Search

What is the spatiotemporal limit of a macroscopic model that describes the optoelectronic interaction at the interface between different media? This fundamental question has become relevant for time-dependent photoemission from solid surfaces using probes that resolve attosecond electron dynamics on an atomic length scale. We address this fundamental question by investigating how ultrafast electron screening affects the infrared field distribution for a noble metal such as Cu(111) at the solid-vacuum interface. Attosecond photoemission delay measurements performed at different angles of incidence of the light allow us to study the detailed spatiotemporal dependence of the electromagnetic field distribution. Surprisingly, comparison with Monte Carlo semiclassical calculations reveals that the macroscopic Fresnel equations still properly describe the observed phase of the IR field on the Cu(111) surface on an atomic length and an attosecond time scale.

Background: Pulseless electrical activity (PEA) cardiac arrest is characterised by a residual organised electrical activity. PEA is frequently induced by reversible conditions. The mnemonic "4H&4T" was proposed as a reminder to assess for Hypoxia, Hypovolaemia, Hypo/Hyperkalaemia, Hypothermia, Thrombosis, cardiac Tamponade, Toxins, and Tension pneumothorax. Other potential aetiologies have been identified, but their respective probability and frequencies are unclear. The aim of this study was to analyse the aetiologies of PEA out-of-hospital cardiac arrests and to evaluate their relative frequencies., Methods: This was a retrospective study based on data routinely and prospectively collected. All adult patients with PEA as the first recorded rhythm and admitted between 2002 and 2012 to the emergency department (ED) after return of spontaneous circulation or under resuscitation were included., Results: A total of 1,866 out-of-hospital cardiac arrests were included. PEA was the first recorded rhythm in 232 adult patients (12.4%) and 144 of these were admitted to the ED. The mean age was 63.8 ± 20.0 years, 58.3% were men. The survival rate at 48 hours was 29%. Hypoxia (23.6%), acute coronary syndrome (12.5%) and trauma (12.5%) were the most frequent causes. We were unable to identify a specific cause in 17.4%. Pulmonary embolism, hypovolaemia, intoxication and hypo/hyperkalaemia occurred in fewer than 10% of the cases. Nonischaemic cardiac disorders and intracranial haemorrhage occurred in 8.3% and 6.9%, respectively., Conclusions: Intracranial haemorrhage and nonischaemic cardiac disorders represent significant causes of PEA, with a prevalence equalling or exceeding the frequency of classical 4H&4T aetiologies. These conditions are potentially accessible to simple diagnostic procedures (computed tomography or echocardiography).

A THz-pump and x-ray-probe experiment is simulated where x-ray photoelectron diffraction (XPD) patterns record the coherent vibrational motion of carbon monoxide molecules adsorbed on a Pt(111) surface. Using molecular dynamics simulations, the excitation of frustrated wagging-type motion of the CO molecules by a few-cycle pulse of 2 THz radiation is calculated. From the atomic coordinates, the time-resolved XPD patterns of the C 1s core level photoelectrons are generated. Due to the direct structural information in these data provided by the forward scattering maximum along the carbon-oxygen direction, the sequence of these patterns represents the equivalent of a molecular movie.

Background: Although the possibility of bleeding during anticoagulant treatment may limit patients from taking part in physical activity, the association between physical activity and anticoagulation-related bleeding is uncertain., Objectives: To determine whether physical activity is associated with bleeding in elderly patients taking anticoagulants., Patients/methods: In a prospective multicenter cohort study of 988 patients aged ≥ 65 years receiving anticoagulants for venous thromboembolism, we assessed patients' self-reported physical activity level. The primary outcome was the time to a first major bleeding, defined as fatal bleeding, symptomatic bleeding in a critical site, or bleeding causing a fall in hemoglobin or leading to transfusions. The secondary outcome was the time to a first clinically relevant non-major bleeding. We examined the association between physical activity level and time to a first bleeding by using competing risk regression, accounting for death as a competing event. We adjusted for known bleeding risk factors and anticoagulation as a time-varying covariate., Results: During a mean follow-up of 22 months, patients with a low, moderate, and high physical activity level had an incidence of major bleeding of 11.6, 6.3, and 3.1 events per 100 patient-years and an incidence of clinically relevant non-major bleeding of 14.0, 10.3, and 7.7 events per 100 patient-years, respectively. A high physical activity level was significantly associated with a lower risk of major bleeding (adjusted sub-hazard ratio 0.40, 95% confidence interval 0.22-0.72). There was no association between physical activity and non-major bleeding., Conclusions: A high level of physical activity is associated with a decreased risk of major bleeding in elderly patients receiving anticoagulant therapy., (© 2014 International Society on Thrombosis and Haemostasis.)

