Low-cost, easy-to-build noninvasive pressure support ventilator for under-resourced regions: open source hardware description, performance and feasibility testing

Aim: Current pricing of commercial mechanical ventilators in low-/middle-income countries (LMICs) markedly restricts their availability, and consequently a considerable number of patients with acute/chronic respiratory failure cannot be adequately treated. Our aim was to design and test an affordable and easy-to- build noninvasive bilevel pressure ventilator to allow a reduction in the serious shortage of ventilators in LMICs. Methods: The ventilator was built using off-the-shelf materials available via e-commerce and was based on a high-pressure blower, two pressure transducers and an Arduino Nano controller with a digital display (total retail cost <75 USD), with construction details provided open source for free replication. The ventilator was evaluated, and compared with a commercially available device (Lumis 150 ventilator; Resmed, San Diego, CA, USA): 1) in the bench setting using an actively breathing patient simulator mimicking a range of obstructive/restrictive diseases; and b) in 12 healthy volunteers wearing high airway resistance and thoracic/abdominal bands to mimic obstructive/restrictive patients. Results: The designed ventilator provided inspiratory/expiratory pressures up to 20/10cmH2O, respectively, with no faulty triggering or cycling; both in the bench test and in volunteers. The breathing difficulty score rated (1-10 scale) by the loaded breathing subjects was significantly (p<0.005) decreased from 5.45±1.68 without support to 2.83±1.66 when using the prototype ventilator, which showed no difference with the commercial device (2.80±1.48; p=1.000). Conclusion: The low-cost, easy-to-build noninvasive ventilator performs similarly to a high-quality commercial device, with its open-source hardware description, which will allow for free replication and use in LMICs, facilitating application of this life-saving therapy to patients who otherwise could not be treated

Alzheimer's disease mutant mice exhibit reduced brain tissue stiffness compared to wild-type mice in both normoxia and following intermittent hypoxia mimicking sleep apnea

Background: Evidence from patients and animal models suggests that obstructive sleep apnea (OSA) may increase the risk of Alzheimer's disease (AD) and that AD is associated with reduced brain tissue stiffness.Aim: To investigate whether intermittent hypoxia (IH) alters brain cortex tissue stiffness in AD mutant mice exposed to IH mimicking OSA.Methods: Six-eight month old (B6C3-Tg(APPswe, PSEN1dE9)85Dbo/J) AD mutant mice and wild-type (WT) littermates were subjected to IH (21% O-2 40 s to 5% O-2 20 s; 6 h/day) or normoxia for 8 weeks. After euthanasia, the stiffness (E) of 200-mu m brain cortex slices was measured by atomic force microscopy.Results: Two-way ANOVA indicated significant cortical softening and weight increase in AD mice compared to WT littermates, but no significant effects of IH on cortical stiffness and weight were detected. In addition, reduced myelin was apparent in AD (vs. WT), but no significant differences emerged in the cortex extracellular matrix components laminin and glycosaminoglycans when comparing baseline AD and WT mice.Conclusion: AD mutant mice exhibit reduced brain tissue stiffness following both normoxia and IH mimicking sleep apnea, and such differences are commensurate with increased edema and demyelination in AD

Pest categorisation of Pseudocercospora pini-densiflorae

Following a request from the European Commission, the EFSA Plant Health (PLH) Panel performed a pest categorisation of Pseudocercospora pini-densiflorae, a well-defined and distinguishable fungal species of the family Mycosphaerellaceae. The regulated harmful organism is the anamorph Cercoseptoria pini-densiflorae (synonym Cercospora pini-densiflorae) with the corresponding teleomorph Mycosphaerella gibsonii. P. pini-densiflorae causes a needle blight of Pinus spp. also known as Cercospora blight of pines or Cercospora needle blight. P. pini-densiflorae is reported from sub-Saharan Africa, Central and South America, Asia and Oceania, but not from the EU. The pathogen is regulated in Council Directive 2000/29/EC (Annex IIAI) as a quarantine organism whose introduction into the EU is banned on plants (other than fruit and seeds) and wood of Pinus. The pest could enter the EU via plants for planting and other means (uncleaned seed, cut branches of pine trees, isolated bark, growing media accompanying plants, and mycorrhizal soil inocula). Hosts are widespread in the EU and favourable climatic conditions are present in Mediterranean countries. Pinus halepensis, Pinus nigra, Pinus pinea, Pinus pinaster and Pinus sylvestris are reported to be highly susceptible to the pathogen. The pest would be able to spread following establishment after introduction in the EU mainly on infected plants for planting. The pest introduction could have impacts in nurseries and young plantations. Cleaning seeds from needles and removing infected seedlings and pine litter from affected nurseries can reduce the risk of establishment in nurseries and of spread from nurseries to forests, especially given the limited scale of splash dispersal. The main knowledge gaps concern (i) the role of means of entry/spread other than plants for planting and (ii) the potential consequences in mature tree plantations and forests. The criteria assessed by the Panel for consideration as potential quarantine pest are met. For regulated nonquarantine pests, the criterion on the pest presence in the EU is not met

Pest categorisation of Ips cembrae

The Panel on Plant Health performed a pest categorisation of the large larch bark beetle, Ips cembrae (Heer) (Coleoptera: Curculionidae, Scolytinae), for the EU. I. cembrae is a well-defined and distinguishable species, native to Europe and recognised mainly as a pest of larch (Larix spp.) and occasionally of pine (Pinus spp.) and spruce (Picea spp.). It is distributed in 16 Member States of the EU and listed in Annex IIB of Council Directive 2000/29/EC. Protected zones are in place in Greece, Ireland and the United Kingdom (Northern Ireland and Isle of Man). Wood, wood products, bark and wood packaging material are considered as pathways for this pest, which is also able to disperse by flight. The insects normally establish on fallen or weakened trees but, when their populations are high, can also mass-attack healthy trees. The males produce aggregation pheromones that attract conspecifics of both sexes. The insects also inoculate pathogenic fungi to their hosts. There are one to two generations per year. Before establishing their broods, the young adults need to proceed to maturation feeding either within the bark of the tree where they developed or in 2–18 years old twigs. I. cembrae has been expanding its geographical range in Europe during the second half of the 20th century. Sanitary thinning or clear felling is the major control methods. Quarantine measures are implemented to prevent entry in the protected zones. All criteria for consideration as potential protected zone quarantine pest are met. The criteria for considering I. cembrae as a potential regulated non-quarantine pest are not met since plants for planting are not viewed as a major pathway