Orders of magnitude loss reduction in photonic bandgap fibers by engineering the core surround.

We demonstrate how to reduce the loss in photonic bandgap fibers by orders of magnitude by varying the radius of the corner strands in the core surround. As a fundamental working principle we find that changing the corner strand radius can lead to backscattering of light into the fiber core. Selecting an optimal corner strand radius can thus reduce the loss of the fundamental core mode in a specific wavelength range by almost two orders of magnitude when compared to an unmodified cladding structure. Using the optimal corner radius for each transmission window, we observe the low-loss behavior for the first and second bandgaps, with the losses in the second bandgap being even lower than that of the first one. Our approach of reducing the confinement loss is conceptually applicable to all kinds of photonic bandgap fibers including hollow core and all-glass fibers as well as on-chip light cages. Therefore, our concept paves the way to low-loss light guidance in such systems with substantially reduced fabrication complexity.

Large Quantum Delocalization of a Levitated Nanoparticle Using Optimal Control: Applications for Force Sensing and Entangling via Weak Forces.

We propose to optimally control the harmonic potential of a levitated nanoparticle to quantum delocalize its center-of-mass motional state to a length scale orders of magnitude larger than the quantum zero-point motion. Using a bang-bang control of the harmonic potential, including the possibility of inverting it, the initial ground-state-cooled levitated nanoparticle coherently expands to large scales and then contracts to the initial state in a time-optimal way. We show that this fast loop protocol can be used to enhance force sensing as well as to dramatically boost the entangling rate of two weakly interacting nanoparticles. We parameterize the performance of the protocol, and therefore the macroscopic quantum regime that could be explored, as a function of displacement and frequency noise in the nanoparticle's center-of-mass motion. This noise analysis accounts for the sources of decoherence relevant to current experiments.

Human Inhalation Study with Zinc Oxide: Analysis of Zinc Levels and Biomarkers in Exhaled Breath Condensate.

Workers in the zinc processing, for example, welding or hot-dip galvanizing, are exposed to aerosols consisting of particles and gases, including zinc oxide (ZnO), which can affect human health. In this study, we addressed the effects of short-term controlled exposure to nano-sized ZnO on the airway inflammatory markers in healthy volunteers. To this end, we determined the influence of ZnO inhalation on the content of zinc and biomarkers (leukotriene B4 (LTB4), peptide leukotrienes (LTC4/D4/E4), 8-iso-PGF2α, pH, and prostaglandin E2 (PGE2)) in exhaled breath condensate (EBC). Sixteen non-smoking subjects (8 females, 8 men) were exposed to filtered air (sham) or ZnO nanoparticles (0.5, 1.0, and 2.0 mg/m3) for 4 h. EBC samples were collected according to specific study design. We found that the peptide leukotrienes were below the limit of quantification (LOQ) in all the EBC samples. ZnO exposure showed no detectable effect on any other parameters investigated when comparing the two groups. The content of Zn in EBC was unaffected by ZnO inhalation at any concentration used. Therefore, we conclude that the evaluation of Zn and biomarker content in EBC would not be a suitable way to assess the exposure to inhaled ZnO.

On the pole expansion of electromagnetic fields.

In several publications, it has been shown how to calculate the near- or far-field properties for a given source or incident field using the resonant states, also known as quasi-normal modes. As previously noted, this pole expansion is not unique, and there exist many equivalent formulations with dispersive expansion coefficients. Here, we approach the pole expansion of the electromagnetic fields using the Mittag-Leffler theorem and obtain another set of formulations with constant weight factors for each pole. We compare the performance and applicability of these formulations using analytical and numerical examples. It turns out that the accuracy of all approaches is rather comparable with a slightly better global convergence of the approach based on a formulation with dispersive expansion coefficients. However, other expansions can be superior locally and are typically faster. Our work will help with selecting appropriate formulations for an efficient description of the electromagnetic response in terms of the resonant states.

Ultrafast X-ray probing of water structure below the homogeneous ice nucleation temperature.