Background: Polypharmacy, defined as the concomitant use of multiple medications, is very common in the elderly and may trigger drug-drug interactions and increase the risk of falls in patients receiving vitamin K antagonists., Objective: To examine whether polypharmacy increases the risk of bleeding in elderly patients who receive vitamin K antagonists for acute venous thromboembolism (VTE)., Design: We used a prospective cohort study., Participants: In a multicenter Swiss cohort, we studied 830 patients aged ≥ 65 years with VTE., Main Measures: We defined polypharmacy as the prescription of more than four different drugs. We assessed the association between polypharmacy and the time to a first major and clinically relevant non-major bleeding, accounting for the competing risk of death. We adjusted for known bleeding risk factors (age, gender, pulmonary embolism, active cancer, arterial hypertension, cardiac disease, cerebrovascular disease, chronic liver and renal disease, diabetes mellitus, history of major bleeding, recent surgery, anemia, thrombocytopenia) and periods of vitamin K antagonist treatment as a time-varying covariate., Key Results: Overall, 413 (49.8 %) patients had polypharmacy. The mean follow-up duration was 17.8 months. Patients with polypharmacy had a significantly higher incidence of major (9.0 vs. 4.1 events/100 patient-years; incidence rate ratio [IRR] 2.18, 95 % confidence interval [CI] 1.32-3.68) and clinically relevant non-major bleeding (14.8 vs. 8.0 events/100 patient-years; IRR 1.85, 95 % CI 1.27-2.71) than patients without polypharmacy. After adjustment, polypharmacy was significantly associated with major (sub-hazard ratio [SHR] 1.83, 95 % CI 1.03-3.25) and clinically relevant non-major bleeding (SHR 1.60, 95 % CI 1.06-2.42)., Conclusions: Polypharmacy is associated with an increased risk of both major and clinically relevant non-major bleeding in elderly patients receiving vitamin K antagonists for VTE.

Objective: Whether or not a high risk of falls increases the risk of bleeding in patients receiving anticoagulants remains a matter of debate., Methods: We conducted a prospective cohort study involving 991 patients ≥ 65 years of age who received anticoagulants for acute venous thromboembolism (VTE) at nine Swiss hospitals between September 2009 and September 2012. The study outcomes were as follows: the time to a first major episode of bleeding; and clinically relevant nonmajor bleeding. We determined the associations between the risk of falls and the time to a first episode of bleeding using competing risk regression, accounting for death as a competing event. We adjusted for known bleeding risk factors and anticoagulation as a time-varying covariate., Results: Four hundred fifty-eight of 991 patients (46%) were at high risk of falls. The mean duration of follow-up was 16.7 months. Patients at high risk of falls had a higher incidence of major bleeding (9.6 vs. 6.6 events/100 patient-years; P = 0.05) and a significantly higher incidence of clinically relevant nonmajor bleeding (16.7 vs. 8.3 events/100 patient-years; P < 0.001) than patients at low risk of falls. After adjustment, a high risk of falls was associated with clinically relevant nonmajor bleeding [subhazard ratio (SHR) = 1.74, 95% confidence interval (CI) = 1.23-2.46], but not with major bleeding (SHR = 1.24, 95% CI = 0.83-1.86)., Conclusion: In elderly patients who receive anticoagulants because of VTE, a high risk of falls is significantly associated with clinically relevant nonmajor bleeding, but not with major bleeding. Whether or not a high risk of falls is a reason against providing anticoagulation beyond 3 months should be based on patient preferences and the risk of VTE recurrence., (© 2014 The Association for the Publication of the Journal of Internal Medicine.)

The exposure of hexagonal boron nitride single layers to low energy ions leads to the formation of vacancy defects that are mobile at elevated temperatures. For the case of h-BN on rhodium, a superhoneycomb surface with 3 nm lattice constant (nanomesh), a concerted self-assembly of these defects is observed, where the "can-opener" effect leads to the cut-out of 2 nm "lids" and stable voids in the h-BN layer. These clean-cut voids repel each other, which enables the formation of arrays with a nearest neighbor distance down to about 8 nm. The density of voids depends on the Ar ion dose, and can reach 10(12) cm(-2). If the structures are annealed above 1000 K, the voids disappear and pristine h-BN nanomesh with larger holes is recovered. The results are obtained by scanning tunneling microscopy and density functional theory calculations.

Background: We aimed to assess whether elderly patients with acute venous thromboembolism (VTE) receive recommended initial processes of care and to identify predictors of process adherence., Methods: We prospectively studied in- and outpatients aged ≥65 years with acute symptomatic VTE in a multicenter cohort study from nine Swiss university- and non-university hospitals between September 2009 and March 2011. We systematically assessed whether initial processes of care, which are recommended by the 2008 American College of Chest Physicians guidelines, were performed in each patient. We used multivariable logistic models to identify patient factors independently associated with process adherence., Results: Our cohort comprised 950 patients (mean age 76 years). Of these, 86% (645/750) received parenteral anticoagulation for ≥5 days, 54% (405/750) had oral anticoagulation started on the first treatment day, and 37% (274/750) had an international normalized ratio (INR) ≥2 for ≥24 hours before parenteral anticoagulation was discontinued. Overall, 35% (53/153) of patients with cancer received low-molecular-weight heparin monotherapy and 72% (304/423) of patients with symptomatic deep vein thrombosis were prescribed compression stockings. In multivariate analyses, symptomatic pulmonary embolism, hospital-acquired VTE, and concomitant antiplatelet therapy were associated with a significantly lower anticoagulation-related process adherence., Conclusions: Adherence to several recommended processes of care was suboptimal in elderly patients with VTE. Quality of care interventions should particularly focus on processes with low adherence, such as the prescription of continued low-molecular-weight heparin therapy in patients with cancer and the achievement of an INR ≥2 for ≥24 hours before parenteral anticoagulants are stopped.

The setup of an apparatus for chemical vapor deposition (CVD) of hexagonal boron nitride (h-BN) and its characterization on four-inch wafers in ultra high vacuum (UHV) environment is reported. It provides well-controlled preparation conditions, such as oxygen and argon plasma assisted cleaning and high temperature annealing. In situ characterization of a wafer is accomplished with target current spectroscopy. A piezo motor driven x-y stage allows measurements with a step size of 1 nm on the complete wafer. To benchmark the system performance, we investigated the growth of single layer h-BN on epitaxial Rh(111) thin films. A thorough analysis of the wafer was performed after cutting in atmosphere by low energy electron diffraction, scanning tunneling microscopy, and ultraviolet and X-ray photoelectron spectroscopies. The apparatus is located in a clean room environment and delivers high quality single layers of h-BN and thus grants access to large area UHV processed surfaces, which had been hitherto restricted to expensive, small area single crystal substrates. The facility is versatile enough for customization to other UHV-CVD processes, e.g., graphene on four-inch wafers.

