Feasibility of a pregnancy intervention mimicking viral transmission mitigation measures on the incidence of preterm birth in high-risk pregnant women enrolled in antenatal clinics in Melbourne, Australia: protocol for a pilot, randomised trial

INTRODUCTION

Preterm birth is a leading cause of perinatal morbidity and mortality. During the COVID-19 pandemic, reduction in rates of preterm birth in women exposed to viral mitigation measures was reported by multiple studies. In addition, others and we observed a more pronounced reduction of preterm birth in women who had previously experienced a preterm birth. The aim of this pilot study is to establish the feasibility of a lifestyle intervention based on viral mitigation measures in high-risk pregnancies, with the ultimate aim to reduce the incidence of preterm birth.

METHODS AND ANALYSIS

One hundred pregnant women, enrolled in antenatal clinics at two tertiary maternity centres in Melbourne, Australia, who have had a previous preterm birth between 22 and 34 weeks gestation will be recruited. This is a two-arm, parallel group, open-label randomised controlled feasibility trial: 50 women will be randomised to the intervention group, where they will be requested to comply with a set of lifestyle changes (similar to the viral mitigation measures observed during the pandemic). Another 50 women will be randomised to the control group, where they will undergo standard pregnancy care. The primary outcome of this trial is feasibility, which will be assessed by measuring patient eligibility rate, recruitment rate, compliance rate and data completion rate. Secondary outcomes include incidence of preterm birth, maternal satisfaction, maternal quality of life and other pregnancy outcomes. Standard methods in statistical analysis for randomised controlled trials on an intention to treat basis will be followed.

ETHICS AND DISSEMINATION

This trial has been approved by the Monash Human Research Ethics Committee; approval reference number RES-22-0000-122A. Study findings will be reported and submitted to peer-reviewed journals for publication, and presentation at conferences.

TRIAL REGISTRATION NUMBER

ACTRN12622000753752; Pre-results.

3D prompt gamma imaging for proton beam range verification

We tested the ability of a single Compton camera (CC) to produce 3-dimensional (3D) images of prompt gammas (PGs) emitted during the irradiation of a tissue-equivalent plastic phantom with proton pencil beams for clinical doses delivered at clinical dose rates. PG measurements were made with a small prototype CC placed at three different locations along the proton beam path. We evaluated the ability of the CC to produce images at each location for two clinical scenarios: (1) the delivery of a single 2 Gy pencil beam from a hypo-fractionated treatment (~9  ×  10⁸ protons), and (2) a single pencil beam from a standard treatment (~1  ×  10⁸ protons). Additionally, the data measured at each location were combined to simulate measurements with a larger scale, clinical CC and its ability to image shifts in the Bragg peak (BP) range for both clinical scenarios. With our prototype CC, the location of the distal end of the BP could be seen with the CC placed up to 4 cm proximal or distal to the BP distal falloff. Using the data from the simulated full scale clinical CC, 3D images of the PG emission were produced with the delivery of as few as 1  ×  10⁸ protons, and shifts in the proton beam range as small as 2 mm could be detected for delivery of a 2 Gy spot. From these results we conclude that 3D PG imaging for proton range verification under clinical beam delivery conditions is possible with a single CC.

Feasibility Studies of a New Event Selection Method to Improve Spatial Resolution of Compton Imaging for Medical Applications

A Compton imaging method for medical applications that includes new energy determination and data filtering techniques has been tested using several point sources with known emission lines. Using a prototype Compton camera, a distance-of-closest approach technique has been employed to determine the initial energy of the incoming γs and to ensure the reconstructed source position is within an acceptable distance from the known γ source location. Further analysis is done by implementing a Compton line filtering technique, keeping only those interactions whose deposited energy in the first interaction matches the theoretical energy deposition predicted by the Compton equation. Using this new event filtering method, we see improvements in the full width at half maximum in the lateral profiles of γ point sources of up to 70% over standard Compton imaging methods, as well as achievable spatial resolutions in the reconstructed images of better than 2 mm. In addition, this new Compton imaging method was able to reconstruct an extended source of γ rays emitted during irradiation of a water tank with a clinical proton radiotherapy beam.

SU-E-J-79: Using the Distance of Closest Approach to Improve Compton Camera Image Quality

PURPOSE

The prompt gamma radiation emitted from tissue during proton therapy offers a means of beam range verification. Compton camera (CC) imaging systems offer high efficiency and 3D imaging capability. However, Doppler broadening and the inaccuracies in the measurement of the scattering positions and energies reduce the image resolution. The purpose of our study is to determine if removing events with a distance-of-closest-approach greater than a threshold value will improve the resolution of images reconstructed using the stochastic origins ensemble (SOE) algorithm.

