Hardware Acceleration of Digital Pulse Shape Analysis Using FPGAs.

The BC501A sensor is a liquid scintillator frequently used in nuclear physics for detecting fast neutrons. This paper describes a hardware implementation of digital pulse shape analysis (DPSA) for real-time analysis. DPSA is an algorithm that extracts the physically relevant parameters from the detected BC501A signals. The hardware solution is implemented in a MicroTCA system that provides the physical, mechanical, electrical, and cooling support for an AMC board (NAMC-ZYNQ-FMC) with a Xilinx ZYNQ Ultrascale-MP SoC. The Xilinx FPGA programmable logic implements a JESD204B interface to high-speed ADCs. The physical and datalink JESD204B layers are implemented using hardware description language (HDL), while the Xilinx high-level synthesis language (HLS) is used for the transport and application layers. The DPSA algorithm is a JESD204B application layer that includes a FIR filter and a constant fraction discriminator (CFD) function, a baseline calculation function, a peak detection function, and an energy calculation function. This architecture achieves an analysis mean time of less than 100 µs per signal with an FPGA resource utilization of about 50% of its most used resources. This paper presents a high-performance DPSA embedded system that interfaces with a 1 GS/s ADC and performs accurate calculations with relatively low latency.

Accuracy of the end-expiratory lung volume measured by the modified nitrogen washout/washin technique: a bench study.

BACKGROUND: The functional residual capacity (FRC) determines the oxygenating capacity of the lung and is heavily affected in the clinical context of the acute respiratory distress syndrome. Nitrogen-wash-in/wash-out methods have been used to measure FRC. These methods have rarely been validated against exactly known volumes. The aim of the study was to assess the accuracy and precision of the N2 washout/washin method in measuring FRC, by comparing it with set volumes in a lung simulator. METHODS: We conducted a diagnostic bench study in the Intensive Care Unit and Radiology Department of a tertiary hospital in Switzerland. Using a fully controllable high fidelity lung simulator (TestChest®), we set the functional residual capacity at 1500 ml, 2000 ml and 2500 ml and connected to the GE Carestation respirator, which includes the nitrogen washout/washin technique (INview™ tool). FRC was then set to vary by different levels of PEEP (5, 8, 12 and 15 cmH2O). The main outcome measures were bias and precision of the TestChest® when compared to the results from the washout/washin technique, according to the results of a Bland Altman Analysis. We verified our findings with volumetric computed tomography. RESULTS: One hundred and thirty-five nitrogen-wash-in/wash-out measurements were taken at three levels of FIO2 (0.4, 0.5, 0.6). The CT volumetry reproduced the set end-expiratory volumes at the Simulator with a bias of 4 ml. The nitrogen-wash-in/wash-out method had a bias of 603 ml with acceptable limits of agreement (95% CI 252 to - 953 ml). Changes were detected with a concordance rate of 97%. CONCLUSIONS: We conclude that the TestChest® simulator is an accurate simulation tool, concerning the simulation of lung volumes. The nitrogen wash-in/wash out method correlated positively with FRC changes, despite a relatively large bias in absolute measurements. The reference volumes in the lung simulator verified with CT volumetry were very close to their expected values. The reason for the bias could not be determined.

Lung nodule detection by microdose CT versus chest radiography (standard and dual-energy subtracted).