By means of spin- and angle-resolved photoelectron spectroscopy we studied the spin structure of thin films of the topological insulator Bi2Se3 grown on InP(111). For thicknesses below six quintuple layers the spin-polarized metallic topological surface states interact with each other via quantum tunneling and a gap opens. Our measurements show that the resulting surface states can be described by massive Dirac cones which are split in a Rashba-like manner due to the substrate induced inversion asymmetry. The inner and the outer Rashba branches have distinct localization in the top and the bottom part of the film, whereas the band apices are delocalized throughout the entire film. Supported by calculations, our observations help in the understanding of the evolution of the surface states at the topological phase transition and provide the groundwork for the realization of two-dimensional spintronic devices based on topological semiconductors.

Hyperthermal atoms may be implanted beneath single layers of graphene or hexagonal boron nitride (h-BN) on a substrate. For the case of h-BN on rhodium, which is a corrugated honeycomb superstructure with a periodicity of 3.2 nm, Ar atoms are implanted at distinct interstitial sites within the supercell, where the h-BN is weakly bound to the substrate. These peculiar structures are reminiscent of "nanotents" with an ultimately thin "rainfly". Here we explore the implantation length (i.e., the distance the atoms move before they come to rest as interstitial defects) and the thermal stability of these atomic agglomerates above room temperature. The results are obtained by variable-temperature scanning tunneling microscopy and density functional theory calculations.

This adult cohort determined the incidence and patients' short-term outcomes of severe traumatic brain injury (sTBI) in Switzerland and age-related differences. A prospective cohort study with a follow-up at 14 days was performed. Patients ≥16 years of age sustaining sTBI and admitted to 1 of 11 trauma centers were included. sTBI was defined by an Abbreviated Injury Scale of the head (HAIS) score >3. The centers participated from 6 months to 3 years. The results are presented as percentages, medians, and interquartile ranges (IQRs). Subgroup analyses were performed for patients ≤65 years (younger) and >65 (elderly). sTBI was observed in 921 patients (median age, 55 years; IQR, 33-71); 683 (74.2%) were male. Females were older (median age, 67 years; IQR, 42-80) than males (52; IQR, 31-67; p<0.00001). The estimated incidence was 10.58 per 100,000 inhabitants per year. Blunt trauma was observed in 879 patients (95.4%) and multiple trauma in 283 (30.7%). Median Glasgow Coma Score (GCS) on the scene was 9 (IQR 4-14; 8 in younger, 12 in elderly) and in emergency departments 5 (IQR, 3-14; 3 in younger, 8 in elderly). Trauma mechanisms included the following: 484 patients with falls (52.6%; younger, 242 patients [50.0%]; elderly, 242 [50.0%]), 291 with road traffic accidents (31.6%; younger, 237 patients [81.4%]; elderly, 54 [18.6%]), and 146 with others (15.8%). Mortality was 30.2% (24.5% in younger, 40.9% in elderly). Median GCS at 14 days was 15 (IQR, 14-15) without differences among subgroups. Estimated incidence of sTBI in Switzerland was low, age was high, and mortality considerable. The elderly had higher initial GCS and a higher death rate, but high GCS at 14 days.

Venous thromboembolism (VTE) is common and has a high impact on morbidity, mortality, and costs of care. Although most of the patients with VTE are aged ≥65 years, there is little data about the medical outcomes in the elderly with VTE. The Swiss Cohort of Elderly Patients with VTE (SWITCO65+) is a prospective multicenter cohort study of in- and outpatients aged ≥65 years with acute VTE from all five Swiss university and four high-volume non-university hospitals. The goal is to examine which clinical and biological factors and processes of care drive short- and long-term medical outcomes, health-related quality of life, and medical resource utilization in elderly patients with acute VTE. The cohort also includes a large biobank with biological material from each participant. From September 2009 to March 2012, 1,863 elderly patients with VTE were screened and 1003 (53.8%) were enrolled in the cohort. Overall, 51.7% of patients were aged ≥75 years and 52.7% were men. By October 16, 2012, after an average follow-up time of 512 days, 799 (79.7%) patients were still actively participating. SWITCO65+ is a unique opportunity to study short- and long-term outcomes in elderly patients with VTE. The Steering Committee encourages national and international collaborative research projects related to SWITCO65+, including sharing anonymized data and biological samples.

