Multi-omics data integration and drug screening of AML cancer using Generative Adversarial Network.

In the era of precision medicine, accurate disease phenotype prediction for heterogeneous diseases, such as cancer, is emerging due to advanced technologies that link genotypes and phenotypes. However, it is difficult to integrate different types of biological data because they are so varied. In this study, we focused on predicting the traits of a blood cancer called Acute Myeloid Leukemia (AML) by combining different kinds of biological data. We used a recently developed method called Omics Generative Adversarial Network (GAN) to better classify cancer outcomes. The primary advantages of a GAN include its ability to create synthetic data that is nearly indistinguishable from real data, its high flexibility, and its wide range of applications, including multi-omics data analysis. In addition, the GAN was effective at combining two types of biological data. We created synthetic datasets for gene activity and DNA methylation. Our method was more accurate in predicting disease traits than using the original data alone. The experimental results provided evidence that the creation of synthetic data through interacting multi-omics data analysis using GANs improves the overall prediction quality. Furthermore, we identified the top-ranked significant genes through statistical methods and pinpointed potential candidate drug agents through in-silico studies. The proposed drugs, also supported by other independent studies, might play a crucial role in the treatment of AML cancer. The code is available on GitHub; https://github.com/SabrinAfroz/omicsGAN_codes?fbclid=IwAR1-/stuffmlE0hyWgSu2wlXo6dYlKUei3faLdlvpxTOOUPVlmYCloXf4Uk9ejK4I.

Dual-Functional Ru/Ni-B-P Electrocatalyst Toward Accelerated Water Electrolysis and High-Stability.

Development of advanced electrocatalysts for the green hydrogen production by water electrolysis is an important task to reduce the climate and environmental issues as well as to meet the future energy demands. Herein, Ru/Ni-B-P sphere electrocatalyst is demonstrated by a combination of hydrothermal and soaking approaches, meeting the industrial requirement of low cell voltage with stable high-current operation. The Ru/Ni-B-P sphere catalyst demonstrates low overpotentials of 191 and 350 mV at 300 mA cm-2 with stable high current operation, ranking it as one of the best oxygen evolution reaction (OER) electrocatalysts. The bifunctional 2-E system demonstrates a low cell voltage of 2.49 V at 2000 mA cm-2 in 6 m KOH at 60 °C of harsh industrial operation condition. It also demonstrates outstanding stability with continuous 120 h (5 days) CA operation at 1000 mA cm-2. Further, the hybrid configuration of Ru/Ni-B-P || Pt/C being paired with the conventional benchmark electrode demonstrates a record low 2-E cell voltage of 2.40 V at 2000 mA cm-2 in 6 m KOH and excellent stability at high current of 1500 mA cm-2 under industrial operational condition.

Plant-assisted green preparation of silver nanoparticles using leaf extract of Dalbergia sissoo and their antioxidant, antibacterial and catalytic applications.

Plant-mediated preparation of silver nanoparticles (AgNPs) is thought to be a more economical and environmentally benign process in comparison to physical and chemical synthesis methods. In the present study, the aqueous leaf extract of Dalbergia sissoo was prepared and utilized to reduce silver ion (Ag+) during the green synthesis of silver nanoparticles (DL-AgNPs). The formation of DL-AgNPs was verified using UV-Vis spectra, exhibiting the surface plasmon resonance (SPR) band at around 450 nm. FT-IR analysis revealed the kinds of phytochemicals that serve as reducing and capping agents while DL-AgNPs are being synthesized. Analysis of scanning electron microscope (SEM) and high-resolution transmission electron microscopy (HR-TEM) images verified the development of spherical and oval-shaped DL-AgNPs, with sizes ranging from 10 to 25 nm. The stability and particle size distribution of synthesized DL-AgNPs were ensured by zeta potential and DLS (dynamic light scattering) investigations. Additionally, X-ray diffraction (XRD) analysis confirmed the crystalline nature of DL-AgNPs. In antioxidant experiments, DL-AgNPs demonstrated significant scavenging capacities of DPPH and ABTS radicals with EC50 values of 51.32 and 33.32 µg/mL, respectively. The antibacterial activity of DL-AgNPs was shown to be significant against harmful bacteria, with a maximum zone of inhibition (21.5 ± 0.86 mm) against Staphylococcus aureus. Furthermore, DL-AgNPs exhibited effective catalytic activity to degrade environment-polluting dyes (methylene blue, methyl orange, and Congo red) and toxic chemicals (p-nitrophenol). The results of all these studies suggested that DL-AgNPs made from the leaf extract of Dalbergia sissoo have merit for application in the environmental and biomedical fields.

