Does the identification of seniors at risk (ISAR) score effectively select geriatric patients on emergency admission?

The number of older patients admitted to emergency departments (ED) increases continuously. The Identification of Seniors at Risk (ISAR) score is currently recommended to screen patients in German ED, but its appropriateness is being criticized. ISAR scores and clinical characteristics from 98 emergency admissions (EA), 80 from acute geriatrics (AG) and 89 from a geriatric rehabilitation (GR) unit were compared retrospectively. No significant differences were found between groups, being the ISAR score positive in 87.7% of EA, 94.9% of AG and 94.4% of GR cases. None of positively identified geriatric patients in the EA was transferred to the geriatric ward of competence. EA patients showed significantly higher number of functional impairments (p = 0.001) and higher BI score (p < 0.0001) compared to AG and GR groups. A higher ISAR score threshold and additional functional information might be needed to better select patients in need of prompt treatment by a geriatric team

Vegetation impacts soil water content patterns by shaping canopy water fluxes and soil properties

Soil water content is a key variable for biogeochemical and atmospheric coupled processes. Its small-scale heterogeneity impacts the partitioning of precipitation (e.g., deep percolation or transpiration) by triggering threshold processes and connecting flow paths. Forest hydrologists frequently hypothesized that throughfall and stemflow patterns induce soil water content heterogeneity, yet experimental validation is limited. Here, we pursued a pattern-oriented approach to explore the relationship between net precipitation and soil water content. Both were measured in independent high-resolution stratified random designs on a 1-ha temperate mixed beech forest plot in Germany. We recorded throughfall (350 locations) and stemflow (65 trees) for 16 precipitation events in 2015. Soil water content was measured continuously in topsoil and subsoil (210 profiles). Soil wetting was only weakly related to net precipitation patterns. The precipitation-induced pattern quickly dissipates and returns to a basic pattern, which is temporally stable. Instead, soil hydraulic properties (by the proxy of field capacity) were significantly correlated with this stable soil water content pattern, indicating that soil structure more than net precipitation drives soil water content heterogeneity. Also, both field capacity and soil water content were lower in the immediate vicinity of tree stems compared to further away at all times, including winter, despite stemflow occurrence. Thus, soil structure varies systematically according to vegetation in our site. We conclude that enhanced macroporosity increases gravity-driven flow in stem proximal areas. Therefore, although soil water content patterns are little affected by net precipitation, the resulting soil water fluxes may strongly be affected. Specifically, this may further enhance the channelling of stemflow to greater depth and beyond the rooting zone