The LeVe CPAP System for Oxygen-Efficient CPAP Respiratory Support: Development and Pilot Evaluation.

Background: The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has placed a significant demand on healthcare providers (HCPs) to provide respiratory support for patients with moderate to severe symptoms. Continuous Positive Airway Pressure (CPAP) non-invasive ventilation can help patients with moderate symptoms to avoid the need for invasive ventilation in intensive care. However, existing CPAP systems can be complex (and thus expensive) or require high levels of oxygen, limiting their use in resource-stretched environments. Technical Development + Testing: The LeVe ("Light") CPAP system was developed using principles of frugal innovation to produce a solution of low complexity and high resource efficiency. The LeVe system exploits the air flow dynamics of electric fan blowers which are inherently suited to delivery of positive pressure at appropriate flow rates for CPAP. Laboratory evaluation demonstrated that performance of the LeVe system was equivalent to other commercially available systems used to deliver CPAP, achieving a 10 cm H2O target pressure within 2.4% RMS error and 50-70% FiO2 dependent with 10 L/min oxygen from a commercial concentrator. Pilot Evaluation: The LeVe CPAP system was tested to evaluate safety and acceptability in a group of ten healthy volunteers at Mengo Hospital in Kampala, Uganda. The study demonstrated that the system can be used safely without inducing hypoxia or hypercapnia and that its use was well-tolerated by users, with no adverse events reported. Conclusions: To provide respiratory support for the high patient numbers associated with the COVID-19 pandemic, healthcare providers require resource efficient solutions. We have shown that this can be achieved through frugal engineering of a CPAP ventilation system, in a system which is safe for use and well-tolerated in healthy volunteers. This approach may also benefit other respiratory conditions which often go unaddressed in Low and Middle Income Countries (LMICs) for want of context-appropriate technology designed for the limited oxygen resources available.

In-vitro antibacterial and anti-encrustation performance of silver-polytetrafluoroethylene nanocomposite coated urinary catheters.

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections, leading to increased morbidity and mortality. A major reason for this is that urinary catheters are not yet capable of preventing CAUTIs. AIM: To develop an anti-infective urinary catheter. METHODS: An efficient silver-polytetrafluoroethylene (Ag-PTFE) nanocomposite coating was deposited on whole silicone catheters, and two in-vitro bladder models were designed to test antibacterial (against Escherichia coli) and anti-encrustation (against Proteus mirabilis) performances. Each model was challenged with two different concentrations of bacterial suspension. FINDINGS: Compared with uncoated catheters, coated catheters significantly inhibited bacterial migration and biofilm formation on the external catheter surfaces. The time to develop bacteriuria was an average of 1.8 days vs 4 days and 6 days vs 41 days when the urethral meatus was infected with 106 and 102 cells/mL, respectively. For anti-encrustation tests, the coated catheter significantly resisted encrustation, although it did not strongly inhibit the increases in bacterial density and urinary pH. The time to blockage, which was found to be independent of the initial bacterial concentration in the bladder, was extended from 36.2±1.1 h (uncoated) to 89.5±3.54 h (coated) following bacterial contamination with 103 cells/mL in the bladder. Moreover, the coated catheter exhibited excellent biocompatibility with L929 fibroblast cells. CONCLUSION: Ag-PTFE coated Foley catheters should undergo further clinical trials to determine their ability to prevent CAUTIs during catheterization.

Dietary intake in people consuming a low-carbohydrate diet in the UK Biobank.

BACKGROUND: Low-carbohydrate diets are becoming increasingly popular, although their dietary quality outside of clinical studies is unknown. A previous study analysed the dietary intake in people consuming a reduced-carbohydrate diet (<40% calories). However, it is not clear what foods people consume when carbohydrate is reduced to below 26% of total calories. METHODS: In the present cross-sectional study, the dietary and nutrient intake collected via up to five consecutive 24-h dietary recalls and a food frequency questionnaire of 444 individuals (aged 46-79 years) consuming <26% of calories from carbohydrate (LCHO) was compared with that of 131 897 individuals consuming ≥45% calories from carbohydrate (NCHO) using the UK Biobank Dataset. Absolute cut-offs to define the low-carbohydrate group (<130 g day-1 ; n = 1953 versus ≥225 g day-1 , n = 113 036) were also used. RESULTS: Both NCHO (>45% calories and ≥225 g) groups consumed significantly more high-sugar, high-fat snacks [median 6.0, interquartile range (IQR) = 2.0-11.0 and median 6.0, IQR = 3.0-11.8, respectively) compared to the LCHO (<26% calories and <130 g) groups (median 0, IQR = 0-2.8 and median 1, IQR = 0-3.8, respectively) (P < 0.0001). Both LCHO groups reported consuming significantly more red meat, oily fish, nuts and seeds but fewer fruits, vegetables and pulses compared to the NCHO groups. In general, the consumption of oily fish, nuts, seeds and pulses was low across the whole cohort and differences in intake between the LCHO and NCHO groups were small. After adjusting for socio-economic status, most differences remained. CONCLUSIONS: Carbohydrate restriction is associated with both beneficial and potentially deleterious dietary changes compared to a normal carbohydrate intake.