Air pollution status and attributable health effects across the state of West Bengal, India, during 2016-2021.

Air pollution is one of the most significant threats to human safety due to its detrimental health consequences worldwide. This study examines the air pollution levels in 22 districts of West Bengal from 2016 to 2021, using data from 81 stations operated by the West Bengal Pollution Control Board (WBPCB). The study assesses the short- and long-term impacts of particulate matter (PM) on human health. The highest annual variation of PM10 was noted in 2016 (106.99 ± 34.17 µg/m3), and the lowest was reported in 2020 (88.02 ± 13.61 µg/m3), whereas the highest annual variations of NO2 (µg/m3) were found in 2016 (35.17 ± 13.55 µg/m3), and lowest in 2019 (29.72 ± 13.08 µg/m3). Similarly, the SO2 level was lower (5.35 µg/m3) in 2017 and higher in 2020 (7.78 µg/m3). In the state, Bardhaman, Bankura, Kolkata, and Howrah recorded the highest PM10 concentrations. The monthly and seasonal variations of pollution showed higher in December, January, and February (winter season) and lowest observed in June, July, and August (rainy season). The southern part of West Bengal state has recorded higher pollution levels than the northern part. The short- and long-term health impact assessment due to particulate matter shows that the estimated number of attributable cases (ENACs) for incidence of chronic bronchitis in adults and prevalence of bronchitis in children were 305,234 and 14,652 respectively. The long-term impact of PM2.5 on human health ENACs for mortality due to chronic obstructive pulmonary disease for adults, acute lower respiratory infections in children aged 0-5, lung cancer, and stroke for adults were 21,303, 12,477, 25,064, 94,406, and 86,272 respectively. This outcome assists decision-makers and stakeholders in effectively addressing the air pollution and health risk concerns within the specified area.

Receptor model-based source-specific health risks of toxic metal(loid)s in coal basin-induced agricultural soil in northwest Bangladesh.

Toxic metal(loid)s (TMLs) in agricultural soils cause detrimental effects on ecosystem and human health. Therefore, source-specific health risk apportionment is very crucial for the prevention and control of TMLs in agricultural soils. In this study, 149 surface soil samples were taken from a coal mining region in northwest Bangladesh and analyzed for 12 TMLs (Pb, Cd, Ni, Cr, Mn, Fe, Co, Zn, Cu, As, Se, and Hg). Positive matrix factorization (PMF) and absolute principal component score-multiple linear regression (APCS-MLR) receptor models were employed to quantify the pollution sources of soil TMLs. Both models identified five possible sources of pollution: agrochemical practice, industrial emissions, coal-power-plant, geogenic source, and atmospheric deposition, while the contribution rates of each source were calculated as 28.2%, 17.2%, 19.3%, 19% and 16.3% in APCS-MLR, 22.2%, 13.4%, 24.3%, 15.1% and 25.1% in PMF, respectively. Agrochemical practice was the major source of non-carcinogenic risk (NCR) (adults: 32.37%, children: 31.54%), while atmospheric deposition was the highest source of carcinogenic risk (CR) (adults: 48.83%, children: 50.11%). NCR and CR values for adults were slightly higher than for children. However, the trends in NCR and CR between children and adults were similar. As a result, among the sources of pollution, agrochemical practices and atmospheric deposition have been identified as the primary sources of soil TMLs, so prevention and control strategies should be applied primarily for these pollution sources in order to protect human health.

