Interference filters and their impact on FM-to-AM conversion: a method for investigation and characterization.

High-power nanosecond laser pulses are usually spectrally broadened via temporal phase modulations to tackle the issue of stimulated Brillouin scattering and to achieve optical smoothing of the focal spot. While propagating along the beamline, such pulses can undergo frequency modulation to amplitude modulation (FM-to-AM) conversion. This phenomenon induces modulations of the optical power that can have a strong impact on laser performance. Interference filters are specific FM-to-AM conversion contributors that lead to high-frequency modulations that cannot be measured using conventional means. We propose an indirect method to investigate for such FM-to-AM contributors using spectral measurements. Further analysis of the collected data makes the quantification of the defining parameters of interference filters possible. In turn, we show that it is possible to estimate the range of power modulations induced by interference filters.

Thermal lens in diode-pumped square-section rods of Nd-doped phosphate glass and 0.5%Nd:5%Lu:CaF2 crystal: simulations and experiments.

We performed simulations and experiments of wavefront distortions induced by propagating through diode-pumped square-section amplifying laser rods of Nd-doped phosphate glass and 0.5%Nd:5%Lu:CaF2. We observed that depending on the material, wavefront distortions' profile can vary from a circular lens-like distortion to a complex astigmatic distortion. We showed that this difference comes from the relative sign of piezo-optic tensor coefficients.

Implications of laser beam metrology on laser damage temporal scaling law for dielectric materials in the picosecond regime.

We report on the implications that the temporal and spatial beam metrologies have on the accuracy of temporal scaling laws of Laser Induced Damage Threshold (LIDT) for dielectric materials in the picosecond regime. Thanks to a specific diagnostic able to measure the temporal pulse shape of subpicosecond and picosecond pulses, we highlight through simulations and experiments how the temporal shape has to be taken into account first in order to correctly understand the temporal dependency of dielectrics LIDT. This directly eases the interpretation of experimental temporal scaling laws of LIDT and improves their accuracy as a prediction means. We also give numerically determined benchmark temporal scaling laws of intrinsic LIDT for SiO2 (thin film) based on the model developed for this work. Finally, we show as well what kind of spatial metrology is needed during any temporal scaling law determination to take into account potential variations of the spatial profile.

Nonlinear FM-AM conversion due to stimulated Brillouin scattering.

We report an effect potentially harmful occurring in regenerative amplifiers due to stimulated Brillouin scattering (SBS). Most high energy laser facilities use phase-modulated pulses to prevent the transverse SBS effect in large optical components and to smooth the focal spot on target. However, this kind of pulse format may undergo a detrimental effect known as frequency modulation to amplitude modulation (FM-AM) conversion in the presence of spectral distortions. In the present letter, we show experimentally and numerically, that SBS can also potentially be created in the regenerative amplifier located in the front-end. In this scenario, some of the side bands of the pulse reflected by regen end-cavity mirror may act as a seed for SBS in an optical component, if the pulse spectrum contains frequency components exactly separated by the Brillouin frequency shift. This self-seeded SBS induces amplitude modulation with a nonlinear dependence that may be detrimental during down-stream propagation. However, we show that a careful choice of the modulation frequencies can mitigate this effect.

1.15 PW-850 J compressed beam demonstration using the PETAL facility.

The Petawatt Aquitaine Laser (PETAL) facility was designed and constructed by the French Commissariat à l'énergie atomique et aux énergies alternatives (CEA) as an additional PW beamline to the Laser MegaJoule (LMJ) facility. PETAL energy is limited to 1 kJ at the beginning due to the damage threshold of the final optics. In this paper, we present the commissioning of the PW PETAL beamline. The first kJ shots in the amplifier section with a large spectrum front end, the alignment of the synthetic aperture compression stage and the initial demonstration of the 1.15 PW @ 850 J operations in the compression stage are detailed. Issues encountered relating to damage to optics are also addressed.

Multiple-frequency injection-seeded nanosecond pulsed laser without parasitic intensity modulation.

Thanks to a phase-modulated injection seeder, we report the operation of a nanosecond Nd:YAG Q-switched laser with pulses having both a large spectral bandwidth and a smooth temporal waveform. Because of the smooth temporal waveform, such pulses allow, for instance, reducing the impact of the Kerr effect and, because of the large spectral bandwidth, suppressing stimulated Brillouin scattering. We conducted a parametric study of the features of the generated pulses versus the injection conditions. We show that, as opposed to the central frequency (wavelength) of the seeder, the phase modulation frequency has to be carefully chosen, but it is not a critical parameter and does not require any particular feedback.

