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Influencing factors for delayed diagnosed injuries in multiple trauma patients – introducing the ‘Risk for Delayed Diagnoses Score’ (RIDD-Score)
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Delayed diagnosed injuries (DDI) in severely injured patients are an essential problem faced by emergency staff. Aim of the current study was to analyse incidence and type of DDI in a large trauma cohort. Furthermore, factors predicting DDI were investigated to create a score to identify patients at risk for DDI.
Methods
Multiply injured patients admitted between 2011 and 2020 and documented in the TraumaRegister DGU® were analysed. Primary admitted patients with severe injuries and/or intensive care who survived at least 24 h were included. The prevalence, type and severity of DDI were described. Through multivariate logistic regression analysis, risk factors for DDI were identified. Results were used to create a ‘Risk for Delayed Diagnoses’ (RIDD) score.
Results
Of 99,754 multiply injured patients, 9,175 (9.2%) had 13,226 injuries first diagnosed on ICU. Most common DDI were head injuries (35.8%), extremity injuries (33.3%) and thoracic injuries (19.7%). Patients with DDI had a higher ISS, were more frequently unconscious, in shock, required more blood transfusions, and stayed longer on ICU and in hospital. Multivariate analysis identified seven factors indicating a higher risk for DDI (OR from 1.2 to 1.9). The sum of these factors gives the RIDD score, which expresses the individual risk for a DDI ranging from 3.6% (0 points) to 24.8% (6 + points).
Conclusion
DDI are present in a sounding number of trauma patients. The reported results highlight the importance of a highly suspicious and thorough physical examination in the trauma room. The introduced RIDD score might help to identify patients at high risk for DDI. A tertiary survey should be implemented to minimise delayed diagnosed or even missed injuries
Influencer-Centered Accounts of Manipulation
Get PDFAdvances in science and technology have added to our insights into the vulnerabilities of human agency as well as to the methods of exploiting them. This has raised the stakes for efforts to clarify the concept and ethics of manipulation. Among these efforts, Robert Noggle’s influencer-centered account of manipulation has been most significant. He defines manipulative acts as those whereby an agent intentionally influences a recipient’s attitudes so that they do not conform as closely as they otherwise would to the pertinent norms and ideals endorsed by the influencer . This provides a relatively simple and in many ways clear definition of manipulation. It sidesteps thorny debates about autonomy, freedom, or practical rationality. It also promises to reveal a conceptual parallel between manipulating and lying, and thus to explain why manipulation is pro tanto wrong. In one respect, however, the account remains ambiguous: It remains unclear whether, and to what extent, it requires that influencers’ beliefs about what is ideal for their recipients to be grounded in some effort on the part of the influencer to identify with or take on the role of her recipient. This paper explains this ambiguity. It argues that influencer-centrism cannot remain indifferent to the validity of an agent’s beliefs about the ideal state of the recipient and provide an identification requirement that would render the whole account plausible and sufficiently determinate
Challenges for Non-Classical Reasoning in Contemporary AI Applications
Get PDFIn knowledge representation and reasoning, a key area in artificial intelligence research, non-classical logics play a prominent double role: firstly, non-classical logic languages allow for a precise and transparent encoding of domain specific knowledge. Secondly, as the logical languages are equipped with custom-tailored rules of logical inference, they make available a principled approach to derive new knowledge from previous information. In practice, the first aspect addresses data storage and retrieval, the second aspect the utilization of available information. This article briefly surveys contemporary challenges of NCL research in AI
The Relationship Between Humor Styles, Optimism and Quality of life, and the Role of the Gender, Age and Socio-Economic Status: A Typological Approach
Get PDFThe present study aims to extend knowledge on the relationship between humor styles, optimism and quality of life by employing the typological approach. Therefore, humor profiles were examined as patterns of humor styles and compared within profiles. The sample of 725 respondents from Spanish community was tested using Humor Styles Questionnaire, Life Orientation Test – Revised and the 12-Item Short Form Survey. Initial insight into the relations between humor styles, optimism and quality of life was provided using correlations controlling for gender, age, and socio-economic status, showing that optimism and quality of life measures correlated positively with affiliative and self-enhancing humor, and negatively with self-defeating humor styles. Four humor profiles (humor enhancers, endorsers, deniers and detrimenters) were identified using latent profile analysis, with the pairwise comparisons between the profiles in the analysis of differences in optimism and quality of life. Results revealed higher optimism and quality of life at humor profiles whose members use positive humor styles compared to profiles whose members use only negative humor styles, or do not use any kind of humor. In addition, significant role of gender, age and socio-economic position on observed relationship were confirmed. Advantages of typological approach in research of humor styles were discussed
