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The impurity density in high-purity germanium detectors is crucial to understand and simulate such detectors. However, the information about the impurities provided by the manufacturer, based on Hall effect measurements, is typically limited to a few locations and comes with a large uncertainty. As the voltage dependence of the capacitance matrix of a detector strongly depends on the impurity density distribution, capacitance measurements can provide a path to improve the knowledge on the impurities. The novel method presented here uses a machine-learned surrogate model, trained on precise GPU-accelerated capacitance calculations, to perform full Bayesian inference of impurity distribution parameters from capacitance measurements. All steps use open-source Julia software packages. Capacitances are calculated with SolidStateDetectors.jl , machine learning is done with Flux.jl and Bayesian inference performed using BAT.jl . The capacitance matrix of a detector and its dependence on the impurity density is explained and a capacitance bias-voltage scan of an n -type true-coaxial test detector is presented. The study indicates that the impurity density of the test detector also has a radial dependence.

Events from alpha interactions on the surfaces of germanium detectors are a major contribution to the background in germanium-based searches for neutrinoless double-beta decay. Surface events are subject to charge trapping, affecting their pulse shape and reconstructed energy. A study of alpha events on the passivated end-plate of a segmented true-coaxial n-type high-purity germanium detector is presented. Charge trapping is analysed in detail and an existing pulse-shape analysis technique to identify alpha events is verified with mirror pulses observed in the non-collecting channels of the segmented test detector. The observed radial dependence of charge trapping confirms previous results. A dependence of the probability of charge trapping on the crystal axes is observed for the first time. A first model to describe charge trapping effects within the framework of the simulation software SolidStateDetectors.jl is introduced. The influence of metalisation on events from low-energy gamma interactions close to the passivated surface is also presented.

The safety and value of same-day mastectomy are well-documented but the patient perspective is underreported, especially among older patients. This study aimed to investigate older patient-reported recovery quality after mastectomy; we hypothesized that patients who were discharged same day would report better recovery. A prospective trial included frailty screening and prehabilitation for patients age ≥ 65 undergoing mastectomy for breast cancer. Primary endpoint, same-day discharge rate, was previously reported and was significantly higher than the year prior. Secondary endpoint was patient-reported postoperative recovery quality, per the Quality of Recovery-15 measure (QoR-15; 15 questions scored 1-10, 10 being best). Patients responded by phone 24-72 h postdischarge. One-tailed -tests compared responses between same-day and admitted patients. 37/55 (67.3%) patients ≥ 65 who underwent unilateral/bilateral mastectomy for early-stage breast cancer responded. Mean age was 73.6 (standard deviation 7.6), most had invasive carcinoma (44, 80.0%), and mean 5-factor Modified Frailty Index (mFI-5) was 1.3 of 5 (standard deviation 0.9); nonresponders had similar characteristics. There were no significant differences in any QoR-15 item (all > 0.05). In fact, most responses were very similar, different by only one-tenth of 1 point or identical. The following answers slightly (0.2 difference or more) numerically favored same-day discharge: feeling rested, having good sleep, less moderate pain, and freedom from feeling anxious or depressed. No items favored admission. Although this trial was not powered for secondary analyses, it is clinically meaningful that older patients undergoing same-day mastectomy reported similar recovery quality as those admitted. Same-day mastectomy should be considered for older patients.

We followed children at family risk of dyslexia and children with preschool language difficulties from age 3½, comparing them with controls (N = 234). At age 8, children were classified as having dyslexia or Developmental Language Disorder (DLD) and compared at earlier time points with controls. Children with dyslexia have specific difficulties with phonology and emergent reading skills in the preschool period, whereas children with DLD, with or without dyslexia, show a wider range of impairments including significant problems with executive and motor tasks. For children with both dyslexia and DLD, difficulties with phonology are generally more severe than those observed in children with dyslexia or DLD alone. Findings confirm that poor phonology is the major cognitive risk factor for dyslexia.

Objective Study of the human infant gut microbiome requires the use of surrogate mammalian species such as mice. We sought to investigate the usefulness of the greater wax moth larva, Galleria mellonella , as an alternative. Results We have analysed the native gut microbiome of Galleria and developed methods for clearing the native microbiome and introducing species from human infant faecal samples. We find that some species, e.g. enterococci, are more successful at recolonisation, but that others, e.g. Bifidobacterium , are less so. The work paves the way for using Galleria rather than mice in this and similar work.

Few studies have reported the outcomes of LDF and immediate fat transfer (LIFT) during breast reconstruction. The aim of this study was to compare the perioperative outcomes and complications of LIFT and standard LDF (without immediate fat transfer) for breast reconstruction. We retrospectively reviewed charts from patients undergoing autologous breast reconstruction after total mastectomy between 2011 and 2021. We compared intraoperative and postoperative outcomes between groups. One hundred nineteen reconstructions (61.02%) were performed with LIFT, while seventy-six (38.98%) were performed with standard LDF. The median volume of total fat transferred during LIFT was 125-cc [110–170 ​cc]. The rates of donor site wound disruption (23.7% versus 12.6%, p ​= ​0.044) were higher using the standard LDF compared to LIFT. Reconstructions performed with LIFT (HR 4.01, p ​< ​0.001) were found to be associated with secondary fat grafting procedures. LIFT is a safe procedure to enhance the volume of LDF in patients desiring autologous reconstruction without increasing recipient-site morbidity. On a time-to-event analysis, LIFT was associated with the requirement of further revision procedures using secondary fat grafting. •LIFT is a safe procedure to enhance the volume of the LDF. A higher rate of revision procedures was evident with LIFT, but lower fat grafting volumes are required during revision procedures compared to the standard LDF if these are needed.