Influence of longitudinal mode beating on laser-induced damage in fused silica.

In our study, the laser-induced damage densities on a fused silica surface produced by multiple longitudinal mode (MLM) pulses are found to be higher than those produced by single longitudinal mode pulses at 1064 nm. This behavior is explained by the enhancement of the three-photon absorption due to the intensity spikes related to longitudinal mode beating. At 355 nm, the absorption is linear and an opposite behavior occurs. It can be explained with the help of a process involving thermomechanics coupled with the fine time structure of MLM pulses, leading to the possible annealing of part of the absorbent defects.

Dual energy imaging using a clinical on-board imaging system.

Dual energy (DE) imaging consists of obtaining kilovoltage (kV) x-ray images at two different diagnostic energies and performing a weighted subtraction of these images. A third image is then produced that highlights soft tissue. DE imaging has been used by radiologists to aid in the detection of lung malignancies. However, it has not been used clinically in radiotherapy. The goal of this study is to assess the feasibility of performing DE imaging using a commercial on-board imaging system. Both a simple and an anthropomorphic phantom were constructed for this analysis. Planar kV images of the phantoms were obtained using varied imaging energies and mAs. Software was written to perform DE subtraction using empirically determined weighting factors. Tumor detectability was assessed quantitatively using the signal-difference-to-noise ratio (SDNR). Overall DE subtraction suppressed high density objects in both phantoms. The optimal imaging technique, providing the largest SDNR with a dose less than our reference technique was 140 kVp, 1.0 mAs and 60 kVp, 3.2 mAs. Based on this analysis, DE subtraction imaging is feasible using a commercial on-board imaging system and may improve the visualization of tumors in lung cancer patients undergoing image-guided radiotherapy.

Efficient identification and referral of low-income women at high risk for hereditary breast cancer: a practice-based approach.

BACKGROUND: Identification of low-income women with the rare but serious risk of hereditary cancer and their referral to appropriate services presents an important public health challenge. We report the results of formative research to reach thousands of women for efficient identification of those at high risk and expedient access to free genetic services. External validity is maximized by emphasizing intervention fit with the two end-user organizations who must connect to make this possible. This study phase informed the design of a subsequent randomized controlled trial. METHODS: We conducted a randomized controlled pilot study (n = 38) to compare two intervention models for feasibility and impact. The main outcome was receipt of genetic counseling during a two-month intervention period. Model 1 was based on the usual outcall protocol of an academic hospital genetic risk program, and Model 2 drew on the screening and referral procedures of a statewide toll-free phone line through which large numbers of high-risk women can be identified. In Model 1, the risk program proactively calls patients to schedule genetic counseling; for Model 2, women are notified of their eligibility for counseling and make the call themselves. We also developed and pretested a family history screener for administration by phone to identify women appropriate for genetic counseling. RESULTS: There was no statistically significant difference in receipt of genetic counseling between women randomized to Model 1 (3/18) compared with Model 2 (3/20) during the intervention period. However, when unresponsive women in Model 2 were called after 2 months, 7 more obtained counseling; 4 women from Model 1 were also counseled after the intervention. Thus, the intervention model that closely aligned with the risk program's outcall to high-risk women was found to be feasible and brought more low-income women to free genetic counseling. Our screener was easy to administer by phone and appeared to identify high-risk callers effectively. The model and screener are now in use in the main trial to test the effectiveness of this screening and referral intervention. A validation analysis of the screener is also underway. CONCLUSION: Identification of intervention strategies and tools, and their systematic comparison for impact and efficiency in the context where they will ultimately be used are critical elements of practice-based research.

SU-E-J-91: FFT Based Medical Image Registration Using a Graphics Processing Unit (GPU).