Background: Emergency departments (EDs) are an essential component of any developed health care system. There is, however, no national description of EDs in Switzerland. Our objective was to establish the number and location of EDs, patient visits and flow, medical staff and organization, and capabilities in 2006, as a benchmark before emergency medicine became a subspecialty in Switzerland., Methods: In 2007, we started to create an inventory of all hospital-based EDs with a preliminary list from the Swiss Society of Emergency and Rescue Medicine that was improved with input from ED physicians nationwide. EDs were eligible if they offered acute care 24 h per day, 7 days per week. Our goal was to have 2006 data from at least 80% of all EDs. The survey was initiated in 2007 and the 80% threshold reached in 2012., Results: In 2006, Switzerland had a total of 138 hospital-based EDs. The number of ED visits was 1.475 million visits or 20 visits per 100 inhabitants. The median number of visits was 8,806 per year; 25% of EDs admitted 5,000 patients or less, 31% 5,001-10,000 patients, 26% 10,001-20,000 patients, and 17% >20,000 patients per year. Crowding was reported by 84% of EDs with >20,000 visits/year. Residents with limited experience provided care for 77% of visits. Imaging was not immediately available for all patients: standard X-ray within 15 min (70%), non-contrast head CT scan within 15 min (38%), and focused sonography for trauma (70%); 67% of EDs had an intensive care unit within the hospital, and 87% had an operating room always available., Conclusions: Swiss EDs were significant providers of health care in 2006. Crowding, physicians with limited experience, and the heterogeneity of emergency care capabilities were likely threats to the ubiquitous and consistent delivery of quality emergency care, particularly for time-sensitive conditions. Our survey establishes a benchmark to better understand future improvements in Swiss emergency care.

Two limiting factors for a new technology of graphene-based electronic devices are the difficulty of growing large areas of defect-free material and the integration of graphene with an atomically flat and insulating substrate material. Chemical vapor deposition (CVD) on metal surfaces, in particular on copper, may offer a solution to the first problem, while hexagonal boron nitride (h-BN) has been identified as an ideal insulating substrate material. The bottom-up growth of graphene/h-BN stacks on copper surfaces appears therefore as a promising route for future device fabrication. As an important step, we demonstrate the consecutive growth of well-aligned graphene on h-BN, both as single layers, by low-pressure CVD on Cu(111) in an ultrahigh vacuum environment. The resulting films show a largely predominant orientation, defined by the substrate, where the graphene lattice aligns parallel to the h-BN lattice, while each layer maintains its own lattice constant. The lattice mismatch of 1.6% between h-BN and graphene leads to a moiré pattern with a periodicity of about 9 nm, as observed with scanning tunneling microscopy. Accordingly, angle-resolved photoemission data reveal two slightly different Brillouin zones for electronic states localized in graphene and in h-BN, reflecting the vertical decoupling of the two layers. The graphene appears n-doped and shows no gap opening at the K[overline] point of the two-dimensional Brillouin zone.

Single atoms, and in particular the least reactive noble gases, are difficult to immobilize at room temperature. Ion implantation into a crystal lattice has this capability, but the randomness of the involved processes does not permit much control over their distribution within the solid. Here we demonstrate that the boron nitride nanomesh, a corrugated single layer of hexagonal boron nitride (h-BN) with a 3.2 nm honeycomb superstructure formed on a Rh(111) surface, can trap individual argon atoms at distinct subsurface sites at room temperature. A kinetic energy window for implantation is identified where the argon ions can penetrate the h-BN layer but not enter the Rh lattice. Scanning tunneling microscopy and photoemission data show the presence of argon atoms at two distinct sites within the nanomesh unit cell, confirmed also by density functional theory calculations. The single atom implants are stable in air. Annealing of implanted structures to 900 K induces the formation of highly regular holes of 2 nm diameter in the h-BN layer with adjacent flakes of the same size found on top of the layer. We explain this "can-opener" effect by the presence of a vacancy defect, generated during the penetration of the Ar ion through the h-BN lattice, and propagating along the rim of a nanomesh pore where the h-BN lattice is highly bent. The reported effects are also observed in graphene on ruthenium and for neon atoms.

The notion of "First Responder" (FR) refers to the system of first-aid volunteers who act to initiate the first-aid care before the classical emergency help arrives. In 2011, the French-speaking Switzerland counts 19 groups, divided up between four cantons (Fribourg, Vaud, Neuchâtel, Valais). The geographical distribution of those FR shows the stakes of these peripherical areas, with the accessibility difficulties for the emergency services, and a low demography of ambulances and doctors. The number of interventions carried out by the FR has significantly increased during the last years. The association of a quality formation, an excellent knowledge of the ground and a quick intervention has a positive impact on the survival of the patients with vital emergency or traumatic conditions.

We present time-resolved photoemission experiments from a peculiar bismuth surface, Bi(114). The strong one-dimensional character of this surface is reflected in the Fermi surface, which consists of spin-polarized straight lines. Our results show that the depletion of the surface state and the population of the bulk conduction band after the initial optical excitation persist for very long times. The disequilibrium within the hot electron gas along with strong electron-phonon coupling cause a displacive excitation of coherent phonons, which in turn are reflected in coherent modulations of the electronic states. Beside the well-known A(1g) bulk phonon mode at 2.76 THz, the time-resolved photoelectron spectra reveal a second mode at 0.72 THz which can be attributed to an optical surface phonon mode along the atomic rows of the Bi(114) surface.

Background: The Outpatient Bleeding Risk Index (OBRI) and the Kuijer, RIETE and Kearon scores are clinical prognostic scores for bleeding in patients receiving oral anticoagulants for venous thromboembolism (VTE). We prospectively compared the performance of these scores in elderly patients with VTE., Methods: In a prospective multicenter Swiss cohort study, we studied 663 patients aged ≥ 65 years with acute VTE. The outcome was a first major bleeding at 90 days. We classified patients into three categories of bleeding risk (low, intermediate and high) according to each score and dichotomized patients as high vs. low or intermediate risk. We calculated the area under the receiver-operating characteristic (ROC) curve, positive predictive values and likelihood ratios for each score., Results: Overall, 28 out of 663 patients (4.2%, 95% confidence interval [CI] 2.8-6.0%) had a first major bleeding within 90 days. According to different scores, the rate of major bleeding varied from 1.9% to 2.1% in low-risk, from 4.2% to 5.0% in intermediate-risk and from 3.1% to 6.6% in high-risk patients. The discriminative power of the scores was poor to moderate, with areas under the ROC curve ranging from 0.49 to 0.60 (P = 0.21). The positive predictive values and positive likelihood ratios were low and varied from 3.1% to 6.6% and from 0.72 to 1.59, respectively., Conclusion: In elderly patients with VTE, existing bleeding risk scores do not have sufficient accuracy and power to discriminate between patients with VTE who are at a high risk of short-term major bleeding and those who are not., (© 2012 International Society on Thrombosis and Haemostasis.)

