Lateral medullary vascular compression manifesting as paroxysmal hypertension.

Neurovascular compression of the rostral ventrolateral medulla (RVLM) has been described as a possible cause of refractory essential hypertension. We present the case of a patient affected by episodes of severe paroxysmal hypertension, some episodes associated with vago-glossopharyngeal neuralgia. Classical secondary forms of hypertension were excluded. Imaging revealed a neurovascular conflict between the posterior inferior cerebellar artery (PICA) and the ventrolateral medulla at the level of the root entry zone of the ninth and tenth cranial nerves (CN IX-X REZ). A MVD of a conflict between the PICA and the RVLM and adjacent CN IX-X REZ was performed, resulting in reduction of the frequency and severity of the episodes. Brain MRI should be performed in cases of paroxysmal hypertension. MVD can be considered in selected patients.

Healthcare resource use and associated costs for patients with an ileostomy experiencing peristomal skin complications.

Peristomal skin complications (PSCs) have a significant impact on quality of life and ostomy treatment costs. This study aimed to assess the healthcare resource use for patients with an ileostomy and PSCs symptoms. Two surveys were developed and, after validation by healthcare professionals and patients, data were collected on healthcare resource use while not experiencing any PSCs symptoms and while experiencing complications of various severities, as defined by the modified Ostomy Skin Tool. Costs applied to resource use were assigned from relevant United Kingdom sources. Additional healthcare resource use associated with PSCs, relative to no complications, was estimated to result in a total cost per instance of £258, £383, and £505 for mild, moderate, or severe PSC, respectively. The average estimated total cost per complication instance, weighted across mild, moderate, and severe PSCs, was £349. Severe-level PSCs were associated with the highest cost, because of the treatment-level required and the longer duration of symptoms. There is potential for clinical benefits and economising in stoma care if interventions are implemented that reduce the incidence and/or severity of PSCs.

Enhanced Cavity Optomechanics with Quantum-Well Exciton Polaritons.

Semiconductor microresonators embedding quantum wells can host tightly confined and mutually interacting excitonic, optical, and mechanical modes at once. We theoretically investigate the case where the system operates in the strong exciton-photon coupling regime, while the optical and excitonic resonances are parametrically modulated by the interaction with a mechanical mode. Owing to the large exciton-phonon coupling at play in semiconductors, we predict an enhancement of polariton-phonon interactions by 2 orders of magnitude with respect to mere optomechanical coupling: a near-unity single-polariton quantum cooperativity is within reach for current semiconductor resonator platforms. We further analyze how polariton nonlinearities affect dynamical backaction, modifying the capability to cool or amplify the mechanical motion.

Measuring Topological Invariants in a Polaritonic Analog of Graphene.

Topological materials rely on engineering global properties of their bulk energy bands called topological invariants. These invariants, usually defined over the entire Brillouin zone, are related to the existence of protected edge states. However, for an important class of Hamiltonians corresponding to 2D lattices with time-reversal and chiral symmetry (e.g., graphene), the existence of edge states is linked to invariants that are not defined over the full 2D Brillouin zone, but on reduced 1D subspaces. Here, we demonstrate a novel scheme based on a combined real- and momentum-space measurement to directly access these 1D topological invariants in lattices of semiconductor microcavities confining exciton polaritons. We extract these invariants in arrays emulating the physics of regular and critically compressed graphene where Dirac cones have merged. Our scheme provides a direct evidence of the bulk-edge correspondence in these systems and opens the door to the exploration of more complex topological effects, e.g., involving disorder and interactions.

Semi-Dirac Transport and Anisotropic Localization in Polariton Honeycomb Lattices.

Compression dramatically changes the transport and localization properties of graphene. This is intimately related to the change of symmetry of the Dirac cone when the particle hopping is different along different directions of the lattice. In particular, for a critical compression, a semi-Dirac cone is formed with massless and massive dispersions along perpendicular directions. Here we show direct evidence of the highly anisotropic transport of polaritons in a honeycomb lattice of coupled micropillars implementing a semi-Dirac cone. If we optically induce a vacancylike defect in the lattice, we observe an anisotropically localized polariton distribution in a single sublattice, a consequence of the semi-Dirac dispersion. Our work opens up new horizons for the study of transport and localization in lattices with chiral symmetry and exotic Dirac dispersions.

