Roadmap for Optical Metasurfaces.

Metasurfaces have recently risen to prominence in optical research, providing unique functionalities that can be used for imaging, beam forming, holography, polarimetry, and many more, while keeping device dimensions small. Despite the fact that a vast range of basic metasurface designs has already been thoroughly studied in the literature, the number of metasurface-related papers is still growing at a rapid pace, as metasurface research is now spreading to adjacent fields, including computational imaging, augmented and virtual reality, automotive, display, biosensing, nonlinear, quantum and topological optics, optical computing, and more. At the same time, the ability of metasurfaces to perform optical functions in much more compact optical systems has triggered strong and constantly growing interest from various industries that greatly benefit from the availability of miniaturized, highly functional, and efficient optical components that can be integrated in optoelectronic systems at low cost. This creates a truly unique opportunity for the field of metasurfaces to make both a scientific and an industrial impact. The goal of this Roadmap is to mark this "golden age" of metasurface research and define future directions to encourage scientists and engineers to drive research and development in the field of metasurfaces toward both scientific excellence and broad industrial adoption.

Photonic chip-based low-noise microwave oscillator.

Numerous modern technologies are reliant on the low-phase noise and exquisite timing stability of microwave signals. Substantial progress has been made in the field of microwave photonics, whereby low-noise microwave signals are generated by the down-conversion of ultrastable optical references using a frequency comb1-3. Such systems, however, are constructed with bulk or fibre optics and are difficult to further reduce in size and power consumption. In this work we address this challenge by leveraging advances in integrated photonics to demonstrate low-noise microwave generation via two-point optical frequency division4,5. Narrow-linewidth self-injection-locked integrated lasers6,7 are stabilized to a miniature Fabry-Pérot cavity8, and the frequency gap between the lasers is divided with an efficient dark soliton frequency comb9. The stabilized output of the microcomb is photodetected to produce a microwave signal at 20 GHz with phase noise of -96 dBc Hz-1 at 100 Hz offset frequency that decreases to -135 dBc Hz-1 at 10 kHz offset-values that are unprecedented for an integrated photonic system. All photonic components can be heterogeneously integrated on a single chip, providing a significant advance for the application of photonics to high-precision navigation, communication and timing systems.

Organisation of paediatric echocardiography laboratories and governance of echocardiography services and training in Europe: current status, disparities, and potential solutions. A survey from the Association for European Paediatric and Congenital Cardiology (AEPC) imaging working group.

BACKGROUND: There is limited data on the organisation of paediatric echocardiography laboratories in Europe. METHODS: A structured and approved questionnaire was circulated across all 95 Association for European Paediatric and Congenital Cardiology affiliated centres. The aims were to evaluate: (1) facilities in paediatric echocardiography laboratories across Europe, (2) accredited laboratories, (3) medical/paramedical staff employed, (4) time for echocardiographic studies and reporting, and (5) training, teaching, quality improvement, and research programs. RESULTS: Respondents from forty-three centres (45%) in 22 countries completed the survey. Thirty-six centres (84%) have a dedicated paediatric echocardiography laboratory, only five (12%) of which reported they were European Association of Cardiovascular Imaging accredited. The median number of echocardiography rooms was three (range 1-12), and echocardiography machines was four (range 1-12). Only half of all the centres have dedicated imaging physiologists and/or nursing staff, while the majority (79%) have specialist imaging cardiologist(s). The median (range) duration of time for a new examination was 45 (20-60) minutes, and for repeat examination was 20 (5-30) minutes. More than half of respondents (58%) have dedicated time for reporting. An organised training program was present in most centres (78%), 44% undertake quality assurance, and 79% perform research. Guidelines for performing echocardiography were available in 32 centres (74%). CONCLUSION: Facilities, staffing levels, study times, standards in teaching/training, and quality assurance vary widely across paediatric echocardiography laboratories in Europe. Greater support and investment to facilitate improvements in staffing levels, equipment, and governance would potentially improve European paediatric echocardiography laboratories.

