Development and validation of a clinical prediction rule for chest wall syndrome in primary care

Le "Chest wall syndrome" (CWS) est défini comme étant une source bénigne de douleurs thoraciques, localisées sur la paroi thoracique antérieure et provoquées par une affection musculosquelettique. Le CWS représente la cause la plus fréquente de douleurs thoraciques en médecine de premier recours. Le but de cette étude est de développer et valider un score de prédiction clinique pour le CWS. Une revue de la littérature a d'abord été effectuée, d'une part pour savoir si un tel score existait déjà, et d'autre part pour retrouver les variables décrites comme étant prédictives d'un CWS. Le travail d'analyse statistique a été effectué avec les données issues d'une cohorte clinique multicentrique de patients qui avaient consulté en médecine de premier recours en Suisse romande avec une douleur thoracique (59 cabinets, 672 patients). Un diagnostic définitif avait été posé à 12 mois de suivi. Les variables pertinentes ont été sélectionnées par analyses bivariées, et le score de prédiction clinique a été développé par régression logistique multivariée. Une validation externe de ce score a été faite en utilisant les données d'une cohorte allemande (n= 1212). Les analyses bivariées ont permis d'identifier 6 variables caractérisant le CWS : douleur thoracique (ni rétrosternale ni oppressive), douleur en lancées, douleur bien localisée, absence d'antécédent de maladie coronarienne, absence d'inquiétude du médecin et douleur reproductible à la palpation. Cette dernière variable compte pour 2 points dans le score, les autres comptent pour 1 point chacune; le score total s'étend donc de 0 à 7 points. Dans la cohorte de dérivation, l'aire sous la courbe sensibilité/spécificité (courbe ROC) est de 0.80 (95% de l'intervalle de confiance : 0.76-0.83). Avec un seuil diagnostic de > 6 points, le score présente 89% de spécificité et 45% de sensibilité. Parmi tous les patients qui présentaient un CWS (n = 284), 71% (n = 201) avaient une douleur reproductible à la palpation et 45% (n= 127) sont correctement diagnostiqués par le score. Pour une partie (n = 43) de ces patients souffrant de CWS et correctement classifiés, 65 investigations complémentaires (30 électrocardiogrammes, 16 radiographies du thorax, 10 analyses de laboratoire, 8 consultations spécialisées, et une tomodensitométrie thoracique) avaient été réalisées pour parvenir au diagnostic. Parmi les faux positifs (n = 41), on compte trois angors stables (1.8% de tous les positifs). Les résultats de la validation externe sont les suivants : une aire sous la courbe ROC de 0.76 (95% de l'intervalle de confiance : 0.73-0.79) avec une sensibilité de 22% et une spécificité de 93%. Ce score de prédiction clinique pour le CWS constitue un complément utile à son diagnostic, habituellement obtenu par exclusion. En effet, pour les 127 patients présentant un CWS et correctement classifiés par notre score, 65 investigations complémentaires auraient pu être évitées. Par ailleurs, la présence d'une douleur thoracique reproductible à la palpation, bien qu'étant sa plus importante caractéristique, n'est pas pathognomonique du CWS.

Conduction mechanisms and charge storage in Si-nanocrystals metal-oxide-semiconductor memory devices studied with conducting atomic force microscopy

In this work, we demonstrate that conductive atomic force microscopy (C-AFM) is a very powerful tool to investigate, at the nanoscale, metal-oxide-semiconductor structures with silicon nanocrystals (Si-nc) embedded in the gate oxide as memory devices. The high lateral resolution of this technique allows us to study extremely small areas ( ~ 300nm2) and, therefore, the electrical properties of a reduced number of Si-nc. C-AFM experiments have demonstrated that Si-nc enhance the gate oxide electrical conduction due to trap-assisted tunneling. On the other hand, Si-nc can act as trapping centers. The amount of charge stored in Si-nc has been estimated through the change induced in the barrier height measured from the I-V characteristics. The results show that only ~ 20% of the Si-nc are charged, demonstrating that the electrical behavior at the nanoscale is consistent with the macroscopic characterization.