Orbital angular momentum bistability in a microlaser.

Light's orbital angular momentum (OAM) is an unbounded degree of freedom emerging in helical beams that appears very advantageous technologically. Using chiral microlasers, i.e., integrated devices that allow generating an emission carrying a net OAM, we demonstrate a regime of bistability involving two modes presenting distinct OAM (ℓ=0 and ℓ=2). Furthermore, thanks to an engineered spin-orbit coupling of light in these devices, these modes also exhibit distinct polarization patterns, i.e., circular and azimuthal polarizations. Using a dynamical model of rate equations, we show that this bistability arises from polarization-dependent saturation of the gain medium. Such a bistable regime appears very promising for implementing ultrafast optical switches based on the OAM of light. As well, it paves the way for the exploration of dynamical processes involving phase and polarization vortices.

Nonlinear Polariton Fluids in a Flatband Reveal Discrete Gap Solitons.

Phase frustration in periodic lattices is responsible for the formation of dispersionless flatbands. The absence of any kinetic energy scale makes flatband physics critically sensitive to perturbations and interactions. We report on the experimental investigation of the nonlinear response of cavity polaritons in the gapped flatband of a one-dimensional Lieb lattice. We observe the formation of gap solitons with quantized size and abrupt edges, a signature of the frozen propagation of switching fronts. This type of gap soliton belongs to the class of truncated Bloch waves, and has only been observed in closed systems up to now. Here, the driven-dissipative character of the system gives rise to a complex multistability of the flatband nonlinear domains. These results open up an interesting perspective regarding more complex 2D lattices and the generation of correlated photon phases.

Probing a Dissipative Phase Transition via Dynamical Optical Hysteresis.

We experimentally explore the dynamical optical hysteresis of a semiconductor microcavity as a function of the sweep time. The hysteresis area exhibits a double power law decay due to the influence of fluctuations, which trigger switching between metastable states. Upon increasing the average photon number and approaching the thermodynamic limit, the double power law evolves into a single power law. This algebraic behavior characterizes a dissipative phase transition. Our findings are in good agreement with theoretical predictions for a single mode resonator influenced by quantum fluctuations, and the present experimental approach is promising for exploring critical phenomena in photonic lattices.

Orbital Edge States in a Photonic Honeycomb Lattice.

We experimentally reveal the emergence of edge states in a photonic lattice with orbital bands. We use a two-dimensional honeycomb lattice of coupled micropillars whose bulk spectrum shows four gapless bands arising from the coupling of p-like photonic orbitals. We observe zero-energy edge states whose topological origin is similar to that of conventional edge states in graphene. Additionally, we report novel dispersive edge states in zigzag and armchair edges. The observations are reproduced by tight-binding and analytical calculations, which we extend to bearded edges. Our work shows the potentiality of coupled micropillars in elucidating some of the electronic properties of emergent two-dimensional materials with orbital bands.

Phase-Controlled Bistability of a Dark Soliton Train in a Polariton Fluid.

We use a one-dimensional polariton fluid in a semiconductor microcavity to explore the nonlinear dynamics of counterpropagating interacting Bose fluids. The intrinsically driven-dissipative nature of the polariton fluid allows us to use resonant pumping to impose a phase twist across the fluid. When the polariton-polariton interaction energy becomes comparable to the kinetic energy, linear interference fringes transform into a train of solitons. A novel type of bistable behavior controlled by the phase twist across the fluid is experimentally evidenced.

Bosonic Condensation and Disorder-Induced Localization in a Flat Band.

We report on the engineering of a nondispersive (flat) energy band in a geometrically frustrated lattice of micropillar optical cavities. By taking advantage of the non-Hermitian nature of our system, we achieve bosonic condensation of exciton polaritons into the flat band. Because of the infinite effective mass in such a band, the condensate is highly sensitive to disorder and fragments into localized modes reflecting the elementary eigenstates produced by geometric frustration. This realization offers a novel approach to studying coherent phases of light and matter under the controlled interplay of frustration, interactions, and dissipation.

Acoustic black hole in a stationary hydrodynamic flow of microcavity polaritons.