OBJECTIVE: The purpose of this study was to investigate the feasibility of microdose CT using a comparable dose as for conventional chest radiographs in two planes including dual-energy subtraction for lung nodule assessment. MATERIALS AND METHODS: We investigated 65 chest phantoms with 141 lung nodules, using an anthropomorphic chest phantom with artificial lung nodules. Microdose CT parameters were 80 kV and 6 mAs, with pitch of 2.2. Iterative reconstruction algorithms and an integrated circuit detector system (Stellar, Siemens Healthcare) were applied for maximum dose reduction. Maximum intensity projections (MIPs) were reconstructed. Chest radiographs were acquired in two projections with bone suppression. Four blinded radiologists interpreted the images in random order. RESULTS: A soft-tissue CT kernel (I30f) delivered better sensitivities in a pilot study than a hard kernel (I70f), with respective mean (SD) sensitivities of 91.1%±2.2% versus 85.6%±5.6% (p=0.041). Nodule size was measured accurately for all kernels. Mean clustered nodule sensitivity with chest radiography was 45.7%±8.1% (with bone suppression, 46.1%±8%; p=0.94); for microdose CT, nodule sensitivity was 83.6%±9% without MIP (with additional MIP, 92.5%±6%; p<10(-3)). Individual sensitivities of microdose CT for readers 1, 2, 3, and 4 were 84.3%, 90.7%, 68.6%, and 45.0%, respectively. Sensitivities with chest radiography for readers 1, 2, 3, and 4 were 42.9%, 58.6%, 36.4%, and 90.7%, respectively. In the per-phantom analysis, respective sensitivities of microdose CT versus chest radiography were 96.2% and 75% (p<10(-6)). The effective dose for chest radiography including dual-energy subtraction was 0.242 mSv; for microdose CT, the applied dose was 0.1323 mSv. CONCLUSION: Microdose CT is better than the combination of chest radiography and dual-energy subtraction for the detection of solid nodules between 5 and 12 mm at a lower dose level of 0.13 mSv. Soft-tissue kernels allow better sensitivities. These preliminary results indicate that microdose CT has the potential to replace conventional chest radiography for lung nodule detection.

High-contrast filtering by multipass diffraction between paired volume Bragg gratings.

High-contrast filtering via multiple reflections between matched volume Bragg gratings (VBGs) is demonstrated. The use of multiple reflections serves to increase the suppression ratio of the out-of-band spectral content such that contributions of grating sidelobes can be mitigated. The result is a device that retains spectral and angular selectivity and diffracts light into a single order with high efficiency but reshapes the spectral/angular response to achieve higher signal-to-noise ratios. We demonstrate that multipass spectral filters can be recorded with extremely high suppression ratios using reflecting Bragg gratings (RBGs) in three different configurations. These filters demonstrate roll-offs of over 150 dB/nm. Similarly, we demonstrate angular filtering by multipass transmitting gratings.

A Simple and Fast Spline Filtering Algorithm for Surface Metrology.

Spline filters and their corresponding robust filters are commonly used filters recommended in ISO (the International Organization for Standardization) standards for surface evaluation. Generally, these linear and non-linear spline filters, composed of symmetric, positive-definite matrices, are solved in an iterative fashion based on a Cholesky decomposition. They have been demonstrated to be relatively efficient, but complicated and inconvenient to implement. A new spline-filter algorithm is proposed by means of the discrete cosine transform or the discrete Fourier transform. The algorithm is conceptually simple and very convenient to implement.

Moiré volume Bragg grating filter with tunable bandwidth.

We propose a monolithic large-aperture narrowband optical filter based on a moiré volume Bragg grating formed by two sequentially recorded gratings with slightly different resonant wavelengths. Such recording creates a spatial modulation of refractive index with a slowly varying sinusoidal envelope. By cutting a specimen at a small angle, to a thickness of one-period of this envelope, the longitudinal envelope profile will shift from a sine profile to a cosine profile across the face of the device. The transmission peak of the filter has a tunable bandwidth while remaining at a fixed resonant wavelength by a transversal shift of incidence position. Analytical expressions for the tunable bandwidth of such a filter are calculated and experimental data from a filter operating at 1064 nm with bandwidth range 30-90 pm is demonstrated.

Stabilization system for holographic recording of volume Bragg gratings using a corner cube retroreflector.

Volume Bragg gratings serve an important role in laser development as devices that are able to manipulate both the wavelength and angular spectrum of light. A common method for producing gratings is holographic recording of a two collimated beam interference pattern in a photosensitive material. This process requires stability of the recording system at a level of a fraction of the recording wavelength. A new method for measuring and stabilizing the phase of the recording beams is presented that is extremely flexible and simple to integrate into an existing holographic recording setup and independent of the type of recording media. It is shown that the presented method increases visibility of an interference pattern and for photo-thermo-refractive glass enables enhancement of the spatial refractive index modulation. The use of this technique allows for longer recording times that can lead to the use of expanded recording beams for large aperture gratings.

