Characterization of patients admitted to specialized geriatric acute care hospital units with the German version of the Standardized Evaluation and Intervention for Seniors at Risk (SEISAR) screening-instrument: a cross-sectional study.

BACKGROUND: The Standardized Evaluation and Intervention for Seniors at Risk (SEISAR) screening tool records major geriatric problems, originally applied in the emergency department. Particularly, the distinction of compensated and uncompensated problems is an interesting and new approach. Therefore, we translated the SEISAR in German language and used it to characterize patients in specialized geriatric hospital wards in Germany and to gather initial experience regarding its usability and practicability. METHODS: The tool was translated by three independent specialists in geriatric medicine and backtranslated for quality-assurance by a non-medical English native speaker. In a second step, 8 acute care geriatric hospital departments used the translated version to characterize all consecutive patients admitted over a period of one month between December 2019 and May 2020 at time of admission. RESULTS: Most of the 756 patients (78%) lived in an own apartment or house prior to hospital admission. Participants had on average 4 compensated and 6 uncompensated problems, a Barthel-Index of 40 pts. on admission with a median increase of 15 points during hospital stay, and a median length of stay of 16 days in the geriatric hospital department. CONCLUSION: SEISAR is an interesting standardized brief comprehensive geriatric assessment tool for the identification of compensated and uncompensated health problems in older persons. The data of this study highlights the number, variability, and complexity of geriatric problems in patients treated in specialized acute care geriatric hospital wards in Germany. TRIAL REGISTRATION: German Clinical trial register (DRKS-ID: DRKS00031354 on 27.02.2023).

In Situ Measurement of Electron Energy Evolution in a Laser-Plasma Accelerator.

We report on a novel, noninvasive method applying Thomson scattering to measure the evolution of the electron beam energy inside a laser-plasma accelerator with high spatial resolution. The determination of the local electron energy enabled the in-situ detection of the acting acceleration fields without altering the final beam state. In this Letter we demonstrate that the accelerating fields evolve from (265±119) GV/m to (9±4) GV/m in a plasma density ramp. The presented data show excellent agreement with particle-in-cell simulations. This method provides new possibilities for detecting the dynamics of plasma-based accelerators and their optimization.

[COVID-19 in old age-The geriatric perspective]. / COVID-19 im Alter ­ Die geriatrische Perspektive.

Predominantly the older population is affected by a severe course of COVID-19. The mortality of hospitalized patients with COVID-19 above the age of 80 years is up to 54% in international studies. These observations indicate the necessity to highlight the geriatric perspective on this disease. The diagnostics and treatment of COVID-19 do not differ between younger and older patients but atypical symptoms should be expected more frequently in old age. Older subjects show an increased need for rehabilitation after COVID-19. Paradoxically, increasing rehabilitation demands go along with a reduced availability of geriatric rehabilitation options, the latter being a consequence of closure or downsizing of rehabilitation departments during the pandemic. In general, measures of isolation and quarantine should be diligently balanced as the health and emotional consequences of such measures may be severe in older persons. In light of the poor prognosis of older COVID-19 patients, advanced care planning becomes even more relevant. Caregivers and physicians should be encouraged to compose advanced care directives that also reflect the specific circumstances of COVID-19. Fortunately, current data suggest that the effectiveness of the vaccination with the mRNA-vaccines approved in Germany may be equally high in older compared to younger persons.

FLASHForward: plasma wakefield accelerator science for high-average-power applications.

The FLASHForward experimental facility is a high-performance test-bed for precision plasma wakefield research, aiming to accelerate high-quality electron beams to GeV-levels in a few centimetres of ionized gas. The plasma is created by ionizing gas in a gas cell either by a high-voltage discharge or a high-intensity laser pulse. The electrons to be accelerated will either be injected internally from the plasma background or externally from the FLASH superconducting RF front end. In both cases, the wakefield will be driven by electron beams provided by the FLASH gun and linac modules operating with a 10 Hz macro-pulse structure, generating 1.25 GeV, 1 nC electron bunches at up to 3 MHz micro-pulse repetition rates. At full capacity, this FLASH bunch-train structure corresponds to 30 kW of average power, orders of magnitude higher than drivers available to other state-of-the-art LWFA and PWFA experiments. This high-power functionality means FLASHForward is the only plasma wakefield facility in the world with the immediate capability to develop, explore and benchmark high-average-power plasma wakefield research essential for next-generation facilities. The operational parameters and technical highlights of the experiment are discussed, as well as the scientific goals and high-average-power outlook. This article is part of the Theo Murphy meeting issue 'Directions in particle beam-driven plasma wakefield acceleration'.

Erratum: Emittance Preservation in an Aberration-Free Active Plasma Lens [Phys. Rev. Lett. 121, 194801 (2018)].

This corrects the article DOI: 10.1103/PhysRevLett.121.194801.

Tunable Plasma-Based Energy Dechirper.

A tunable plasma-based energy dechirper has been developed at FLASHForward to remove the correlated energy spread of a 681 MeV electron bunch. Through the interaction of the bunch with wakefields excited in plasma the projected energy spread was reduced from a FWHM of 1.31% to 0.33% without reducing the stability of the incoming beam. The experimental results for variable plasma density are in good agreement with analytic predictions and three-dimensional simulations. The proof-of-principle dechirping strength of 1.8 GeV/mm/m significantly exceeds those demonstrated for competing state-of-the-art techniques and may be key to future plasma wakefield-based free-electron lasers and high energy physics facilities, where large intrinsic chirps need to be removed.