Perception and legacy of soil chromium and lead contamination in an operational small-scale coal mining community.

Operational small-scale coal mining (OSCM) is one of the most significant sources of chromium (Cr) and lead (Pb) pollution in Bangladesh. Attempts to minimize or lessen the use of Cr and Pb in OSCM have shown unsatisfactory results, mainly because they need to address the sociotechnical complexity of pollution concerns in OSCM. This research adopts a multidisciplinary, sociotechnical approach to addressing Cr and Pb problems, coupling soil sampling for Cr and Pb with questionnaires of miners' and inhabitants' perceptions of pollution and its distribution. The study was undertaken in the Barapukuria coal basin in northwest Bangladesh. Except for mining areas (average of 49.80 ± 27.25 mg/kg), Cr levels in soils exceeded the world average in the periphery (73.34 ± 24.39 mg/kg, ~ 1.2 times) and residential areas (88.85 ± 35.87 mg/kg, 1.5 times the world standard of 59.5 mg/kg). Pb levels in soils exceeded national and global averages in mining (53.56 ± 37.62 mg/kg, ~ 1.9 times), periphery (35.05 ± 21.77 mg/kg, ~ 1.3 times), and residential areas (32.14 ± 26.59 mg/kg, ~ 1.2 times) when compared to Bangladesh and global standards of 20 and 27 mg/kg. Pb levels were highest in mining areas, while Cr concentrations were highest in residential areas. The questionnaire findings indicated that miners and inhabitants did not correctly assume that the highest levels of Cr and Pb pollution would be found in these areas. Among all respondents, 54% are unaware of the health impacts of prolonged Cr and Pb exposure. They face respiratory problems (38.6%), skin diseases (32.7%), and other health issues. A large number of people (66.6%) agreed with the fact that Cr and Pb contamination has an impact on drinking water. Cr and Pb pollution has caused 40% crop loss and a 36% decrease in productivity in the agricultural sector. However, respondents underestimated the level of Cr pollution in mining areas, and most assumed that only individuals working directly with mines were impacted by the Cr and Pb content. Participants also rated the reduction of Cr and Pb contamination as of low importance. There is less awareness of Cr and Pb pollution among miners and inhabitants. Sincere efforts to reduce Cr and Pb pollution will likely be met with extra attention and hostility.

Genomic characterization of the dominating Beta, V2 variant carrying vaccinated (Oxford-AstraZeneca) and nonvaccinated COVID-19 patient samples in Bangladesh: A metagenomics and whole-genome approach.

Bangladesh is experiencing a second wave of COVID-19 since March 2021, despite the nationwide vaccination drive with ChAdOx1 (Oxford-AstraZeneca) vaccine from early February 2021. Here, we characterized 19 nasopharyngeal swab (NPS) samples from COVID-19 suspect patients using genomic and metagenomic approaches. Screening for SARS-CoV-2 by reverse transcriptase polymerase chain reaction and metagenomic sequencing revealed 17 samples of COVID-19 positive (vaccinated = 10, nonvaccinated = 7) and 2 samples of COVID-19 negative. We did not find any significant correlation between associated factors including vaccination status, age or sex of the patients, diversity or abundance of the coinfected organisms/pathogens, and the abundance of SARS-CoV-2. Though the first wave of the pandemic was dominated by clade 20B, Beta, V2 (South African variant) dominated the second wave (January 2021 to May 2021), while the third wave (May 2021 to September 2021) was responsible for Delta variants of the epidemic in Bangladesh including both vaccinated and unvaccinated infections. Noteworthily, the receptor binding domain (RBD) region of S protein of all the isolates harbored similar substitutions including K417N, E484K, and N501Y that signify the Beta, while D614G, D215G, D80A, A67V, L18F, and A701V substitutions were commonly found in the non-RBD region of Spike proteins. ORF7b and ORF3a genes underwent a positive selection (dN/dS ratio 1.77 and 1.24, respectively), while the overall S protein of the Bangladeshi SARS-CoV-2 isolates underwent negative selection pressure (dN/dS = 0.621). Furthermore, we found different bacterial coinfections like Streptococcus agalactiae, Neisseria meningitidis, Elizabethkingia anophelis, Stenotrophomonas maltophilia, Klebsiella pneumoniae, and Pseudomonas plecoglossicida, expressing a number of antibiotic resistance genes such as tetA and tetM. Overall, this approach provides valuable insights on the SARS-CoV-2 genomes and microbiome composition from both vaccinated and nonvaccinated patients in Bangladesh.

