Saving the Object of Research Before Its Destruction: Renate Wagner-Rieger’s Commitment to 19th-Century Architecture In the Context of the Ringstrasse-Publication Project

Der Beitrag untersucht die Bezüge zwischen Renate Wagner-Riegers bedeutendem Forschungsunternehmen „Wiener Ringstraße“ und ihrem Engagement für die Erhaltung der Architektur des 19. Jahrhunderts im Kontext der kunsthistorischen Neubewertung des Historismus.U članku se istražuju veze između istraživačkog projekta Renate Wagner-Rieger „Wiener Ringstraße” i njezina zalaganja za očuvanje arhitekture 19. stoljeća u kontekstu povijesnoumjetničke reevaluacije historicizma.The article examines the relationship between Renate Wagner-Rieger’s important research project „Wiener Ringstrasse“ and her commitment to preserving 19th-century architecture in the context of evaluating historicism

The use of mid-regional proadrenomedullin to identify disease severity and treatment response to sepsis - a secondary analysis of a large randomised controlled trial

Background: This study assessed the ability of mid-regional proadrenomedullin (MR-proADM) in comparison to conventional biomarkers (procalcitonin (PCT), lactate, C-reactive protein) and clinical scores to identify disease severity in patients with sepsis. Methods: This is a secondary analysis of a randomised controlled trial in patients with severe sepsis or septic shock across 33 German intensive care units. The association between biomarkers and clinical scores with mortality was assessed by Cox regression analysis, area under the receiver operating characteristic and Kaplan-Meier curves. Patients were stratified into three severity groups (low, intermediate, high) for all biomarkers and scores based on cutoffs with either a 90% sensitivity or specificity. Results: 1089 patients with a 28-day mortality rate of 26.9% were analysed. According to the Sepsis-3 definition, 41. 2% and 58.8% fulfilled the criteria for sepsis and septic shock, with respective mortality rates of 20.0% and 32.1%. MR-proADM had the strongest association with mortality across all Sepsis-1 and Sepsis-3 subgroups and could facilitate a more accurate classification of low (e.g. MR-proADM vs. SOFA: N = 265 vs. 232;9.8% vs. 13.8% mortality) and high (e.g. MR-proADM vs. SOFA: N = 161 vs. 155;55.9% vs. 41.3% mortality) disease severity. Patients with decreasing PCT concentrations of either >= 20% (baseline to day 1) or >= 50% (baseline to day 4) but continuously high MR-proADM concentrations had a significantly increased mortality risk (HR (95% CI): 19.1 (8.0-45.9) and 43.1 (10.1-184.0)). Conclusions: MR-proADM identifies disease severity and treatment response more accurately than established biomarkers and scores, adding additional information to facilitate rapid clinical decision-making and improve personalised sepsis treatment

Efficacy and safety of Vilobelimab (IFX-1), a novel monoclonal anti-C5a antibody, in patients with early severe sepsis or septic shock — a randomized, placebo-controlled, double-blind, multicenter, phase IIa Trial (SCIENS Study)