We report an experimental study of superfluid hydrodynamic effects in a one-dimensional polariton fluid flowing along a laterally patterned semiconductor microcavity and hitting a micron-sized engineered defect. At high excitation power, superfluid propagation effects are observed in the polariton dynamics; in particular, a sharp acoustic horizon is formed at the defect position, separating regions of sub- and supersonic flow. Our experimental findings are quantitatively reproduced by theoretical calculations based on a generalized Gross-Pitaevskii equation. Promising perspectives to observe Hawking radiation via photon correlation measurements are illustrated.

Infective endocarditis on ICU: risk factors, outcome and long-term follow-up.

OBJECTIVE: To identify factors associated with short-term, intermediate and long-term outcome in patients with infective endocarditis (IE) and the need for treatment on intensive care unit (ICU). DESIGN AND SETTING: Retrospective analysis and long-term follow-up by questionnaire in the two medical ICUs of our university hospital. PATIENTS: We conducted a retrospective analysis of all consecutive patients with IE and need for ICU treatment in our department between 2002 and 2009. All patients fulfilled the modified Duke criteria for definite diagnosis of IE. MEASUREMENTS AND MAIN RESULTS: Data of 216 patients (aged 62 ± 14 years, 31 % female) were analyzed, 15.7 % of whom had prosthetic valve endocarditis. Infectious agent (IA) was identified in 74 % and surgery was performed in 57 %. 56 patients (24.9 %) died on ICU, 9 patients were sent to palliative care units and died several days later. During follow-up, another 44 patients died. Multivariate Cox-regression analysis identified the following independent risk factors: High initial SAPS II for 30d-, multiple organ failure and high maximum SAPS II for 100d- and high maximum leukocyte count for long-term mortality. Surgical intervention during ICU was an independent predictor of a better 30d outcome. CONCLUSIONS: In contrast to general IE populations, IA and the type of infected impaired valve are not main predictors of survival in critically ill IE-patients. Biomarker of acute infection and markers for severity of illness (scores and organ failure) are independent risk factors for mortality. The surgical clearance of infected valve, device or abscesses is an independent predictor of 30d outcome.

Collective fluid dynamics of a polariton condensate in a semiconductor microcavity.

Semiconductor microcavities offer unique systems in which to investigate the physics of weakly interacting bosons. Their elementary excitations, polaritons-mixtures of excitons and photons-can accumulate in macroscopically degenerate states to form various types of condensate in a wide range of experimental configurations, under either incoherent or coherent excitation. Condensates of polaritons have been put forward as candidates for superfluidity, and the formation of vortices as well as elementary excitations with linear dispersion are actively sought as evidence to support this. Here, using a coherent excitation triggered by a short optical pulse, we have created and set in motion a macroscopically degenerate state of polaritons that can be made to collide with a variety of defects present in the microcavity. Our experiments show striking manifestations of a coherent light-matter packet, travelling at high speed (of the order of one per cent of the speed of light) and displaying collective dynamics consistent with superfluidity, although one of a highly unusual character as it involves an out-of-equilibrium dissipative system. Our main results are the observation of a linear polariton dispersion accompanied by diffusionless motion; flow without resistance when crossing an obstacle; suppression of Rayleigh scattering; and splitting into two fluids when the size of the obstacle is comparable to the size of the wave packet. This work opens the way to the investigation of new phenomenology of out-of-equilibrium condensates.

Fractal energy spectrum of a polariton gas in a Fibonacci quasiperiodic potential.

We report on the study of a polariton gas confined in a quasiperiodic one-dimensional cavity, described by a Fibonacci sequence. Imaging the polariton modes both in real and reciprocal space, we observe features characteristic of their fractal energy spectrum such as the opening of minigaps obeying the gap labeling theorem and log-periodic oscillations of the integrated density of states. These observations are accurately reproduced solving an effective 1D Schrödinger equation, illustrating the potential of cavity polaritons as a quantum simulator in complex topological geometries.

Direct observation of Dirac cones and a flatband in a honeycomb lattice for polaritons.

Two-dimensional lattices of coupled micropillars etched in a planar semiconductor microcavity offer a workbench to engineer the band structure of polaritons. We report experimental studies of honeycomb lattices where the polariton low-energy dispersion is analogous to that of electrons in graphene. Using energy-resolved photoluminescence, we directly observe Dirac cones, around which the dynamics of polaritons is described by the Dirac equation for massless particles. At higher energies, we observe p orbital bands, one of them with the nondispersive character of a flatband. The realization of this structure which holds massless, massive, and infinitely massive particles opens the route towards studies of the interplay of dispersion, interactions, and frustration in a novel and controlled environment.