PURPOSE: To evaluate the efficiency gains obtained from using a Graphics Processing Unit (GPU) to perform a Fourier Transform (FT) based image registration. METHODS: Fourier-based image registration involves obtaining the FT of the component images, and analyzing them in Fourier space to determine the translations and rotations of one image set relative to another. An important property of FT registration is that by enlarging the images (adding additional pixels), one can obtain translations and rotations with sub-pixel resolution. The expense, however, is an increased computational time. GPUs may decrease the computational time associated with FT image registration by taking advantage of their parallel architecture to perform matrix computations much more efficiently than a Central Processor Unit (CPU). In order to evaluate the computational gains produced by a GPU, images with known translational shifts were utilized. A program was written in the Interactive Data Language (IDL; Exelis, Boulder, CO) to performCPU-based calculations. Subsequently, the program was modified using GPU bindings (Tech-X, Boulder, CO) to perform GPU-based computation on the same system. Multiple image sizes were used, ranging from 256×256 to 2304×2304. The time required to complete the full algorithm by the CPU and GPU were benchmarked and the speed increase was defined as the ratio of the CPU-to-GPU computational time. RESULTS: The ratio of the CPU-to- GPU time was greater than 1.0 for all images, which indicates the GPU is performing the algorithm faster than the CPU. The smallest improvement, a 1.21 ratio, was found with the smallest image size of 256×256, and the largest speedup, a 4.25 ratio, was observed with the largest image size of 2304×2304. CONCLUSIONS: GPU programming resulted in a significant decrease in computational time associated with a FT image registration algorithm. The inclusion of the GPU may provide near real-time, sub-pixel registration capability.

SU-E-J-93: Fourier Transform-Based Medical Image Registration.

PURPOSE: To evaluate the use of a Fast Fourier Transform (FFT) based pattern-matching algorithm for two-dimensional translational and rotational medical image registration. METHODS: The FFT pattern matching algorithm is based on the Fourier shift theorem. Briefly, image registration is accomplished by obtaining the Fourier Transform (FT) of two images, taking the normalized cross-correlation of the two FT, and performing an inverse FT on this correlation matrix. This results in a Dirchlet delta function that has a maximum value at a location corresponding to the translational shift between the two images. Rotational registration can also be achieved by performing this algorithm on the polar transformation of the FT images. The FT registration method was evaluated through the use of clinical images with induced translational and rotational shifts. RESULTS: Over a range of induced shifts of +/-10 mm in both the x and y directions, and induced rotations of +/-10 degrees, all recovered rotations were within 0.1 degree of the induced rotation, and all recovered translations were within 0.5 mm of the induced translation. The computational time of the FT registration on a 1024×1024 image was approximately 2.23 sec. CONCLUSIONS: An FFT based image registration algorithm is computationally efficient and provides a high degree of accuracy for two dimensional image registrations. The FFT registration approach provides a distinct analytical solution and does not rely on iterative methods to converge on a solution. In addition, the discrete nature of the FFT means that the accuracy of the solution is directly related to the size of the pixels in the images. The equivalent of sub-pixel registration can be achieved by simply resizing the image to a larger matrix (i.e. 512×512 to 1024×1024).

SU-E-J-44: Dual Energy Subtraction Imaging to Improve Tumor Visibility at Oblique Angles.

PURPOSE: To characterize the contrast improvement of simulated tumors in an anthropomorphic phantom using Dual Energy (DE) subtraction with a clinical on-board imager (OBI) at oblique angles. METHODS: An Alderson lung/chest anthropomorphic phantom with simulated tumors in the thoracic cavity was imaged using a sequential DE imaging methodology. High (120kVp) and low (60kVp) planar images were obtained in pairs every 100 in a full (3600) rotation using the OBI (Varian Medical Systems, Palo Alto, CA). Optimal mAs settings for DE component images were determined byvarying the x-ray exposure time, while maintaining a constant tube current. DE images were created to best suppress the bone overlaying the simulated tumors. Tumor visibility in DE images was quantified using the Contrast-to-Noise Ratio (CNR). The ratio of the CNR from the DE image relative to a single image (standard protocol) was evaluated as a function of gantry angle. RESULTS: CNR was improved with DE imaging by an average ratio of 1.66 over all gantry angles. The greatest improvement occurred at gantry angles where the tumor was obstructed by the ribs alone. More modest improvements were observed where the tumor overlapped other soft tissue structures (such as the heart) or the dense spine, on a given projection. CONCLUSIONS: This study illustrates the feasibility of performing DE imaging at oblique gantry angles using a clinical on-board imaging system. Incorporating DE imaging into clinical practice may allow for verification of tumor position at oblique gantry angles, and may facilitate the development of markerless motion tracking techniques. Supported by a grant from Varian Medical Systems.

Compensation of phase-to-amplitude modulation conversion in a complete frequency conversion system with an all-fiber system.

We report on an experimental demonstration of linear precompensation of nonlinear phase and amplitude transfer functions. We show the effective compensation with a linear all-fiber system of phase-to-amplitude modulation conversion due to a complete frequency conversion system including plane gratings and a nonlinear crystal.

Experimental demonstration of a synthetic aperture compression scheme for multi-Petawatt high-energy lasers.