All electromagnetic scattering bodies are matrix-valued oscillators.

Scattering theory is the basis of all linear optical and photonic devices, whose spectral response underpins wide-ranging applications from sensing to energy conversion. Unlike the Shannon theory for communication channels, or the Fano theory for electric circuits, understanding the limits of spectral wave scattering remains a notoriously challenging open problem. We introduce a mathematical scattering representation that inherently embeds fundamental principles of causality and passivity into its elemental degrees of freedom. We use this representation to reveal strong constraints in the mathematical structure of scattered fields, and to develop a general theory of the maximum radiative heat transfer in the near field, resolving a long-standing open question. Our approach can be seamlessly applied to high-interest applications across nanophotonics, and appears extensible to general classical and quantum scattering theory.

COVID-19 in congenital heart disease (COaCHeD) study.

BACKGROUND: COVID-19 has caused significant worldwide morbidity and mortality. Congenital heart disease (CHD) is likely to increase vulnerability and understanding the predictors of adverse outcomes is key to optimising care. OBJECTIVE: Ascertain the impact of COVID-19 on people with CHD and define risk factors for adverse outcomes. METHODS: Multicentre UK study undertaken 1 March 2020-30 June 2021 during the COVID-19 pandemic. Data were collected on CHD diagnoses, clinical presentation and outcomes. Multivariable logistic regression with multiple imputation was performed to explore predictors of death and hospitalisation. RESULTS: There were 405 reported cases (127 paediatric/278 adult). In children (age <16 years), there were 5 (3.9%) deaths. Adjusted ORs (AORs) for hospitalisation in children were significantly lower with each ascending year of age (OR 0.85, 95% CI 0.75 to 0.96 (p<0.01)). In adults, there were 24 (8.6%) deaths (19 with comorbidities) and 74 (26.6%) hospital admissions. AORs for death in adults were significantly increased with each year of age (OR 1.05, 95% CI 1.01 to 1.10 (p<0.01)) and with pulmonary arterial hypertension (PAH; OR 5.99, 95% CI 1.34 to 26.91 (p=0.02)). AORs for hospitalisation in adults were significantly higher with each additional year of age (OR 1.03, 95% CI 1.00 to 1.05 (p=0.04)), additional comorbidities (OR 3.23, 95% CI 1.31 to 7.97 (p=0.01)) and genetic disease (OR 2.87, 95% CI 1.04 to 7.94 (p=0.04)). CONCLUSIONS: Children were at low risk of death and hospitalisation secondary to COVID-19 even with severe CHD, but hospital admission rates were higher in younger children, independent of comorbidity. In adults, higher likelihood of death was associated with increasing age and PAH, and of hospitalisation with age, comorbidities and genetic disease. An individualised approach, based on age and comorbidities, should be taken to COVID-19 management in patients with CHD.

Probing the Limits to Near-Field Heat Transfer Enhancements in Phonon-Polaritonic Materials.

Near-field radiative heat transfer (NFRHT) arises between objects separated by nanoscale gaps and leads to dramatic enhancements in heat transfer rates compared to the far-field. Recent experiments have provided first insights into these enhancements, especially using silicon dioxide (SiO2) surfaces, which support surface phonon polaritons (SPhP). Yet, theoretical analysis suggests that SPhPs in SiO2 occur at frequencies far higher than optimal. Here, we first show theoretically that SPhP-mediated NFRHT, at room temperature, can be 5-fold larger than that of SiO2, for materials that support SPhPs closer to an optimal frequency of 67 meV. Next, we experimentally demonstrate that MgF2 and Al2O3 closely approach this limit. Specifically, we demonstrate that near-field thermal conductance between MgF2 plates separated by 50 nm approaches within nearly 50% of the global SPhP bound. These findings lay the foundation for exploring the limits to radiative heat transfer rates at the nanoscale.

Medication use in Canadian blood donors.