Random misalignment and anisotropic deformation of the nested cladding elements in hollow-core anti-resonant fibers.

Hollow-core anti-resonant fibers (HC-ARFs) are en route to compete with and surpass the transmission performance of standard single-mode fibers (SSMFs). Recently, nested cladding elements emerged as a key enabler in reaching ultra-low transmission losses over a wide bandwidth. However, implementing nested geometry features poses a great challenge even in the current state-of-the-art fiber fabrication technology, often leading to structural imperfections, which ultimately worsen overall fiber performance. This article provides insights into the impact of fabrication-based perturbations of the cladding elements on the transmission performance and identifies areas of highest susceptibility. The impact of random outer and nested cladding tube misalignments as well as their anisotropic deformation on the propagation loss is analyzed based on observations of experimentally fabricated fibers. A dominance of the deformation effect over the misalignment effect is observed, with higher-order modes (HOMs) being affected one order of magnitude stronger than the fundamental mode (FM). The impact on propagation loss by structural perturbations is highly wavelength dependent, ranging from negligibly small values up to loss increases of 65% and 850% for FM and HOM propagation, respectively. The investigations are directly linked to fabrication metrics and therefore pave the way for assessing, predicting, and improving the transmission quality of fabricated hollow-core fibers.

Randomised controlled trial showed long-term efficacy, immunogenicity and safety of varicella vaccines in Norwegian and Swedish children.

AIM: Several countries, such as Norway and Sweden, have not implemented universal varicella vaccination. We present data for Norway and Sweden that were generated by a paediatric multi-country Phase III study over a 10-year period. This assessed the efficacy, antibody persistence and safety of two varicella vaccines containing the same Oka strain. METHODS: This was an observer-blind, controlled trial conducted in 10 European countries. Children aged 12-22 months (n = 5803) were randomised 3:3:1 and vaccinated between 1 September 2005 and 10 May 2006. The two-dose group received two tetravalent measles-mumps-rubella-varicella vaccine doses. The one-dose group received one monovalent varicella vaccine dose after a measles-mumps-rubella vaccine dose. Control group participants received two measles-mumps-rubella vaccine doses. Main study outcomes were vaccine efficacy against confirmed varicella cases and incidence of adverse events. RESULTS: Vaccine efficacy in the two-dose group was ≥92.1% in both Norwegian and Swedish children compared to 72.3% in Norway and 58.0% in Sweden in the one-dose group. Incidences of adverse events and serious adverse events were similar in the Norwegian and Swedish study populations. CONCLUSION: Consistent with overall study results, high efficacy against varicella and acceptable safety profiles of the two varicella vaccines were observed in Norwegian and Swedish populations. These findings highlight the benefits of varicella vaccines, particularly when administered as a two-dose schedule.

Consumer attitudes toward dairy products from sheep and goats: A cross-continental perspective.

