Predicting complicated appendicitis based on clinical findings: the role of Alvarado and appendicitis inflammatory response scores

PURPOSE: The pre-interventional differentiation between complicated and uncomplicated appendicitis is decisive for treatment. In the context of conservative therapy, the definitive diagnosis of uncomplicated appendicitis is mandatory. This study investigates the ability of clinical scoring systems and imaging to differentiate between the two entities. METHODS: This is a retrospective analysis of two cohorts from two tertiary referral centers in Switzerland and Germany. All consecutive patients underwent appendectomy between January 2008 and April 2013 (in the first cohort) or between January 2017 and June 2019 (the second cohort). Exclusion criteria did not apply as all patients found by the database search and received an appendectomy were included. Diagnostic testing and calculation of a receiver operating curve were performed to identify a cutoff for clinical scores that resulted in a minimum sensitivity of 90% to detect complicated appendicitis. The cutoff was combined with additional diagnostic imaging criteria to see if diagnostic properties could be improved. RESULTS: Nine hundred fifty-six patients were included in the analysis. Two hundred twenty patients (23%) had complicated appendicitis, and 736 patients (77%) had uncomplicated appendicitis or no inflammation. The complicated appendicitis cohort had a mean Alvarado score of 7.03 and a mean AIR of 5.21. This compared to a mean Alvarado of 6.53 and a mean AIR of 4.07 for the uncomplicated appendicitis cohort. The highest Alvarado score with a sensitivity of > 90% to detect complicated appendicitis was >== 5 (sensitivity = 95%, specificity 8.99%). The highest AIR score with a sensitivity of > 90% to detect complicated appendicitis was >== 3 (sensitivity 91.82%, specificity 18.53). The analysis showed that additional CT information did not improve the sensitivity of the proposed cut-offs. CONCLUSION: AIR and Alvarado scores showed limited capability to distinguish between complicated and uncomplicated appendicitis even with additional imaging in this retrospective cohort. As conservative management of appendicitis needs to exclude patients with complicated disease reliably, appendectomy seems until now to remain the safest option to prevent undertreatment of this mostly benign disease

Bethe-Salpeter Amplitudes and Static Properties of the Deuteron

Extended calculations of the deuteron's static properties, based on the numerical solution of the Bethe-Salpeter equation, are presented. A formalism is developed, which provides a comparative analysis of the covariant amplitudes in various representations and nonrelativistic wave functions. The magnetic and quadrupole moments of the deuteron are calculated in the Bethe-Salpeter formalism and the role of relativistic corrections is discussed.Comment: 33 pages ([aps]{revtex} style), 9 Postscript figures; (55 pages if [preprint,aps]{revtex} style is used

Cluster Performance reconsidered: Structure, Linkages and Paths in the German Biotechnology Industry, 1996-2003

This paper addresses the evolution of biotechnology clusters in Germany between 1996 and 2003, paying particular attention to their respective composition in terms of venture capital, basic science institutions and biotechnology firms. Drawing upon the significance of co-location of "money and ideas", the literature stressing the importance of a cluster's openness and external linkages, and the path dependency debate, the paper aims to analyse how certain cluster characteristics correspond with its overall performance. After identifying different cluster types, we investigate their internal and external interconnectivity in comparative manner and draw on changes in cluster composition. Our results indicate that the structure, i.e. to which group the cluster belongs, and the openness towards external knowledge flows deliver merely unsystematic indications with regard to a cluster's overall success. Its ability to change composition towards a more balanced ratio of science and capital over time, on the other hand, turns out as a key explanatory factor. Hence, the dynamic perspective proves effective illuminating cluster growth and performance, where our explorative findings provide a promising avenue for further evolutionary research

Modelling Hot Spots of Soil Loss by Wind Erosion (SoLoWind) in Western Saxony, Germany