Spin-orbit interaction (SOI) in low-dimensional systems results in the fascinating property of spin-momentum locking. In a Rashba system the inversion symmetry normal to the plane of a two-dimensional (2D) electron gas is broken, generating a Fermi surface spin texture reminiscent of spin vortices of different radii which can be exploited in spin-based devices. Crucial for any application is the possibility to tune the momentum splitting through an external parameter. Here we show that in Pb quantum well states (QWS) the Rashba splitting depends on the Si substrate doping. Our results imply a doping dependence of the Schottky barrier which shifts the Si valence band relative to the QWS. A similar shift can be achieved by an external gate voltage or ultra-short laser pulses, opening up the possibility of terahertz spintronics.

Background: The Geneva Prognostic Score (GPS), the Pulmonary Embolism Severity Index (PESI) and its simplified version (sPESI) are well-known clinical prognostic scores for a pulmonary embolism (PE)., Objectives: To compare the prognostic performance of these scores in elderly patients with a PE., Patients and Methods: In a multicenter Swiss cohort of elderly patients with venous thromboembolism, we prospectively studied 449 patients aged ≥ 65 years with a symptomatic PE. The outcome was 30-day overall mortality. We dichotomized patients as low vs. higher risk in all three scores using the following thresholds: GPS scores ≤ 2 vs. > 2, PESI risk classes I-II vs. III-V and sPESI scores 0 vs. ≥ 1. We compared 30-day mortality in low- vs. higher-risk patients and the areas under the receiver-operating characteristic curve (ROC)., Results: Overall, 3.8% of patients (17/449) died within 30 days. The GPS classified a greater proportion of patients as low risk (92% [413/449]) than the PESI (36.3% [163/449]) and the sPESI (39.6% [178/449]) (P < 0.001 for each comparison). Low-risk patients based on the sPESI had a mortality of 0% (95% confidence interval [CI] 0-2.1%) compared with 0.6% (95% CI 0-3.4%) for low-risk patients based on the PESI and 3.4% (95% CI 1.9-5.6%) for low-risk patients based on the GPS. The areas under the ROC curves were 0.77 (95% CI 0.72-0.81), 0.76 (95% CI 0.72-0.80) and 0.71 (95% CI 0.66-0.75), respectively (P = 0.47)., Conclusions: In this cohort of elderly patients with PE, the GPS identified a higher proportion of patients as low risk but the PESI and sPESI were more accurate in predicting mortality., (© 2012 International Society on Thrombosis and Haemostasis.)

Ice nuclei have been studied on the hexagonal boron nitride nanomesh (h-BN/Rh(111)), a template with 2 nm wide molecule traps. Scanning tunneling microscopy shows confined clusters, where oligomers with three protrusions are particularly abundant. Together with local barrier height dI/dz maps, it is found that the dipoles of the water molecules arrange in a homodrome, which is consistent with density functional theory calculations. Hydrogen bonds toward the substrate identify h-BN/Rh(111) to be hydrophilic. The substrate distorts the hexamers (n = 6) and possibly pentamers (n = 5), where the experimentally observed footprints of the three protrusions appear more chiral than expected.

BiTeI has a layered and noncentrosymmetric structure where strong spin-orbit interaction leads to a giant Rashba spin splitting in the bulk bands. We present direct measurements of the bulk band structure obtained with soft x-ray angle-resolved photoemission (ARPES), revealing the three-dimensional Fermi surface. The observed spindle torus shape bears the potential for a topological transition in the bulk by hole doping. Moreover, the bulk electronic structure is clearly disentangled from the two-dimensional surface electronic structure by means of high-resolution and spin-resolved ARPES measurements in the ultraviolet regime. All findings are supported by ab initio calculations.

Photoemitted electrons move in a vacuum; their quantum state can be completely characterized in terms of energy, momentum and spin polarization by spin-polarized photoemission experiments. A review article in this issue by Heinzmann and Dil (2012 J. Phys.: Condens. Matter 24 173001) considers whether the measured spin properties, i.e. the magnitude and direction of the spin polarization vector, can be traced back to the quantum state from which these electrons originate. The careful conclusion is that they can, which is highly relevant in view of the current interest in these experiments and their application to topological insulators, where the spin-orbit interaction produces spin-polarized surface states., (© 2012 IOP Publishing Ltd)

We report a Rashba spin splitting of a two-dimensional electron gas in the topological insulator Bi(2)Se(3) from angle-resolved photoemission spectroscopy. We further demonstrate its electrostatic control, and show that spin splittings can be achieved which are at least an order-of-magnitude larger than in other semiconductors. Together these results show promise for the miniaturization of spintronic devices to the nanoscale and their operation at room temperature., (© 2011 American Physical Society)

Energy distribution curves of laser-induced electron pulses from a tungsten tip have been measured as a function of tip voltage and laser power. Electron emission via tunneling through and/or excitation over the surface barrier from photoexcited nonequilibrium electron distributions are clearly observed. The spectral shapes largely vary with the emission processes and are strongly affected by electron dynamics. Simulations successfully reproduce the spectra, thus allowing direct insight into the involved electron dynamics and revealing the temporal tunability of electron emission via the two experimental parameters. These results should be useful to optimize the pulse characteristics for many applications based on ultrafast laser-induced electron emission., (© 2011 American Physical Society)