This study aimed to assess consumer knowledge, attitudes, and perceptions toward dairy products from sheep and goats. A web-based survey was conducted in Latin America (Mexico and Chile), Europe (Italy, Spain, Greece, and Denmark), and Asia (Bangladesh). From March to June 2021, adult participants answered an online survey available in 5 languages. In total, 1,879 surveys were completed. Categorical and ordinal data were analyzed as frequencies and percentages. To determine the relationship between the variables for purchasing and consumption behaviors of respondents who declared that they consume dairy products, a multiple correspondence analysis was carried out. Most completed surveys were from Mexico and Italy (30% and 33.7%, respectively). Most respondents were between 18 and 29 yr old, female, highly educated, and employed. The majority of respondents (70.8%) declared that they consume dairy products from small ruminants. Consumers preferred products from both sheep and goats (49.4%); however, it was observed that in Mexico, Denmark, and Bangladesh, more than 50% preferred goat dairy products. The most-consumed products were mature and fresh cheeses. Mature cheese was the most-preferred product in Chile; in Mexico, Italy, Greece, and Denmark, it was fresh cheese. Unlike the rest of the countries, in Bangladesh, dairy product consumption from small ruminants was observed by more than 30% of respondents. In Mexico, a higher percentage of people do not consume sheep or goat dairy products because they are unfamiliar with them. In Mexico, Chile, and Bangladesh, limited market availability was also a variable responsible for nonconsumption. In European and Asian countries, sheep and goat dairy products are not consumed because consumers dislike them, in addition to a greater awareness of sustainability and climate change issues. The multiple correspondence analysis defined 5 dimensions. Dimension 1 was associated with the geographic location of the respondent (country and continent), the type of milk (sheep or goat), and the consideration of well-being and health as characteristics associated with the consumption of dairy products from small ruminants. Dimension 2 was associated with the respondent's country of origin and the frequency of consumption. Dimension 3 was associated with gender, education, and employment status. Dimension 4 was associated with the respondent's age, the association of the "healthy" concept of sheep and goat dairy products, and the consideration of the nutritional benefits of dairy as responsible for considering them healthy. Dimension 5 was associated with a "strong smell and taste" of sheep and goat dairy products. This study showed that consumer attitudes toward dairy products from sheep and goats vary between continents. In conclusion, results showed consumer interest in animal welfare and environmental impact issues related to small ruminant farming as well as a general attraction to local products. It seems that these factors contribute to consumers' perception of the quality of dairy products, so the industry and select farmers should carefully consider incorporating them into their supply chain.

Rheological Analysis of Bio-ink for 3D Bio-printing Processes.

3D bio-printing is an emerging technology to fabricate tissue scaffold in-vitro through the controlled allocation of biomaterial and cells, which can mimic the in-vivo counterpart of living tissue. Live cells are often encapsulated into the biomaterials (i.e., bio-ink) and extruded by controlling the printing parameters. The functionality of the bioink depends upon three factors: (a) printability, (b) shape fidelity, and (c) bio-compatibility. Increasing viscosity will improve the printability and the shape fidelity but require higher applied extrusion pressure, which is detrimental to the living cell dwelling in the bio-ink, which is often ignored in the bio-ink optimization process. This paper demonstrates a roadmap to develop and optimize bio-inks, ensuring printability, shape fidelity, and cell survivability. The pressure exerted on the bio-ink during extrusion processes is measured analytically, and the information is incorporated in the bio-ink's rheology design. Cell-laden filaments are fabricated with multiple cell lines, i.e., Human Embryonic Kidney (HEK 293), BxPC3, and prostate cancer cells which are analyzed for cell viability. The cross-sectional live-dead assay of the extruded filament demonstrates a spatial pattern for HEK 293 cell viability, which correlates with our analytical finding of the shear stress at the nozzle tip. All three cell lines were able to sustain a transient shear stress of 3.7 kPa and demonstrate 90% viability with our designed bio-ink after 15 days of incubation. Simultaneously, the shape fidelity and printability matrices show its suitability for 3D bio-printing process.

