Quality indicators for the diagnosis and antibiotic treatment of acute respiratory tract infections in general practice:a RAND Appropriateness Method

Objective: To develop quality indicators for the diagnosis and antibiotic treatment of acute respiratory tract infections, tailored to the Danish general practice setting. Design: A RAND/UCLA Appropriateness Method was used. Setting: General practice. Subjects: A panel of nine experts, mainly general practitioners, was asked to rate the relevance of 64 quality indicators for the diagnosis and antibiotic treatment of acute respiratory tract infections based on guidelines. Subsequently, a face-to-face meeting was held to resolve misinterpretations and to achieve consensus. Main outcome measures: The experts were asked to rate the indicators on a nine-point Likert scale. Consensus of appropriateness for a quality indicator was reached if the overall panel median rating was 7–9 with agreement. Results: A total of 50 of the 64 proposed quality indicators attained consensus. Consensus was achieved for 12 indicators focusing on the diagnostic process and 19 indicators focusing on the decision about antibiotic treatment and choice of antibiotics, respectively. Conclusion: These newly developed quality indicators may be used to strengthen Danish general practitioners’ focus on their management of patients with acute respiratory tract infections and to identify where there is a need for future quality improvements

Quality assessment of diagnosis and antibiotic treatment of infectious diseases in primary care:a systematic review of quality indicators

Objective: To identify existing quality indicators (QIs) for diagnosis and antibiotic treatment of patients with infectious diseases in primary care. Design: A systematic literature search was performed in PubMed and EMBASE. We included studies with a description of the development of QIs for diagnosis and antibiotic use in patients with infectious diseases in primary care. We extracted information about (1) type of infection; (2) target for quality assessment; (3) methodology used for developing the QIs; and (4) whether the QIs were developed for a national or international application. The QIs were organised into three categories: (1) QIs focusing on the diagnostic process; (2) QIs focusing on the decision to prescribe antibiotics; and (3) QIs concerning the choice of antibiotics. Results: Eleven studies were included in this review and a total of 130 QIs were identified. The majority (72%) of the QIs were focusing on choice of antibiotics, 22% concerned the decision to prescribe antibiotics, and few (6%) concerned the diagnostic process. Most QIs were either related to respiratory tract infections or not related to any type of infection. A consensus method (mainly the Delphi technique), based on either a literature study or national guidelines, was used for the development of QIs in all of the studies. Conclusions: The small number of existing QIs predominantly focuses on the choice of antibiotics and is often drug-specific. There is a remarkable lack of diagnostic QIs. Future development of new QIs, especially disease-specific QIs concerning the diagnostic process, is needed.KEY POINTS In order to improve the use of antibiotics in primary care, measurable instruments, such as quality indicators, are needed to assess the quality of care being provided. A total of 11 studies were found, including 130 quality indicators for diagnosis and antibiotic treatment of infectious diseases in primary care. The majority of the identified quality indicators were focusing on the choice of antibiotics and only a few concerned the diagnostic process. All quality indicators were developed by means of a consensus method and were often based on literature studies or guidelines

Diagnosis and Antibiotic Treatment of Urinary Tract Infections in Danish General Practice: A Quality Assessment

Rational antibiotic treatment of urinary tract infections (UTI) is important. To improve the quality of antibiotic treatment of UTI, it is essential to obtain insight into diagnostic approaches and prescribing patterns in general practice. The aim of this study was to investigate the quality of diagnostics and treatment of UTI in general practice by means of quality indicators (QIs). QIs provide a quantitative measure of quality and are defined by a numerator (the number of patients receiving a specific investigation or treatment) and a denominator (the number of patients included in the quality assessment). For adult patients with suspected UTI, practices registered the following: age, sex, risk factors, symptoms and signs, examinations, diagnosis and treatment. The levels of the QIs were compared with their corresponding standards. Half of the patients diagnosed with lower UTI or pyelonephritis fulfilled the diagnostic criteria for UTI: characteristic UTI symptoms and clear signs of bacteriuria, respectively. Urinalysis was performed for nearly all patients, including patients without characteristic symptoms of UTI. One-fourth of the patients with suspected lower UTI were treated with antibiotics despite no urinalysis and nearly half received antibiotics despite an inconclusive dipstick test. Pivmecillam was the preferred antibiotic. The findings of this study indicate that there is room for improvement in the management of UTI in Danish general practice

