Optimized patient transfer using an innovative multidisciplinary assessment in the Kanton Aargau (OPTIMA I): an observational survey in lower respiratory tract infections

BACKGROUND: Current medical scores have limited efficiency and safety profiles to enable assignment to the most appropriate treatment site in patients with lower respiratory tract infections (LRTIs). We describe our current triage practice and assess the potential of a combination of CURB65 with proadrenomedullin (ProADM) levels for triage decisions. METHODS: Consecutive patients with LRTIs presenting to our emergency department were prospectively followed and retrospectively classified according to CURB65 and ProADM levels (CURB65-A). Low medical risk patients were further subgrouped according to biopsychosocial and functional risks. We compared the proportion of patients virtually allocated to triage sites with actual triage decisions and assessed the added impact of ProADM in a subgroup. RESULTS: Overall, 93% of 146 patients were hospitalised. Among the 138 patients with available CURB65-A, 17.4% had a low medical risk indicating possible treatment in an outpatient or non-acute medical setting; 34.1% had an intermediate medical risk (short-hospitalisation); and 48.6% had a high medical risk (hospitalisation). Fewer patients were in a low CURB65-A class (I) than a low CURB65 class (0,1) (17.4% vs. 46.3%, p >0.001). Mean length of hospitalisation was 9.8 days including 3.6 days after reaching medical stability. In 60.3% of patients, hospitalisation was prolonged after medical stability mainly for medical reasons. CONCLUSIONS: Current rates of hospitalisation are high in patients with LRTI and length of stay frequently extended beyond time of medical stabilization. The lower proportion of patients reclassified as low risk by adding ProADM to the CURB65 score might improve confidence in the triage algorithm

The potential impact of biomarker-guided triage decisions for patients with urinary tract infections

Objectives: Current guidelines provide limited evidence as to which patients with urinary tract infection (UTI) require hospitalisation. We evaluated the currently used triage routine and tested whether a set of criteria including biomarkers like proadrenomedullin (proADM) and urea have the potential to improve triage decisions. Methods: Consecutive adults with UTI presenting to our emergency department (ED) were recruited and followed for 30days. We defined three virtual triage algorithms, which included either guideline-based clinical criteria, optimised admission proADM or urea levels in addition to a set of clinical criteria. We compared actual treatment sites and observed adverse events based on the physician judgment with the proportion of patients assigned to treatment sites according to the three virtual algorithms. Adverse outcome was defined as transfer to the intensive care unit (ICU), death, recurrence of UTI or rehospitalisation for any reason. Results: We recruited 127 patients (age 61.8±20.8 years; 73.2% females) and analysed the data of 123 patients with a final diagnosis of UTI. Of these 123 patients, 27 (22.0%) were treated as outpatients. Virtual triage based only on clinical signs would have treated only 22 (17.9%) patients as outpatients, with higher proportions of outpatients equally in both biomarker groups (29.3%; p=0.02). There were no significant differences in adverse events between outpatients according to the clinical (4.5%), proADM (2.8%) or urea groups (2.8%). The mean length of stay was 6.6days, including 2.2days after reaching medical stability. Conclusions: Adding biomarkers to clinical criteria has the potential to improve risk-based triage without impairing safety. Current rates of admission and length of stay could be shortened in patients with UT

HIRDES - The High-Resolution Double-Echelle Spectrograph for the World Space Observatory Ultraviolet (WSO/UV)

The World Space Observatory Ultraviolet (WSO/UV) is a multi-national project grown out of the needs of the astronomical community to have future access to the UV range. WSO/UV consists of a single UV telescope with a primary mirror of 1.7m diameter feeding the UV spectrometer and UV imagers. The spectrometer comprises three different spectrographs, two high-resolution echelle spectrographs (the High-Resolution Double-Echelle Spectrograph, HIRDES) and a low-dispersion long-slit instrument. Within HIRDES the 102-310nm spectral band is split to feed two echelle spectrographs covering the UV range 174-310nm and the vacuum-UV range 102-176nm with high spectral resolution (R>50,000). The technical concept is based on the heritage of two previous ORFEUS SPAS missions. The phase-B1 development activities are described in this paper considering performance aspects, design drivers, related trade-offs (mechanical concepts, material selection etc.) and a critical functional and environmental test verification approach. The current state of other WSO/UV scientific instruments (imagers) is also described.Comment: Accepted for publication in Advances in Space Researc

Claiming Space and Struggling for Recognition Partispace Working Paper Two

Aiming at contributing to a better understanding of the current developments, paradoxes and ways to deal with youth political participation in Europe, the main research question of the PARTISPACE project is: How and where do 15- to 30 year-old young people participate differently across social milieus and youth cultural scenes and across eight European cities (framed by different national welfare, education and youth policies)? In relation to this research question, this report was intended to analyse case studies which explore participation practices in formal, non-formal and informal contexts and reconstruct practices, meanings, relationship and dynamics of different forms of youth participation in a comparative perspective and local constellations of youth participation. In so doing, the report has outlined a mosaic of the different practices, activities, styles and spaces wherein young people situate their participation in the eight countries involved in the PARTISPACE project

Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: Derivation of a clinical algorithm

Proadrenomedullin (ProADM) confers additional prognostic information to established clinical risk scores in lower respiratory tract infections (LRTI). We aimed to derive a practical algorithm combining the CURB65 score with ProADM-levels in patients with community-acquired pneumonia (CAP) and non-CAP-LRTI

A Place in Public. Spatial Dynamics of Youth Participation in Eight European Cities

This report aims to analyse young people's participation in connection to local urban spaces of the eight PARTISPACE cities. Analysing spatial aspects of youth participation according to a relational understanding of space first of all shifts the focus to the (co-)production of spaces of youth participation. It thus investigates both how young people influence urban spaces and how their participation in the city is influenced by urban spaces. While youth participation spaces in some instances of the PARTISPACE research process have been conceived predominantly as discursive or social, this report focuses on physical (material and touchable) spaces. However, this includes the discursive production of spaces and reflections on why some material spaces are thought of as youth (participation) spaces while others are not. This invites the question of how youth participation becomes visible, audible or is experienced with other senses in specific sites or places of the urban space. A spatial analysis of youth participation can thus extend the understanding of youth participation not only by showing the interrelation and relational configuration of various aspects of participation practices (discourses, materialities, doings) on different scales but also by pointing out the importance of spatial orderings that orient practices and relevancies, especially through boundary work that includes and excludes people, topics and forms of participation