METHODS

We first simulated a 3-stage CC detecting gammas from a 0.511 MeV point source. We then used SOE to reconstruct images from the point source and from a) all gammas, b) gammas with DCA < 3 mm, and c) gammas with DCA < 1 mm. We measured the point-spread-function for the point source for a), b), and c). Next, we simulated a 3-stage CC detecting prompt gammas emitted from tissue during proton therapy. We reconstructed the gammas using SOE and compared 2D images of all gammas, gammas with DCA < 3 mm, and gammas with DCA < 1 mm.

RESULTS

The FWHM of the PSF of the 0.511 MeV point source was reduced by 50% when DCA was required to be < 5 mm, and it was reduced by 65% when DCA was required to be < 3 mm. 2D images of a proton beam are of visibly higher quality as the DCA requirement is lowered.

CONCLUSIONS

The DCA for MC events can be used to identify the events with significant resolution loss due to the detector effects. Removing these events before running the reconstruction algorithm results in higher quality images. We discuss methods to predict the DCA based on the measured scatter data, so that a similar technique can be applied to data from real detectors. This work was supported by the National Institutes of Health through award number R21CA137362 from the National Cancer Institute.

Measurements of WW and WZ production in W + jets final states in pp collisions

We study WW and WZ production with ℓνqq (ℓ=e,μ) final states using data collected by the D0 detector at the Fermilab Tevatron Collider corresponding to 4.3  fb(-1) of integrated luminosity from pp collisions at sqrt[s]=1.96  TeV. Assuming the ratio between the production cross sections σ(WW) and σ(WZ) as predicted by the standard model, we measure the total WV (V=W,Z) cross section to be σ(WV)=19.6(-3.0)(+3.2)  pb and reject the background-only hypothesis at a level of 7.9 standard deviations. We also use b-jet discrimination to separate the WZ component from the dominant WW component. Simultaneously fitting WW and WZ contributions, we measure σ(WW)=15.9(-3.2)(+3.7)  pb and σ(WZ)=3.3(-3.3)(+4.1)  pb, which is consistent with the standard model predictions.

Search for universal extra dimensions in pp collisions

We present a search for Kaluza-Klein (KK) particles predicted by models with universal extra dimensions (UED) using a data set corresponding to an integrated luminosity of 7.3 fb(-1), collected by the D0 detector at a pp center-of-mass energy of 1.96 TeV. The decay chain of KK particles can lead to a final state with two muons of the same charge. This signature is used to set a lower limit on the compactification scale of R(-1)>260 GeV in a minimal UED model.

Search for charged massive long-lived particles

We report on a search for charged massive long-lived particles (CMLLPs), based on 5.2  fb(-1) of integrated luminosity collected with the D0 detector at the Fermilab Tevatron pp collider. We search for events in which one or more particles are reconstructed as muons but have speed and ionization energy loss (dE/dx) inconsistent with muons produced in beam collisions. CMLLPs are predicted in several theories of physics beyond the standard model. We exclude pair-produced long-lived gauginolike charginos below 267 GeV and Higgsino-like charginos below 217 GeV at 95% C.L., as well as long-lived scalar top quarks with mass below 285 GeV.

Evidence for spin correlation in t ̅t production

We present a measurement of the ratio of events with correlated t and t ̅t spins to the total number of t ̅t events. This ratio f is evaluated using a matrix-element-based approach in 729 t ̅t candidate events with a single lepton ℓ (electron or muon) and at least four jets. The analyzed p ̅p collisions data correspond to an integrated luminosity of 5.3 fb(-1) and were collected with the D0 detector at the Fermilab Tevatron collider operating at a center-of-mass energy √s=1.96 TeV. Combining this result with a recent measurement of f in dileptonic final states, we find f in agreement with the standard model. In addition, the combination provides evidence for the presence of spin correlation in t ̅t events with a significance of more than 3 standard deviations.

