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

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

Erfolgreiche Resektion einer fokalen kortikalen Dysplasie (FCD) der Zentralregion bei einem 6 Monate alten Säugling mit nur sehr milder postoperativer Parese

Auch im Säuglingsalter stellt die Epilepsiechirurgie bei einem pharmakoresistenten Verlauf eine wichtige Behandlungsoption dar. Viele der ansonsten in der prächirurgischen Diagnostik infrage kommenden Methoden zur Abschätzung des individuellen Risikos für postoperative Verluste lassen sich in dieser Altersgruppe allerdings nicht anwenden. Wir berichten den Fall eines Säuglings mit Epilepsiebeginn im Neugeborenenalter auf der Grundlage einer fokalen kortikalen Dysplasie (FCD). Diese lokalisierte in der linken Zentralregion unter Einbeziehung der Handregion im Gyrus praecentralis und wurde im MRT im Alter von 6 Lebenswochen diagnostiziert. Beim Säugling traten bilateral tonische Anfälle, rechts betonte myoklonische Anfälle und epileptische Spasmen auf, die auf die Therapie mit Phenobarbital, Vigabatrin, Topiramat, Levetiracetam, Oxcarbazepin sowie Kortikosteroiden (ACTH, Prednisolon) nicht ansprachen. Klinisch zeigte sich eine nur milde Parese im rechten Arm, wobei die Finger unabhängig bewegt und kaum eingeschränkt benutzt werden konnten. Die Entwicklung wurde mit 6 Monaten als nur sehr leicht verzögert dokumentiert. In der prächirurgischen Diagnostik ergaben sich Befunde, die ein kuratives epilepsiechirurgisches Vorgehen rechtfertigten. Die Eltern wurden darüber aufgeklärt, dass postoperativ mit einem vollständigen Verlust der Handfunktion zu rechnen wäre. Im Alter von 6 Monaten und bei einem Körpergewicht von 7 kg erfolgte am Neurozentrum Freiburg eine durch Neuronavigation und Elektrokortikographie (ECoG) gesteuerte erweiterte Läsionektomie links zentral. Erfreulicherweise wurde das Kind bei saniertem EEG komplett anfallsfrei, sodass nach einem Jahr mit der Reduktion der Antiepileptika begonnen wurde. Bereits in der unmittelbar postoperativ erfolgten neurologischen Rehabilitation konnte eine rasche Besserung nach initialer Verschlechterung der Arm-/Handparese festgestellt werden. Im Verlauf zeigten sich gegenüber der präoperativen Situation keine wesentlichen Funktionseinschränkungen mehr. Die im Rahmen der aktiven Epilepsie aufgetretene Entwicklungsverzögerung konnte das Mädchen im Verlauf des ersten postoperativen Jahres aufholen. Diese Aufholentwicklung wurde testpsychologisch 3, 6 und 12 Monate postoperativ dokumentiert. Dieser erfreuliche postoperative Verlauf ohne wesentliche Einbuße der Handmotorik ist nicht in erster Linie einer Plastizität im frühen Säuglingsalter zu verdanken, sondern am ehesten Folge der Persistenz ipsilateraler motorischer Bahnen, die ansonsten bei Gesunden bis zur Geburt regredieren. Dieser Fall unterstreicht die besonderen Chancen und den hohen Stellenwert der Epilepsiechirurgie im Säuglingsalter

Predictors for Delayed Emergency Department Care in Medical Patients with Acute Infections - An International Prospective Observational Study.

INTRODUCTION:In overcrowded emergency department (ED) care, short time to start effective antibiotic treatment has been evidenced to improve infection-related clinical outcomes. Our objective was to study factors associated with delays in initial ED care within an international prospective medical ED patient population presenting with acute infections. METHODS:We report data from an international prospective observational cohort study including patients with a main diagnosis of infection from three tertiary care hospitals in Switzerland, France and the United States (US). We studied predictors for delays in starting antibiotic treatment by using multivariate regression analyses. RESULTS:Overall, 544 medical ED patients with a main diagnosis of acute infection and antibiotic treatment were included, mainly pneumonia (n = 218; 40.1%), urinary tract (n = 141; 25.9%), and gastrointestinal infections (n = 58; 10.7%). The overall median time to start antibiotic therapy was 214 minutes (95% CI: 199, 228), with a median length of ED stay (ED LOS) of 322 minutes (95% CI: 308, 335). We found large variations of time to start antibiotic treatment depending on hospital centre and type of infection. The diagnosis of a gastrointestinal infection was the most significant predictor for delay in antibiotic treatment (+119 minutes compared to patients with pneumonia; 95% CI: 58, 181; p<0.001). CONCLUSIONS:We found high variations in hospital ED performance in regard to start antibiotic treatment. The implementation of measures to reduce treatment times has the potential to improve patient care

Performance of the Manchester Triage System in Adult Medical Emergency Patients: A Prospective Cohort Study

BACKGROUND: Accurate initial patient triage in the emergency department (ED) is pivotal in reducing time to effective treatment by the medical team and in expediting patient flow. The Manchester Triage System (MTS) is widely implemented for this purpose. Yet the overall effectiveness of its performance remains unclear. OBJECTIVES: We investigated the ability of MTS to accurately assess high treatment priority and to predict adverse clinical outcomes in a large unselected population of medical ED patients. METHODS: We prospectively followed consecutive medical patients seeking ED care for 30 days. Triage nurses implemented MTS upon arrival of patients admitted to the ED. The primary endpoint was high initial treatment priority adjudicated by two independent physicians. Secondary endpoints were 30-day all-cause mortality, admission to the intensive care unit (ICU), and length of stay. We used regression models with area under the receiver operating characteristic curve (AUC) as a measure of discrimination. RESULTS: Of the 2407 patients, 524 (21.8%) included patients (60.5 years, 55.7% males) who were classified as high treatment priority; 3.9% (n = 93) were transferred to the ICU; and 5.7% (n = 136) died. The initial MTS showed fair prognostic accuracy in predicting treatment priority (AUC 0.71) and ICU admission (AUC 0.68), but not in predicting mortality (AUC 0.55). Results were robust across most predefined subgroups, including patients diagnosed with infections, or cardiovascular or gastrointestinal diseases. In the subgroup of neurological symptoms and disorders, the MTS showed the best performance. CONCLUSION: The MTS showed fair performance in predicting high treatment priority and adverse clinical outcomes across different medical ED patient populations. Future research should focus on further refinement of the MTS so that its performance can be improved. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01768494

A Theory of Non-Universal Laws

Laws in the special sciences are usually regarded to be non-universal. A theory of laws in the special sciences faces two challenges: (I) According to Lange’s dilemma, laws in the special sciences are either false or trivially true; (II) they have to meet the Requirement of Relevance, which a way to require the non-accidentality of special science laws. I argue that both challenges can be meet, if one distinguishes four dimensions of (non-)universality. The upshot is that I argue for the following explication of special science laws: L is a special science law iff (1) L is a system law, (2) L is quasi-Newtonian, and (3) L is minimally invariant