In systems with many 1000 SiPM pixels and with one electronic channel per SiPM pixel, the total cost is usually dominated by the cost of the electronics. We present a simple and low-cost solution for reducing the cost of the electronics without significantly affecting the time and energy resolution. The method requires no active electronic components. We tested the method using the PETsys TOFPET2 ASIC and its readout system. The CTR time resolution is reduced by $12 \%$ compared to a readout with one electronic channel per SiPM pixel. We observed no measurable degradation of the energy resolution and negligible cross talk.

The CMS Detector will be upgraded for the HL-LHC to include a MIP Timing Detector (MTD). The MTD will consist of barrel and endcap timing layers, BTL and ETL respectively, providing precision timing of charged particles. The BTL sensors are based on LYSO:Ce scintillation crystals coupled to SiPMs with TOFHIR2 ASICs for the front-end readout. A resolution of 30–40 ps for MIP signals at a rate of 2.5 Mhit/s per channel is expected at the beginning of HL-LHC operation. We present an overview of the TOFHIR2 requirements and design, simulation results and the first measurements with TOFHIR2A silicon samples.

A new PETsys ASIC in the TOFPET series, named TOFPET3, has been developed aiming at high performance PET applications. The new chip has a 64-channel analog front-end with baseline stabilization, pulse tail cancelation, dark noise rejection and gain configuration. In each channel, three 10-bit digitization of pulses above a configurable threshold are performed (2 TDC, 1 QDC). The maximum event rate per channel is 500 kHz, and the output bandwidth is $3.8 \mathrm{~Gb} / \mathrm{s}$ matching the input rate. The new timing and energy circuits have outstanding performance: 1) the TOFPET3 contribution to CTR is 26 ps FWHM, implying that a CTR =80(120) ps due to crystal and SiPM, increases to 84(123) ps with TOFPET3; 2) the contribution to 511 keV photopeak resolution is 1.1% and the deviation to linearity is $\pm 1 \%$ in the range 300-3000 p.e for SiPM gain $3.5 \times 10^{6}$. Charge integration of single photons is possible with $\mathrm{S} / \mathrm{N}\gt10$. The chip includes four additional channels with sums of 16,32 or 64 cannels (configurable) suitable for light sharing applications, as well as advanced triggering features allowing the selective readout of a group of channels triggered by the energy of one channel. The power consumption is 8 mW per channel. In this summary we present simulation results of the chip performance. At the conference, measurements with the prototype chip will be presented.

In this paper we present an analog circuit for the new MIP Timing Detector of the CMS experiment at CERN, featuring, for the first time, a silicon implementation of the Differential Leading Edge Discriminating technique to suppress SiPM dark noise. This technique also stabilizes the baseline, leading to a time resolution of 25 ps at beginning of life and 55 ps at end of life while dissipating less than 4 mW. The full analog front-end ASIC has 32 channels and has been designed in a CMOS 130 nm technology with a total die area of 8.5 x 5.2 mm2. The radiation tolerance of this design has been confirmed by radiation tests.

The CMS Detector will be upgraded for the High-Luminosity LHC to include a MIP Timing Detector (MTD). The MTD will consist of barrel and endcap timing layers, BTL and ETL, respectively, providing precision timing of charged particles. The BTL sensors are based on LYSO:Ce scintillating crystals coupled to SiPMs that are read out by TOFHIR2 ASICs in the front-end system. A resolution of 30 ps for MIP signals is expected at the beginning of HL-LHC operation degrading to 60 ps at the end of operation due to the SiPMs radiation damage. Relative to the first version of the front-end ASIC, TOFHIR2X implements improved circuitry for mitigation of the SiPM dark current noise as well as a new current mode discriminator. We present an overview of the TOFHIR2 requirements and design, simulation results and the first measurements with TOFHIR2X silicon samples coupled to LYSO/SiPM prototype sensors.

