Proton tracking in a high-granularity Digital Tracking Calorimeter for proton CT purposes

Radiation therapy with protons as of today utilizes information from x-ray CT in order to estimate the proton stopping power of the traversed tissue in a patient. The conversion from x-ray attenuation to proton stopping power in tissue introduces range uncertainties of the order of 2-3% of the range, uncertainties that are contributing to an increase of the necessary planning margins added to the target volume in a patient. Imaging methods and modalities, such as Dual Energy CT and proton CT, have come into consideration in the pursuit of obtaining an as good as possible estimate of the proton stopping power. In this study, a Digital Tracking Calorimeter is benchmarked for proof-of-concept for proton CT purposes. The Digital Tracking Calorimeteris applied for reconstruction of the tracks and energies of individual high energy protons. The presented prototype forms the basis for a proton CT system using a single technology for tracking and calorimetry. This advantage simplifies the setup and reduces the cost of a proton CT system assembly, and it is a unique feature of the Digital Tracking Calorimeter. Data from the AGORFIRM beamline at KVI-CART in Groningen in the Netherlands and Monte Carlo simulation results are used to in order to develop a tracking algorithm for the estimation of the residual ranges of a high number of concurrent proton tracks. The range of the individual protons can at present be estimated with a resolution of 4%. The readout system for this prototype is able to handle an effective proton frequency of 1 MHz by using 500 concurrent proton tracks in each readout frame, which is at the high end range of present similar prototypes. A future further optimized prototype will enable a high-speed and more accurate determination of the ranges of individual protons in a therapeutic beam.Comment: 21 pages, 8 figure

Photodiode read-out of the ALICE photon spectrometer PbWO4PbWO_{4} crystals

Proposal of abstract for LEB99, Snowmass, Colorado, 20-24 September 1999The PHOton Spectrometer of the ALICE experiment is an electromagnetic calorimeter of high granularity consisting of 17280 lead-tungstate (PWO) crystals of dimensions 22x22x180 mm3, read out by large-area PIN-diodes with very low-noise front-end electronics. The crystal assembly is operated at -25C to increase the PWO light yield. A 16.1x17.1 mm2 photodiode, optimized for the PWO emissio spectrum at 400-500 nm, has been developed. The 20x20 mm2 preamplifier PCB is attached to the back side of the diode ceramic frame. The charge sensitive preamplifier is built in discrete logic with two input JFETs for optimum matching with the ~150pF PIN-diode. A prototype shaper has been designed and built in discrete logic. For a detector matrix of 64 units the measured ENCs are between 450-550e at -25C. Beam tests demonstrate that the required energy resolution is reached.Summary:The PHOton Spectrometer of the ALICE experiment is an electromagnetic calorimeter of high granularity consisting of 17280 lead-tungstate (PWO) crystals of dimensions 22x22x180 mm3, coupled to large-area PIN-diodes with matching low-noise preamplifiers. PHOS is optimized for measuring photons, pi0s and eta mesons in the momentum ranges 0.5-10, 1-10 and 2-10 GeV/c, respectively, and is designed for the expected large number of particles that will be produced in central Pb-Pb collisions. Lead tungstate (PWO) is a fast scintillating crystal with a rather complex emission spectrum, consisting of two components: a blue component peaking at 420 nm and a green component peaking at 480-520 nm. The light yield of PWO at room temperature is low compared with other heavy scintillating crystals, for instance BGO. However, the yield depends strongly on the temperature with a coefficient of ~-2 degree. At the selected operating temperature of -25C the yield is about a factor of 3 higher compared to room temperature. Still, in order to reach the required energy resolution for a PHOS channel, an ENC noise of less than 600e for the PIN-diode-preamplifier-shaper stage is required. This is a very low value taking into account the high capacitance of 150-200 pF of the large area PIN-diodes. In collaboration with the PHOS project, the company AME (Horten, Norway) has designed and produced a PIN-photodiode optimized for the cross-section and spectral responsivity of the PHOS PWO crystal. The photodiode has an active area of 17.1x16.1 mm2 and is fabricated on n-type silicon material of thickness 280 um. The wafer specific resistivity is between 3000 and 6000 ohm-cm, which corresponds to a depletion voltage of 70V. The photodiode response is optimized for the spectral region 400-500 nm in order to match the PWO emission spectrum. The PIN-diode is mounted on a ceramic substrate 0.65 mm thick. On this substrate the diode is surrounded by a ceramic frame. The preamplifier PCB of dimension 20x20 mm2 is attached to the back side of the frame. The PIN-diode and bondings to ground and preamplifier input are protected by an optically transparent epoxy layer. The front side of the PIN-diode is glued onto the endface of the PWO crystal with optically transparent glue (Melt-Mount Quick-Stick, Cargille Laboratories, USA). Each crystal is wrapped in White Tyvek to ensure maximum light collection efficiency and optical insulation between the crystals. The PHOS detector consists of four independent modules, each with 4320 channels. The crystal assembly with the photo detectors are operated at -25 +/- 0.3C. The power dissipation per module is ~1 kW. The charge sensitive preamplifier is an operational amplifier built in discrete logic and with two input JFETs (BF861A). Using two JFETs in parallel gives the lowest noise for detector capacitance >100 pF. A prototype shaper, comprising three amplification stages, has been designed and built in discrete logic. For a PIN-diode with capacitance ~150 pF and a leakage current <1 nA under cooling, calculations give optimum time differentiation and integration constants around 3 microsec. For a detector matrix of 64 units the measured ENCs are between 450-550 e at -25C. Beam tests of this matrix show that the required energy resolution for the PHOS is reached