Examination of duodenal and colonic microbiome changes in mouse models of acute and chronic pancreatitis
Get PDFThe exocrine pancreas is the main source of digestive enzymes which are released from secretory vesicles of acinar cells into the small intestine. Enzymes, including amylases, proteases and lipases, degrade the ingested food and thus determine the nutritional substrate for the gut microbiota. Acute (AP) and chronic pancreatitis (CP) are associated with a transitional or progressive exocrine pancreatic dysfunction, we analysed in the present study how an experimental induction of pancreatitis in mouse models affects the colonic and duodenal microbiome composition. Evaluation by 16 S rRNA gene sequencing revealed specific microbiome changes in colonic as well as in duodenal samples in different models of AP and CP. Mild acute pancreatitis, which is associated with a transient impairment of pancreatic secretion showed only minor changes in microbial composition, comparable to the ones seen in progressive dysfunctional mouse models of CP. The strongest changes were observed in a mouse model of severe AP, which suggest a direct effect of the immune response on gut microbiome in addition to a pancreatic dysfunction. Our data indicate that highly dysbiotic microbiome changes during pancreatitis are more associated with the inflammatory reaction than with a disturbed pancreatic secretion
Schlaganfall-induzierte Veränderungen der angeborenen Immunantwort am Beispiel von humanen Myeloid-Derived Suppressor Cells und Monozyten
Get PDFDie Schlaganfall-induzierte Immunsuppression trägt wesentlich zu einer Verschlechterung der Prognose und des klinischen Outcomes nach ischämischem Schlaganfall bei. Die hier vorgelegte Arbeit erweitert das Wissen um die damit einhergehenden immunologischen Veränderungen im angeborenen Immunsystem hinsichtlich humaner Myeloid-Derived Suppressor Cells und Monozyten. Hierzu erfolgte die durchflusszytometrische Analyse der genannten Immunzellpopulationen im peripheren Blut von Schlaganfallpatient*innen.
Hinsichtlich der humanen Myeloid-Derived Suppressor Cells (MDSCs) konnte gezeigt werden, dass es innerhalb der Gruppe CD11b+ Zellen zu einem relativen Anstieg potentieller monozytärer MDSCs nach ischämischem Schlaganfall kommt. Obgleich der abschließende Nachweis ihrer Funktion anhand geeigneter funktioneller Assays aufgrund einer insuffizienten Isolation der Zielpopulation nicht gelang, spricht die erhaltene Expression der funktionell bedeutsamen Moleküle, STAT3-phospho und Arginase-1, prinzipiell für eine Expansion potentieller monozytärer MDSCs nach ischämischem Schlaganfall. Als potente Immunsuppressoren der angeborenen Immunantwort stellen monozytäre MDSCs einen weiteren möglichen Protagonisten bei den komplexen immunologischen Veränderungen der Schlaganfall-induzierten Immunsuppression dar. Hinsichtlich der Monozyten machte sich die hier vorgelegte Arbeit den Nachweis einer immunregulatorischen Monozytenpopulation nach D’Aveni et al. zum Ziel. Der Nachweis dieser Monozytenpopulation konnte nicht erbracht werden. Neben einer reduzierten HLA-DR-Expression zeigten humane Monozyten nach ischämischem Schlaganfall jedoch als bisher neuen Befund eine gesteigerte CD34-Expression unter Stimulation mit LPS. Unabhängig von der Kohortenzugehörigkeit zeigte sich für IL-10+ Monozyten ferner eine signifikant höhere HLA-DR und PD-L1-Expression. Obgleich dieser Befund noch keine explizit immunregulatorische Monozytenpopulation definiert, erscheint ein funktioneller, immunregulatorischer Status bestimmter Monozyten möglich. Aus Sicht des Autors sind weitere vertiefende Studien zur Rolle der hier genannten Immunzellpopulationen im Rahmen der Schlaganfall-induzierten Immunsuppression nötig
Unlocking the potential of peatlands and paludiculture to achieve Germany’s climate targets: obstacles and major fields of action