IntroductionA significant proportion of acutely ill hospitalised elderly patients have impaired consciousness and this has been associated with increased mortality. It remains unclear which factors underlie this relation. Identification of mortality predictors in this population is important to improve care.ObjectivesDetermine if advanced age, cognitive impairment, high burden of comorbidities and poor functional status are predictors of increased mortality during hospitalisation in acutely-ill medical hospitalised elderly patients with altered state of consciousness.MethodsAll male patients (> 65 years) admitted to a medical ward (> 48 h) between 01/03/2015 to 31/08/2015 with delirium or RASS lower than–2 were included in the study. Patients were excluded if unable to be assessed due to sensorial deficits, communication problems or medical condition precluding the evaluation. Baseline evaluation included socio-demographic variables, RASS, CAM, IQCODE-SF, DSM-IV-TR criteria for dementia, Charlson Comorbidity Index and Barthel Index. The variables were entered in a logistic regression model (significance level < 0.05).ResultsThe final sample consisted of 75 male subjects with altered state of consciousness, 14 of them died during hospitalisation. Dementia and Barthel Index were significantly associated with mortality during hospitalisation (P = 0.01 and P < 0.01, respectively). On the other hand, age and Charlson Co-morbidity Index were not associated significantly with mortality during hospitalisation (P = 0.22 and P = 0.1, respectively).ConclusionsAcutely ill elderly patients with altered state of consciousness at admission have higher risk of death during hospitalisation if they have prior dementia or poor functional status. Health care should be improved to provide better response to this type of patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionDementia is one of the leading causes of disability and burden in Western countries. In Portugal, there is a lack of data regarding dementia prevalence in hospitalized elderly patients and factors associated with in-hospital adverse outcomes of these patients.ObjectivesDetermine dementia prevalence in acutely-ill medical hospitalized elderly patients and its impact in health outcomes.MethodsAll male patients (> 65 years) admitted to a medical ward (> 48 h) between 1.03.2015 to 31.08.2015 were included in the study. Patients were excluded if unable to be assessed due to sensorial deficits, communication problems or severity of the acute medical condition. Baseline evaluation included socio-demographic variables, RASS, NPI, Barthel Index and Confusion Assessment Method.ResultsThe final sample consisted of 270 male subjects with a mean age of 80.9 years, 116 (43%) having prior dementia. Dementia patients were significantly older (83.5 vs 78.9; P < 0.001) and had lower values of Barthel Index (dementia: 34.8 vs non-dementia: 85.8; P < 0.001). Mortality rate (9,3%) and length of hospitalization (11.2 days) were similar between groups (12.1 vs 7.1; P = 0.204 and 11.9 vs 10.6; P = 0.218, respectively). Patients with dementia had higher rates of all neuropsychiatric symptoms except depression, anxiety and mood elation. The level of consciousness (measured by RASS) was impaired in 50% of patients with dementia, which was significantly higher than in non-demented subjects (12.3%; P < 0.001). Delirium rates were 29.5% in dementia compared with 7.1% in controls (P < 0.001).ConclusionsThere is a high prevalence of dementia and an appreciable rate of delirium among these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionInnovative approaches are needed to respond to the increasing number of elderly subjects with complex psychiatric conditions who require flexible and rapid responses, avoiding unnecessary hospital admissions. A new organizational model was implemented in our psychogeriatric service in September 2011 consisting of:– a comprehensive multidisciplinary geriatric assessment;– a helpline for caregivers for management of acute behavioral problems;– programmed visits to nursing homes.AimsTo evaluate whether the implementation of this program was associated with a reduction in hospital admissions and emergency department visits.MethodsThis is a pre-post test design study, involving 1197 patients who attended the Old Age Psychiatric (OAP) Unit three years before and three years after the implementation of the organizational intervention (1.09.2008 to 1.10.2014). An index of patient × year was calculated considering the period during which the patient was followed in OAP Unit. Data was obtained from the medical files of all eligible patients regarding demographic variables, number and type of hospital admissions and emergency department visits.ResultsDuring the 3 years before the intervention 671.2 patients × years were included (mean age of 75.8 years) while after the intervention this reached 2010.1 patients × years (mean age of 77.8 years). The intervention was associated with a decrease of 44% in psychiatry emergency visits, 48% in general emergency visits, 44% in psychiatric ward admissions and 51% in geriatric ward admissions.ConclusionsThe implementation of this new model was associated with significant reduction of hospital-based service utilization. Future research should determine if this was coupled with increased health outcomes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionPatients with head and neck cancer have to cope with the uncertainty about the evolution of their disease, the need to change risky behaviours as alcohol and nicotine dependence, and even with the mutilation and dysfunction resulting from treatments. Literature shows that these patients suffer from psychiatric comorbidity and high levels of distress with little response to their psycho-social needs. Moreover, alcoholism, smoking and personality disorders are probably risk factors for the onset and development of cancer.AimsWe propose a research project to determine the prevalence of psychiatric morbidity in patients with head and neck cancer hospitalized in a regional oncology center, and to what extent the psychiatric morbidity predisposes to medical and surgical complications during inpatient treatment.MethodsWe collected socio-demographic variables, clinical variables related to the oncological disease and psychopathological and cognitive variables. For the last ones, the following instruments were used: Mini Mental State Examination (MMSE), Brief Symptom Inventory (BSI), and CAGE as a screening test for alcohol consumption. Results were analyzed using the Statistical Package for the Social Sciences - SPSS (19th version).ResultsOur preliminary results are in accordance with the available literature, showing high levels of psychopathology in patients with cancer of the head and neck, with associated medical complications during inpatient treatment. These findings stress the need of routine psychiatric assessment in this particular population.