Contrast-enhanced point of care ultrasound for the evaluation of stable blunt abdominal trauma by the emergency physician: A prospective diagnostic study.

Objectives: Clinical examination alone cannot reliably rule out significant traumatic abdominal injury. Computed tomography (CT) has become the primary method for evaluating blunt abdominal trauma and clinicians rely heavily on it to rule out abdominal injury. Ultrasound examination may miss significant abdominal injury particularly in stable patients. The use of a contrast agent improves ultrasound sensitivity to visceral abdominal injuries. The objective of this diagnostic study is to compare bedside contrast enhanced ultrasound (CEUS) performed by emergency physicians to CT in hemodynamically stable adults for the assessment of blunt abdominal trauma and evaluate CEUS accuracy outcomes. Methods: Hemodynamically stable patients with blunt trauma were prospectively enrolled in the trauma bay. After initial evaluation, we included patients at risk of abdominal injury and for whom an abdominal CT was planned by the trauma leader. Ultrasonography was performed prospectively and at the bedside by the emergency physician followed by abdominal CT used as a reference standard. Results: Thirty-three patients were enrolled in the study; among them, 52% showed positive traumatic findings in abdominal CT scans, and 42% were diagnosed with solid organ lesions. Compared to CT, a focused abdominal sonography (FOCUS) examination, looking for free fluid or perirenal hematoma, showed limited performance for traumatic findings with a sensitivity of 65% (95% confidence interval [CI]: 38%-86%), a specificity of 75% (95% CI: 48%-93%), a negative likelihood ratio (NLR) of 0.47 (95% CI: 0.23-0.95), and a positive likelihood ratio (PLR) of 2.59 (95% CI: 1.03-6.48). When combining FOCUS with CEUS, the sensitivity of the sonography increased to 94% (95% CI: 71%-100%) with a specificity of 75% (95% CI: 48%-93%). The PLR was 3.76 (95% CI: 1.6-8.87) and the NLR was 0.08 (95% CI: 0.01-0.54). In our population, abdominal sonography with contrast failed to identify a single positive abdominal CT with a grade 1 kidney injury. Conclusions: A FOCUS examination shows limited sensitivity and specificity to detect positive abdominal CT in stable adults with abdominal trauma. With the addition of contrast and careful inspection of solid organs, abdominal sonography with contrast performed by the emergency physician improves the ability to rule out traumatic findings on abdominal CT. CEUS performed by emergency physicians may miss injuries, especially in the absence of free fluid, in cases of low-grade injuries, simultaneous injuries, or poor-quality examinations.

Scaling the spectral beam combining channels in a multiplexed volume Bragg grating.

In order to generate high power laser radiation it is often necessary to combine multiple lasers into a single beam. The recent advances in high power spectral beam combining using multiplexed volume Bragg gratings recorded in photo-thermo-refractive glass are presented. The focus is on using multiple gratings recorded within the same volume to lower the complexity of the combining system. Combining of 420 W with 96% efficiency using a monolithic, multiplexed double grating recorded in PTR glass is demonstrated. A multiplexed quadruple grating that maintains high efficiency and good beam quality is demonstrated to pave a way for further scaling of combining channels.

Effect of aberrations in a holographic system on reflecting volume Bragg gratings.

The effect of aberrations in the recording beams of a holographic setup is discussed regarding the deterioration of properties of a reflecting volume Bragg grating. Imperfect recording beams result in a spatially varying grating vector, which causes broadening, asymmetry, and washed out side lobes in the reflection spectrum as well as a corresponding reduction in peak diffraction efficiency. These effects are more significant for gratings with narrower spectral widths.

Travel related histoplasmosis - a diagnostic challenge in a patient with tumor necrosis factor alpha (TNF-α) inhibitor therapy.

