Predictive factors of adrenal insufficiency in patients admitted to acute medical wards: a case control study.

BACKGROUND: Adrenal insufficiency is a rare and potentially lethal disease if untreated. Several clinical signs and biological markers are associated with glucocorticoid failure but the importance of these factors for diagnosing adrenal insufficiency is not known. In this study, we aimed to assess the prevalence of and the factors associated with adrenal insufficiency among patients admitted to an acute internal medicine ward. METHODS: Retrospective, case-control study including all patients with high-dose (250 μg) ACTH-stimulation tests for suspected adrenal insufficiency performed between 2008 and 2010 in an acute internal medicine ward (n = 281). Cortisol values <550 nmol/l upon ACTH-stimulation test were considered diagnostic for adrenal insufficiency. Area under the ROC curve (AROC), sensitivity, specificity, negative and positive predictive values for adrenal insufficiency were assessed for thirteen symptoms, signs and biological variables. RESULTS: 32 patients (11.4%) presented adrenal insufficiency; the others served as controls. Among all clinical and biological parameters studied, history of glucocorticoid withdrawal was the only independent factor significantly associated with patients with adrenal insufficiency (Odds Ratio: 6.71, 95% CI: 3.08 -14.62). Using a logistic regression, a model with four significant and independent variable was obtained, regrouping history of glucocorticoid withdrawal (OR 7.38, 95% CI [3.18 ; 17.11], p-value <0.001), nausea (OR 3.37, 95% CI [1.03 ; 11.00], p-value 0.044), eosinophilia (OR 17.6, 95% CI [1.02; 302.3], p-value 0.048) and hyperkalemia (OR 2.41, 95% CI [0.87; 6.69], p-value 0.092). The AROC (95% CI) was 0.75 (0.70; 0.80) for this model, with 6.3 (0.8 - 20.8) for sensitivity and 99.2 (97.1 - 99.9) for specificity. CONCLUSIONS: 11.4% of patients with suspected adrenal insufficient admitted to acute medical ward actually do present with adrenal insufficiency, defined by an abnormal response to high-dose (250 μg) ACTH-stimulation test. A history of glucocorticoid withdrawal was the strongest factor predicting the potential adrenal failure. The combination of a history of glucocorticoid withdrawal, nausea, eosinophilia and hyperkaliemia might be of interest to suspect adrenal insufficiency

Impact of smoking on fertility and age of menopause: a population-based assessment.

Studies in patients seeking medically assisted reproduction have shown that smoking reduces fertility, but little information is available in the general population. We assessed the associations between smoking and the number of children, childbearing planning and age at menopause in a representative sample of the population of Lausanne, Switzerland. Data from 6711 participants (3530 women, age range 35-75 years) collected between 2003 and 2006 and again in 2009 and 2012. Smoking status, number of offsprings and age of menopause were assessed. Women who currently smoke had significantly less children than former or never smokers: the number of children per women (average±SD) was 1.38±1.05, 1.45±1.07 and 1.576±1.16, respectively (p<0.001). Women who currently smoke had their first child at an earlier age than the others: 26.7±5.2, 27.4±5.4 and 26.9±5.2 years old for current, former and never smokers, respectively, (p=0.01). Similar findings were found for men: number of children per men 1.475±1.16, 1.67±1.13 and 1.55±1.22 for current, former and never smokers, respectively (p<0.001); no difference was found regarding age at the first child. The difference persisted after multivariate adjustment (adjusted for age, body mass index, Caucasian origins, alcohol consumption, caffeinated drinks consumption, educational level, receiving social help and women taking contraceptives) for the age at first child among women. No association was found between Heaviness of Smoking Index and the number of children among current smokers in both genders. Women who smoke had their menopause more than 1 year prior than never-smoking women (48.9±0.2 years compared with 47.8±0.3 years, respectively, p=0.002). Smoking is associated with an earlier age of having the first child and of menopause among women

Interface modes of two-dimensional composite structures

The surface modes of a composite consisting of aligned metallic wires with square cross sections are investigated, on the basis of photonic band structure calculations. The effective long-wavelength dielectric response function is computed, as a function of the filling fraction. The dependence of the optical absorption on the shape of the wires and the polarization of light is discussed, and the effect of sharp corners analyzed. The effect of the interaction between the wires on the localization of surface plasmons is also addressed.Comment: 12 pages, 4 figures, to appear in Surf. Sc

Towards a reasoned 1-D river model calibration

Le calage de modèle reste une étape critique de la modélisation numérique. Après de nombreuses tentatives d`automatisation de cette tâche dans différentes domaines liés à l`eau, des questions se posent encore sur la nécessité de caler des modèles à base physique. Cet article propose aux utilisateurs de codes de calcul en hydraulique un cadre pour réaliser cette tâche selon un « code de bonnes pratiques ». Ce cadre comporte une formalisation des objets manipulés en hydraulique fluviale 1-D ainsi qu`une description conceptuelle générique du processus de calage. Ces deux éléments ont été implémentés dans un système à base de connaissances, intégrant un code de calcul ainsi que des connaissances d`experts sur le calage de modèle. Un prototype de système d`assistance au calage a ensuite été construit à l`aide d`un code de calcul résolvant les équations de Saint-Venant dans des rivières à lit fixe. Le cadre fourni pour le calage de modèle est composé de trois niveaux indépendants reliés respectivement à la tâche générique, au domaine d`application, et au code de calcul lui-même. Les deux premiers niveaux de connaissances peuvent ainsi aisément être réutilisés pour construire des systèmes d`assistance au calage pour d`autres domaines d`application, comme l`hydraulique 2-D ou encore la modélisation hydrologique à base physique. / Model calibration remains a critical step in numerical modelling. After many attempts to automate this task in water-related domains, questions about the actual need for calibrating physics-based models are still open. This article proposes a framework for good model calibration practice for end-users of 1-D hydraulic simulation codes. This framework includes a formalisation of objects used in 1-D river hydraulics along with a generic conceptual description of the model calibration process. It was implemented within a knowledge-based system integrating a simulation code and expert knowledge about model calibration. A prototype calibration support system was then built up with a specific simulation code solving subcritical unsteady flow equations for fixed-bed rivers. The framework for model calibration is composed of three independent levels related respectively to the generic task, to the application domain, and to the simulation code itself. The first two knowledge levels can thus easily be reused to build calibration support systems for other application domains, like 2-D hydrodynamics or physics-based rainfall-runoff modelling