IntroductionDepression, anxiety and distress are common during the course of cancer. Studies suggest prevalence of distress greater than 30%. Distress and depression influence quality of life. However, depression is often overlooked by cancer professionals. It is needed short and easy instruments to help to assess depression symptoms and its severity. PHQ-9 is an example of a short instrument to assess depressive symptoms and its severity.ObjectivesIn this work the preliminary study of the psychometric characteristics of PHQ-9 in a sample of breast cancer Portuguese women is described.AimsWe purpose to evaluate psychometric characteristics of PHQ-9 in a Portuguese sample, namely: internal consistency, test-retest reliability and concurrent validity.MethodsPsychometric analyses were performed on a sample composed of 49 breast cancer women, with ages from 30 to 80 years old (M = 59.27, SD = 11.12). Participants answered to PHQ-9 twice (with a 2 months interval) and once to Hospital Anxiety and Depression Scale (HADS). The procedure enclose: translation; back translation; discussion group for inspection of lexical equivalence and content validity and application to a target population.ResultsIt was obtained a Cronbach alpha of .82. The test-retest reliability show a significant statistical positive correlation (rS = .82, p = .000). Significant positive statistical correlation with HADS was also observed (rS = .60, p = .000 for anxiety and rS = .65, p = .000 for depression).ConclusionsThe validation of the Portuguese PHQ-9 has good psychometric proprieties of internal consistency, test-retest reliability and concurrent validity. Therefore, we can conclude that PHQ-9 is a useful and a valid scale.

IntroductionDepression is one of the most common health issues impacting the university student population. The Patient Health Questionnaire (PHQ-9) is a short measure that has the potential to serve as a dual-purpose instrument that establishes depressive disorder diagnoses as well as grades the depressive symptom severity.ObjectivesThe current study was designed to study the psychometric properties of a Portuguese version of the PHQ-9 in a sample of university students.AimsSpecifically, we examined the internal reability and convergent validity of the measure.MethodsThe English language of the PHQ-9 was translated into Portuguese. The process involved back-translation, crosscultural adaptation, field testing of the pre-final version, as well as final adjustments. A sample of university students completed the PHQ-9, the Hospital Anxiety and Depression Scale (HADS) and the Beck Depression Inventory (BDI).ResultsComplete data were obtained from 1241 participants. The mean age of the participants was 23.81 years (SD = 4.87) and 75.3% of them were females. The mean PHQ-9 score was 4.15 (SD = 4.05). The Portuguese version of the PHQ-9 had satisfactory internal consistency (Cronbach's alpha = 0.86) and showed moderate convergent validity with the HADS anxiety (r = 0.61; p < 0.01) and HADS depression (r = 0.59; p < 0.01), and strong convergent validity with the BDI (r = 0.85; p < 0.01).ConclusionsThe PHQ-9 has good psychometric properties amongst Portuguese university students. Implications for using the measure as an assessment instrument in the university setting are discussed.

Background and objectives Although there is a growing impact of psychiatric disorders and depressive disorders in cancer patients, there is scarce literature on the idiosyncrasies of antidepressants (ADs) used in those conditions and their interactions with antineoplastic agents (ANs). Sharing the same biotransformation roots enhances the risk of drug interaction between ADs e ANs, which specific pharmacokinetic properties are determinant to their nature as inducer, inhibitor or substrate of cytochromes P450 (CYP450). In cancer patient, such drug interactions (DIs) may result in less efficacy of the drug and/or increase their side effects. Therefore, the choice of AD should be cautious (safe and effective) and well supported. The main purpose of this paper is to analyse the individual pharmacokinetic properties of the most used ADs and ANs, in order to summarize the risk of possible DIs between them, anticipating the consequences of their co-administration. Methods The authors reviewed books, articles and PubMed on line articles, published in the last 6 years. Results Most of ANs suffer transformation in CYP450 3A4 and that co-administration of ADs with inhibiting properties of this CYP isoform as fluoxetine, sertraline, paroxetine and fluvoxamine may result in loss of efficacy or higher toxicity and should be used cautiously. Conclusion Among the ADs, escitalopran, citalopram, venlafaxine, mirtazapine and milnacipran stood out regarding their weak CYP450 inhibitory potential and safety profile in those patients.