BACKGROUND AND OBJECTIVES: Policies regarding medication use vary between blood centres. We evaluated medication use in eligible Canadian Blood Services whole blood donors to inform possible process improvements and allow comparisons between donors and the general population. MATERIALS AND METHODS: All donors are asked about medication use in the last 3 days, and medications and their reason for use are documented in our donor computer system. Donor computer records were reviewed from January 1, 2020, to March 31, 2022 to extract information on medications by donor age and sex; medications were grouped into therapeutic classes. Stability of medication use over time was determined in a random sample of 100 donors who made at least two donations in the study period. RESULTS: One-third of successful (eligible) donors were taking medications; of these, 80% were on one or two medications. Five classes of medication accounted for 72% of medication use, and 13 classes account for 93% of use. Use remains relatively stable over time. CONCLUSION: Medication use is common, with a few classes accounting for most use. Drop-down lists and storage of information from one donation to the next may enhance efficiency.

Towards maximum optical efficiency of ensembles of colloidal nanorods.

Experimental and theoretical studies of colloidal nanoparticles have primarily focused on accurate characterization and simulation of observable characteristics, such as resonant wavelength. In this paper, we tackle the optimal design of colloidal-nanoparticle ensembles: what is the largest possible per-volume optical cross-section, which designs might achieve them, and can such response be experimentally demonstrated? We combine theory and experiment to answer each of these questions. We derive general bounds on the maximum cross-sections per volume, and we apply an analytical antenna model to show that resonant nanorods should nearly achieve such bounds. We use a modified seed-mediated synthesis approach to synthesize ensembles of gold nanorods with small polydispersity, i.e., small variations in size and aspect ratio. Polydispersity is the key determinant of how closely such ensembles can approach their respective bounds yet is difficult to characterize experimentally without near-field measurements. We show that a certain "extinction metric," connecting extinction cross-section per volume with the radiative efficiencies of the nanoparticles, offers a quantitative prediction of polydispersity via quantities that can be rapidly measured with far-field characterization tools. Our predictions apply generally across all plasmonic materials and offer a roadmap to the largest possible optical response of nanoparticle ensembles.

Evolving policies for donors with diabetes: The Canadian experience.

BACKGROUND AND OBJECTIVES: Donor criteria for diabetes vary significantly. We describe our evolving policies for donors with diabetes, their contribution to the Canadian blood supply and their rate of syncopal reactions compared to other donors. MATERIALS AND METHODS: All donors are asked if they have diabetes and have taken medications in the last 3 days. We assessed donors with diabetes on various medications, the number deferred over time, and syncopal reactions in donors with diabetes and other donors in our donor reaction database. RESULTS: Policy changes allowing type 2 diabetic donors on oral hypoglycaemics alone, type 2 diabetic donors on oral medications and insulin and type 1 diabetic donors (all on insulin) to donate resulted in a decrease in deferrals from 450 to 22 donors annually. Of donors being treated with medication for diabetes, 11% are receiving insulin as part of their treatment. Syncopal reaction rates were low and not statistically different between diabetic and non-diabetic donors, although confidence intervals (CIs) are large. CONCLUSION: Policies decreased deferrals while maintaining safety. A longer observation period would strengthen these observations.

Medium-Term Cardiac Outcomes in Young People with Multi-system Inflammatory Syndrome: The Era of COVID-19.