Changing current practice in urological cancer care: Providing better information, advice and related support on work engagement.

There is a growing body of evidence on the importance of work following a diagnosis of cancer and the need to provide better information, advice and related support to patients on work engagement. The aim of this study was to better understand the nature of those needs and to identify better ways to meet these for those with a urological cancer. The focus was on the issues that were common to three key stakeholder groups. Semi-structured interviews were conducted with stakeholders in North East Scotland: 12 individuals with kidney, bladder or prostate cancer, 10 healthcare providers and 10 managers from large organisations. Five key themes emerged from the Framework Analysis: perceived importance of work engagement; decision-making: treatment, work and cancer; roles and responsibilities; education and training; information, advice and support resources. The data confirmed that work engagement is important to those with urological cancer. It also made clear that the current provision of information and advice could be improved. Any such interventions should involve all three key stakeholder groups with greater clarity on their respective roles and responsibilities. Finally, any new system would be best integrated with existing care provision and supported by adequate education and training of those involved.

Proteinuria and lipoprotein lipase activity in Miniature Schnauzer dogs with and without hypertriglyceridemia.

Spontaneous hyperlipidemia in rats causes glomerular disease. Idiopathic hypertriglyceridemia (HTG) is prevalent in Miniature Schnauzers, but its relationship with proteinuria is unknown. Decreased activity of major lipid metabolism enzymes, lipoprotein lipase (LPL) and hepatic lipase (HL), may play a role in the cyclic relationship between hyperlipidemia and proteinuria. These enzymes have also not been previously investigated in Miniature Schnauzers. The aims of this study were to determine the relationship between HTG and proteinuria in Miniature Schnauzers and to measure LPL and HL activities in a subset of dogs. Fifty-seven Miniature Schnauzers were recruited (34 with and 23 without HTG). Fasting serum triglyceride concentrations and urine protein-to-creatinine ratios (UPC) were measured in all dogs, and LPL and HL activities were determined in 17 dogs (8 with and 9 without HTG). There was a strong positive correlation between triglyceride concentration and UPC (r = 0.77-0.83, P < 0.001). Proteinuria (UPC ≥ 0.5) was present in 60% of dogs with HTG and absent from all dogs without HTG (P < 0.001). Proteinuric dogs were not azotemic or hypoalbuminemic. Dogs with HTG had a 65% reduction in LPL activity relative to dogs without HTG (P < 0.001); HL activity did not differ. Proteinuria occurs with HTG in Miniature Schnauzers and could be due to lipid-induced glomerular injury. Reduced LPL activity may contribute to the severity of HTG, but further assay validation is required.

Measurement of microresonator frequency comb coherence by spectral interferometry.

We experimentally investigate the spectral coherence of microresonator optical frequency combs. Specifically, we use a spectral interference method, typically used in the context of supercontinuum generation, to explore the variation of the magnitude of the complex degree of first-order coherence across the full comb bandwidth. We measure the coherence of two different frequency combs and observe wholly different coherence characteristics. In particular, we find that the observed dynamical regimes are similar to the stable and unstable modulation instability regimes reported in previous theoretical studies. Results from numerical simulations are found to be in good agreement with experimental observations. In addition to demonstrating a new technique to assess comb stability, our results provide strong experimental support for previous theoretical analyses.

Efficiency of dispersive wave generation from a dual-frequency beat signal.

The emission of dispersive waves (DWs) by temporal solitons can be described as a cascaded four-wave mixing process triggered by a pair of monochromatic continuous waves (CWs). We report experimental and numerical results demonstrating that the efficiency of this process is strongly and nontrivially affected by the frequency detuning of the CW pump lasers. We explain our results by showing that individual cycles of the input dual-frequency beat signal can evolve as higher-order solitons whose temporal compression and soliton fission govern the DW efficiency. Analytical predictions based on the detuning dependence of the soliton order are shown to be in excellent agreement with experimental and numerical observations.

Cascaded Bragg scattering in fiber optics.

We report on a theoretical and experimental study of cascaded Bragg scattering in fiber optics. We show that the usual energy-momentum conservation of Bragg scattering can be considerably relaxed via cascade-induced phase-matching. Experimentally we demonstrate frequency translation over six- and 11-fold cascades, in excellent agreement with derived phase-matching conditions.

Generalized dispersive wave emission in nonlinear fiber optics.

We show that the emission of dispersive waves in nonlinear fiber optics is not limited to soliton-like pulses propagating in the anomalous dispersion regime. We demonstrate, both numerically and experimentally, that pulses propagating in the normal dispersion regime can excite resonant dispersive radiation across the zero-dispersion wavelength into the anomalous regime.

High performance mode locking characteristics of single section quantum dash lasers.

Mode locking features of single section quantum dash based lasers are investigated. Particular interest is given to the static spectral phase profile determining the shape of the mode locked pulses. The phase profile dependence on cavity length and injection current is experimentally evaluated, demonstrating the possibility of efficiently using the wide spectral bandwidth exhibited by these quantum dash structures for the generation of high peak power sub-picosecond pulses with low radio frequency linewidths.