We present the experimental demonstration of a subaperture compression scheme achieved in the PETAL (PETawatt Aquitaine Laser) facility. We evidence that by dividing the beam into small subapertures fitting the available grating size, the sub-beam can be individually compressed below 1 ps, synchronized below 50 fs and then coherently added thanks to a segmented mirror.

Direct spectral phase measurement with spectral interferometry resolved in time extra dimensional.

The complete spectral characterization of ultrashort pulses is demonstrated with a new diagnostic called Spectral Interferometry Resolved in Time Extra Dimensional. This method, based on spectral shearing interferometry, is self-referenced and self-calibrated. It yields directly to an interferogram pattern displaying an intuitive representation of the derivative of the spectral phase. No iterative algorithm is needed for phase measurement making this method suitable for real time and easy characterization. This technique is highlighted by the spectral phase characterization of pulses out of a folded nondispersive line and the pulse shape is compared with a trace recorded with an intensity autocorrelator.

Low tidal volume ventilation is associated with reduced mortality in HIV-infected patients with acute lung injury.

BACKGROUND: Respiratory failure remains the leading indication for admission to the intensive care unit (ICU) and a leading cause of death for HIV-infected patients in spite of overall improvements in ICU mortality. It is unclear if these improvements are due to combination anti-retroviral therapy, low tidal volume ventilation for acute lung injury, or both. A study was undertaken to identify therapies and clinical factors associated with mortality in acute lung injury among HIV-infected patients with respiratory failure in the period 1996-2004. A secondary aim was to compare mortality before and after introduction of a low tidal volume ventilation protocol in 2000. METHODS: A retrospective cohort study was performed of 148 consecutive HIV-infected adults admitted to the ICU at San Francisco General Hospital with acute lung injury requiring mechanical ventilation. Demographic and clinical information including data on mechanical ventilation was abstracted from medical records and analysed by multivariate analysis using logistic regression. RESULTS: In-hospital mortality was similar before and after introduction of a low tidal volume ventilation protocol, although the study was not powered to exclude a clinically significant difference (risk difference -5.4%, 95% CI -21% to 11%, p = 0.51). Combination antiretroviral therapy was not clearly associated with mortality, except in patients with Pneumocystis pneumonia. Among all those with acute lung injury, lower tidal volume was associated with decreased mortality (adjusted odds ratio 0.76 per 1 ml/kg decrease, 95% CI 0.58 to 0.99, p = 0.043), after controlling for Pneumocystis pneumonia, serum albumin, illness severity, gas exchange impairment and plateau pressure. CONCLUSIONS: Lower tidal volume ventilation is independently associated with reduced mortality in HIV-infected patients with acute lung injury and respiratory failure.

The performance of routine immunization in selected African countries during the first six months of the COVID-19 pandemic

Introduction: following the declaration of the COVID-19 pandemic on 11 March 2020, countries started implementing strict control measures, health workers were re-deployed and health facilities re-purposed to assist COVID-19 control efforts. These measures, along with the public concerns of getting COVID-19, led to a decline in the utilization of regular health services including immunization.Methods: we reviewed the administrative routine immunization data from 15 African countries for the period from January 2018 to June 2020 to analyze the trends in the monthly number of children vaccinated with specific antigens, and compare the changes in the first three months of the COVID-19 pandemic.Results: thirteen of the 15 countries showed a decline in the monthly average number of vaccine doses provided, with 6 countries having more than 10% decline. Nine countries had a lower monthly mean of recipients of first dose measles vaccination in the second quarter of 2020 as compared to the first quarter. Guinea, Nigeria, Ghana, Angola, Gabon, and South Sudan experienced a drop in the monthly number of children vaccinated for DPT3 and/ or MCV1 of greater than 2 standard deviations at some point in the second quarter of 2020 as compared to the mean for the months January-June of 2018 and 2019.Conclusion: countries with lower immunization coverage in the pre-COVID period experienced larger declines in the number of children vaccinated immediately after the COVID-19 pandemic was declared. Prolonged and significant reduction in the number of children vaccinated poses a serious risk for outbreaks such as measles. Countries should monitor coverage trends at national and subnational levels, and undertake catch-up vaccination activities to ensure that children who have missed scheduled vaccines receive them at the earliest possible time

Implementation of a low tidal volume ventilation protocol for patients with acute lung injury or acute respiratory distress syndrome.

