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Silicon nitride is demonstrated as a high performance and cost-effective solution for dense integrated photonic circuits in the visible spectrum. Experimental results for nanophotonic waveguides fabricated in a standard CMOS pilot line with losses below 0.71dB/cm in an aqueous environment and 0.51dB/cm with silicon dioxide cladding are reported. Design and characterization of waveguide bends, grating couplers and multimode interference couplers (MMI) at a wavelength of 660 nm are presented. The index contrast of this technology enables high integration densities with insertion losses below 0.05 dB per 90° bend for radii as small as 35 µm. By a proper design of the buried oxide layer thickness, grating couplers with efficiencies above 38% for the TE polarization have been obtained.

Background: Onycholysis, which is separation of the nail plate from the nail bed at its distal and lateral attachments, can cause pain and impair function and is a well-known side effect of traditional chemotherapeutic agents., Objectives: We present two cases of onycholysis associated with capecitabine in women with advanced breast cancer, who were initially referred for evaluation of onychomycosis and review the literature on capecitabine., Conclusion: Owing to the increased frequency of use of capecitabine for different cancers, physicians should be aware of this side effect.

Single-photon avalanche diodes (SPADs) provide photons' time of arrival for various applications. In recent years, attempts have been made to miniaturize SPADs in order to facilitate large-array integration and in order to reduce the dead time of the device. We investigate the benefits and drawbacks of device miniaturization by characterizing a new fast SPAD in a commercial 0.18 microm complementary metal oxide semiconductor technology. The device employs a novel and efficient guard ring, resulting in a high fill factor. Thanks to its small size, the dead time is only 5 ns, resulting in the fastest reported SPAD to date. However, the short dead time is accompanied by a high after-pulsing rate, which we show to be a limiting parameter for SPAD miniaturization. We describe a new and compact active-recharge scheme which improves signal-to-noise tenfold compared with the passive configuration, using a fraction of the area of state-of-the-art active-recharge circuits, and without increasing the dead time. The performance of compact SPADs stands to benefit such applications as high-resolution fluorescence-lifetime imaging, active-illumination three-dimensional imagers, and quantum key distribution systems.

The alpha-adrenergic agonist oxymetazoline was compared to cocaine and to lidocaine with epinephrine with respect to prevention of epistaxis on nasotracheal intubation. The nares of three groups of 14 patients each were topically pretreated with 4% lidocaine with 1:100,000 epinephrine (group 1), 10% cocaine (group 2), or 0.05% oxymetazoline (group 3) prior to nasotracheal intubation. After intubation, epistaxis was estimated on a scale of 0 to 3, with 0 indicating no bleeding, 1 representing blood on the nasotracheal tube only, 2 indicating blood pooling in the pharynx, and 3 representing blood in the pharynx sufficient to impede intubation. Only 29% of the patients in group 1 displayed no bleeding, whereas 57% of those in group 2 and 86% of those in group 3 had no bleeding. Nonparametric analysis showed a statistically significant difference (p less than 0.013) between oxymetazoline and lidocaine with epinephrine. In addition, heart rate (HR) and blood pressure (BP) were examined prior to administration of the medications; at 5 minutes, 10 minutes, and 15 minutes after administration of the medications; and after intubation. No significant differences were noted (p greater than 0.05) between the medications except for a slightly higher systolic BP for cocaine than for lidocaine with epinephrine at 15 minutes. The results of this double-blind, randomized trial demonstrate that the alpha-adrenergic agonist oxymetazoline is as effective as cocaine, and more effective than lidocaine with epinephrine, for the prevention of epistaxis associated with nasotracheal intubation.

We studied the effects of changes in heart rate and coronary blood flow on the decay of the cardiac inotropic response to sympathetic stimulation in 10 anesthetized dogs. After we induced complete heart block, we paced the ventricles at rates of 90, 120 and 150.min-1. At each pacing frequency, we perfused the left main coronary artery with blood at a baseline flow and at a flow 85% above the baseline rate. At each combination of pacing frequency and flow, we stimulated the left ansa subclavia supramaximally at a frequency of 5 Hz for 2 min. To assess the rate of norepinephrine removal from the ventricular myocardium, we measured the 50% decay time of the left ventricular inotropic response [(dP/dt)max] immediately after cessation of sympathetic stimulation. We found that the inotropic response decayed faster (P = 0.03) when the coronary artery blood flow was high than when the flow was baseline. The effect of heart rate on the decay of the left ventricular inotropic response depended on the level of the coronary blood flow. When the blood flow was baseline, the inotropic response decayed more rapidly (P = 0.001) when the heart rate was 150.min-1 than when it was 90 or 120.min-1. However, when the flow was high, heart rate did not affect the response decay significantly. We conclude that the mechanical contraction of the ventricles facilitates the washout of norepinephrine from the cardiac interstitium and into the coronary circulation by virtue of a massaging action.

A review of the literature indicates some evidence for an association between early death of the mother and severe forms of depression in adulthood. The relationship of early parent death with later alcoholism, other forms of depression, and milder effects within the general population also is suggested. A number of factors that may mitigate the long-term effects of the loss are discussed. The experience of early parent death is conceptualized as an exceptionally visible representation of the capacity of the child to cope adaptively with developmental crisis.