The effect of substrate on high-temperature annealing of GaN epilayers: Si versus sapphire

We have studied the effects of rapid thermal annealing at 1300¿°C on GaN epilayers grown on AlN buffered Si(111) and on sapphire substrates. After annealing, the epilayers grown on Si display visible alterations with craterlike morphology scattered over the surface. The annealed GaN/Si layers were characterized by a range of experimental techniques: scanning electron microscopy, optical confocal imaging, energy dispersive x-ray microanalysis, Raman scattering, and cathodoluminescence. A substantial Si migration to the GaN epilayer was observed in the crater regions, where decomposition of GaN and formation of Si3N4 crystallites as well as metallic Ga droplets and Si nanocrystals have occurred. The average diameter of the Si nanocrystals was estimated from Raman scattering to be around 3¿nm. Such annealing effects, which are not observed in GaN grown on sapphire, are a significant issue for applications of GaN grown on Si(111) substrates when subsequent high-temperature processing is required.

Efficient energy transfer from Si clusters to Er3+ in complex silicate glasses

We present an extensive study of the structural and optical emission properties in aluminum silicates and soda-lime silicates codoped with Si nanoclusters (Si-nc) and Er. Si excess of 5 and 15¿at.¿% and Er concentrations ranging from 2×1019 up to 6×1020¿cm¿3 were introduced by ion implantation. Thermal treatments at different temperatures were carried out before and after Er implantation. Structural characterization of the resulting structures was performed to obtain the layer composition and the size distribution of Si clusters. A comprehensive study has been carried out of the light emission as a function of the matrix characteristics, Si and Er contents, excitation wavelength, and power. Er emission at 1540¿nm has been detected in all coimplanted glasses, with similar intensities. We estimated lifetimes ranging from 2.5¿to¿12¿ms (depending on the Er dose and Si excess) and an effective excitation cross section of about 1×10¿17¿cm2 at low fluxes that decreases at high pump power. By quantifying the amount of Er ions excited through Si-nc we find a fraction of 10% of the total Er concentration. Upconversion coefficients of about 3×10¿18¿cm¿3¿s¿1 have been found for soda-lime glasses and one order of magnitude lower in aluminum silicates.

Linear and nonlinear optical properties of Si nanocrystals in SiO2 deposited by plasma-enhanced chemical-vapor deposition

Linear and nonlinear optical properties of silicon suboxide SiOx films deposited by plasma-enhanced chemical-vapor deposition have been studied for different Si excesses up to 24¿at.¿%. The layers have been fully characterized with respect to their atomic composition and the structure of the Si precipitates. Linear refractive index and extinction coefficient have been determined in the whole visible range, enabling to estimate the optical bandgap as a function of the Si nanocrystal size. Nonlinear optical properties have been evaluated by the z-scan technique for two different excitations: at 0.80¿eV in the nanosecond regime and at 1.50¿eV in the femtosecond regime. Under nanosecond excitation conditions, the nonlinear process is ruled by thermal effects, showing large values of both nonlinear refractive index (n2 ~ ¿10¿8¿cm2/W) and nonlinear absorption coefficient (ß ~ 10¿6¿cm/W). Under femtosecond excitation conditions, a smaller nonlinear refractive index is found (n2 ~ 10¿12¿cm2/W), typical of nonlinearities arising from electronic response. The contribution per nanocrystal to the electronic third-order nonlinear susceptibility increases as the size of the Si nanoparticles is reduced, due to the appearance of electronic transitions between discrete levels induced by quantum confinement.

Nucleation and growth of GaN nanorods on Si (111) surfaces by plasma-assisted molecular beam epitaxy - The influence of Si- and Mg-doping

The self-assembled growth of GaN nanorods on Si (111) substrates by plasma-assisted molecular beam epitaxy under nitrogen-rich conditions is investigated. An amorphous silicon nitride layer is formed in the initial stage of growth that prevents the formation of a GaN wetting layer. The nucleation time was found to be strongly influenced by the substrate temperature and was more than 30 min for the applied growth conditions. The observed tapering and reduced length of silicon-doped nanorods is explained by enhanced nucleation on nonpolar facets and proves Ga-adatom diffusion on nanorod sidewalls as one contribution to the axial growth. The presence of Mg leads to an increased radial growth rate with a simultaneous decrease of the nanorod length and reduces the nucleation time for high Mg concentrations.

Influence of the (111) twinning on the formation of diamond cubic/diamond hexagonal heterostructures in Cu-catalyzed Si nanowires

The occurrence of heterostructures of cubic silicon/hexagonal silicon as disks defined along the nanowire (111) growth direction is reviewed in detail for Si nanowires obtained using Cu as catalyst. Detailed measurements on the structural properties of both semiconductor phases and their interface are presented. We observe that during growth, lamellar twinning on the cubic phase along the (111) direction is generated. Consecutive presence of twins along the (111) growth direction was found to be correlated with the origin of the local formation of the hexagonal Si segments along the nanowires, which define quantum wells of hexagonal Si diamond. Finally, we evaluate and comment on the consequences of the twins and wurtzite in the final electronic properties of the wires with the help of the predicted energy band diagram.

