Visible light emission from a silica microbottle resonator by second- and third-harmonic generation.

We report the first observation of nonlinear harmonic generation and sum frequency generation (SFG) coupled with stimulated Raman scattering (SRS) via the second-order (χ(2)) and the third-order (χ(3)) nonlinearities in a silica microbottle resonator. The visible light emission due to third-harmonic generation (THG) was observed in both the output of a tapered fiber and the optical microscope images, which can be used to identify the axial mode profiles. SFG enabled by three- and four-wave mixing processes between the pump light and the light generated via SRS was also observed. Second-harmonic generation (SHG) and the SFG are enabled by χ(2) induced in silica by surface effects and multipole excitations.

Anomalous time delays and quantum weak measurements in optical micro-resonators.

Quantum weak measurements, wavepacket shifts and optical vortices are universal wave phenomena, which originate from fine interference of multiple plane waves. These effects have attracted considerable attention in both classical and quantum wave systems. Here we report on a phenomenon that brings together all the above topics in a simple one-dimensional scalar wave system. We consider inelastic scattering of Gaussian wave packets with parameters close to a zero of the complex scattering coefficient. We demonstrate that the scattered wave packets experience anomalously large time and frequency shifts in such near-zero scattering. These shifts reveal close analogies with the Goos-Hänchen beam shifts and quantum weak measurements of the momentum in a vortex wavefunction. We verify our general theory by an optical experiment using the near-zero transmission (near-critical coupling) of Gaussian pulses propagating through a nano-fibre with a side-coupled toroidal micro-resonator. Measurements demonstrate the amplification of the time delays from the typical inverse-resonator-linewidth scale to the pulse-duration scale.

Comparison of risk and patterns of practice in patients older and younger than 70 years with acute myocardial infarction in a two-year period (1987-1989)

To further evaluate contemporary risk and practice patterns in acute myocardial infarction (AMI), 402 consecutive patients with AMI between July 1, 1988, and June 30, 1989 were studied. The clinical investigations, medical therapy and outcome of patients aged greater than or equal to 70 years (n = 132; group 1) were compared with patients aged less than 70 years (n = 270; group 2). In group 1, 20% of patients had no typical cardiac pain versus 6% in group 2 (p less than 0.01). History of previous AMI, Q-wave AMI and peak creatine kinase were not different in the 2 groups. In-hospital mortality was markedly higher in group 1 (27%) than in group 2 (8%), p less than 0.01. Multivariate analysis revealed previous AMI, presentation without typical pain and age greater than or equal to 70 years to be independently associated with the greatest relative risk. Post-AMI exercise testing, ejection fraction calculations and coronary angiography were all performed less often (p less than 0.01); proven effective medical therapies, including thrombolysis, beta blockers, acetylsalicylic acid and nitrates were all used less frequently (p less than 0.01). The very high mortality and less aggressive management of elderly patients with AMI confirm similar data from our 1987 AMI patient cohort and other recently reported AMI patient outcome analyses. However, it remains uncertain why older patients with AMI are investigated and treated differently from younger patients. Further studies are warranted.

Mortality risk and patterns of practice in 2,070 patients with acute myocardial infarction, 1987-92. Relative importance of age, sex, and medical therapy.

OBJECTIVE: To define contemporary age- and sex-related mortality risks and patterns of medical practice in acute myocardial infarction (AMI). DESIGN: Retrospective comparison of demographic and clinical variables, including the use of proven effective AMI medical therapy, among AMI patients cohorts from 1987 to 1992. PATIENTS/SETTING: Of a total of 2,070 AMI patients, 629 were women and 1,441, men; 951 patients were managed in university hospitals, 641 in a regional hospital, and 478 in community hospitals. INTERVENTIONS: No direct study interventions; results of practice patterns and risk analyses of the earlier (1987-90) AMI cohorts, however, were published concurrently with the actual practices of the more recent (1991-92) cohorts and may have had some indirect effect on the recent practice patterns. RESULTS: Univariate analysis showed that mortality was higher (p < 0.0001) and use of thrombolysis, beta blockers, and acetylsalicylic acid was lower (p < 0.0001) in patients 70 years of age and older, compared with younger patients, and in women, compared with men. Multivariate analysis of the entire patient sample revealed age of 75 years or older (154 percent) and age 70 to 74 years (141 percent) to be associated with the highest relative risk of death in hospital. The increased relative risk associated with previous AMI was 45 percent. Acetylsalicylic acid use was associated with the greatest decrease in relative risk of death (-69 percent), followed by beta blockers (-36 percent) and thrombolysis (-31 percent). These patterns of relative risk were the same for men and women. CONCLUSIONS: Among contemporary AMI patients, advanced age and female sex are associated with relative under-utilization of proven effective medical therapy and increased risk of dying in the hospital. Although the contribution of age to AMI risk appears greater than that of gender, survival in any high risk group would likely be improved by increased use of proven medical therapy.

The utilization of antithrombotic prophylaxis for atrial fibrillation in a geriatric rehabilitation hospital.

OBJECTIVE: To determine the utilization of anticoagulant and antithrombotic agents in older patients with atrial fibrillation. DESIGN: Retrospective chart review. SETTING: A geriatric rehabilitation hospital. PATIENTS: Subjects were 102 patients with atrial fibrillation as an intermittent or prevailing cardiac rhythm during a hospital admission in the 1993 fiscal year. MEASUREMENTS: Age, sex, and mental status of the patients; duration and etiology of atrial fibrillation; presence of contraindications to anticoagulants or antithrombotic agents; and utilization of these agents in this population. RESULTS: Of 102 older patients with atrial fibrillation at admission, only 51 were taking some form of anticoagulant or antithrombotic therapy proven effective for stroke prophylaxis (19 warfarin and 32 aspirin). Although 67 patients had relative contraindications to anticoagulation with warfarin, only 25 of the 35 with no contraindications were taking warfarin at the time of discharge. In addition, of the 43 patients with contraindications to warfarin but no contraindications to aspirin, only 28 were prescribed antithrombotic therapy. CONCLUSIONS: Although anticoagulation or antithrombotic therapies for atrial fibrillation appear to be relatively widely used, there are still significant windows of opportunity for the improvement of clinician practice patterns and clinical outcomes in older patients.