Background: Although practice guidelines recommend outpatient care for selected, haemodynamically stable patients with pulmonary embolism, most treatment is presently inpatient based. We aimed to assess non-inferiority of outpatient care compared with inpatient care., Methods: We undertook an open-label, randomised non-inferiority trial at 19 emergency departments in Switzerland, France, Belgium, and the USA. We randomly assigned patients with acute, symptomatic pulmonary embolism and a low risk of death (pulmonary embolism severity index risk classes I or II) with a computer-generated randomisation sequence (blocks of 2-4) in a 1:1 ratio to initial outpatient (ie, discharged from hospital ≤24 h after randomisation) or inpatient treatment with subcutaneous enoxaparin (≥5 days) followed by oral anticoagulation (≥90 days). The primary outcome was symptomatic, recurrent venous thromboembolism within 90 days; safety outcomes included major bleeding within 14 or 90 days and mortality within 90 days. We used a non-inferiority margin of 4% for a difference between inpatient and outpatient groups. We included all enrolled patients in the primary analysis, excluding those lost to follow-up. This trial is registered with ClinicalTrials.gov, number NCT00425542., Findings: Between February, 2007, and June, 2010, we enrolled 344 eligible patients. In the primary analysis, one (0·6%) of 171 outpatients developed recurrent venous thromboembolism within 90 days compared with none of 168 inpatients (95% upper confidence limit [UCL] 2·7%; p=0·011). Only one (0·6%) patient in each treatment group died within 90 days (95% UCL 2·1%; p=0·005), and two (1·2%) of 171 outpatients and no inpatients had major bleeding within 14 days (95% UCL 3·6%; p=0·031). By 90 days, three (1·8%) outpatients but no inpatients had developed major bleeding (95% UCL 4·5%; p=0·086). Mean length of stay was 0·5 days (SD 1·0) for outpatients and 3·9 days (SD 3·1) for inpatients., Interpretation: In selected low-risk patients with pulmonary embolism, outpatient care can safely and effectively be used in place of inpatient care., Funding: Swiss National Science Foundation, Programme Hospitalier de Recherche Clinique, and the US National Heart, Lung, and Blood Institute. Sanofi-Aventis provided free drug supply in the participating European centres., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The recently discovered three-dimensional or bulk topological insulators are expected to exhibit exotic quantum phenomena. It is believed that a trivial insulator can be twisted into a topological state by modulating the spin-orbit interaction or the crystal lattice, driving the system through a topological quantum phase transition. By directly measuring the topological quantum numbers and invariants, we report the observation of a phase transition in a tunable spin-orbit system, BiTl(S(1-δ)Se(δ))(2), in which the topological state formation is visualized. In the topological state, vortex-like polarization states are observed to exhibit three-dimensional vectorial textures, which collectively feature a chirality transition as the spin momentum-locked electrons on the surface go through the zero carrier density point. Such phase transition and texture inversion can be the physical basis for observing fractional charge (±e/2) and other fractional topological phenomena.

Using a three-dimensional spin polarimeter we have gathered evidence for the interference of spin states in photoemission from the surface alloy Sb/Ag(111). This system features a small Rashba-type spin splitting of a size comparable to the momentum broadening of the quasiparticles, thus causing an intrinsic overlap between states with orthogonal spinors. Besides a small spin polarization caused by the spin splitting, we observe a large spin polarization component in the plane normal to the quantization axis of the Rashba effect. Strongly suggestive of coherent spin rotation, this effect is largely independent of the photon energy and photon polarization., (© 2011 IOP Publishing Ltd)

Photoelectron spectroscopy (PES) is a versatile tool, which provides insight into electronic structure and dynamics in condensed matter, surfaces, interfaces and molecules. The history of PES is briefly outlined and illustrated by current developments in the field of time-resolved PES. Our group's research is mostly aimed at studying ultrafast processes and associated lifetimes related to electronic excitation at solid surfaces.

The influence of structural defects, in the form of step lattices, on the spin polarization of the spin-orbit split Shockley surface state of Au(111) has been investigated. Spin- and angle-resolved photoemission data from three vicinal surfaces with different step densities are presented. The spin splitting is preserved in all three cases, and there is no reduction of the spin polarization of individual subbands, including the umklapp bands induced by the step lattice. On the sample with the highest step density studied, where the wave functions are delocalized over several terraces, the spin splitting is enhanced substantially, likely as an effect of the effective surface corrugation as on related surface alloys. The spin texture shows in all cases spin polarization vectors tangential to the Fermi circles, with the same helicities as on Au(111).

Water was investigated on a h-BN/Rh(111) nanomesh template using variable temperature scanning tunneling microscopy (STM) and density functional theory (DFT) calculations. Below 52 K, two distinct phases self-assemble within the 3.2 nm unit cell of the nanomesh that consists of "holes" and "wires". In the 2 nm holes, an ordered phase of nano-ice crystals with about 40 molecules is found. The ice crystals arrange in a bilayer honeycomb lattice, where hydrogen atoms of the lower layer point to the substrate. The phase on the 1 nm wires is a low density gas phase. Tunneling barrier height dI/dz spectroscopy measurements reveal the dipoles of individual molecules in the nano-ice clusters and access proton disorder.