Prevalence and characteristics of children with mild intellectual disability in a French county.

BACKGROUND: Studies conducted on mild intellectual disability (MID) in children are infrequent and the prevalence rates vary widely. This study aimed to estimate the prevalence of MID in children in a French county (Isère), to describe the clinical signs and associated comorbidities, and to specify the aetiologies of this disability. METHODS: The target population was comprised of the 15 100 children born in 1997 residing in Isère County, France, in 2008. Our goal was to find the children in this group with MID diagnosed between 9 and 13 years of age. MID was defined as an overall IQ score of between 50 and 69 [International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)]; this definition was adjusted for the study by integrating confidence intervals so that the risk of IQ measurement relativity and possible discrepancy of scores could be taken into account. Children were identified through an administrative data source designed to assist disabled persons that contains health information, and an educational data source. Parents who agreed to let their children participate responded to an in-depth questionnaire on their child's medical and academic history. A genetic investigation was proposed for those children whose MID had an unknown aetiology. RESULTS: The preliminary selection included 267 children, resulting in a prevalence rate of 18 per 1000 (CI [15.6; 19.9]), within the expected mean. Of these 267 cases, 181 families agreed to participate in the study (68%). MID more often affected boys [male gender ratio = 1.4 (CI [1.2; 1.6])], low socioeconomic groups, and families with a history of intellectual disability. The clinical signs and comorbidities associated with MID were very frequent, with 54% spoken language disorders and 10% pervasive developmental disorder. Only 9% of the children had undergone a genetic investigation before the study. The known aetiology rate for MID was 19% among all the children who had had genetic tests performed. CONCLUSION: MID is an important public health issue based on its prevalence. The associated clinical signs and comorbidities may be warning signs of MID in case of learning difficulties. This study may help decision-makers to develop and organise screening and care for MID.

Nondestructive measurement of nuclear magnetization by off-resonant Faraday rotation.

We report on the nondestructive measurement of nuclear magnetization in n-GaAs via cavity enhanced Faraday rotation. In contrast with the existing optical methods, this detection scheme does not require the presence of detrimental out-of-equilibrium electrons. Specific mechanisms of the Faraday rotation are identified for (i) nuclear spins situated within the localized electron orbits, these spins are characterized by fast dynamics, (ii) all other nuclear spins in the sample characterized by much slower dynamics. Our results suggest that even in degenerate semiconductors nuclear spin relaxation is limited by the presence of localized electron states and spin diffusion, rather than by Korringa mechanism.

Realization of a double-barrier resonant tunneling diode for cavity polaritons.

We report on the realization of a double-barrier resonant tunneling diode for cavity polaritons, by lateral patterning of a one-dimensional cavity. Sharp transmission resonances are demonstrated when sending a polariton flow onto the device. We show that a nonresonant beam can be used as an optical gate and can control the device transmission. Finally, we evidence distortion of the transmission profile when going to the high-density regime, signature of polariton-polariton interactions.

Prediction and hydrogen acceleration of ordering in iron-vanadium alloys.

Ab initio calculations of binary metallic systems often predict ordered compounds in contrast to empirical reports of solid solutions or disordered phases. These discrepancies are usually attributed to slow kinetics that retains metastable structures at low temperatures. The Fe-V system is an example of this phenomenon, in which we predict two ordered stable ground states, Fe3V and FeV3, whereas a disordered σ phase is reported. We propose to overcome this difficulty by hydrogen absorption, which facilitates metal atom mobility through vacancy formation and separation between the two elements due to their opposite affinities towards it, thus accelerating transformation kinetics. Hydrogen also increases the relative stability of the ordered structures compared with that of the σ phase without affecting the shape of the phase diagram. The hydrogen-induced formation of the ordered structures is expressed by a reversible decrease of the electrical resistivity with increasing hydrogen pressure. Such behavior has not been reported before in thin H absorbing films. Formation of the ordered structures is further substantiated by the kinetics of the resistivity changes upon variation of the hydrogen pressure, where two stages are distinguished: a fast initial stage and a much slower subsequent process in which the resistivity changes direction, associated with hydrogen dissolution and phase transformation, respectively.