Water has a number of anomalous physical properties, and some of these become drastically enhanced on supercooling below the freezing point. Particular interest has focused on thermodynamic response functions that can be described using a normal component and an anomalous component that seems to diverge at about 228 kelvin (refs 1-3). This has prompted debate about conflicting theories that aim to explain many of the anomalous thermodynamic properties of water. One popular theory attributes the divergence to a phase transition between two forms of liquid water occurring in the 'no man's land' that lies below the homogeneous ice nucleation temperature (TH) at approximately 232 kelvin and above about 160 kelvin, and where rapid ice crystallization has prevented any measurements of the bulk liquid phase. In fact, the reliable determination of the structure of liquid water typically requires temperatures above about 250 kelvin. Water crystallization has been inhibited by using nanoconfinement, nanodroplets and association with biomolecules to give liquid samples at temperatures below TH, but such measurements rely on nanoscopic volumes of water where the interaction with the confining surfaces makes the relevance to bulk water unclear. Here we demonstrate that femtosecond X-ray laser pulses can be used to probe the structure of liquid water in micrometre-sized droplets that have been evaporatively cooled below TH. We find experimental evidence for the existence of metastable bulk liquid water down to temperatures of 227(-1)(+2) kelvin in the previously largely unexplored no man's land. We observe a continuous and accelerating increase in structural ordering on supercooling to approximately 229 kelvin, where the number of droplets containing ice crystals increases rapidly. But a few droplets remain liquid for about a millisecond even at this temperature. The hope now is that these observations and our detailed structural data will help identify those theories that best describe and explain the behaviour of water.

[Outpatient treatment of acute injuries of upper extremities with axillary plexus anesthesia in the emergency department-Is that possible without continuous anesthesia attendance?] / Ambulante Versorgung akuter Verletzungen der oberen Extremität in der Notfallambulanz in axillärer Plexusanästhesie ­ Ist das ohne durchgehende Anästhesiebegleitung machbar?

BACKGROUND: The incorporation into the routine operating procedure of patients with small but acute hand and forearm injuries requiring surgery who present in the emergency admission department, represents a challenge due to limited resources. The prompt treatment in the emergency admission department represents an alternative. This article retrospectively reports the authors' experiences with a treatment algorithm in which emergency patients were treated by ultrasound-guided axillary brachial plexus blocks (ABPB) and surgery carried out in the emergency department without further anesthesia attendance. METHODS: Patients were preselected by the surgeon if they were suitable for a standardized treatment without anesthesia attendance during surgery. If there were no anesthesiological or surgical contraindications patients received an ABPB in the holding area of the operating room (OR) under standard monitoring. Blocks were performed as a multi-injection, ultrasound-guided technique which is anatomically described in detail. Patients >60 kg received a total volume of 30 ml of a mixture of 10 ml 1% ropivacaine (100 mg) and 20 ml 2% prilocaine (400 mg). Patients <60 kg received the same mixture with a reduced volume of 25 ml corresponding to 82.5 mg ropivacaine and 332.5 mg prilocaine. After controlling for block success patients were admitted to the emergency department and the surgical procedure was carried out under supervision by the surgeon without further anesthesia attendance. At discharge patients were explicitly instructed that in the case of any complications or a continuation of the block for more than 24 h they should contact the emergency department. RESULTS: Between January 2013 and November 2017 a total of 566 patients (46.4 years, range 11-88 years, 174.9 cm, range 140-211cm, 80.8 kg, range 42-178kg, ASA 1/2/3, 190/338/38, respectively) were treated according to a standardized protocol. The ABPBs were performed by 74 anesthetists. In 5% of the patients the initial block was incomplete and rescue blocks were performed with a maximum of 2­3ml 1% prilocaine per corresponding nerve. After completion the block was ensured and all patients underwent surgery without further analgesics or local anesthetic infiltration by the surgeon. Complications related to the ABPB and readmissions were not observed. CONCLUSION: It could be demonstrated that minor surgery could be carried out safely and effectively with a defined algorithm using ABPB in selected patients outside the OR without permanent anesthesia attendance: however, indispensable prerequisites for such procedures are careful patient selection, patient compliance, the safe and effective performance of the ABPB and reliable agreement with the surgeon.