Get PDFGreenhouse gas emissions from drained peatlands must be substantially reduced to meet climate mitigation targets. In Germany, annual peatland emissions of 53 Mt CO2e account for more than 7% of total national GHG emissions. Peatland drainage and reclamation is traditionally considered as a symbol of progress and technical achievement, where agriculture has been the major driver. In Germany, an area of 1.3 million ha of drained peatlands used for agriculture ought to be rewetted by 2050 to meet the 1.5°C target of the Paris Agreement. Paludiculture allows a productive use of wet peatlands instead of abandonment following rewetting. This approach might therefore pave the way for voluntary large-scale peatland rewetting. However, implementation remains scarce. The long history and large extent of peatland drainage has shaped the political and legal framework as well as perceptions and attitudes, thus impeding rewetting and climate-friendly peatland use. This policy and practice review investigates the political, legal, economic and social aspects that hinder the implementation in Germany and derives approaches to overcome multifold restrictions. Finally, three major fields of action are identified: (1) To increase and accelerate rewetting, a consistent peatland mainstreaming approach is needed that overcomes structural barriers and adapts the policy and legal framework, e.g., the Common Agricultural Policy, planning law, water law and nature conservation law. (2) To motivate for a rapid transition, a system of immediate, comprehensive and attractive positive incentives is needed. This should be accompanied by early announcement and gradual introduction of negative incentives to set a clear course and provide planning certainty for farmers and landowners. (3) A just transition depends on empowering local communities to develop and pursue perspectives tailored to their peatland region. Future research of peatlands as social-ecological systems can help to identify region-specific drivers for sustainable peatland management
Integrative Analyses of Circulating Proteins and Metabolites Reveal Sex Differences in the Associations with Cardiac Function among DCM Patients
Get PDFDilated cardiomyopathy (DCM) is characterized by reduced left ventricular ejection fraction (LVEF) and left or biventricular dilatation. We evaluated sex-specific associations of circulating proteins and metabolites with structural and functional heart parameters in DCM. Plasma samples (297 men, 71 women) were analyzed for proteins using Olink assays (targeted analysis) or LC-MS/MS (untargeted analysis), and for metabolites using LC MS/MS (Biocrates AbsoluteIDQ p180 Kit). Associations of proteins (n = 571) or metabolites (n = 163) with LVEF, measured left ventricular end diastolic diameter (LVEDD measured ), and the dilation percentage of LVEDD from the norm (LVEDD acc. to HENRY ) were examined in combined and sex-specific regression models. To disclose protein–metabolite relations, correlation analyses were performed. Associations between proteins, metabolites and LVEF were restricted to men, while associations with LVEDD were absent in both sexes. Significant metabolites were validated in a second independent DCM cohort (93 men). Integrative analyses demonstrated close relations between altered proteins and metabolites involved in lipid metabolism, inflammation, and endothelial dysfunction with declining LVEF, with kynurenine as the most prominent finding. In DCM, the loss of cardiac function was reflected by circulating proteins and metabolites with sex-specific differences. Our integrative approach demonstrated that concurrently assessing specific proteins and metabolites might help us to gain insights into the alterations associated with DCM
Ausgewählte Lyrik
Get PDFMit der vorliegenden Buchserie werden erstmals Alfred Franzkeits Übersetzungen litauischer Lyrik ins Deutsche systematisch veröffentlicht
Schulische Förderung der emotionalen und sozialen Entwicklung von Kindern durch Erweiterung spezifischer Lehrkraftkompetenzen
Get PDFZu den größten beruflichen Herausforderungen von Lehrkräften zählt die Förderung von Kindern mit Verhaltensschwierigkeiten. Der deutschsprachige Raum bietet dazu allerdings bislang kaum bewährte Professionalisierungsformate. Im vorliegenden Buch entwickelt und evaluiert die Autorin ein prozessbegleitendes Fortbildungskonzept. Die Ergebnisse geben einen konzeptionellen Rahmen für die Entwicklung zukünftiger Professionalisierungsmaßnahmen und stellen einen wichtigen Beitrag auf dem Weg zu einem inklusiven Bildungssystem dar.
Anhand der in der Forschung beschriebenen Wirksamkeitsfaktoren für die Professionalisierung von Lehrkräften und für die schulische Prävention im Bereich Verhalten entwickelt die Autorin eine über ein halbes Schuljahr angelegte Fortbildungsmaßnahme für Grundschullehrkräfte. Ziel ist es die Lehrkraftkognitionen- und kompetenzen zu erweitern sowie das Schüler*innenverhalten zu fördern. Bei der entwickelten Konzeption steht der Gedanke der Prozessbegleitung im Vordergrund: Gestreckt über drei Handlungsfelder wurden Input-, Erprobungs- und Reflexionsphasen miteinander verzahnt. Um die Effektivität des Formats zu evaluieren, wurde ein längsschnittlich über ein ganzes Schuljahr angelegtes Mixed-Methods-Design mit kontrollierten Einzelfallstudien, standardisierten sowie qualitativen Befragungen eingesetzt und auf vier Evaluationsebenen ausgewertet. Sowohl auf Schüler*innen- als auch auf Lehrkraftebene zeigen sich vielfältige positive Effekte, die die Bedeutung inklusiver Bildungssysteme unterstreichen