Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study

In the emergency setting, non-traumatic headache is a benign symptom in 80% of cases, but serious underlying conditions need to be ruled out. Copeptin improves risk stratification in several acute diseases. Herein, we investigated the value of copeptin to discriminate between serious secondary headache and benign headache forms in the emergency setting.; Patients presenting with acute non-traumatic headache were prospectively enrolled into an observational cohort study. Copeptin was measured upon presentation to the emergency department. Primary endpoint was serious secondary headache defined by a neurologic cause requiring immediate treatment of the underlying disease. Secondary endpoint was the combination of mortality and hospitalization within 3 months. Two board-certified neurologist blinded to copeptin levels verified the endpoints after a structured 3-month-telephone interview.; Of the 391 patients included, 75 (19%) had a serious secondary headache. Copeptin was associated with serious secondary headache (OR 2.03, 95%CI 1.52-2.70, p < 0.0001). Area under the curve (AUC) for copeptin to identify the primary endpoint was 0.70 (0.63-0.76). After adjusting for age > 50, focal-neurological abnormalities, and thunderclap onset of symptoms, copeptin remained an independent predictive factor for serious secondary headache (OR 1.74, 95%CI 1.26-2.39, p = 0.001). Moreover, copeptin improved the AUC of the multivariate logistic clinical model (p-LR-test < 0.001). Even though copeptin values were higher in patients reaching the secondary endpoint, this association was not significant in multivariate logistic regression.; Copeptin was independently associated with serious secondary headache as compared to benign headaches forms. Copeptin may be a promising novel blood biomarker that should be further validated to rule out serious secondary headache in the emergency department.; Study Registration on 08/02/2010 as NCT01174901 at clinicaltrials.gov

Confusional migraine is an adult as well as a childhood disease

Background: Acute confusional migraine (ACM) is considered a rare migraine variant primarily seen in children and adolescents. Patients and Methods: We present a series of eight adults and two adolescents suffering from migraine attacks associated with transient confusional states. Results: Eight patients reported two or more such attacks. One of them reported mild head trauma in the past. One patient reported mild head trauma as a possible trigger. Further investigations were unremarkable in all patients and did not suggest underlying structural abnormalities, epilepsy or cerebrovascular disease. In none of these patients did we find another cause to explain the observed phenomenon. Conclusions: Based on this series of patients, we suggest expanding the concept of confusional migraine from the paediatric population to adults. The temporal course of the confusion as well as the association with visual and other aura symptoms suggest cortical spreading depression as the underlying pathophysiology

Fabriksimulation – innovative Lehrkonzepte im praktischen Einsatz

Am 19. Juni 1999 haben 30 europäische Staaten in der italienischen Universitätsstadt die sogenannte Bologna-Erklärung unterzeichnet. Sie legten damit den Grundstein für einen europäischen Hochschulraum, der inzwischen 47 Mitgliedsstaaten umfasst. Die Europäische Studienreform hat in ganz Europa zu weitreichenden Veränderungen der nationalen Hochschulsysteme geführt (vgl. Bundesministerium für Bildung und Forschung 2017). Neben zahlreichen strukturellen Veränderungen besteht der Kern der Reform vor allem aus Forderungen, welche die Lehre und das Lernen und somit die Hochschuldidaktik betreffen (Wehr und Ertel 2007, S. 17). Vor diesem Hintergrund stellt dieser Beitrag ein innovatives Lehr- und Lernkonzept im Bereich der Wirtschaftswissenschaften und insbesondere im Fachgebiet Produktion und Logistik vor: die simulationsbasierte Lehre

Determining the Optimal Network Partition and Kanban Allocation in JIT Production Lines

. One way to reduce costs in high volume production lines is to smooth and balance the material flow by means of controlled inventories. Kanban systems are now being implemented worldwide due to their ability of reducing inventories and production lead times. This paper addresses two fundamental design issues in kanban systems and presents an efficient heuristic method for designing such systems. An analytical method for modelling kanban systems and a general-purpose genetic algorithm are integrated in a heuristic design methodology which evaluates the performance of kanban systems using alternative network partitions and allocations of kanbans. As we demonstrate, the heuristic method provides a useful procedure to evaluate the impact of design alternatives and can thus serve as a rough-cut decision support tool which assists managers in the planning of largescale manufacturing systems. Keywords. Just-in-time, kanban systems, queueing networks, genetic algorithms. 1 Introduction The..