Strong Brillouin suppression in a passive fiber ring resonator.

We demonstrate the passive suppression of stimulated Brillouin scattering in meter-length fiber-ring cavities through careful control of the fiber length. Experimentally we are able to demonstrate an over sixty-times increase in the Brillouin threshold of a 0.4 m fiber ring. This very simple suppression technique greatly simplifies the design of optical parametric devices based on fiber-ring cavities.

Cascaded phase matching and nonlinear symmetry breaking in fiber frequency combs.

We report theoretical, numerical, and experimental studies of cascaded phase matching in fiber frequency combs and show how this mechanism is directly connected to the dynamics of supercontinuum generation. In particular, linking cascaded four-wave mixing with direct higher-order nonlinear processes allows us to derive a simple phase matching condition that governs nonlinear symmetry breaking in the presence of higher-order dispersion. We discuss how this mechanism provides a physical interpretation of soliton-induced Cherenkov radiation and associated spectral recoil in terms of phase-matched frequency mixing pumped by bichromatic pump pairs in the soliton spectrum. Theoretical and numerical predictions are confirmed via experiments using both quasicontinuous wave and picosecond pulse excitation.

High conversion efficiency fiber optical parametric oscillator.

We present a χ(3) fiber parametric oscillator with high conversion efficiency from the input pump wave to the output parametric sidebands. By introducing an intracavity filter detuned from the oscillator's phase-matched frequency conversion efficiencies considerably higher than those possible when operating at the phase-matched frequency are demonstrated. Experimentally we are able to obtain a total internal conversion efficiency in excess of 93% from the pump to the Stokes and anti-Stokes sidebands.

Spectral amplitude and phase measurement of a 40 GHz free-running quantum-dash modelocked laser diode.

We present a linear self-referenced measurement of the spectral amplitude and phase of a free-running quantum-dash modelocked laser diode. The technique is suitable for measuring optical signals with repetition rates up to 100 GHz. In contrast to many other linear techniques it requires no external electronic clock synchronized to the signal under test. Using this method we are able to compensate for the intracavity dispersion of the diode to demonstrate 500 fs pulses at a repetition rate of 39.8 GHz. We also use the technique to characterize the dependence of the diode's intracavity dispersion on the applied current.

Multiwatt level output powers from a tunable fiber optical parametric oscillator.

We present an all-fiber high average power fiber optical parametric oscillator based on standard telecommunications dispersion-shifted fiber. The output of the oscillator is continuously tunable out to ±28 THz from the pump wavelength. The average power of the oscillator's output is in excess of 1.9 W in each sideband out to ±25 THz detuning. Between 5 and 14 THz detuning, the average power of the Stokes output is in excess of 3.8 W.

Bragg scattering in a positive ß4 fiber.

The phase-matching curves for the four-wave mixing effect of Bragg scattering in two fibers with opposite sign ß(4) dispersion coefficients have been measured experimentally. The measured phase-matching curves are in good agreement with theoretical expectations, and their dependence on several key parameters has been determined.

Stepped-heterodyne optical complex spectrum analyzer.

We present a heterodyne measurement of the spectral amplitude and phase of periodic optical signals. In contrast to previous techniques this measurement requires no optical modulation of either the signal or the local oscillator, places much relaxed tunability requirements on the optical local oscillator, and requires no electronic clock to be passed to the receiver. We present measurements of the spectral amplitude and phase of 20 GHz 33% return-to-zero, and 66% carrier-suppressed return-to-zero optical signals, as well as a passively modelocked optical source with in excess of 100 modes.

Gain statistics of a fiber optical parametric amplifier with a temporally incoherent pump.

We present an investigation of the statistics of the gain fluctuations of a fiber optical parametric amplifier pumped with a temporally incoherent pump. We derive a simple expression for the probability distribution of the gain of the amplified optical signal. The gain statistics are shown to be a strong function of the signal detuning and allow the possibility of generating optical gain distributions with controllable long-tails. Very good agreement is found between this theory and the experimentally measured gain distributions of an incoherently pumped amplifier.

Gain spectrum of an optical parametric amplifier with a temporally incoherent pump.

We experimentally investigate the performance of a fiber optic parametric amplifier pumped with a temporally incoherent pump. The measured gain curves are compared with both a simple theory capable of predicting the maximum attainable mean incoherent parametric gain and full numerical simulations of the nonlinear Schrödinger equation. Parametric gain slopes seven times higher than that of an equivalent coherently pumped parametric amplifier are reported.

Widely tunable photonic crystal fiber Fabry-Perot optical parametric oscillator.

We present a widely tunable low-threshold chi(3) optical parametric oscillator. The oscillator cavity is formed by butt coupling dichroic mirrors to either end of a highly nonlinear index-guiding photonic crystal fiber. This yields a singly resonant Fabry-Perot oscillator with a high feedback fraction for the resonant parametric sideband. The tuning range of the output parametric sideband stretches from 23 to 164 THz above the pump frequency. The threshold power of the oscillator is only 15 W.