Modifications in the Si valence band after ion-beam-induced oxidation

The changes undergone by the Si surface after oxygen bombardment have special interest for acquiring a good understanding of the Si+-ion emission during secondary ion mass spectrometry (SIMS) analysis. For this reason a detailed investigation on the stoichiometry of the builtup surface oxides has been carried out using in situ x-ray photoemission spectroscopy (XPS). The XPS analysis of the Si 2p core level indicates a strong presence of suboxide chemical states when bombarding at angles of incidence larger than 30°. In this work a special emphasis on the analysis and interpretation of the valence band region was made. Since the surface stoichiometry or degree of oxidation varies with the angle of incidence, the respective valence band structures also differ. A comparison with experimentally measured and theoretically derived Si valence band and SiO2 valence band suggests that the new valence bands are formed by a combination of these two. This arises from the fact that Si¿Si bonds are present on the Si¿suboxide molecules, and therefore the corresponding 3p-3p Si-like subband, which extends towards the Si Fermi level, forms the top of the respective new valence bands. Small variations in intensity and energy position for this subband have drastic implications on the intensity of the Si+-ion emission during sputtering in SIMS measurements. A model combining chemically enhanced emission and resonant tunneling effects is suggested for the variations observed in ion emission during O+2 bombardment for Si targets.

Bipolar pulsed excitation of erbium-doped nanosilicon light emitting diodes

High quantum efficiency erbium doped silicon nanocluster (Si-NC:Er) light emitting diodes (LEDs) were grown by low-pressure chemical vapor deposition (LPCVD) in a complementary metal-oxide-semiconductor (CMOS) line. Erbium (Er) excitation mechanisms under direct current (DC) and bipolar pulsed electrical injection were studied in a broad range of excitation voltages and frequencies. Under DC excitation, Fowler-Nordheim tunneling of electrons is mediated by Er-related trap states and electroluminescence originates from impact excitation of Er ions. When the bipolar pulsed electrical injection is used, the electron transport and Er excitation mechanism change. Sequential injection of electrons and holes into silicon nanoclusters takes place and nonradiative energy transfer to Er ions is observed. This mechanism occurs in a range of lower driving voltages than those observed in DC and injection frequencies higher than the Er emission rate.

Sintesis por implantacion ionica de nanocristales semiconductores para dispositivos en tecnologia de Si

En este artículo se estudia la síntesis de nanocristales semiconductores elementales y compuestos elaborados por implantación iónica en SiO2. En el caso de los nanocristales de Si, se ha desarrollado un estudio sistemático que correlaciona las características de los precipitados y sus propiedades de luminiscencia. Nanopartículas de Ge, que presentan menor emisión pero mayor contraste en Microscopía Electrónica de Transmisión, han sido fabricadas para desarrollar un nuevo método de medida de la densidad de nanocristales en matrices amorfas. Por otro lado, nanopartículas de ZnS dopadas con Mn han sido elaboradas por primera vez con esta técnica, observando la emisión de un pico de luminescencia característico de una transición intra-Mn. Finalmente, se presentan los primeros resultados ópticos de capas coimplantadas con Si+ y C+, que muestran la presencia de tres picos intensos de luminescencia en las regiones roja, verde y azul del espectro visible, que ha sido relacionada con la presencia de diferentes tipos de nanopartículas. Cabe destacar que la emisión simultánea de los tres picos ha permitido la observación de una intensa emisión de luz blanca.

Polarization strategies to improve the emission of a Si-based light source emitting at 1.55 um

We present a electroluminescence (EL) study of the Si-rich silicon oxide (SRSO) LEDs with and without Er3+ ions under different polarization schemes: direct current (DC) and pulsed voltage (PV). The power efficiency of the devices and their main optical limitations are presented. We show that under PV polarization scheme, the devices achieve one order of magnitude superior performance in comparison with DC. Time-resolved measurements have shown that this enhancement is met only for active layers in which annealing temperature is high enough (>1000 ◦C) for silicon nanocrystal (Si-nc) formation. Modeling of the system with rate equations has been done and excitation cross-sections for both Si-nc and Er3+ ions have been extracted.

