Pulse oximetry as a screening test for congenital heart defects in newborn infants: a test accuracy study with evaluation of acceptability and cost-effectiveness

Background: Screening for congenital heart defects (CHDs) relies on antenatal ultrasound and postnatal clinical examination; however, life-threatening defects often go undetected. Objective: To determine the accuracy, acceptability and cost-effectiveness of pulse oximetry as a screening test for CHDs in newborn infants. Design: A test accuracy study determined the accuracy of pulse oximetry. Acceptability of testing to parents was evaluated through a questionnaire, and to staff through focus groups. A decision-analytic model was constructed to assess cost-effectiveness. Setting: Six UK maternity units. Participants: These were 20,055 asymptomatic newborns at = 35 weeks’ gestation, their mothers and health-care staff. Interventions: Pulse oximetry was performed prior to discharge from hospital and the results of this index test were compared with a composite reference standard (echocardiography, clinical follow-up and follow-up through interrogation of clinical databases). Main outcome measures: Detection of major CHDs – defined as causing death or requiring invasive intervention up to 12 months of age (subdivided into critical CHDs causing death or intervention before 28 days, and serious CHDs causing death or intervention between 1 and 12 months of age); acceptability of testing to parents and staff; and the cost-effectiveness in terms of cost per timely diagnosis. Results: Fifty-three of the 20,055 babies screened had a major CHD (24 critical and 29 serious), a prevalence of 2.6 per 1000 live births. Pulse oximetry had a sensitivity of 75.0% [95% confidence interval (CI) 53.3% to 90.2%] for critical cases and 49.1% (95% CI 35.1% to 63.2%) for all major CHDs. When 23 cases were excluded, in which a CHD was already suspected following antenatal ultrasound, pulse oximetry had a sensitivity of 58.3% (95% CI 27.7% to 84.8%) for critical cases (12 babies) and 28.6% (95% CI 14.6% to 46.3%) for all major CHDs (35 babies). False-positive (FP) results occurred in 1 in 119 babies (0.84%) without major CHDs (specificity 99.2%, 95% CI 99.0% to 99.3%). However, of the 169 FPs, there were six cases of significant but not major CHDs and 40 cases of respiratory or infective illness requiring medical intervention. The prevalence of major CHDs in babies with normal pulse oximetry was 1.4 (95% CI 0.9 to 2.0) per 1000 live births, as 27 babies with major CHDs (6 critical and 21 serious) were missed. Parent and staff participants were predominantly satisfied with screening, perceiving it as an important test to detect ill babies. There was no evidence that mothers given FP results were more anxious after participating than those given true-negative results, although they were less satisfied with the test. White British/Irish mothers were more likely to participate in the study, and were less anxious and more satisfied than those of other ethnicities. The incremental cost-effectiveness ratio of pulse oximetry plus clinical examination compared with examination alone is approximately £24,900 per timely diagnosis in a population in which antenatal screening for CHDs already exists. Conclusions: Pulse oximetry is a simple, safe, feasible test that is acceptable to parents and staff and adds value to existing screening. It is likely to identify cases of critical CHDs that would otherwise go undetected. It is also likely to be cost-effective given current acceptable thresholds. The detection of other pathologies, such as significant CHDs and respiratory and infective illnesses, is an additional advantage. Other pulse oximetry techniques, such as perfusion index, may enhance detection of aortic obstructive lesions.

Pulse transition to similaritons in normally dispersive fibre amplifiers

A detailed experimental characterization of the transition process of an initially Gaussian pulse to the asymptotic self-similar parabolic solution in optical fibre amplifiers operating in the normal dispersion regime is performed.

High performance numerical modeling of ultra-short laser pulse propagation based on multithreaded parallel hardware

The focus of this study is development of parallelised version of severely sequential and iterative numerical algorithms based on multi-threaded parallel platform such as a graphics processing unit. This requires design and development of a platform-specific numerical solution that can benefit from the parallel capabilities of the chosen platform. Graphics processing unit was chosen as a parallel platform for design and development of a numerical solution for a specific physical model in non-linear optics. This problem appears in describing ultra-short pulse propagation in bulk transparent media that has recently been subject to several theoretical and numerical studies. The mathematical model describing this phenomenon is a challenging and complex problem and its numerical modeling limited on current modern workstations. Numerical modeling of this problem requires a parallelisation of an essentially serial algorithms and elimination of numerical bottlenecks. The main challenge to overcome is parallelisation of the globally non-local mathematical model. This thesis presents a numerical solution for elimination of numerical bottleneck associated with the non-local nature of the mathematical model. The accuracy and performance of the parallel code is identified by back-to-back testing with a similar serial version.