Approved varieties of grain and corn for Minnesota

19 pages. This archival publication may not reflect current scientific knowledge or recommendations. Current information available from the University of Minnesota Extension: https://www.extension.umn.edu

Racial Variation in Echocardiographic Reference Ranges for Left Chamber Dimensions in Children and Adolescents: A Systematic Review.

Echocardiography plays a critical role in the assessment of cardiac disease. Important differences in echocardiographically derived cardiac chamber dimensions have been previously highlighted in different population groups in adult studies, but this has not been systematically studied in children, whose body size changes throughout childhood. The aim of this study was to review the distribution of available reference ranges for the left cardiac chamber dimensions in older children and adolescents. The following electronic data bases were searched: Medline, Embase and Web of Science were searched to identify studies which have established echocardiographic reference ranges of left heart parameters in children and adolescents from 1975 to December 2017. There was no geographical limitation. All results were imported into Endnote. Retrieved articles were screened and data extracted by two independent reviewers. A total of 4398 studies were retrieved, with 36 studies finally included in this review. 29 (81%) references were from North America and European (Caucasians) populations, with only one study each from Africa and South America. Two-dimensional and M-mode techniques were the most commonly used echocardiography techniques. There were methodological variations in techniques and normalisation of references. Comparison of selected cardiac measures showed significant differences for interventricular septal thickness among Black African, Indian, German and US American children. Available echocardiographic references cannot be generalised to all settings and therefore, there is need for locally relevant reference ranges. Africa and South America are particularly under-represented. Future studies should focus on developing comprehensive echocardiographic reference ranges for children from different racial backgrounds and should use standardised techniques

Effect of azithromycin on incidence of acute respiratory exacerbations in children with HIV taking antiretroviral therapy and co-morbid chronic lung disease: a secondary analysis of the BREATHE trial

Background - In the BREATHE trial weekly azithromycin decreased the rate of acute respiratory exacerbations (AREs) compared to placebo among children and adolescents with HIV-associated chronic lung disease (CLD) taking antiretroviral therapy (ART). The aim of this analysis was to identify risk factors associated with AREs and mediators of the effect of azithromycin on AREs. Methods - The primary outcome of this analysis was the rate of AREs by study arm up to 49 weeks. We analysed rates using Poisson regression with random intercepts. Interaction terms were fitted for potential effect modifiers. Participants were recruited from Zimbabwe and Malawi between15 June 2016 and 4 September 2018. Findings - We analysed data from 345 participants (171 allocated to azithromycin and 174 allocated to placebo). Rates of AREs were higher among those with an abnormally high respiratory rate at baseline (adjusted rate ratio (aRR) 2.08 95% CI 1.10-3.95 p-value 0.02) and among those with a CD4 cell count -2 and participants without baseline resistance to azithromycin. However, there was no statistical evidence for interaction due to low statistical power. Interpretation - These may represent subgroups who may benefit the most from treatment with weekly azithromycin, which could help guide targeted treatment. Funding - There was no funding source for this post hoc analysis