First-order perturbation theory for changes in the surrounding of open optical resonators.

The single-mode approximation of resonant state expansion has proven to give accurate first-order approximations of resonance shifts and linewidth changes when modifying the material properties inside open optical resonators. Here, we extend this first-order perturbation theory to modifications of the material properties in the surrounding medium. As a side product of our derivations, we retrieve the already known analytical normalization condition for resonant states. We apply our theory to two example systems: a metallic nanosphere and a periodic array of metallic nanoslits.

Quasinormal mode solvers for resonators with dispersive materials.

Optical resonators are widely used in modern photonics. Their spectral response and temporal dynamics are fundamentally driven by their natural resonances, the so-called quasinormal modes (QNMs), with complex frequencies. For optical resonators made of dispersive materials, the QNM computation requires solving a nonlinear eigenvalue problem. This raises a difficulty that is only scarcely documented in the literature. We review our recent efforts for implementing efficient and accurate QNM solvers for computing and normalizing the QNMs of micro- and nanoresonators made of highly dispersive materials. We benchmark several methods for three geometries, a two-dimensional plasmonic crystal, a two-dimensional metal grating, and a three-dimensional nanopatch antenna on a metal substrate, with the perspective to elaborate standards for the computation of resonance modes.

Modeling of second-harmonic generation in periodic nanostructures by the Fourier modal method with matched coordinates.

We present an advanced formulation of the Fourier modal method for analyzing the second-harmonic generation in multilayers of periodic arrays of nanostructures. In our method, we solve Maxwell's equations in a curvilinear coordinate system, in which the interfaces are defined by surfaces of constant coordinates. Thus, we can apply the correct Fourier factorization rules as well as adaptive spatial resolution to nanostructures with complex cross sections. We extend here the factorization rules to the second-harmonic susceptibility tensor expressed in the curvilinear coordinates. The combination of adaptive curvilinear coordinates and factorization rules allows for efficient calculation of the second-harmonic intensity, as demonstrated for one- and two-dimensional periodic nanostructures.

Analytical mode normalization and resonant state expansion for bound and leaky modes in optical fibers - an efficient tool to model transverse disorder.

We adapt the resonant state expansion to optical fibers such as capillary and photonic crystal fibers. As a key requirement of the resonant state expansion and any related perturbative approach, we derive the correct analytical normalization for all modes of these fiber structures, including leaky modes that radiate energy perpendicular to the direction of propagation and have fields that grow with distance from the fiber core. Based on the normalized fiber modes, an eigenvalue equation is derived that allows for calculating the influence of small and large perturbations such as structural disorder on the guiding properties. This is demonstrated for two test systems: a capillary fiber and a photonic crystal fiber.

Resonant-state expansion for open optical systems: generalization to magnetic, chiral, and bi-anisotropic materials.

The resonant-state expansion, a recently developed powerful method in electrodynamics, is generalized here for open optical systems containing magnetic, chiral, or bi-anisotropic materials. It is shown that the key matrix eigenvalue equation of the method remains the same, but the matrix elements of the perturbation now contain variations of the permittivity, permeability, and bi-anisotropy tensors. A general normalization of resonant states in terms of the electric and magnetic fields is presented.

Analytic Mode Normalization for the Kerr Nonlinearity Parameter: Prediction of Nonlinear Gain for Leaky Modes.

Based on the resonant-state expansion with analytic mode normalization, we derive a general master equation for the nonlinear pulse propagation in waveguide geometries that is valid for bound and leaky modes. In the single-mode approximation, this equation transforms into the well-known nonlinear Schrödinger equation with a closed expression for the Kerr nonlinearity parameter. The expression for the Kerr nonlinearity parameter can be calculated on the minimal spatial domain that spans only across the regions of spatial inhomogeneities. It agrees with previous vectorial formulations for bound modes, while for leaky modes the Kerr nonlinearity parameter turns out to be a complex number with the imaginary part providing either nonlinear loss or even gain for the overall attenuating pulses. This nonlinear gain results in more intense pulse compression and stronger spectral broadening, which is demonstrated here on the example of liquid-filled capillary-type fibers.