Er-Coupled Si Nanocluster Waveguide

Rib-loaded waveguides containing Er3+-coupled Si nanoclusters (Si-nc) have been produced to observe optical gain at 1535 nm. The presence ofSi-nc strongly improves the efficiency ofEr 3+ excitation but may introduce optical loss mechanisms, such as Mie scattering and confined carrier absorption. Losses strongly affect the possibility of obtaining positive optical gain. Si-nc-related losses have been minimized to 1 dB/cm by lowering the annealing time ofthe Er3+-doped silicon-rich oxide deposited by reactive magnetron cosputtering. Photoluminescence (PL) and lifetime measurements show that all Er3+ ions are optically active while those that can be excited at high pump rates via Si-nc are only a small percentage. Er3+ absorption cross section is found comparable to that ofEr 3+ in SiO 2.However, dependence on the effective refractive index has been found. In pump-probe measurements, it is shown how the detrimental role ofconfined carrier absorption can be attenuated by reducing the annealing time. A maximum signal enhancement ofabout 1.34 at 1535 nm was measured.

Model for the emission of Si+ ions during oxygen bombardment of Si(100) surfaces

The variation in the emission of Si+ ions from ion-beam-induced oxidized silicon surfaces has been studied. The stoichiometry and the electronic structure of the altered layer has been characterized using x-ray photoelectron spectroscopy (XPS). The XPS analysis of the Si 2p core level indicates the strong presence of suboxide chemical states when bombarding at angles of incidence larger than 30 °. Since the surface stoichiometry or degree of oxidation varies with the angle of incidence, the corresponding valence-band structures also differ among each other. A comparison between experimental measurements and theoretically calculated Si and SiO2 valence bands indicates that the valence bands for the altered layers are formed by a combination of those two. Since Si-Si bonds are present in the suboxide molecules, the top of the respective new valence bands are formed by the corresponding 3p-3p Si-like subbands, which extend up to the Si Fermi level. The changes in stoichiometry and electronic structure have been correlated with the emission of Si+ ions from these surfaces. From the results a general model for the Si+ ion emission is proposed combining the resonant tunneling and local-bond-breaking models.

The vasodilatory response of skin microcirculation to local heating is subject to desensitization

RAPPORT DE SYNTHESE Introduction : dans la présente étude, nous nous sommes intéressés à la vasodilatation cutanée induite par le réchauffement local (hyperémie thermique). Il est établi, qu'une partie de cette réponse vasculaire est médiée par l'oxyde nitrique (NO). De manière générale, les effets du NO peuvent être sujets à une désensibilisation, comme nous le démontre le phénomène bien connu de tolérance aux dérivés nitrés. Le but du présent travail était d'évaluer si une telle désensibilisation existe dans le cas de l'hyperémie thermique. Méthodes : nous avons donc examiné si une première stimulation thermique pouvait en atténuer une deuxième, induite plus tard sur le même site cutané à une intervalle de 2h ou 4h. Pour vérifier directement l'effet du réchauffement local sur la sensibilité de la microcirculation cutanée au NO, nous avons de plus appliqué un donneur de NO (nitroprussiate de sodium, SNP) par la technique d' iontophorèse, sur des sites cutanés préalablement soumis à un échauffement local 2h ou 4h auparavant. Nous avons examinés 12 sujets en bonne santé habituelle, de sexe masculin, non fumeurs, âgés de 18 à 30 ans, ne prenant aucune médication. Le flux sanguin dermique a été mesuré par imagerie laser Doppler (LDI, Moor Instruments) sur la face antérieur de l'avant-bras. Le réchauffement local de la peau a été effectué grâce a des petits anneaux métalliques thermo-contrôlés contenant de l'eau. La température était initialement de 34°C. Elle a été augmentée à 41 °C en une minute et maintenue à cette valeur durant 30 minutes. Cette manoeuvre a été répétée sur le même site cutané soit 2 h, soit 4h plus tard. Quant à l'iontophorèse de SNP, elle a été effectuée sur des sites ayant préalablement subi, 2h ou 4h auparavant, un échauffement unique appliqué selon la technique qui vient d'être décrite. Résultats : nous avons observé une atténuation de l'hyperémie thermique lorsque celleci était examinée 2h après un premier échauffement local. Lorsque l'intervalle était de 4h la réponse vasodilatatrice n'était pas réduite. Nous avons également observé une atténuation de la réponse vasodilatatrice au SNP lorsque celui-ci a était appliqué 2h, mais non 4h après un premier échauffement local. Conclusion :cette étude démontre que la réponse vasodilatatrice cutanée induite par l'échauffement local est bien sujette à désensibilisation, comme nous en avions formulé l'hypothèse. Ce phénomène est transitoire. Il est lié, au moins en partie, à une baisse de sensibilité de la microcirculation cutanée aux effets vasodilatateurs du NO.