The ARDS (acute respiratory distress syndrome) Network study found 22% lower mortality in acute lung injury and ARDS patients ventilated with low tidal volumes (V(T)) than in those ventilated with traditional V(T) ventilation. Several points should be considered when using the low V(T) protocol for clinical practice. Prior to implementation, hemodynamic and acid-base status, minute ventilation, and adequacy of sedation should be assessed to minimize the potential for intolerance. The volume-preset, assist-control mode is recommended for better control of V(T), and the respiratory rate should be increased as V(T) is reduced, so as to maintain minute ventilation and prevent acute hypercapnia. When unavoidable, hypercapnia should be induced slowly. Ventilator inspiratory flow (V(I)) and trigger sensitivity settings should be optimized to limit the increase in work of breathing and dyspnea. When dyspnea results in double-triggered breaths, V(T) can be titrated to 7-8 mL/kg, provided end-inspiratory plateau pressure is < or = 30 cm H(2)O. In severe acidosis (pH < 7.15) V(T) also can be increased. However, every effort should be made to maintain plateau pressure and V(T) goals by buffering severe acidosis and treating patient-ventilator asynchrony with sedation. Evaluation for weaning should occur when adequate oxygenation can be maintained on 40% oxygen and a positive end-expiratory pressure of 8 cm H(2)O. Pressure support levels between 5 and 20 cm H(2)O (above 5 cm H(2)O positive end-expiratory pressure) are used for weaning and titrated to keep the respiratory rate < 35 breaths/min. Pressure support levels should be weaned aggressively, as long as the protocol's weaning tolerance criteria can be maintained.

Community-based cancer screening for underserved women: design and baseline findings from the Breast and Cervical Cancer Intervention Study.

BACKGROUND: Underutilization of breast and cervical cancer screening has been observed in many ethnic groups and underserved populations. Effective community-based interventions are needed to eliminate disparities in screening rates and thus to improve prospects for survival. METHODS: The Breast and Cervical Cancer Intervention Study was a controlled trial of three interventions in the San Francisco Bay Area from 1993 to 1996: (1) community-based lay health worker outreach; (2) clinic-based provider training and reminder system; and (3) patient navigator for follow-up of abnormal screening results. Study design and a description of the interventions are reported along with baseline results of a household survey conducted in four languages among 1599 women, aged 40-75. RESULTS: Seventy-six percent of women ages 40 and over had had at least one mammogram, and most had had a clinical breast examination (88%) and Pap smear (89%). Rates were significantly lower for non-English-speaking Latinas and Chinese women (56 and 32%, respectively, for mammography), and maintenance screening (three mammograms in the past 5 years) varied from 7% (non-English-speaking Chinese) to 53% (Blacks). Pap smear screening in the past 3 years was low among non-English-speaking Latinas (72%) and markedly lower among non-English-speaking Chinese women (24%). The strongest predictors of screening behavior were having private health insurance and frequent use of medical services. Having a regular clinic and speaking English were also important. Race/ethnicity, education, household income, and employment status were, overall, not significant predictors of screening behavior. CONCLUSIONS: These baseline results support the importance of cancer screening interventions targeted to persons of foreign origin, particularly those less acculturated.

Efficacy of low tidal volume ventilation in patients with different clinical risk factors for acute lung injury and the acute respiratory distress syndrome.

In patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), a recent ARDS Network randomized controlled trial demonstrated that a low tidal volume (VT) mechanical ventilation strategy (6 ml/kg) reduced mortality by 22% compared with traditional mechanical ventilation (12 ml/kg). In this study, we examined the relative efficacy of low VT mechanical ventilation among 902 patients with different clinical risk factors for ALI/ARDS who participated in ARDS Network randomized controlled trials. The clinical risk factor for ALI/ARDS was associated with substantial variation in mortality. The risk of death (before discharge home with unassisted breathing) was highest in patients with sepsis (43%); intermediate in subjects with pneumonia (36%), aspiration (37%), and other risk factors (35%); and lowest in those with trauma (11%) (p < 0.0001). Despite these differences in mortality, there was no evidence that the efficacy of the low VT strategy varied by clinical risk factor (p = 0.76, for interaction between ventilator group and risk factor). There was also no evidence of differential efficacy of low VT ventilation in the other study outcomes: proportion of patients achieving unassisted breathing (p = 0.59), ventilator-free days (p = 0.58), or development of nonpulmonary organ failure (p = 0.44). Controlling for demographic and clinical covariates did not appreciably affect these results. After reclassifying the clinical risk factors as pulmonary versus nonpulmonary predisposing conditions and infection-related versus non-infection-related conditions, there was still no evidence that the efficacy of low VT ventilation differed among clinical risk factor subgroups. In conclusion, we found no evidence that the efficacy of the low VT ventilation strategy differed among clinical risk factor subgroups for ALI/ARDS.