[Basic principles of diagnosis and treatment of gliomas]. / Grundlagen zur Diagnose und Therapie von Gliomen.

BACKGROUND: Traditionally, gliomas were classified based on histopathological features alone. The revised World Health Organization (WHO) classification of tumors of the central nervous system from 2016 integrated molecular features into the histopathological diagnosis. OBJECTIVE: To summarize key aspects of the WHO classification from 2016 and implications for the clinical management of glioma patients. An overview of novel treatment approaches is also provided. RESULTS: Oligodendrogliomas are defined independently of their histopathological appearance by the simultaneous presence of a mutation in the isocitrate dehydrogenase (IDH)-1 or IDH-2 gene and co-deletion of chromosome arms 1p and 19q. Astrocytomas are classified based on the presence or absence of mutations in IDH. Astrocytic tumors with wild-type IDH comprise approximately 90% of glioblastomas, the most common malignant primary brain tumor in adults. The extent of resection is a favorable prognostic factor in diffuse gliomas. Postoperatively, most patients are treated with a combination of radiotherapy and alkylating agent chemotherapy. In IDH wild-type astrocytic tumors, hypermethylation of the promoter of the DNA repair protein O6-methylguanine-DNA methyltransferase (MGMT) gene is predictive for benefit from the alkylating agent temozolomide. Most novel treatment approaches that are currently being assessed in clinical trials aim at reprogramming the immune system to specifically eradicate tumor cells, but the efficacy of such approaches in gliomas remains to be demonstrated. DISCUSSION: To date the classical treatment modalities comprising surgery, radiotherapy and chemotherapy remain the mainstay of glioma treatment. The integration of molecular features into the classification of gliomas is a basis for personalized treatment approaches.

Violation of the Leggett-Garg Inequality in Neutrino Oscillations.

The Leggett-Garg inequality, an analogue of Bell's inequality involving correlations of measurements on a system at different times, stands as one of the hallmark tests of quantum mechanics against classical predictions. The phenomenon of neutrino oscillations should adhere to quantum-mechanical predictions and provide an observable violation of the Leggett-Garg inequality. We demonstrate how oscillation phenomena can be used to test for violations of the classical bound by performing measurements on an ensemble of neutrinos at distinct energies, as opposed to a single neutrino at distinct times. A study of the MINOS experiment's data shows a greater than 6σ violation over a distance of 735 km, representing the longest distance over which either the Leggett-Garg inequality or Bell's inequality has been tested.

From Dark to Bright: First-Order Perturbation Theory with Analytical Mode Normalization for Plasmonic Nanoantenna Arrays Applied to Refractive Index Sensing.

We present a first-order perturbation theory to calculate the frequency shift and linewidth change of photonic resonances in one- and two-dimensional periodic structures under modifications of the surrounding refractive index. Our method is based on the resonant state expansion, for which we extend the analytical mode normalization to periodic structures. We apply this theory to calculate the sensitivity of bright dipolar and much darker quadrupolar plasmonic modes by determining the maximum shift and optimal sensing volume.

Safety and efficacy of pharmacological cardioversion of recent-onset atrial fibrillation: a single-center experience.