Multi-system inflammatory syndrome in children (MIS-C) causes widespread inflammation including a pancarditis in the weeks following a COVID infection. As we prepare for further coronavirus surges, understanding the medium-term cardiac impacts of this condition is important for allocating healthcare resources. A retrospective single-center study of 67 consecutive patients with MIS-C was performed evaluating echocardiographic and electrocardiographic (ECG) findings to determine the point of worst cardiac dysfunction during the admission, then at intervals of 6-8 weeks and 6-8 months. Worst cardiac function occurred 6.8 ± 2.4 days after the onset of fever with mean 3D left ventricle (LV) ejection fraction (EF) 50.5 ± 9.8%. A pancarditis was typically present: 46.3% had cardiac impairment; 31.3% had pericardial effusion; 26.8% demonstrated moderate (or worse) valvar regurgitation; and 26.8% had coronary dilatation. Cardiac function normalized in all patients by 6-8 weeks (mean 3D LV EF 61.3 ± 4.4%, p < 0.001 compared to presentation). Coronary dilatation resolved in all but one patient who initially developed large aneurysms at presentation, which persisted 6 months later. ECG changes predominantly featured T-wave changes resolving at follow-up. Adverse events included need for ECMO (n = 2), death as an ECMO-related complication (n = 1), LV thrombus formation (n = 1), and subendocardial infarction (n = 1). MIS-C causes a pancarditis. In the majority, discharge from long-term follow-up can be considered as full cardiac recovery is expected by 8 weeks. The exception includes patients with medium sized aneurysms or greater as these may persist and require on-going surveillance.

Radiation safety for cardiovascular computed tomography imaging in paediatric cardiology: a joint expert consensus document of the EACVI, ESCR, AEPC, and ESPR.

Children with congenital and acquired heart disease may be exposed to relatively high lifetime cumulative doses of ionizing radiation from necessary medical invasive and non-invasive imaging procedures. Although these imaging procedures are all essential to the care of these complex paediatric population and have contributed to meaningfully improved outcomes in these patients, exposure to ionizing radiation is associated with potential risks, including an increased lifetime attributable risk of cancer. The goal of this manuscript is to provide a comprehensive review of radiation dose management and cardiac computed tomography performance in the paediatric population with congenital and acquired heart disease, to encourage informed imaging to achieve indication-appropriate study quality at the lowest achievable dose.

Analysis of cannabidiol (CBD) and THC in nonprescription consumer products: Implications for patients and practitioners.

PURPOSE: Cannabidiol products remains largely unregulated in the US. Unlike the Rx formulation of CBD [EpidiolexR], little information is available regarding labeling accuracy (does the product contain what the label says it does), lot to lot variability, nor long-term product stability. Understanding these properties are fundamental if these products are to be used in patients with epilepsy, where product variability of traditional AEDs has been suspected to result in inadequate seizure control. Therefore, we analyzed commercial CBD products, including oils, aqueous products (i.e., beverages), and various Other products for cannabinoid content vs label claims and stability under United States Pharmacopeia (USP) standards. METHOD: Samples were diluted and analyzed by HPLC for CBD, THC, and CBN concentrations in order to assess product label accuracy. Products with <90% of label claim CBD were denoted over-labeled, products with >110% of label claim CBD were denoted under-labeled, and products between 90% and 110% of label claim CBD were denoted appropriately labeled, per USP standards. RESULTS: Among commercial CBD Oils (n = 11), mean CBD concentration vs label claim was 91.56% [95% CI, 66.02-117.10%], although 18.18% of oils (n = 2) made nonspecific label claims of "hemp extract" in lieu of CBD. Among all oils, 36.36% (n = 4) were appropriately labeled, another 36.4% (n = 4) of all oils were under-labeled, maximum 128.3% label claim, and finally, 9.09% (n = 1) of oils were over-labeled. The remaining 18.18% (n = 2) of oils lacked specific CBD label claims, minimum of 0.3 mg CBD per 1-ml "dose". THC was detected in 54.55% (n = 6) of oils with a maximum concentration of 0.2% w/v and a minimum concentration of 0.036% w/v. Cannabinol was detectable in only 9.1% (n = 1) of products at a concentration of 0.00465% w/v. Among aqueous products (n = 21) tested, only 66.67% (n = 14) gave specific CBD label claims, with mean CBD concentration vs label claim of 59.93% [95% CI, 38.24-81.63%]. Only 7.14% (n = 1) of aqueous products with a label claim were appropriately labeled, 14.29% (n = 2) were found to be under-labeled, and 78.57% (n = 11) over-labeled. THC was detected in 23.81% (n = 5) of aqueous products tested with a maximum THC concentration of 0.0005% w/v, and a minimum concentration of 0.0002% w/v. Cannabinol was detected in 9.52% (n = 2) of aqueous products, both at a concentration of 0.0015% w/v. "Other" products (n = 7) tested ranged from chocolate bars to transdermal patches. Some 42.86% (n = 3) gave specific CBD label claims, with mean CBD concentration vs label claim of 67.01% [95% CI, 0.87-133.14%]. Among these three "Other" products with specific label claims, 33% (n = 1) was appropriately labeled, and 66.67% (n = 2) were over-labeled, with CBD concentrations vs label claim ranging from a minimum of 39.30% to a maximum of 101.99%. The remaining 57.14% (n = 5) of "Other" products tested made nonspecific CBD label claims, denoting CBD content in terms of "full spectrum hemp extract" or "activated cannabinoids". One such product was labeled with a "40-50-mg CBD" range instead of a single, specific value. Tetrahydrocannabinol was detected in 71.43% (n = 5) of Other products tested with a maximum concentration of 0.0046% w/w, and a minimum concentration of 0.0008% w/w. Cannabinol was detected in 14.3% (n = 1) of Other products at a concentration of 0.0001% w/w. CONCLUSION: We demonstrate that commercial CBD products, especially aqueous beverages, can show inconsistent labeling, vary largely from their label claims should they make them, and show lot-to-lot variability making dosing unpredictable.