Introduction Ductal carcinoma in situ (DCIS) with foci of invasion measuring ≤ 1 mm (DCISM), represents < 1% of all invasive breast cancers. Sentinel lymph node biopsy (SLNB) has been a standard component of surgery for patients with invasive carcinoma or extensive DCIS. We hypothesize that selective performance of SLNB may be appropriate given the low incidence of sentinel node (SN) metastasis for DCISM. We investigated the clinicopathologic predictors for SN positivity in DCISM, to identify which patients might benefit from SLNB. Methods A retrospective review of the National Cancer Database was performed for cases from 2012 to 2015. Clinical and tumor characteristics, including SN results, were evaluated, and Pearson’s Chi square tests and logistic regression were performed. Results Of 7803 patients with DCISM, 306 (4%) had at least one positive SN. Patients with positive SNs were younger, more often of Black race, had higher-grade histology and larger tumor size, and were more likely to have lymphovascular invasion (LVI; all p  < 0.001). In an adjusted model, the presence of LVI was associated with the highest odds ratio (OR) for node positivity (OR 8.80, 95% confidence interval 4.56–16.96). Conclusions Among women with DCISM, only 4% had a positive SN. Node positivity was associated with more extensive and higher-grade DCIS, and the presence of LVI was strongly correlated with node positivity. Our data suggest that LVI is the most important factor in determining which patients with DCISM will benefit from SN biopsy.

Background Mammographic breast density (MBD) is an independent risk factor for breast cancer. Information regarding the relationship of MBD and breast cancer biology in women with ductal carcinoma in situ (DCIS) is currently lacking. This study aimed to examine the clinicopathologic characteristics of DCIS in women stratified by MBD. Methods A retrospective review was performed to identify women with pure DCIS who underwent preoperative mammography between 2010 and 2018. Clinicopathologic and demographic data were collected. For the purpose of analysis, MBD was categorized as “non-dense” (Breast Imaging-Reporting and Data System [BI-RADS] density categories A and B) or “dense” (BI-RADS C and D) according to its identification in radiology reports. Results Of 3227 patients with a breast cancer diagnosis enrolled in the institutional Breast Cancer Database during the study period, 658 (20%) had pure DCIS. Of these 658 patients, 42% had non-dense breasts, and 58% had dense breasts. Most lesions were non-palpable (92%) and detected by mammography (84%). Patients with dense breasts were more likely to be younger at the time of diagnosis ( p  < 0.001), premenopausal ( p  < 0.001), and Asian ( p  = 0.018), and to have higher-grade disease ( p  = 0.006; Table  2 ). Family history, BRCA status, parity, mammogram frequency, palpability, method of presentation, lesion size, hormone receptor status, comedo histology, and recurrence did not differ significantly between the two groups (Table  1 ). The median follow-up period was 7.1 years. Conclusion Women with pure DCIS and higher MBD are more likely to be younger at the time of diagnosis, premenopausal, and Asian, and to present with higher-grade disease. Further research on the relationship of age, MBD, and tumor biology in DCIS is warranted.

Background A positive lumpectomy margin after breast-conserving surgery (BCS) is a significant predictor for ipsilateral cancer recurrence. The MarginProbe, a Food and Drug Administration (FDA)-approved device for intraoperative assessment of lumpectomy margins, is associated with a reduction in re-excision surgery. This study aimed to evaluate the relationship of mammographic breast density (MBD) and clinicopathologic characteristics with margin status in women undergoing BCS with the MarginProbe. Methods The institutional database was queried for patients with breast cancer who had BCS with the MarginProbe from 2013 to 2017. Clinicopathologic characteristics were collected. The study defined MBD as less dense (Breast Imaging Reporting and Data System [BI-RADS] A and B) and more dense (BI-RADS C and D). A positive margin was defined as smaller than 1 mm. Pearson Chi square and uni- and multivariate logistic regression were performed. Results Of 1734 patients, 341 met the study criteria. The median patient age was 63 years. The patients with higher mammographic density were younger ( p  < 0.0001) and had a lower body mass index (BMI) ( p  < 0.0001). The patients with higher MBD were more likely to present with a palpable mass ( p  = 0.0360). Of the 341 patients, 135 (39.6%) had one or more positive margins on the main specimen, and 101 (74.8%) were converted to final negative margins after the MarginProbe directed re-excisions. Positive final margins were associated with larger tumor size ( p  = 0.0242) and more advanced stage of disease at diagnosis ( p  = 0.0255). Conclusions In this study of patients undergoing BCS, breast density was not correlated with the likelihood of a positive margin. The presence of positive final lumpectomy margins was associated with older age and more extensive disease.