We have investigated field-emission patterns from a clean tungsten tip apex induced by femtosecond laser pulses. Strongly asymmetric modulations of the field-emission intensity distributions are observed depending on the polarization of the light and the laser incidence direction relative to the azimuthal orientation of tip apex. In effect, we have realized an ultrafast pulsed field-emission source with site selectivity. Simulations of local fields on the tip apex and of electron emission patterns based on photoexcited nonequilibrium electron distributions explain our observations quantitatively.

We show that the strongly spin-orbit coupled materials Bi2Te3 and Sb2Te3 and their derivatives belong to the Z2 topological-insulator class. Using a combination of first-principles theoretical calculations and photoemission spectroscopy, we directly show that Bi2Te3 is a large spin-orbit-induced indirect bulk band gap (delta approximately 150 meV) semiconductor whose surface is characterized by a single topological spin-Dirac cone. The electronic structure of self-doped Sb2Te3 exhibits similar Z2 topological properties. We demonstrate that the dynamics of spin-Dirac fermions can be controlled through systematic Mn doping, making these materials classes potentially suitable for topological device applications.

Background: We reviewed the current evidence on the benefit and harm of pre-hospital tracheal intubation and mechanical ventilation after traumatic brain injury (TBI)., Methods: We conducted a systematic literature search up to December 2007 without language restriction to identify interventional and observational studies comparing pre-hospital intubation with other airway management (e.g. bag-valve-mask or oxygen administration) in patients with TBI. Information on study design, population, interventions, and outcomes was abstracted by two investigators and cross-checked by two others. Seventeen studies were included with data for 15,335 patients collected from 1985 to 2004. There were 12 retrospective analyses of trauma registries or hospital databases, three cohort studies, one case-control study, and one controlled trial. Using Brain Trauma Foundation classification of evidence, there were 14 class 3 studies, three class 2 studies, and no class 1 study. Six studies were of adults, five of children, and three of both; age groups were unclear in three studies. Maximum follow-up was up to 6 months or hospital discharge., Results: In 13 studies, the unadjusted odds ratios (ORs) for an effect of pre-hospital intubation on in-hospital mortality ranged from 0.17 (favouring control interventions) to 2.43 (favouring pre-hospital intubation); adjusted ORs ranged from 0.24 to 1.42. Estimates for functional outcomes after TBI were equivocal. Three studies indicated higher risk of pneumonia associated with pre-hospital (when compared with in-hospital) intubation., Conclusions: Overall, the available evidence did not support any benefit from pre-hospital intubation and mechanical ventilation after TBI. Additional arguments need to be taken into account, including medical and procedural aspects.

Helical Dirac fermions-charge carriers that behave as massless relativistic particles with an intrinsic angular momentum (spin) locked to its translational momentum-are proposed to be the key to realizing fundamentally new phenomena in condensed matter physics. Prominent examples include the anomalous quantization of magneto-electric coupling, half-fermion states that are their own antiparticle, and charge fractionalization in a Bose-Einstein condensate, all of which are not possible with conventional Dirac fermions of the graphene variety. Helical Dirac fermions have so far remained elusive owing to the lack of necessary spin-sensitive measurements and because such fermions are forbidden to exist in conventional materials harbouring relativistic electrons, such as graphene or bismuth. It has recently been proposed that helical Dirac fermions may exist at the edges of certain types of topologically ordered insulators-materials with a bulk insulating gap of spin-orbit origin and surface states protected against scattering by time-reversal symmetry-and that their peculiar properties may be accessed provided the insulator is tuned into the so-called topological transport regime. However, helical Dirac fermions have not been observed in existing topological insulators. Here we report the realization and characterization of a tunable topological insulator in a bismuth-based class of material by combining spin-imaging and momentum-resolved spectroscopies, bulk charge compensation, Hall transport measurements and surface quantum control. Our results reveal a spin-momentum locked Dirac cone carrying a non-trivial Berry's phase that is nearly 100 per cent spin-polarized, which exhibits a tunable topological fermion density in the vicinity of the Kramers point and can be driven to the long-sought topological spin transport regime. The observed topological nodal state is shown to be protected even up to 300 K. Our demonstration of room-temperature topological order and non-trivial spin-texture in stoichiometric Bi(2)Se(3).M(x) (M(x) indicates surface doping or gating control) paves the way for future graphene-like studies of topological insulators, and applications of the observed spin-polarized edge channels in spintronic and computing technologies possibly at room temperature.

We report the main characteristics of the advanced photoelectric effect experiments beamline, operational at Elettra storage ring, featuring a fully independent double branch scheme obtained by the use of chicane undulators and able to keep polarization control in both linear and circular mode. The paper describes the novel technical solutions adopted, namely, (a) the design of a quasiperiodic undulator resulting in optimized suppression of higher harmonics over a large photon energy range (10-100 eV), (b) the thermal stability of optics under high heat load via cryocoolers, and (c) the end station interconnected setup allowing full access to off-beam and on-beam facilities and, at the same time, the integration of users' specialized sample growth chambers or modules.

The (114) surface of the semimetal Bi is found to support a quasi-one-dimensional, metallic surface state. As required by symmetry, the state is degenerate along the Gamma-Y line of the surface Brillouin zone with a highest binding energy of approximately 150 meV. In the Gamma-X direction the degeneracy is lifted by the strong spin-orbit splitting in Bi, as directly shown by spin-resolved photoemission. This results in a Fermi contour consisting of two closely separated, parallel lines of opposite spin direction. It is argued that similar states on related insulators would give rise to a one-dimensional quantum spin Hall effect.