Outcome and Impact of Associated Left-Sided Cardiac Lesions in Coarctation of the Aorta Diagnosed During Fetal Life.

Significant effort has been put into the optimization of the antenatal diagnosis of coarctation of the aorta (CoA). However, although left-sided cardiac lesions are known to cluster, the necessity to intervene postnatally for other left-sided cardiac lesions has not been reported in a cohort of fetuses with suspected CoA. We report a study of all 89 fetuses with antenatally suspected and postnatally confirmed diagnosis of CoA who underwent CoA repair as the primary procedure at a single tertiary congenital heart disease center over 10 years (January 1, 2010, to December 31, 2019). Almost 1 in 5 patients (18%) had to undergo surgery and/or transcatheter intervention on additional left-sided cardiac lesions (14%) and/or reintervention on the aortic arch (12%) during follow-up to median age of 2.85 years. Freedom from intervention at 5 years was 78% (95% confidence interval [CI] 67 to 88%) if reintervention on CoA was excluded, and 72% (95% CI 60 to 82%) if this was included. Five-year survival was 95% (95% CI 90 to 100%). Furthermore, 20% of affected infants had genetic (10%) and/or extracardiac (16%) abnormalities. Our study highlights the need for comprehensive antenatal counseling, including the prognosis of primary repair of CoA and the potential development of additional left-sided cardiac lesions, which may be difficult to diagnose prenatally even in expert hands or impossible to diagnose because of the physiology of the fetal circulation.

Causes and consequences of variation in development time in a field cricket.

Variation in development time can affect life-history traits that contribute to fitness. In Gryllus vocalis, a non-diapausing cricket with variable development time, we used a path analysis approach to determine the causative relationships between parental age, offspring development time and offspring life-history traits. Our best-supported path model included both the effects of parental age and offspring development time on offspring morphological traits. This result suggests that offspring traits are influenced by both variation in acquisition of resources and trade-offs between traits. We found that crickets with longer development times became larger adults with better phenoloxidase-based immunity. This is consistent with the hypothesis that crickets must make a trade-off between developing quickly to avoid predation before reproduction and attaining better immunity and a larger adult body size that provides advantages in male-male competition, mate choice and female fecundity. Slower-developing crickets were also more likely to be short-winged (unable to disperse by flight). Parental age has opposing direct and indirect effects on the body size of daughters, but when both the direct and indirect effects of parental age are taken into account, younger parents had smaller sons and daughters. This pattern may be attributable to a parental trade-off between the number and size of eggs produced with younger parents producing more eggs with fewer resources per egg. The relationships between variables in the life-history traits of sons and daughters were similar, suggesting that parental age and development time had similar causative effects on male and female life-history traits.