Nonlinear pulse shaping and polarization dynamics in mode-locked fibre lasers

We review our recent progress on the study of new nonlinear mechanisms of pulse shaping in passively mode-locked fibre lasers. These include a mode-locking regime featuring pulses with a triangular distribution of the intensity, and spectral compression arising from nonlinear pulse propagation. We also report on our recent experimental studies unveiling new families of vector solitons with precessing states of polarization for multipulsing and bound-state soliton operations in a carbon nanotube mode-locked fibre laser with anomalous dispersion cavity. © 2013 IEEE.

Low-loss waveguides fabricated by femtosecond chirped-pulse oscillator

Recent results on direct femtosecond inscription of straight low-loss waveguides in borosilicate glass are presented. We also demonstrate lowest ever losses in curvilinear waveguides, which we use as main building blocks for integrated photonics circuits. Low-loss waveguides are of great importance to a variety of applications of integrated optics. We report on recent results of direct femtosecond fabrication of smooth low-loss waveguides in standard optical glass by means of femtosecond chirped-pulse oscillator only (Scientific XL, Femtolasers), operating at the repetition rate of 11 MHz, at the wavelength of 800 nm, with FWHM pulse duration of about 50 fs, and a spectral widths of 30 nm. The pulse energy on target was up to 70 nJ. In transverse inscription geometry, we inscribed waveguides at the depth from 10 to 300 micrometers beneath the surface in the samples of 50 x 50 x 1 mm dimensions made of pure BK7 borosilicate glass. The translation of the samples accomplished by 2D air-bearing stage (Aerotech) with sub-micrometer precision at a speed of up to 100 mm per second (hardware limit). Third direction of translation (Z-, along the inscribing beam or perpendicular to sample plane) allows truly 3D structures to be fabricated. The waveguides were characterized in terms of induced refractive index contrast, their dimensions and cross-sections, mode-field profiles, total insertion losses at both 633 nm and 1550 nm. There was almost no dependence on polarization for the laser inscription. The experimental conditions – depth, laser polarization, pulse energy, translation speed and others, were optimized for minimum insertion losses when coupled to a standard optical fibre SMF-28. We found coincidence of our optimal inscription conditions with recently published by other groups [1, 3] despite significant difference in practically all experimental parameters. Using optimum regime for straight waveguides fabrication, we inscribed a set of curvilinear tracks, which were arranged in a way to ensure the same propagation length (and thus losses) and coupling conditions, while radii of curvature varied from 3 to 10 mm. This allowed us to measure bend-losses – they less than or about 1 dB/cm at R=10 mm radius of curvature. We also demonstrate a possibility to fabricate periodical perturbations of the refractive index in such waveguides with the periods using the same set-up. We demonstrated periods of about 520 nm, which allowed us to fabricate wavelength-selective devices using the same set-up. This diversity as well as very short time for inscription (the optimum translation speed was found to be 40 mm/sec) makes our approach attractive for industrial applications, for example, in next generation high-speed telecom networks.

Nonlinear pulse shaping and polarization dynamics in mode-locked fibre lasers

We review our recent progress on the study of new nonlinear mechanisms of pulse shaping in passively mode-locked fibre lasers. These include a mode-locking regime featuring pulses with a triangular distribution of the intensity, and spectral compression arising from nonlinear pulse propagation. We also report on our recent experimental studies unveiling new families of vector solitons with precessing states of polarization for multipulsing and bound-state soliton operations in a carbon nanotube mode-locked fibre laser with anomalous dispersion cavity. © 2013 IEEE.

Ultrafast all-optical Nth-order differentiator and simultaneous repetition-rate multiplier of periodic pulse train

The letter presents a technique for Nth-order differentiation of periodic pulse train, which can simultaneously multiply the input repetition rate. This approach uses a single linearly chirped apodized fiber Bragg grating, which grating profile is designed to map the spectral response of the Nth-order differentiator, and the chirp introduces a dispersion that, besides space-to-frequency mapping, it also causes a temporal Talbot effect.