Reckoning the Inhaled Sedation in Critically Ill Patients (INSTINCT) Study.

How to cite this article: Karim HMR, Mitra JK. Reckoning the Inhaled Sedation in Critically Ill Patients (INSTINCT) Study. Indian J Crit Care Med 2022;26(11):1227-1228.

Ketamine Sedation for Noninvasive Ventilation in Distressed Elderly Patients with Acute Decompensated Heart Failure: Is it Safe?

How to cite this article: Karim HMR, Esquinas AM. Ketamine Sedation for Noninvasive Ventilation in Distressed Elderly Patients with Acute Decompensated Heart Failure: Is it Safe? Indian J Crit Care Med 2022;26(10):1161.

Alveolar-arterial Oxygen Gradient in COVID-19 Pneumonia Initiated on Noninvasive Ventilation: Looking into the Mortality-prediction Ability.

How to cite this article: Karim HMR, Esquinas AM. Alveolar-arterial Oxygen Gradient in COVID-19 Pneumonia Initiated on Noninvasive Ventilation: Looking into the Mortality-prediction Ability. Indian J Crit Care Med 2022;26(10):1152.

Common Defects Accelerate Charge Separation and Reduce Recombination in CNT/Molecule Composites: Atomistic Quantum Dynamics.

Carbon nanotubes (CNTs) are appealing candidates for solar and optoelectronic applications. Traditionally used as electron sinks, CNTs can also perform as electron donors, as exemplified by coupling with perylenediimide (PDI). To achieve high efficiencies, electron transfer (ET) should be fast, while subsequent charge recombination should be slow. Typically, defects are considered detrimental to material performance because they accelerate charge and energy losses. We demonstrate that, surprisingly, common CNT defects improve rather than deteriorate the performance. CNTs and other low dimensional materials accommodate moderate defects without creating deep traps. At the same time, charge redistribution caused by CNT defects creates an additional electrostatic potential that increases the CNT work function and lowers CNT energy levels relative to those of the acceptor species. Hence, the energy gap for the ET is decreased, while the gap for the charge recombination is increased. The effect is particularly important because charge acceptors tend to bind near defects due to enhanced chemical interactions. The time-domain simulation of the excited-state dynamics provides an atomistic picture of the observed phenomenon and characterizes in detail the electronic states, vibrational motions, inelastic and elastic electron-phonon interactions, and time scales of the charge separation and recombination processes. The findings should apply generally to low-dimensional materials, because they dissipate defect strain better than bulk semiconductors. Our calculations reveal that CNT performance is robust to common defects and that moderate defects are essential rather than detrimental for CNT application in energy, electronics, and related fields.

Impact of cladding elements on the loss performance of hollow-core anti-resonant fibers.

Understanding the impact of the cladding tube structure on the overall guiding performance is crucial for designing a single-mode, wide-band, and ultra low-loss nested hollow-core anti-resonant fiber (HC-ARF). Here we thoroughly investigate on how the propagation loss is affected by the nested elements when their geometry is realistic (i.e., non-ideal). Interestingly, it was found that the size, rather than the shape, of the nested elements has a dominant role in the final loss performance of the regular nested HC-ARFs. We identify a unique 'V-shape' pattern for suppression of higher-order modes loss by optimizing free design parameters of the HC-ARF. We find that a 5-tube nested HC-ARF has wider transmission window and better single-mode operation than a 6-tube HC-ARF. We show that the propagation loss can be significantly improved by using anisotropic nested anti-resonant tubes elongated in the radial direction. Our simulations indicate that with this novel fiber design, a propagation loss as low as 0.11 dB/km at 1.55 µm can be achieved. Our results provide design insight toward fully exploiting a single-mode, wide-band, and ultra low-loss HC-ARF. In addition, the extraordinary optical properties of the proposed fiber can be beneficial for several applications such as future optical communication system, high energy light transport, extreme non-nonlinear optics and beyond.