Patient-Specific Dietary Therapy to Treat Chronic Diseases.

Although unconventional, for many years naturopathic physicians have theorized that patient-specific dietary intolerances are a significant cause of chronic disease. This is in addition to common health limiting dietary factors, such as excess calories or insufficient nutrients. Over the past 36 years of clinical practice, our doctors have developed a unique patient-specific dietary evaluation and treatment strategy aimed at preventing, mitigating, and even resolving chronic disease. We call this procedure the Advanced Universal Dietary Intolerance Test (AUDIT). The goal of this dietary therapy is to improve health and decrease risk by identifying and eliminating a patient's unique food intolerances. The AUDIT is similar to the standard E-RD, which for many decades has been considered by the naturopathic profession to be the "gold standard" for identifying dietary intolerances. Although the standard technique has a history of being helpful, its shortcomings regarding efficiency and accuracy significantly limit its utility. The AUDIT is an attempt to resolve these issues. Contrary to the common technique (E-RD), which depends largely on subjective patient improvement upon elimination and an exacerbation upon reintroduction, the AUDIT employs common objective markers. These include weight, lipid panel, blood sugar, and a metabolic panel to validate the results. Unlike the many weeks required by the common technique to make a distinction of intolerance, the AUDIT tracks rise in water weight (i.e., systemic edema) that occurs after a five-day elimination phase. Twelve hours after reintroducing a test food, the initial observation is made of a patient-specific intolerance reaction. The second association is observed in the improvement of laboratory markers after 5 weeks of the AUDIT, defining a reduction in disease risk. This outcome study demonstrates that AUDIT has the potential to prevent and treat some of the common chronic diseases seen in primary care. Though not presented in this literature, patients who followed the AUDIT strategy routinely achieved a long-term, sustainable improvement in their chronic disease, or even a resolution.

Fundamental Limits to the Refractive Index of Transparent Optical Materials.

Increasing the refractive index available for optical and nanophotonic systems opens new vistas for design, for applications ranging from broadband metalenses to ultrathin photovoltaics to high-quality-factor resonators. In this work, fundamental limits to the refractive index of any material are derived, given only the underlying electron density and either the maximum allowable dispersion or the minimum bandwidth of interest. In the realm of small to modest dispersion, the bounds are closely approached and not surpassed by a wide range of natural materials, showing that nature has already nearly reached a Pareto frontier for refractive index and dispersion. Conversely, for narrow-bandwidth applications, nature does not provide the highly dispersive, high-index materials that the bounds suggest should be possible. The theory of composites to identify metal-based metamaterials that can exhibit small losses and sizeable increases in refractive index over the current best materials is used. Moreover, if the "elusive lossless metal" can be synthesized, it is shown that it would enable arbitrarily high refractive index in the high-dispersion regime, nearly achieving the bounds even at refractive indices of 100 and beyond at optical frequencies.

Conservation-Law-Based Global Bounds to Quantum Optimal Control.

Active control of quantum systems enables diverse applications ranging from quantum computation to manipulation of molecular processes. Maximum speeds and related bounds have been identified from uncertainty principles and related inequalities, but such bounds utilize only coarse system information and loosen significantly in the presence of constraints and complex interaction dynamics. We show that an integral-equation-based formulation of conservation laws in quantum dynamics leads to a systematic framework for identifying fundamental limits to any quantum control scenario. We demonstrate the utility of our bounds in three scenarios-three-level driving, decoherence suppression, and maximum-fidelity gate implementations-and show that in each case our bounds are tight or nearly so. Global bounds complement local-optimization-based designs, illuminating performance levels that may be possible, as well as those that cannot be surpassed.