. However, assessing whether this approach is viable for future intensity mapping surveys where precision cosmology is the aim, remains unexplored. In this work, using simulations, we validate for the first time the use of a foreground transfer function to reconstruct power spectra of foreground-cleaned low-redshift intensity maps and look to expose any limitations. We reveal that even when aggressive foreground cleaning is required, which causes >50%{>}\,50\% negative bias on the largest scales, the power spectrum can be reconstructed using a transfer function to within sub-percent accuracy. We specifically outline the recipe for constructing an unbiased transfer function, highlighting the pitfalls if one deviates from this recipe, and also correctly identify how a transfer function should be applied in an auto-correlation power spectrum. We validate a method that utilises the transfer function variance for error estimation in foreground-cleaned power spectra. Finally, we demonstrate how incorrect fiducial parameter assumptions (up to 100%{\pm}100\% bias) in the generation of mocks, used in the construction of the transfer function, do not significantly bias signal reconstruction or parameter inference (inducing <5%{<}\,5\% bias in recovered values).Comment: 25 pages, 20 figures. See Figure 4 for the main demonstration of the transfer function's performance for reconstructing signal loss from foreground cleaning. Submitted to MNRAS for publicatio

    The Third Fermi Large Area Telescope Catalog of Gamma-ray Pulsars

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    International audienceWe present 294 pulsars found in GeV data from the Large Area Telescope (LAT) on the Fermi Gamma-ray Space Telescope. Another 33 millisecond pulsars (MSPs) discovered in deep radio searches of LAT sources will likely reveal pulsations once phase-connected rotation ephemerides are achieved. A further dozen optical and/or X-ray binary systems co-located with LAT sources also likely harbor gamma-ray MSPs. This catalog thus reports roughly 340 gamma-ray pulsars and candidates, 10% of all known pulsars, compared to 11\leq 11 known before Fermi. Half of the gamma-ray pulsars are young. Of these, the half that are undetected in radio have a broader Galactic latitude distribution than the young radio-loud pulsars. The others are MSPs, with 6 undetected in radio. Overall, >235 are bright enough above 50 MeV to fit the pulse profile, the energy spectrum, or both. For the common two-peaked profiles, the gamma-ray peak closest to the magnetic pole crossing generally has a softer spectrum. The spectral energy distributions tend to narrow as the spindown power E\dot E decreases to its observed minimum near 103310^{33} erg s1^{-1}, approaching the shape for synchrotron radiation from monoenergetic electrons. We calculate gamma-ray luminosities when distances are available. Our all-sky gamma-ray sensitivity map is useful for population syntheses. The electronic catalog version provides gamma-ray pulsar ephemerides, properties and fit results to guide and be compared with modeling results

    Receiver design for the REACH global 21-cm signal experiment

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    We detail the the REACH radiometric system designed to enable measurements of the 21-cm neutral hydrogen line. Included is the radiometer architecture and end-to-end system simulations as well as a discussion of the challenges intrinsic to highly-calibratable system development. Following this, we share laboratory results based on the calculation of noise wave parameters utilising an over-constrained least squares approach demonstrating a calibration RMSE of 80 mK for five hours of integration on a custom-made source with comparable impedance to that of the antenna used in the field. This paper therefore documents the state of the calibrator and data analysis in December 2022 in Cambridge before shipping to South Africa.Comment: 30 pages, 19 figure

    The COVID - AGICT study: COVID鈥19 and advanced gastro-intestinal cancer surgical treatment. A multicentric Italian study on the SARS-CoV-2 pandemic impact on gastro-intestinal cancers surgical treatment during the 2020. Analysis of perioperative and short-term oncological outcomes

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    Background: This Italian multicentric retrospective study aimed to investigate the possible changes in outcomes of patients undergoing surgery for gastrointestinal cancers during the COVID-19 pandemic. Method: Our primary endpoint was to determine whether the pandemic scenario increased the rate of patients with colorectal, gastroesophageal, and pancreatic cancers resected at an advanced stage in 2020 compared to 2019. Considering different cancer staging systems, we divided tumors into early stages and advanced stages, using pathological outcomes. Furthermore, to assess the impact of the COVID-19 pandemic on surgical outcomes, perioperative data of both 2020 and 2019 were also examined. Results: Overall, a total of 8250 patients, 4370 (53%) and 3880 (47%) were surgically treated during 2019 and 2020 respectively, in 62 Italian surgical Units. In 2020, the rate of patients treated with an advanced pathological stage was not different compared to 2019 (P = 0.25). Nevertheless, the analysis of quarters revealed that in the second half of 2020 the rate of advanced cancer resected, tented to be higher compared with the same months of 2019 (P = 0.05). During the pandemic year 'Charlson Comorbidity Index score of cancer patients (5.38 +/- 2.08 vs 5.28 +/- 2.22, P = 0.036), neoadjuvant treatments (23.9% vs. 19.5%, P &lt; 0.001), rate of urgent diagnosis (24.2% vs 20.3%, P &lt; 0.001), colorectal cancer urgent resection (9.4% vs. 7.37, P &lt; 0.001), and the rate of positive nodes on the total nodes resected per surgery increased significantly (7 vs 9% -2.02 +/- 4.21 vs 2.39 +/- 5.23, P &lt; 0.001). Conclusions: Although the SARS-CoV-2 pandemic did not influence the pathological stage of colorectal, gastro-esophageal, and pancreatic cancers at the time of surgery, our study revealed that the pandemic scenario negatively impacted on several perioperative and post-operative outcomes

    Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

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