Land Degradation and Development published by John Wiley & Sons, Ltd. While it needs yet to be assessed whether or not wind erosion in Western Saxony is a major point of concern regarding land degradation and fertility, it has already been recognized that considerable off-site effects of wind erosion in the adjacent regions of Saxony-Anhalt and Brandenburg are connected to the spread of herbicides, pesticides and dust. So far, no wind erosion assessment for Western Saxony, Germany, exists. The wind erosion model previously applied for Germany (DIN standard 19706) is considering neither changes in wind direction over time nor influences of field size. This study aims to provide a first assessment of wind erosion for Western Saxony by extending the existing DIN model to a multidirectional model on soil loss by wind (SoLoWind) with new controlling factors (changing wind directions, soil cover, mean field length and mean protection zone) combined by fuzzy logic. SoLoWind is used for a local off-site effect evaluation in combination with high-resolution wind speed and wind direction data at a section of the highway A72. The model attributes 3·6% of the arable fields in Western Saxony to the very-high-wind erosion risk class. A relationship between larger fields (greater than 116 ha) and higher proportions (51·7%) of very-high-wind erosion risk can be observed. Sections of the highway A72 might be under high risk according to the modelled off-site effects of wind erosion. The presented applications showed the potential of SoLoWind to support and consult management for protection measures on a regional scale. © 2016 The Authors. Land Degradation and Development published by John Wiley & Sons, Ltd.The authors would like to thank Jürgen Heinrich and Gudrun Mayer for the technical revision of the model conception and the German Weather Service, the Saxon State Office for the Environment, Agriculture and Geology, the Saxon State Office for Road Construction and Traffic, the Saxon State Ministry of the Environment and Agriculture, the Saxon State Spatial Data and Land Survey Corporation, the Saxon Road Maintenance Depots, OpenStreetMap and the National Aeronautics and Space Administration for providing the datasets. We would also like to thank three anonymous reviewers for helpful comments.info:eu-repo/semantics/publishedVersio

The role of universities in regional development: conceptual models and policy institutions in the UK, Sweden and Austria

The literature on universities’ contributions to regional development is broad and diverse. A precise understanding of how regions may draw advantages from various university activities and the role of public policy institutions in promoting such activities is still missing. The aim of this paper is to provide a framework for analysing universities’ contributions to regional economic and societal development in differing national contexts and the policy institutions that underpin them. To do this, we review four conceptual models: the entrepreneurial university model, the regional innovation system (RIS) model, the mode 2 university model and the engaged university model. The paper demonstrates that these four models emphasize very different activities and outputs by which universities are seen to benefit regional economy and society. It is also shown that these models differ markedly with respect to the policy implications and practice. Analysing some of the public policy imperatives and incentives in the UK, Austria and Sweden, the paper highlights that in the UK, policies encourage all four university models. In contrast, in Sweden and Austria, policy institutions tend to privilege the RIS university model, whilst at the same time, there is some evidence for increasing support of the entrepreneurial university model

Manejo de la defoliación y fertilización nitrogenada en pasto llorón, Eragrostis curvula, cv. Tanganyka : 1-rendimiento de materia seca, digestibilidad in vitro y rendimiento de materia seca digestible

p.7-14En una pradera de pasto llorón ubicada en Argerich se estudió el efecto de dos tratamientos de defoliación y tres niveles de fertilización nitrogenada durante tres ciclos consecutivos. El forraje se cortó con una frecuencia de 35 cm de altura o acumulado, hasta el 20 de febrero (primavera-verano), y sus rebrotes otoñales se cortaron en invierno (diferido). En primavera-verano el corte a 35 cm, produjo en promedio más materia seca que el acumulado y en el diferido a la inversa. Sus totales anuales fueron similares. La fertilización aumentó los rendimientos promedios parciales y totales (P menor a 0,05). La digestibiüdad primavera-estival fue mayor con cortes a 35 cm que en el acumulado y ambos tratamientos de defoliación respondieron al nitrógeno pero en sus diferidos el efecto fue de pequeña magnitud. Los rendimientos de materia seca digestible siguieron la misma tendencia que los de materia seca aunque, por influencia primavera-estival, en el total anual el corte a 35 cm superó al acumulado (P menor a 0,05). El rebrote primaveral sólo mostró un efecto residual parcial del fertilizante

Age, retirement and health as factors in volunteering in later life

Volunteering in later life attracts attention because its benefits older volunteers, voluntary associations, and society. Unfortunately, researchers and practitioners struggle with the complexity of predicting who volunteers. The authors ask whether a rough identification of older volunteers solely based on age is possible. The authors answer this question by means of structural equation modeling, analyzing international survey data. The findings show that the direct effect of age on the time older people spend volunteering is negligible. Moreover, the age patterns in volunteering created by retirement and declining health are weak. Those findings make age an unsuitable indicator for volunteering in later life. The authors recommend that voluntary organizations and policy makers use personal characteristics, such as health status, when defining their target groups for programs that encourage volunteering. In addition, researchers should not use an age group when referring to the third age, meaning the active and productive part of old age