INTRODUCTION: In a non-endemic setting, disseminated histoplasmosis is a rare travel-related health problem of immunosuppressed returnees from endemic regions. METHODS: We describe the case of a 68-year-old man with rheumatoid arthritis and tumor necrosis factor alpha (TNF-α) inhibitor treatment-related immunodeficiency, who suffered from disseminated histoplasmosis after traveling to Brazil. Based on this case, we discuss challenges and pitfalls associated with the diagnosis of disseminated histoplasmosis in a non-endemic setting. RESULTS: The disease mimicked a hemophagocytic lymphohistiocytosis (HLH) like syndrome. Histoplasma capsulatum was microscopically detected in bronchoalveolar fluid and bone marrow aspirate smears, but was initially misclassified as Leishmania spp., another class of pathogens, which may cause HLH like syndromes in immunocompromised individuals. DISCUSSION: Since the clinical symptoms of histoplasmosis are nonspecific and physicians in non-endemic regions might not be familiar with this disease pattern, there is a risk of delayed diagnosis of travel related cases. Taking a thorough travel history is key in unclear cases of illness in immunocompromised patients.

Genetic variation of lodgepole pine, Pinus contorta var. latifolia, chemical and physical defenses that affect mountain pine beetle, Dendroctonus ponderosae, attack and tree mortality.

Plant secondary chemistry is determined by both genetic and environmental factors, and while large intraspecific variation in secondary chemistry has been reported frequently, the levels of genetic variation of many secondary metabolites in forest trees in the context of potential resistance against pests have been rarely investigated. We examined the effect of tree genotype and environment/site on the variation in defensive secondary chemistry of lodgepole pine, Pinus contorta var. latifolia, against the fungus, Grosmannia clavigera (formerly known as Ophiostoma clavigerum), associated with the mountain pine beetle, Dendroctonus ponderosae. Terpenoids were analyzed in phloem samples from 887, 20-yr-old trees originating from 45 half-sibling families planted at two sites. Samples were collected both pre- and post-inoculation with G. clavigera. Significant variation in constitutive and induced terpenoid compounds was attributed to differences among families. The response to the challenge inoculation with G. clavigera was strong for some individual compounds, but primarily for monoterpenoids. Environment (site) also had a significant effect on the accumulation of some compounds, whereas for others, no significant environmental effect occurred. However, for a few compounds significant family x environment interactions were found. These results suggest that P. c. latifolia secondary chemistry is under strong genetic control, but the effects depend on the individual compounds and whether or not they are expressed constitutively or following induction.

Interspecific variation in spruce constitutive and induced defenses in response to a bark beetle-fungal symbiont provides insight into traits associated with resistance.

Differences in defensive traits of tree species may predict why some conifers are susceptible to bark beetle-fungal complexes and others are not. A symbiotic fungus (Leptographium abietinum (Peck) M.J. Wingf.) associated with the tree-killing bark beetle (Dendroctonus rufipennis Kirby) is phytopathogenic to host trees and may hasten tree decline during colonization by beetles, but defense responses of mature trees to the fungus have not been experimentally examined. To test the hypothesis that interspecific variation in spruce resistance is explained by defense traits we compared constitutive (bark thickness and constitutive resin ducts) and induced defenses (resin flow, monoterpene composition, concentration, phloem lesion formation and traumatic resin ducts) between two sympatric spruces: Engelmann spruce (Picea engelmannii Parry ex Engelm.-a susceptible host) and blue spruce (Picea pungens Engelm.-a resistant host) in response to fungal inoculation. Four central findings emerged: (i) blue spruce has thicker outer bark and thinner phloem than Engelmann spruce, which may restrict fungal access to phloem and result in less beetle-available resource overall; (ii) both spruce species induce monoterpenes in response to inoculation but blue spruce has higher constitutive monoterpene levels, induces monoterpenes more rapidly, and induces higher concentrations over a period of time consistent with spruce beetle attack duration; (iii) Engelmann and blue spruce differed in the monoterpenes they upregulated in response to fungal inoculation: blue spruce upregulated α-pinene, terpinolene and γ-terpinene, but Engelmann spruce upregulated 3-carene and linalool; and (iv) blue spruce has a higher frequency of constitutive resin ducts and produces more traumatic resin ducts in annual growth increments than Engelmann spruce, though Engelmann spruce produces more resin following aseptic wounding or fungal inoculation. These findings suggest that higher constitutive resin duct densities and monoterpene concentrations, as well as the ability to rapidly induce specific monoterpenes in response to L. abietinum inoculation, are phenotypic traits associated with hosts resistant to spruce beetle colonization.