A topologically ordered material is characterized by a rare quantum organization of electrons that evades the conventional spontaneously broken symmetry-based classification of condensed matter. Exotic spin-transport phenomena, such as the dissipationless quantum spin Hall effect, have been speculated to originate from a topological order whose identification requires a spin-sensitive measurement, which does not exist to this date in any system. Using Mott polarimetry, we probed the spin degrees of freedom and demonstrated that topological quantum numbers are completely determined from spin texture-imaging measurements. Applying this method to Sb and Bi(1-x)Sb(x), we identified the origin of its topological order and unusual chiral properties. These results taken together constitute the first observation of surface electrons collectively carrying a topological quantum Berry's phase and definite spin chirality, which are the key electronic properties component for realizing topological quantum computing bits with intrinsic spin Hall-like topological phenomena.

A Rashba-type spin-orbit splitting is found for quantum well states formed in ultrathin Pb films on Si (111). The resulting momentum splitting is comparable to what is found for semiconductor heterostructures. The splitting shows no coverage dependency and the sign of the spin polarization is reversed compared to Rashba splitting in the Au(111) surface state. We explain our results by competing effects at the two boundaries of the Pb layer.

Background: Tobacco dependence is the leading cause of preventable death and disabilities worldwide and nicotine is the main substance responsible for the addiction to tobacco. A vaccine against nicotine was tested in a 6-month randomized, double blind phase II smoking cessation study in 341 smokers with a subsequent 6-month follow-up period., Methodology/principal Findings: 229 subjects were randomized to receive five intramuscular injections of the nicotine vaccine and 112 to receive placebo at monthly intervals. All subjects received individual behavioral smoking cessation counseling. The vaccine was safe, generally well tolerated and highly immunogenic, inducing a 100% antibody responder rate after the first injection. Point prevalence of abstinence at month 2 showed a statistically significant difference between subjects treated with Nicotine-Qbeta (47.2%) and placebo (35.1%) (P = 0.036), but continuous abstinence between months 2 and 6 was not significantly different. However, in subgroup analysis of the per-protocol population, the third of subjects with highest antibody levels showed higher continuous abstinence from month 2 until month 6 (56.6%) than placebo treated participants (31.3%) (OR 2.9; P = 0.004) while medium and low antibody levels did not increase abstinence rates. After 12 month, the difference in continuous abstinence rate between subjects on placebo and those with high antibody response was maintained (difference 20.2%, P = 0.012)., Conclusions: Whereas Nicotine-Qbeta did not significantly increase continuous abstinence rates in the intention-to-treat population, subgroup analyses of the per-protocol population suggest that such a vaccination against nicotine can significantly increase continuous abstinence rates in smokers when sufficiently high antibody levels are achieved. Immunotherapy might open a new avenue to the treatment of nicotine addiction., Trial Registration: Swiss Medical Registry 2003DR2327; ClinicalTrials.gov NCT00369616.

The trapping of single molecules on surfaces without the formation of strong covalent bonds is a prerequisite for molecular recognition and the exploitation of molecular function. On nanopatterned surfaces, molecules may be selectively trapped and addressed. In a boron nitride nanomesh formed on Rh(111), the pattern consisted of holes 2 nanometers in diameter on a hexagonal superlattice, separated by about 3 nanometers. The trapping was further investigated with density functional theory and the photoemission of adsorbed xenon, where the holes were identified as regions of low work function. The analysis showed that the trapping potential was localized at the rims of the holes.

Hexagonal boron nitride (h-BN) nanostructures were grown on Ru(0001), and are very similar to those previously reported on Rh(111). They show a highly regular 12 x 12 superstructure, comprising 2 nm wide apertures with a depth of about 0.1 nm. Valence band photoemission reveals two distinctly bonded h-BN species, and X-ray photoelectron spectroscopy indicates an h-BN monolayer film. The functionality of the h-BN/Ru(0001) nanomesh is demonstrated by using this structure for the assembly of gold nanoclusters.

We used angle-resolved photoemission spectroscopy to measure the electronic dispersion and single-particle spectral function in a liquid metal. A lead monolayer supported on a copper (111) surface was investigated as the temperature was raised through the melting transition of the film. Electron spectra and momentum distribution maps of the liquid film revealed three key features of the electronic structure of liquids: the persistence of a Fermi surface, the filling of band gaps, and the localization of the wave functions upon melting. Distinct coherence lengths for different sheets of the Fermi surface were found, indicating a strong dependence of the localization lengths on the character of the constituent atomic wave functions.

The character of the surface state wave function on regularly stepped Cu(111) is reinvestigated. It is shown that the qualitative change at terrace lengths around 17 A observed previously by Ortega et al. [Phys. Rev. Lett. 84, 6110 (2000)]] must necessarily be described as a change from a propagating superlattice state to a terrace-confined quasi-one-dimensional state. This reconciles previous, apparently contradictory experimental results and sheds new light on the behavior of nearly free electrons in nanostructures. Possible mechanisms driving the localization are discussed on the basis of the surface state bulk penetration depth, which has been measured in both regimes.

A highly regular mesh of hexagonal boron nitride with a 3-nanometer periodicity and a 2-nanometer hole size was formed by self-assembly on a Rh(111) single crystalline surface. Two layers of mesh cover the surface uniformly after high-temperature exposure of the clean rhodium surface to borazine (HBNH)3. The two layers are offset in such a way as to expose a minimum metal surface area. Hole formation is likely driven by the lattice mismatch of the film and the rhodium substrate. This regular nanostructure is thermally very stable and can serve as a template to organize molecules, as is exemplified by the decoration of the mesh by C60 molecules.