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We describe a series of microcalorimeter X-ray spectrometers designed for a broad suite of measurement applications. The chief advantage of this type of spectrometer is that it can be orders of magnitude more efficient at collecting X-rays than more traditional high-resolution spectrometers that rely on wavelength-dispersive techniques. This advantage is most useful in applications that are traditionally photon-starved and/or involve radiation-sensitive samples. Each energy-dispersive spectrometer is built around an array of several hundred transition-edge sensors (TESs). TESs are superconducting thin films that are biased into their superconducting-to-normal-metal transitions. The spectrometers share a common readout architecture and many design elements, such as a compact, 65 mK detector package, 8-column time-division-multiplexed superconducting quantum-interference device readout, and a liquid-cryogen-free cryogenic system that is a two-stage adiabatic-demagnetization refrigerator backed by a pulse-tube cryocooler. We have adapted this flexible architecture to mate to a variety of sample chambers and measurement systems that encompass a range of observing geometries. There are two different types of TES pixels employed. The first, designed for X-ray energies below 10 keV, has a best demonstrated energy resolution of 2.1 eV (full-width-at-half-maximum or FWHM) at 5.9 keV. The second, designed for X-ray energies below 2 keV, has a best demonstrated resolution of 1.0 eV (FWHM) at 500 eV. Our team has now deployed seven of these X-ray spectrometers to a variety of light sources, accelerator facilities, and laboratory-scale experiments; these seven spectrometers have already performed measurements related to their applications. Another five of these spectrometers will come online in the near future. We have applied our TES spectrometers to the following measurement applications: synchrotron-based absorption and emission spectroscopy and energy-resolved scattering; accelerator-based spectroscopy of hadronic atoms and particle-induced-emission spectroscopy; laboratory-based time-resolved absorption and emission spectroscopy with a tabletop, broadband source; and laboratory-based metrology of X-ray-emission lines. Here, we discuss the design, construction, and operation of our TES spectrometers and show first-light measurements from the various systems. Finally, because X-ray-TES technology continues to mature, we discuss improvements to array size, energy resolution, and counting speed that we anticipate in our next generation of TES-X-ray spectrometers and beyond.

Time-division multiplexing (TDM) is a mature scheme for the readout of arrays of transition-edge sensors (TESs). TDM is based on superconducting-quantum-interference-device (SQUID) current amplifiers. Multiple spectrometers based on gamma-ray and X-ray microcalorimeters have been operated with TDM readout, each at the scale of 200 sensors per spectrometer, as have several astronomical cameras with thousands of sub-mm or microwave bolometers. Here we present the details of two different versions of our TDM system designed to read out X-ray TESs. The first has been field-deployed in two 160-sensor (8 columns × 20 rows) spectrometers and four 240-sensor (8 columns × 30 rows) spectrometers. It has a three-SQUID-stage architecture, switches rows every 320 ns, and has total readout noise of 0.41 μΦ 0 /√Hz. The second, which is presently under development, has a two-SQUID-stage architecture, switches rows every 160 ns, and has total readout noise of 0.19 μΦ 0 /√Hz. Both quoted noise values are non-multiplexed and referred to the first-stage SQUID. In a demonstration of this new architecture, a multiplexed 1-column × 32-row array of NIST TESs achieved average energy resolution of 2.55±0.01 eV at 6 keV.

Improvements in superconductor device fabrication, detector hybridization techniques, and superconducting quantum interference device readout have made square-centimeter-sized arrays of gamma-ray microcalorimeters, based on transition-edge sensors (TESs), possible. At these collecting areas, gamma microcalorimeters can utilize their unprecedented energy resolution to perform spectroscopy in a number of applications that are limited by closely-spaced spectral peaks, for example, the nondestructive analysis of nuclear materials. We have built a 256 pixel spectrometer with an average full-width-at-half-maximum energy resolution of 53 eV at 97 keV, a useable dynamic range above 400 keV, and a collecting area of 5 cm(2). We have demonstrated multiplexed readout of the full 256 pixel array with 236 of the pixels (91%) giving spectroscopic data. This is the largest multiplexed array of TES microcalorimeters to date. This paper will review the spectrometer, highlighting the instrument design, detector fabrication, readout, operation of the instrument, and data processing. Further, we describe the characterization and performance of the newest 256 pixel array.

Some patients have headaches that are refractory to standard treatments, and they require chronic administration of opioid analgesics. The use of opioids in a clinical setting must be closely monitored due to the medications' potential for addiction, abuse, and fatal interactions. Limited access to opioids and the demand for them outside the clinical setting leads to another danger. Patients can mislead their providers into prescribing opioids, intending to sell the medications instead of using them to alleviate their own pain. For protection of the patient, as well as the community, it is vital that such activity be prevented. We recently encountered a patient we suspected of abusing or misusing OxyContin (oxycodone). In order to determine whether the patient was taking the medication as prescribed, we ordered a urine-based immunoassay drug screen. The results were negative; the patient appeared to not have oxycodone in his system. Based on these results, we dismissed the patient from our practice. At the patient's request, a second test was performed, this time using gas chromatography-mass spectrometry. It indicated that the patient did indeed have sufficiently high levels of oxycodone in the urine. The minimum level threshold was too high to detect the presence of oxycodone in the immunoassay. We would like to help prevent future misunderstandings such as we experienced. To do so, we will first present the case of our patient, followed by a discussion of the actions taken. Finally, we will provide an overview of analgesic monitoring systems.

Enhanced external counterpulsation (EECP) is effective in patients with angina refractory to medical therapy or revascularization. However, as a noninvasive treatment it should perhaps be considered the first-line treatment with invasive revascularization reserved for EECP failures or high-risk patients. The International EECP Patient Registry was used to analyze a cohort of patients with prior percutaneous coronary intervention (PCI) and/or coronary artery bypass graft (CABG) (n = 4,454) compared with a group of patients (PUMPERS) who were candidates for PCI and/or CABG and chose EECP as their initial revascularization treatment (n = 215). The PUMPERS responded to treatment with EECP with decreased anginal episodes and nitroglycerin use and with improvement in their Canadian Cardiovascular Society functional class, similarly to previously revascularized patients. Treatment with EECP resulted in sustained, and often progressive, reduction in angina over the succeeding 6 months. Given the findings of this study, it is interesting to speculate on the possibility of using EECP as the primary revascularization intervention after medical therapy proves unsatisfactory.

A 53-year-old man presented to hospital after an overdose (4.8 g) of verapamil. He developed profound bradycardia and hypotension, requiring treatment with calcium salts, dobutamine, isoprenaline and cardiac pacing. As calcium channel blockers are more widely used, self-poisoning will become more common. The effects, although serious, are self-limiting and recovery within 48 hours is the rule provided adequate support is given.