IMPORTANCE:. Anaphylatoxin C5a, a proinflammatory complement split product, plays a central role in mediating organ dysfunction. OBJECTIVES:. This phase II clinical trial was conducted to study safety, tolerability, pharmacokinetics, and pharmacodynamics of vilobelimab, a recombinant monoclonal antibody against C5a, in patients with severe sepsis or septic shock. DESIGN:. Multicenter, randomized, and placebo-controlled study. SETTING AND PARTICIPANTS:. Eleven multidisciplinary ICUs across Germany. Adult patients with severe sepsis or septic shock and with early onset of infection-associated organ dysfunction. MAIN OUTCOMES AND MEASURES:. Patients were randomly assigned in a ratio of 2:1 to three subsequent dosing cohorts for IV vilobelimab or placebo receiving either 2 × 2 mg/kg (0 and 12 hr), 2 × 4 mg/kg (0 and 24 hr), and 3 × 4 mg/kg (0, 24, and 72 hr). Co-primary endpoints were pharmacodynamics (assessed by C5a concentrations), pharmacokinetics (assessed by vilobelimab concentrations), and safety of vilobelimab. Preliminary efficacy was evaluated by secondary objectives. RESULTS:. Seventy-two patients were randomized (16 patients for each vilobelimab dosing cohort and eight patients for each placebo dosing cohort). Vilobelimab application was associated with dosing dependent decrease in C5a compared with baseline (p < 0.001). Duration of C5a decrease increased with more frequent dosing. Membrane attack complex lysis capacity measured by 50% hemolytic complement was not affected. Vilobelimab was well tolerated with similar safety findings in all dose cohorts. No vilobelimab-specific adverse events emerged. For vilobelimab-treated patients, investigators attributed less treatment-emergent adverse events as related compared with placebo. Dosing cohorts 2 and 3 had the highest ICU-free and ventilator-free days. There was no difference in mortality, vasopressor-free days, or renal replacement therapy-free days between the groups. CONCLUSIONS AND RELEVANCE:. Administration of vilobelimab in patients with severe sepsis and septic shock selectively neutralizes C5a in a dose-dependent manner without blocking formation of the membrane attack complex and without resulting in detected safety issues. The data warrant further investigation of C5a inhibition in sepsis

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Kreuzenstein

Kreuzenstein Castle was built between 1874 and 1906 on the ruins of a medieval fortress. It was conceived as a family mausoleum and venue for preserving and displaying the owner’s collection of medieval art, but it can also be interpreted as the idealized vision of a medieval castle from the perspective of the 19th century. This study clarifies to what extent our view of the medieval castle is contingent on the faults, fractures and “constructs” of modernity.Burg Kreuzenstein wurde zwischen 1874 und 1906 auf den Ruinen einer mittelalterlichen Festung errichtet. Der Bau sollte als Familienmausoleum ebenso wie als Aufbewahrungs- und Präsentationsort für eine umfangreiche Kunstsammlung dienen und kann als mittelalterliche „Idealburg“ des 19. Jahrhunderts bezeichnet werden. Ausgehend von Kreuzenstein macht die vorliegende Studie deutlich, dass unser heutiges Bild von der mittelalterlichen Burg in entscheidenden Bereichen auf „Konstruktionen“ der Moderne beruht

Exhibitions on the Baroque as media of the construction of Austrian identities in the 20th century

This essay deals with the construction of national identity in Austria through museum presentations and exhibitions of Baroque art between 1900 and 1960. The approach understands museums and exhibitions as ‘media’ providing visual expression of a variety of narratives on national identities. Around 1900 the Baroque was presented as being a style ‘typical’ of Austria – a country whose multi-ethnic make-up meant that it lacked the characteristics of a classic modern nation. References to the ‘supranational’ Baroque were thus seen as an appropriate manner in which to construct ‘Austrianness’ as distinction from the the German Reich. Yet, after the 1914–1918 war, Baroque art began to be used to demonstrate the cultural unity of Austria with Germany. Again, after 1945, the grounding for the construction of an Austrian nation – one seemingly independent of Germany and of its Nazi past – once more took hold of historical references to the Baroque, which now served to demonstrate the country’s European orientation. Today, however, the recently rediscovered golden age of ‘Vienna 1900’ seems to have replaced the Baroque as a central reference in defining the Austrian identity

Kreuzenstein

Kreuzenstein Castle was built between 1874 and 1906 on the ruins of a medieval fortress. It was conceived as a family mausoleum and venue for preserving and displaying the owner’s collection of medieval art, but it can also be interpreted as the idealized vision of a medieval castle from the perspective of the 19th century. This study clarifies to what extent our view of the medieval castle is contingent on the faults, fractures and “constructs” of modernity