A Call for Urgent Monitoring of Food and Water Security Based on Relevant Indicators for the Arctic

This perspective paper argues for an urgent need to monitor a set of 12 concrete, measurable indicators of food and water security in the Arctic over time. Such a quantitative indicator approach may be viewed as representing a reductionist rather than a holistic perspective, but is nevertheless necessary for actually knowing what reality aspects to monitor in order to accurately understand, quantify, and be able to project critical changes to food and water security of both indigenous and non-indigenous people in the Arctic. More relevant indicators may be developed in the future, taking us further toward reconciliation between reductionist and holistic approaches to change assessment and understanding. However, the potential of such further development to improved holistic change assessment is not an argument not to urgently start to monitor and quantify the changes in food and water security indicators that are immediately available and adequate for the Arctic context

Echocardiographic reference ranges in older children and adolescents in sub-Saharan Africa.

BACKGROUND: Echocardiographic reference ranges are important to identify abnormalities of cardiac dimensions. Reference ranges for children in sub-Saharan Africa have not been established. The aim of this study was to establish echocardiographic z-score references for Black children in sub-Saharan Africa. METHODS: 282 healthy subjects aged 6-16years (143 [51%] males) with no known history of cardiac disease were enrolled in the study in Harare, Zimbabwe between 2014 and 2016. Standard M-mode echocardiography was performed and nine cardiac chamber dimensions were obtained. Two non-linear statistical models (gamma weighted model and cubic polynomial model) were tested on the data and the best fitting model was used to calculate z-scores of these cardiac chamber measures. The reference ranges are presented on scatter plots against BSA. RESULTS: Normative data for the following cardiac measures were obtained and z-scores calculated: right ventricular diameter at end diastole (RVEDD); left ventricular diameter at end diastole (LVEDD) and systole (LVESD); interventricular septal wall thickness at end diastole (IVSd) and systole (IVSs); left ventricular posterior wall thickness at end diastole (LVPWd) and systole (LVPWs); left atrium diameter at end systole (LA) and tricuspid annular plane systolic excursion (TAPSE). Girls had higher values for BMI and heart rate than boys (p=0.048 and p=0.001, respectively). Mean interventricular septal and left ventricular posterior walls thickness was higher than published normal values in predominantly Caucasian populations. CONCLUSION: These are the first echocardiographic reference ranges for children from sub Saharan Africa and will allow accurate assessment of cardiac dimensions in clinical practice

Social correlates of term small for gestational age babies in a Russian arctic setting

BACKGROUND. Small for gestational age (SGA) births have been associated with both short- and long-term adverse health outcomes. Although social risk factors for SGA births have been studied earlier, such data are limited from Northern Russia. OBJECTIVE. We assessed maternal social risk factors for term SGA births based on data from the populationbased Murmansk County Birth Registry (MCBR). DESIGN. Data on term live-born singleton infants born between 2006 and 2011 in Murmansk County were obtained from the MCBR. We applied the 10th percentile for only birth weight (SGAW) or for both birth weight and birth length (SGAWL). Binary logistic regression was used to estimate the effect of independent variables on SGA males and females with adjustment for known risk factors and potential confounders. Both crude and adjusted odds ratios with 95% confidence intervals for the studied risk factors were calculated. RESULTS. The proportions of term SGAW and SGAWL births were 9.7 and 4.1%, respectively. After adjustment for potential confounders, the risk of term SGA births among less educated, unemployed, unmarried, smoking and underweight women was higher compared with women from the reference groups. Evidence of alcohol abuse was also associated with birth of SGAWL and SGAW boys. Maternal overweight and obesity decreased the risk of SGA. CONCLUSIONS. Maternal low education, unemployment, unmarried status, smoking, evidence of alcohol abuse and underweight increased the risk of term SGA births in a Russian Arctic setting. This emphasizes the importance of both social and lifestyle factors for pregnancy outcomes. Public health efforts to reduce smoking, alcohol consumption and underweight of pregnant women may therefore promote a decrease in the prevalence of SGA births.http://www.tandfonline.com/loi/zich20am2017School of Health Systems and Public Health (SHSPH