Search for doubly charged Higgs boson pair production in pp¯ collisions at √s=1.96 TeV

We present a search for pair production of doubly charged Higgs bosons in the processes qq¯→H(++)H(--) decaying through H(±±)→τ(±)τ(±),μ(±)τ(±),μ(±)μ(±). The search is performed in pp¯ collisions at a center-of-mass energy of √s = 1.96 TeV using an integrated luminosity of up to 7.0 fb(-1) collected by the D0 experiment at the Fermilab Tevatron Collider. The results are used to set 95% C.L. limits on the pair production cross section of doubly charged Higgs bosons and on their mass for different H(±±) branching fractions. Models predicting different H(±±) decays are investigated. Assuming B(H(±±)→τ(±)τ(±))=1 yields an observed (expected) lower limit on the mass of a left-handed H(L)(±±) boson of 128 (116) GeV and assuming B(H(±±)→μ(±)τ(±))=1 the corresponding limits are 144 (149) GeV. In a model with B(H(±±)→τ(±)τ(±))=B(H(±±)→μ(±)τ(±))=B(H(±±)→μ(±)μ(±))=1/3, we obtain M(H(L)(±±))>130 (138) GeV.

Wγ production and limits on anomalous WWγ couplings in pp collisions at sqrt[s] = 1.96 TeV

We measure the cross section and the difference in rapidities between photons and charged leptons for inclusive W(→lν) + γ production in eγ and μγ final states. Using data corresponding to an integrated luminosity of 4.2  fb(-1) collected with the D0 detector at the Fermilab Tevatron Collider, the measured cross section times branching fraction for the process pp → Wγ + X → lνγ + X and the distribution of the charge-signed photon-lepton rapidity difference are found to be in agreement with the standard model. These results provide the most stringent limits on anomalous WWγ couplings for data from hadron colliders: -0.4<Δκ(γ)<0.4 and -0.08<λ(γ)<0.07 at the 95% C.L.

Search for a fermiophobic and standard model Higgs boson in diphoton final states

We present a search for the standard model Higgs boson and a fermiophobic Higgs boson in the diphoton final states based on 8.2  fb(-1) of pp collisions at sqrt[s]=1.96  TeV collected with the D0 detector at the Fermilab Tevatron Collider. No excess of data above background predictions is observed and upper limits at the 95% C.L. on the cross section multiplied by the branching fraction are set which are the most restrictive to date. A fermiophobic Higgs boson with a mass below 112.9 GeV is excluded at the 95% C.L.

Search for neutral minimal supersymmetric standard model Higgs bosons decaying to tau pairs produced in association with b quarks in pp collisions at √s = 1.96 TeV

We report results from a search for neutral Higgs bosons produced in association with b quarks using data recorded by the D0 experiment at the Fermilab Tevatron Collider and corresponding to an integrated luminosity of 7.3 fb(-1). This production mode can be enhanced in several extensions of the standard model (SM) such as in its minimal supersymmetric extension (MSSM) at high tanβ. We search for Higgs bosons decaying to tau pairs with one tau decaying to a muon and neutrinos and the other to hadrons. The data are found to be consistent with SM expectations, and we set upper limits on the cross section times branching ratio in the Higgs boson mass range from 90 to 320 GeV/c(2). We interpret our result in the MSSM parameter space, excluding tanβ values down to 25 for Higgs boson masses below 170 GeV/c(2).

Precision measurement of the ratio B(t→Wb)/B(t→Wq) and extraction of V(tb)

We present a measurement of the ratio of top quark branching fractions R=B(t→Wb)/B(t→Wq), where q can be a d, s, or b quark, in the lepton+jets and dilepton tt final states. The measurement uses data from 5.4 fb(-1) of pp collisions collected with the D0 detector at the Fermilab Tevatron Collider. We measure R=0.90±0.04, and we extract the Cabibbo-Kobayashi-Maskawa (CKM) matrix element |V(tb)| as |V(tb)|=0.95±0.02, assuming unitarity of the 3×3 CKM matrix.

Search for a fourth generation t' Quark in p ̄p collisions at √s = 1.96 TeV

We present a search for pair production of a fourth generation t' quark and its antiparticle, followed by their decays to a W boson and a jet, based on an integrated luminosity of 5.3 fb(-1) of proton-antiproton collisions at √s = 1.96  TeV collected by the D0 Collaboration at the Fermilab Tevatron Collider. We set upper limits on the t' ̄t' production cross section that exclude at the 95% C.L. a t' quark that decays exclusively to W+jet with a mass below 285 GeV. We observe a small excess in the μ+jets channel which reduces the mass range excluded compared to the expected limit of 320 GeV in the absence of a signal.