BACKGROUND AND AIM: The management of patients with recent-onset atrial fibrillation (AF) presenting at emergency departments (EDs) varies widely. Our aim was to describe the management of patients with recent-onset (<48 hours) AF, to determine safety and efficacy of pharmacological cardioversion at the ED, and to evaluate the incidence of thromboembolism or death at 30 days. METHODS: In a prospective, observational, single-center study, 236 subjects with recent-onset AF were consecutively enrolled from January 2011 until January 2013. Follow-up information was obtained by reviewing all available clinical records. RESULTS: As first-line therapy, 45.3% (n = 107) received ibutilide, 28.8% (n = 68) vernakalant, 25% (n = 59) flecainide, and 0.8% (n = 2) amiodarone, respectively. Successful cardioversion was achieved in 72.5% (n = 171) of patients after first-line therapy. There was no significant difference between treatment groups. In univariable logistic regression analysis, age (odds ratio [OR] = 1.027; 95% confidence interval [CI], 1.003-1.052; P= .03), duration of symptoms (OR = 0.968; 95% CI, 0.938-0.999; P= .045), as well as the CHA2DS2-VASc score (1 point for Congestive heart failure, Hypertension, Age between 65 and 74 years, Diabetes, Vascular disease, Sex category if female and 2 points for previous TIA/Stroke and Age ≥ 75 years) (OR = 1.237; 95% CI, 1.01-1.515; P= .04) were associated with success of pharmacological cardioversion. Within 30 days, 1 patient suffered from fatal ischemic stroke. CONCLUSION: Pharmacological cardioversion followed by discharge after a short observation period is safe. There was no significant difference between the agents used in terms of short-term safety and efficacy. Importantly, the coherence of the ED to recent guidelines regarding first-line therapy is high.

Surface- and tip-enhanced resonant Raman scattering from CdSe nanocrystals.

Surface- and tip-enhanced resonant Raman scattering (resonant SERS and TERS) by optical phonons in a monolayer of CdSe quantum dots (QDs) is demonstrated. The SERS enhancement was achieved by employing plasmonically active substrates consisting of gold arrays with varying nanocluster diameters prepared by electron-beam lithography. The magnitude of the SERS enhancement depends on the localized surface plasmon resonance (LSPR) energy, which is determined by the structural parameters. The LSPR positions as a function of nanocluster diameter were experimentally determined from spectroscopic micro-ellipsometry, and compared to numerical simulations showing good qualitative agreement. The monolayer of CdSe QDs was deposited by the Langmuir-Blodgett-based technique on the SERS substrates. By tuning the excitation energy close to the band gap of the CdSe QDs and to the LSPR energy, resonant SERS by longitudinal optical (LO) phonons of CdSe QDs was realized. A SERS enhancement factor of 2 × 10(3) was achieved. This allowed the detection of higher order LO modes of CdSe QDs, evidencing the high crystalline quality of QDs. The dependence of LO phonon mode intensity on the size of Au nanoclusters reveals a resonant character, suggesting that the electromagnetic mechanism of the SERS enhancement is dominant. Finally, the resonant TERS spectrum from CdSe QDs was obtained using electrochemically etched gold tips providing an enhancement on the order of 10(4). This is an important step towards the detection of the phonon spectrum from a single QD.

Effects of Exposure to Welding Fume on Lung Function: Results from the German WELDOX Study.

The association between exposure to welding fume and chronic obstructive pulmonary disease (COPD) has been insufficiently clarified. In this study we assessed the influence of exposure to welding fume on lung function parameters. We investigated forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and expiratory flow rates in 219 welders. We measured current exposure to respirable particles and estimated a worker's lifetime exposure considering welding techniques, working conditions and protective measures at current and former workplaces. Multiple regression models were applied to estimate the influence of exposure to welding fume, age, and smoking on lung function. We additionally investigated the duration of working as a welder and the predominant welding technique. The findings were that age- and smoking-adjusted lung function parameters showed no decline with increasing duration, current exposure level, and lifetime exposure to welding fume. However, 15% of the welders had FEV1/FVC below the lower limit of normal, but we could not substantiate the presence of an association with the measures of exposure. Adverse effects of cigarette smoking were confirmed. In conclusion, the study did not support the notion of a possible detrimental effect of exposure to welding fume on lung function in welders.

[Residual limb and phantom pain : Causes and therapeutic approaches]. / Stumpf- und Phantomschmerzen : Ursachen und Therapieansätze.

INTRODUCTION: Residual limb pain and phantom pain are severe complications following an amputation. Various reasons are responsible for these complaints. It must be distinguished between amputation stump pain, phantom sensations and phantom pain. CAUSE AND THERAPY: In this paper we describe the most common reasons for stump pain and propose some non-operative therapeutic approaches. Furthermore path physiology and phantom pain therapy will be discussed. The recommendations offered in this paper are based on practical experience over three decades in a specialized out-patient department for patients with amputation injuries.