Covid-19 triage in the emergency department 2.0: how analytics and AI transform a human-made algorithm for the prediction of clinical pathways

The Covid-19 pandemic has pushed many hospitals to their capacity limits. Therefore, a triage of patients has been discussed controversially primarily through an ethical perspective. The term triage contains many aspects such as urgency of treatment, severity of the disease and pre-existing conditions, access to critical care, or the classification of patients regarding subsequent clinical pathways starting from the emergency department. The determination of the pathways is important not only for patient care, but also for capacity planning in hospitals. We examine the performance of a human-made triage algorithm for clinical pathways which is considered a guideline for emergency departments in Germany based on a large multicenter dataset with over 4,000 European Covid-19 patients from the LEOSS registry. We find an accuracy of 28 percent and approximately 15 percent sensitivity for the ward class. The results serve as a benchmark for our extensions including an additional category of palliative care as a new label, analytics, AI, XAI, and interactive techniques. We find significant potential of analytics and AI in Covid-19 triage regarding accuracy, sensitivity, and other performance metrics whilst our interactive human-AI algorithm shows superior performance with approximately 73 percent accuracy and up to 76 percent sensitivity. The results are independent of the data preparation process regarding the imputation of missing values or grouping of comorbidities. In addition, we find that the consideration of an additional label palliative care does not improve the results

Mutations in PINK1 and Parkin Impair Ubiquitination of Mitofusins in Human Fibroblasts

PINK1 and Parkin mutations cause recessive Parkinson's disease (PD). In Drosophila and SH-SY5Y cells, Parkin is recruited by PINK1 to damaged mitochondria, where it ubiquitinates Mitofusins and consequently promotes mitochondrial fission and mitophagy

URBAN SELF-ORGANISATION IN DEPRIVED NEIGHBORHOODS: POSSIBILITIES AND LIMITS OF AUTONOMOUS COLLECTIVE ARTICULATION IN SALVADOR DA BAHIA

From a comparative point of view, the given article is concerned with the possibilities and restrictions of urban self-organization within city’s neighbourhoods. Drawing upon a qualitative comparison between the case studies Alto de Ondina and Alto da Sereia – two disadvantaged urban neighbourhoods in the southern city centre of Salvador da Bahia (Brazil) – and considering the conditional framework of daily life there, the idiographic context conditions that foster and alternatively impede self-organization are to be developed on data drawn from empirical surveys. Here, the data-led interpretations reach beyond the local and regional context and offer fundamental insights into auto-centered and autonomous acts of articulation. In Brazil, participative planning processes have been the common sense for urban governance. However, participative strategies tend to stand under the sign of codetermination, whereas the principles of self-determination and auto-centered articulation of collective interests are immantently present during processes of civic self-organization. Due to the fact that self-organized communities do not fall within a defined institutional framework or existing system, they are capable to articulate their needs and interests collectively. The underlying concept of “Agora Governance” in accordance with Korff & Rothfuss (2009) offers the possibility to stimulate urban management processes in a sustainable way, bringing together the civic perspective of the “human city” and the expert perspective of the “infrastructural city” into a consensual but often highly disputed negotiation process

URBAN SELF-ORGANISATION IN DEPRIVED NEIGHBORHOODS: POSSIBILITIES AND LIMITS OF AUTONOMOUS COLLECTIVE ARTICULATION IN SALVADOR DA BAHIA

From a comparative point of view, the given article is concerned with the possibilities and restrictions of urban self-organization within city’s neighbourhoods. Drawing upon a qualitative comparison between the case studies Alto de Ondina and Alto da Sereia – two disadvantaged urban neighbourhoods in the southern city centre of Salvador da Bahia (Brazil) – and considering the conditional framework of daily life there, the idiographic context conditions that foster and alternatively impede self-organization are to be developed on data drawn from empirical surveys. Here, the data-led interpretations reach beyond the local and regional context and offer fundamental insights into auto-centered and autonomous acts of articulation. In Brazil, participative planning processes have been the common sense for urban governance. However, participative strategies tend to stand under the sign of codetermination, whereas the principles of self-determination and auto-centered articulation of collective interests are immantently present during processes of civic self-organization. Due to the fact that self-organized communities do not fall within a defined institutional framework or existing system, they are capable to articulate their needs and interests collectively. The underlying concept of “Agora Governance” in accordance with Korff & Rothfuss (2009) offers the possibility to stimulate urban management processes in a sustainable way, bringing together the civic perspective of the “human city” and the expert perspective of the “infrastructural city” into a consensual but often highly disputed negotiation process

Pneumocystis jirovecii pneumonia in IBD patients treated with immunomodulator(s)

Background: Pneumocystis jirovecii Pneumonia (PJP) is an extremely rare life-threatening pulmonary fungal infection that occurs in immunocompromised individuals including patients with inflammatory bowel disease (IBD). Prophylaxis for PJP is recommended in IBD patients treated with triple immunomodulators where one agent is a calcineurin inhibitor or an anti-TNFα1 but there is no consistency in a preventive approach in patients with double or single immunomodulators. Our aim was to describe immunosuppressive treatment profile of IBD patients infected by PJP and the outcome of the disease. Methods: Cases of PJP were retrospectively collected through the COllaborative Network For Exceptionally Rare case reports of the European Crohn’s and Colitis Organization (ECCO CONFER). All ECCO members were invited to report cases of PJP. Data were collected through a case report form. Results: A total of 15 PJP infections were reported in 14 IBD patients (9 ulcerative colitis and 5 Crohn’s disease including 10 men and 4 women). The median age at PJP diagnosis was 55 years (IQR 44-80). Diagnosis was performed by a positive PJ polymerase chain reaction on the bronchoalveolar lavage in 87% of the cases and by a microscopic direct exam in 7% (unreported in 1 patient). One patient was co-infected by HIV and 57% were non-smokers. Immunosuppressive therapies at the time of diagnosis included steroids (n=11), thiopurines (n=9), infliximab (n=3), cyclosporin (n=2), methotrexate (n=1) and tacrolimus (n=1). Two PJP (13%) occurred in patients on triple immunosuppression, 9 patients (60 %) had a double immunosuppressive treatment, 3 patients (20%) were on monotherapy and PJP in the HIV patient occurred in absence of immunosuppressive treatment (Table 1). None of the patients diagnosed with PJP had received prophylaxis. All patients were treated by trimethoprim/sulfamethoxazole or atovaquone and 5 required an intensive care unit stay. Two patients (14%) died and 1 patient had a recurrent episode 16 months after initial treatment. Evolution was favourable for the others. Conclusion: This small case series reports PJP in IBD patients while on single or double immunosuppression highlighting a significant risk in this population. Identifying risk factors for PJP infection in the IBD population is essential to provide a case-by-case prophylaxis