Precise measurement of the top quark mass in the dilepton channel at D0

We measure the top quark mass (m(t)) in p ̄p collisions at a center of mass energy √s = 1.96 TeV using dilepton t ̄t→W(+)bW(-) ̄b→ℓ(+)ν(ℓ)bℓ(-) ̄ν(ℓ) ̄b events, where ℓ denotes an electron, a muon, or a tau that decays leptonically. The data correspond to an integrated luminosity of 5.4 fb(-1) collected with the D0 detector at the Fermilab Tevatron Collider. We obtain m(t)=174.0±1.8(stat)±2.4(syst) GeV, which is in agreement with the current world average m(t)=173.3±1.1 GeV. This is currently the most precise measurement of m(t) in the dilepton channel.

Measurement of spin correlation in tt production using a matrix element approach

We determine the fraction of tt events with spin correlation, assuming that the spin of the top quark is either correlated with the spin of the top antiquark as predicted by the standard model or is uncorrelated. For the first time we use a matrix-element-based approach to study tt spin correlation. We use tt → W+ b W- b → ℓ+ νbℓ- ν b final states produced in pp collisions at a center-of-mass energy sqrt(s)=1.96  TeV, where ℓ denotes an electron or a muon. The data correspond to an integrated luminosity of 5.4  fb(-1) and were collected with the D0 detector at the Fermilab Tevatron collider. The result agrees with the standard model prediction. We exclude the hypothesis that the spins of the tt are uncorrelated at the 97.7% C.L.

Search for Resonant WW and WZ Production in pp collisions at √s=1.96 TeV

We search for resonant WW or WZ production by using up to 5.4 fb(-1) of integrated luminosity collected by the D0 experiment in run II of the Fermilab Tevatron Collider. The data are consistent with the standard model background expectation, and we set limits on a resonance mass by using the sequential standard model W' boson and the Randall-Sundrum model graviton G as benchmarks. We exclude a sequential standard model W' boson in the mass range 180-690 GeV and a Randall-Sundrum graviton in the range 300-754 GeV at 95% C.L.

Bounds on an anomalous dijet resonance in W+jets production in pp collisions at √s = 1.96 TeV

We present a study of the dijet invariant mass spectrum in events with two jets produced in association with a W boson in data corresponding to an integrated luminosity of 4.3 fb(-1) collected with the D0 detector at √s = 1.96 TeV. We find no evidence for anomalous resonant dijet production and derive upper limits on the production cross section of an anomalous dijet resonance recently reported by the CDF Collaboration, investigating the range of dijet invariant mass from 110 to 170 GeV/c(2). The probability of the D0 data being consistent with the presence of a dijet resonance with 4 pb production cross section at 145 GeV/c(2) is 8×10(-6).

Search for the standard model Higgs boson in the H→WW→lνq'q decay channel

We present a search for the standard model Higgs boson (H) in pp collisions at sqrt(s)=1.96  TeV in events containing a charged lepton (ℓ), missing transverse energy, and at least two jets, using 5.4  fb(-1) of integrated luminosity recorded with the D0 detector at the Fermilab Tevatron Collider. This analysis is sensitive primarily to Higgs bosons produced through the fusion of two gluons or two electroweak bosons, with subsequent decay H→WW→ℓνq'q, where ℓ is an electron or muon. The search is also sensitive to contributions from other production channels, such as WH→ℓνbb. In the absence of a signal, we set limits at the 95% C.L. on the cross section for H production σ(pp→H+X) in these final states. For a mass of M(H)=160  GeV, the limit is a factor of 3.9 larger than the cross section in the standard model and consistent with an a priori expected sensitivity of 5.0.

Precise study of the Z/γ* boson transverse momentum distribution in pp collisions using a novel technique

Using 7.3 fb⁻¹ of pp collisions collected by the D0 detector at the Fermilab Tevatron, we measure the distribution of the variable φ(η)*, which probes the same physical effects as the Z/γ* boson transverse momentum, but is less susceptible to the effects of experimental resolution and efficiency. A QCD prediction is found to describe the general features of the φ(η)* distribution, but is unable to describe its detailed shape or dependence on boson rapidity. A prediction that includes a broadening of transverse momentum for small values of the parton momentum fraction is strongly disfavored.

Search for single vectorlike quarks in pp ̄ collisions at √s=1.96 TeV

We present a search for hypothetical vectorlike quarks in pp ̅ collisions at √s=1.96  TeV. The data were collected by the D0 detector at the Fermilab Tevatron Collider and correspond to an integrated luminosity of 5.4  fb(-1). We select events with a final state composed of a W or Z boson and a jet consistent with a heavy object decay. We observe no significant excess in comparison to the background prediction and set limits on production cross sections for vectorlike quarks decaying to W+jet and Z+jet. These are the most stringent limits to date for electroweak single vectorlike quark production at hadron colliders.