The distortion of distant galaxy images by large-scale structure

Inhomogeneity in the distribution of mass in the universe on scales ≲ 100 Mpc can generate a coherent shear distortion or polarization of the images of background galaxies. This distortion may be measurable over patches of the sky up to a few square degrees in size. If this distortion is measured, or conversely, if its magnitude is limited, it should help us understand the degree to which luminosity traces the underlying mass over cosmological scales. A prescription is given for quantifying the galaxy distortion and a propagation equation for its evolution in an inhomogeneous universe is derived. The creation of shear by inhomogeneity is illustrated using model kinematic universes comprising random distributions of point masses, spheres and circular discs designed to simulate the superclusters, voids and ‘walls’ reported in galaxy velocity surveys. Using these simulations, we estimate that an rms induced ellipticity of |p|_(rms) ˜ 0.2Ω_(LSS) (where Ω_(LSS) is the fraction of the mass of the universe clustered on the large scale) will be produced. The angular correlation length is ˜ 1.6°. In an alternative prescription, the universe is modelled using a power spectrum of density fluctuations and the mean correlation function is computed both analytically and numerically. In these simulations we find that |p|_(rms) ˜0.02 for biased cold dark matter models of an Einslein–De Sitter universe, and the effective correlation length is θ_(1/2) ˜ 0.5^ΰ. For a hot dark matter dominated universe the correlation length is θ_(1/2) ˜ 0.7^ΰ. The faint, blue galaxies discovered by Tyson and collaborators have a surface density of ˜ 3 × 10^5 deg^(−2) and should provide an ideal set of sources for measuring this effect

Segmentübergreifende Bahnplanung mittels eines analytischen Optimierungsverfahrens für die autonome Fahrzeugführung auf dem Braunschweiger Stadtring

Mit dem Projekt Stadtpilot stellt sich die TU Braunschweig der Herausforderung, autonom in der komplexen Umgebung des Braunschweiger Stadtrings zu fahren. Die besonderen Umgebungsbedingungen stellen höchste Anforderungen an die einzelnen Teilmodule und damit auch an die Bahnplanung. Im Rahmen des Projekts ist ein neuartiges analytisches Optimierungsverfahren entwickelt worden, das segmentübergreifend krümmungs- und krümmungsänderungsoptimierte Trajektorien mit dem Ziel berechnet, eine für die Gesamtstrecke fahrdynamisch optimierte Sollbahn zu ermitteln. Damit werden gleichzeitig die Spurtreue und der Fahrkomfort erhöht. In dieser Arbeit wird der Algorithmus vorgestellt und die Wirksamkeit anhand eines typischen Fahrmanövers präsentiert

The MUSE-Wide Survey: A first catalogue of 831 emission line galaxies

We present a first instalment of the MUSE-Wide survey, covering an area of 22.2 arcmin$^2$ (corresponding to $\sim$20% of the final survey) in the CANDELS/Deep area of the Chandra Deep Field South. We use the MUSE integral field spectrograph at the ESO VLT to conduct a full-area spectroscopic mapping at a depth of 1h exposure time per 1 arcmin$^2$ pointing. We searched for compact emission line objects using our newly developed LSDCat software based on a 3-D matched filtering approach, followed by interactive classification and redshift measurement of the sources. Our catalogue contains 831 distinct emission line galaxies with redshifts ranging from 0.04 to 6. Roughly one third (237) of the emission line sources are Lyman $\alpha$ emitting galaxies with $3 < z < 6$, only four of which had previously measured spectroscopic redshifts. At lower redshifts 351 galaxies are detected primarily by their [OII] emission line ($0.3 \lesssim z \lesssim 1.5$), 189 by their [OIII] line ($0.21 \lesssim z \lesssim 0.85$), and 46 by their H$\alpha$ line ($0.04 \lesssim z \lesssim 0.42$). Comparing our spectroscopic redshifts to photometric redshift estimates from the literature, we find excellent agreement for $z<1.5$ with a median $\Delta z$ of only $\sim 4 \times 10^{-4}$ and an outlier rate of 6%, however a significant systematic offset of $\Delta z = 0.26$ and an outlier rate of 23% for Ly$\alpha$ emitters at $z>3$. Together with the catalogue we also release 1D PSF-weighted extracted spectra and small 3D datacubes centred on each of the 831 sources.Comment: 24 pages, 14 figures, accepted for publication in A&A, data products are available for download from http://muse-vlt.eu/science/muse-wide-survey/ and later via the CD

Entwicklungsbegleitendes Simulations- und Testkonzept für autonome Fahrzeuge in städtischen Umgebungen

Das Projekt "Stadtpilot" hat das Ziel, aufbauend auf den Erfahrungen der DARPA Urban Challenge den Braunschweiger Stadtring vollständig autonom zu befahren. Im Rahmen des Projektes wird zur Gewährleistung der Sicherheit im öffentlichen Straßenverkehr ein entwicklungsbegleitendes Simulations- und Testkonzept umgesetzt. Das Konzept beinhaltet die Definition von festen Grundsätzen, die sowohl für die einzelnen Komponenten und ihre Bestandteile als auch für das Gesamtsystem erfüllt sein müssen. Neben der manuellen Erzeugung von Testfällen wird die automatisierte Evaluierung und Testfallgenerierung vorgestellt, in die insbesondere definierte Gütemaße und explizit zugelassene Fehlertoleranzen einfließen. Dadurch wird schon in einer sehr frühen Phase die Entwicklung robuster Module gefördert. Das Testkonzept wird ergänzt durch eine Verkehrssimulation. Dabei entstehen aus dem simulierten Verkehrsfluss kontinuierlich neue Testszenarien, so dass die Testtiefe nochmals erhöht werden kann. Erst wenn das System durch ein solches Testkonzept ausgereift ist, kann eine Erprobung unter realen Bedingungen erfolgen