[COVID-19 in the Family Practice - Outpatient Treatment or Hospitalization?] / COVID-19 in der Praxis ­ wann ambulant, wann stationär behandeln?

COVID-19 in the Family Practice - Outpatient Treatment or Hospitalization? Abstract. Switzerland has been severely affected by the COVID-19 pandemic. The clinical spectrum of this disease in terms of its clinical presentation and course is very broad. A correct initial evaluation in the practice or in the emergency department is important and includes history-taking and clinical examination as well as imaging and laboratory tests. Most patients with COVID-19 can be treated as outpatients. Hospitalization may be necessary in patients with a marked COVID-19 pneumonia or further complications, which occur primarily in the second or third phase of the disease. The dynamics of the disease must also be taken into consideration. In outpatients, symptomatic therapy is often sufficient, antibiotics and corticosteroids are not indicated.

Curved-crease origami face shields for infection control.

The COVID-19 pandemic has created enormous global demand for personal protective equipment (PPE). Face shields are an important component of PPE for front-line workers in the context of the COVID-19 pandemic, providing protection of the face from splashes and sprays of virus-containing fluids. Existing face shield designs and manufacturing procedures may not allow for production and distribution of face shields in sufficient volume to meet global demand, particularly in Low and Middle-Income countries. This paper presents a simple, fast, and cost-effective curved-crease origami technique for transforming flat sheets of flexible plastic material into face shields for infection control. It is further shown that the design could be produced using a variety of manufacturing methods, ranging from manual techniques to high-volume die-cutting and creasing. This demonstrates the potential for the design to be applied in a variety of contexts depending on available materials, manufacturing capabilities and labour. An easily implemented and flexible physical-digital parametric design methodology for rapidly exploring and refining variations on the design is presented, potentially allowing others to adapt the design to accommodate a wide range of ergonomic and protection requirements.

Computed tomographic coronary angiography in patients with surgically treated type A aortic dissection: preliminary results.

Acute type A aortic dissection is a serious emergency with a mortality rate of up to 40% within the first 24 h when left untreated. Surgical therapy needs to be initiated promptly. Due to this urgent situation, preoperative evaluation of the coronary arteries is not routinely performed in these patients. The aim of this study was to evaluate the accuracy of 64-slice computed tomography angiography (CTA) for postoperative coronary artery assessment in these patients. Ten consecutive patients with two or more cardiovascular risk factors were prospectively enrolled. Patients had type A aortic dissection treated surgically with a supracoronary graft of the ascending aorta. Performance of CTA to exclude significant stenosis (>50% lumen narrowing) and/or coronary artery dissection was compared with quantitative coronary angiography. A total of 147 segments were evaluated. Three segments (2%) were excluded from analysis. CTA correctly assessed one of three significant stenoses in three patients and correctly excluded coronary artery disease (CAD) in six of ten patients. One patient was rated false positive. Overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT for identifying coronary artery disease by segment was 98%, 33%, 99%, 50%, and 99%, respectively (P<0.05). By patient, it was 70%, 33%, 86%, 50%, and 75%, respectively. No coronary artery dissection was found. Noninvasive CTA may be a viable alternative to conventional angiography for postoperative coronary artery evaluation in patients with surgically treated type A aortic dissection and cardiovascular risk factors. An NPV of 99% should allow for reliable exclusion of CAD. Further studies with higher patient numbers are warranted.

Penetrating chest trauma after attempted suicide: An extraordinary behavior of a posttraumatic pulmonary artery pseudoaneurysm.