River model calibration, from guidelines to operational support tools

Numerical modelling is now used routinely to make predictions about the behaviour of environmental systems. Model calibration remains a critical step in the modelling process and different approaches have been taken to develop guidelines to support engineers and scientists in this task. This article reviews currently available guidelines for a river hydraulics modeller by dividing them into three types: on the calibration process, on hydraulic parameters, and on the use of hydraulic simulation codes. The article then presents an integration of selected guidelines within a knowledge-based calibration support system. A prototype called CaRMA-1 (Calibration of River Model Assistant) has been developed for supporting the calibration of models based on a specific 1D code. Two case studies illustrate the ability of the prototype to face operational situations in river hydraulics engineering, for which both data quality and quantity are not sufficient for an optimal calibration. Using CaRMA-1 allows the modeller to achieve the calibration task in accordance with good calibration practice implemented in the knowledge base. Relevant reasoning rules can easily be added to the knowledge base to extend the prototype range of applications. This study thus provides a framework for building operational support tools from various types of existing engineering guidelines

A comparison of DA white dwarf temperatures and gravities from Lyman and Balmer line studies

We present measurements of the effective temperatures and surface gravities for a sample of hot DA white dwarfs, using the Lyman line data available from the HUT, ORFEUS and FUSE far-UV space missions. Comparing the results with those from the standard Balmer line technique, we find that there is a general good overall agreement between the two methods. However, significant differences are found for a number of stars, but not always of a consistent nature in that sometimes the Balmer temperature exceeds that derived from the Lyman lines and in other instances is lower. We conclude that, with the latest model atmosphere calculations, these discrepancies probably do not arise from an inadequate theoretical treatment of the Lyman lines but rather from systematic effects in the observation and data reduction processes, which dominate the statistical errors in these spectra. If these systematic data reduction effects can be adequately controlled, the Lyman line temperature and gravity measurements are consistent with those obtained from the Balmer lines when allowance is made for reasonable observational uncertainties.Comment: Accepted for publication in Monthly Notices of the Royal Astronomical Society 14 pages, 13 figure

Excitation Spectrum of One-dimensional Extended Ionic Hubbard Model

We use Perturbative Continuous Unitary Transformations (PCUT) to study the one dimensional Extended Ionic Hubbard Model (EIHM) at half-filling in the band insulator region. The extended ionic Hubbard model, in addition to the usual ionic Hubbard model, includes an inter-site nearest-neighbor (n.n.) repulsion, $V$. We consider the ionic potential as unperturbed part of the Hamiltonian, while the hopping and interaction (quartic) terms are treated as perturbation. We calculate total energy and ionicity in the ground state. Above the ground state, (i) we calculate the single particle excitation spectrum by adding an electron or a hole to the system. (ii) the coherence-length and spectrum of electron-hole excitation are obtained. Our calculations reveal that for V=0, there are two triplet bound state modes and three singlet modes, two anti-bound states and one bound state, while for finite values of $V$ there are four excitonic bound states corresponding to two singlet and two triplet modes. The major role of on-site Coulomb repulsion $U$ is to split singlet and triplet collective excitation branches, while $V$ tends to pull the singlet branches below the continuum to make them bound states.Comment: 10 eps figure

Electrically tunable solid-state silicon nanopore ion filter

We show that a nanopore in a silicon membrane connected to a voltage source can be used as an electrically tunable ion filter. By applying a voltage between the heavily doped semiconductor and the electrolyte, it is possible to invert the ion population inside the nanopore and vary the conductance for both cations and anions in order to achieve selective conduction of ions even in the presence of significant surface charges in the membrane. Our model based on the solution of the Poisson equation and linear transport theory indicates that in narrow nanopores substantial gain can be achieved by controlling electrically the width of the charge double layer

Study of Loschmidt Echo for a qubit coupled to an XY-spin chain environment

We study the temporal evolution of a central spin-1/2 (qubit) coupled to the environment which is chosen to be a spin-1/2 transverse XY spin chain. We explore the entire phase diagram of the spin-Hamiltonian and investigate the behavior of Loschmidt echo(LE) close to critical and multicritical point(MCP). To achieve this, the qubit is coupled to the spin chain through the anisotropy term as well as one of the interaction terms. Our study reveals that the echo has a faster decay with the system size (in the short time limit) close to a MCP and also the scaling obeyed by the quasiperiod of the collapse and revival of the LE is different in comparison to that close to a QCP. We also show that even when approached along the gapless critical line, the scaling of the LE is determined by the MCP where the energy gap shows a faster decay with the system size. This claim is verified by studying the short-time and also the collapse and revival behavior of the LE at a quasicritical point on the ferromagnetic side of the MCP. We also connect our observation to the decoherence of the central spin.Comment: Accepted for publication in EPJ