Enhanced birefringence in conventional and hybrid anti-resonant hollow-core fibers.

A hollow-core anti-resonant fiber (HC-ARF) design based on hybrid silica/silicon cladding is proposed for single-polarization, single-mode and high birefringence. We show that by adding silicon layers in a semi-nested HC-ARF, one of the polarization states can be strongly suppressed while simultaneously maintaining low propagation loss for other polarization states, single-mode and high birefiringence. The optimized HC-ARF design exhibits propagation loss, high birefringence, and polarization-extinction ratio of 0.05 dB/m, 0.5 × 10-4, >300 respectively for y-polarization while the loss of x-polarization is >5 dB/m at 1064 nm. The fiber also has low bend-loss and thus can be coiled to a small bend radii of 5 cm having ≈0.06 dB/m bend loss.

Multi-wavelength high-energy gas-filled fiber Raman laser spanning from 1.53 µm to 2.4 µm.

In this work, we present a high-pulse-energy multi-wavelength Raman laser spanning from 1.53 µm up to 2.4 µm by employing the cascaded rotational stimulated Raman scattering effect in a 5 m hydrogen (H2)-filled nested anti-resonant fiber, pumped by a linearly polarized Er/Yb fiber laser with a peak power of ∼13kW and pulse duration of ∼7ns in the C-band. The developed Raman laser has distinct lines at 1683 nm, 1868 nm, 2100 nm, and 2400 nm, with pulse energies as high as 18.25 µJ, 14.4 µJ, 14.1 µJ, and 8.2 µJ, respectively. We demonstrate how the energy in the Raman lines can be controlled by tuning the H2 pressure from 1 bar to 20 bar.

Secretion management in patients with ineffective airway clearance with non-invasive mechanical ventilation use: Expert guidance for clinical practice.

Non-invasive ventilation (NIV) is a mainstay of management of chronic respiratory failure in many disorders which are known to cause abnormal airway secretion clearance. Currently, there is no guidance regarding either the secretion handling during NIV use or the role of NIV in secretion management in these patients. The aim of this document was to provide an overview of the various techniques available in the management of respiratory secretions and their use in conjunction with NIV. Literature search was performed using the keywords, "(secretion OR secretions) AND (noninvasive ventilation OR NIV)" on PubMed and EMBASE. The search yielded 1681 and 509 titles from PubMed and EMBASE, respectively. After screening, 19 articles were included in this review. Suggestions of the expert panel were formulated by mutual consensus after reviewing the relevant literature. The draft of the expert panel's suggestions was circulated among all authors via electronic mail for comments. Any conflicts were resolved by mutual discussion to achieve agreement. The final document was approved by all. This document by the International Network for Airway Secretions Management in NIV describes various airway secretion clearance techniques. It provides the expert panel's suggestions for the use of these techniques in conjunction with NIV for patients with muco-obstructive and neuromuscular disorders.

High pulse energy and quantum efficiency mid-infrared gas Raman fiber laser targeting CO2 absorption at 4.2 µm.

In this Letter, we demonstrate a high pulse energy and linearly polarized mid-infrared Raman fiber laser targeting the strongest absorption line of ${\rm CO}_2$CO2 at $\sim{4.2}\;\unicode {x00B5} {\rm m}$∼4.2µm. This laser was generated from a hydrogen (${\rm H}_2$H2)-filled antiresonant hollow-core fiber, pumped by a custom-made 1532.8 nm Er-doped fiber laser delivering 6.9 ns pulses and 11.6 kW peak power. A quantum efficiency as high as 74% was achieved, to yield 17.6 µJ pulse energy at 4.22 µm. Less than 20 bar ${\rm H}_2$H2 pressure was required to maximize the pulse energy since the transient Raman regime was efficiently suppressed by the long pump pulses.