Posttraumatic pulmonary artery pseudoaneurysm is a very rare, yet potentially lethal complication after thoracic trauma. Pulmonary artery pseudoaneurysm is associated with high mortality. Still literature highlights that untreated, lesions can enlarge, rupture, and lead to exsanguination and death. We present a case of a posttraumatic peripheral pulmonary artery pseudoaneurysm with complete disappearance after one year. This case confirms that conservative treatment can be an effective option in asymptomatic and stable patients.

Agrobacterium spp. nosocomial outbreak assessment using rapid MALDI-TOF MS based typing, confirmed by whole genome sequencing.

Background: A number of episodes of nosocomial Agrobacterium spp. bacteremia (two cases per year) were observed at Bern University Hospital, Switzerland, from 2015 to 2017. This triggered an outbreak investigation. Methods: Cases of Agrobacterium spp. bacteremias that occurred between August 2011 and February 2017 were investigated employing line lists, environmental sampling, rapid protein- (MALDI-TOF MS), and genome-based typing (pulsed field gel electrophoresis and whole genome sequencing) of the clinical isolates. Results: We describe a total of eight bacteremia episodes due to A. radiobacter (n = 2), Agrobacterium genomovar G3 (n = 5) and A. pusense (n = 1). Two tight clusters were observed by WGS typing, representing the two A. radiobacter isolates (cluster I, isolated in 2015) and four of the Agrobacterium genomovar G3 isolates (cluster II, isolated in 2016 and 2017), suggesting two different point sources. The epidemiological investigations revealed two computer tomography (CT) rooms as common patient locations, which correlated with the two outbreak clusters. MALDI-TOF MS permitted faster evaluation of strain relatedness than DNA-based methods. High resolution WGS-based typing confirmed the MALDI-TOF MS clustering. Conclusions: We report clinical and epidemiological characteristics of two outbreak clusters with Agrobacterium. spp. bacteremia likely acquired during CT contrast medium injection and highlight the use of MALDI-TOF MS as a rapid tool to assess relatedness of rare gram-negative pathogens in an outbreak investigation.

Estimating error rates for firearm evidence identifications in forensic science.

Estimating error rates for firearm evidence identification is a fundamental challenge in forensic science. This paper describes the recently developed congruent matching cells (CMC) method for image comparisons, its application to firearm evidence identification, and its usage and initial tests for error rate estimation. The CMC method divides compared topography images into correlation cells. Four identification parameters are defined for quantifying both the topography similarity of the correlated cell pairs and the pattern congruency of the registered cell locations. A declared match requires a significant number of CMCs, i.e., cell pairs that meet all similarity and congruency requirements. Initial testing on breech face impressions of a set of 40 cartridge cases fired with consecutively manufactured pistol slides showed wide separation between the distributions of CMC numbers observed for known matching and known non-matching image pairs. Another test on 95 cartridge cases from a different set of slides manufactured by the same process also yielded widely separated distributions. The test results were used to develop two statistical models for the probability mass function of CMC correlation scores. The models were applied to develop a framework for estimating cumulative false positive and false negative error rates and individual error rates of declared matches and non-matches for this population of breech face impressions. The prospect for applying the models to large populations and realistic case work is also discussed. The CMC method can provide a statistical foundation for estimating error rates in firearm evidence identifications, thus emulating methods used for forensic identification of DNA evidence.

Applying 3D measurements and computer matching algorithms to two firearm examination proficiency tests.

In order for a crime laboratory to assess a firearms examiner's training, skills, experience, and aptitude, it is necessary for the examiner to participate in proficiency testing. As computer algorithms for comparisons of pattern evidence become more prevalent, it is of interest to test algorithm performance as well, using these same proficiency examinations. This article demonstrates the use of the Congruent Matching Cell (CMC) algorithm to compare 3D topography measurements of breech face impressions and firing pin impressions from a previously distributed firearms proficiency test. In addition, the algorithm is used to analyze the distribution of many comparisons from a collection of cartridge cases used to construct another recent set of proficiency tests. These results are provided along with visualizations that help to relate the features used in optical comparisons by examiners to the features used by computer comparison algorithms.