Emittance Preservation in an Aberration-Free Active Plasma Lens.

Active plasma lensing is a compact technology for strong focusing of charged particle beams, which has gained considerable interest for use in novel accelerator schemes. While providing kT/m focusing gradients, active plasma lenses can have aberrations caused by a radially nonuniform plasma temperature profile, leading to degradation of the beam quality. We present the first direct measurement of this aberration, consistent with theory, and show that it can be fully suppressed by changing from a light gas species (helium) to a heavier gas species (argon). Based on this result, we demonstrate emittance preservation for an electron beam focused by an argon-filled active plasma lens.

Knudsen-to-hydrodynamic crossover in liquid 3He in a high-porosity aerogel.

We present a combined experimental and theoretical study of the drag force acting on a high porosity aerogel immersed in liquid (3)He and its effect on sound propagation. The drag force is characterized by the Knudsen number, which is defined as the ratio of the quasiparticle mean free path to the radius of an aerogel strand. Evidence of the Knudsen-hydrodynamic crossover is clearly demonstrated by a drastic change in the temperature dependence of ultrasound attenuation in 98% porosity aerogel. Our theoretical analysis shows that the frictional sound damping caused by the drag force is governed by distinct laws in the two regimes, providing excellent agreement with the experimental observation.

[Assessment of elderly intensive care patients]. / Assessment des älteren Intensivpatienten.

The standard geriatric basic assessment validly presents the functional limitations of elderly patients. The prognosis estimation of elderly people is less precise using the instruments for cardiovascular and preoperative risk evaluation or by the intensive care medicine scores on organ failure. An adaptation and further development of score systems could clarify these vague areas.

[Medical geriatric aspects in intensive care therapy of elderly patients]. / Medizinisch-geriatrische Aspekte in der Intensivtherapie alter Patienten.

For elderly patients specific medical problems, such as the consequences of aging organs, comorbidities or geriatric syndromes must be considered in the intensive care treatment of acute diseases. Under these circumstances special instruments for geriatric assessment are particularly useful. Up to now geriatrics and intensive care medicine have made complementary contributions in the treatment of severely ill elderly patients. A closer interdisciplinary cooperation of the two disciplines could be of substantial beneficial value in the care of the sick and elderly to overcome the many open questions and pressing problems.

[Evidence-based recommendations on primary diagnostics of peripheral arterial occlusive disease in geriatric patients]. / Evidenzbasierte Empfehlungen zur Basisdiagnostik der peripheren arteriellen Verschlusskrankheit bei geriatrischen Patienten.

The prevalence of peripheral arterial occlusive disease (PAOD) is high in elderly patients and its clinical manifestation is often atypical. Comorbidity and morbidity as a consequence of PAOD are significant. Therefore, standardized primary diagnostics are required among geriatric patients. Drawn from a search of the literature, evidence-based recommendations are provided. Pulse palpation and the evaluation of a patient's medical history are obligatory components of primary diagnostics, even in the absence of typical symptoms. In the case of pathological and ambiguous findings, measuring Doppler ankle pressures is suggested as the next diagnostic step. Further measures depend on the following factors: the presence of lesions on the leg with disturbed blood flow, predominantly in the foot and lower leg areas, degree of PAOD-related ailments, and, finally, intended surgery of the affected leg for other medical reasons.

[Life-threatening necrotizing fasciitis colli caused by Serratia marcescens]. / Lebensbedrohliche nekrotisierende Fasciitis colli durch Serratia marcescens.

Necrotizing fasciitis colli is a rare, but life-threatening disease. A 43-year-old female patient was admitted to our department because of increasing dysphagia and slight swelling of the left side of her neck due to severe necrotizing pharyngolaryngitis. Initial treatment with cephalosporin I was ineffective. The patient developed a rapidly spreading necrotizing fasciitis of the neck requiring open surgery for débridement and drainage as well as tracheostomy. Microbiological analysis revealed Serratia marcescens, thus allowing targeted and ultimately successful antibiotic therapy. The case shows that even saprophytes like Serratia marcescens may cause a necrotizing fasciitis. Therefore, the initially calculated antibiotic treatment should include a wide spectrum of aerobic and anaerobic germs.

[Elderly patients with cardiovascular diseases]. / Altere Patienten mit kardiovaskulären Erkrankungen.

What is the difference in cardio-vascular diseases in the elderly? - In elderly patients with acute coronary syndrome the diagnosis is frequently hampered by non-specific symptoms and these patients often seek medical help later than younger individuals. Elderly and old patients with acute coronary syndrome are still less frequently being referred to percutaneous coronary intervention (PCI) than younger patients, although statistically even octogenarians profit from PCI more than from thrombolysis or purely drug therapy. In stable coronary artery disease the focus is on consistent treatment of risk factors. Therapy of systolic heart failure in the elderly is not fundamentally different from that administered to younger individuals, and therapy is just as effective. In old age diastolic heart failure is frequent. The risk of thrombo-embolic complications in atrial fibrillation increases with age. What makes the difference in cardio-vascular diseases in the elderly? - Physiological organ aging processes and immunosenescence provide possible explanations for the frequently atypical clinical presentation of severe ailments and altered pharmacokinetics in old age. Influenza and pneumococcus vaccinations are effective in preventing cardiovascular events.

Ultrasound attenuation of superfluid 3He in aerogel.

We have performed longitudinal ultrasound (9.5 MHz) attenuation measurements in the B phase of superfluid 3He in 98% porosity aerogel down to the zero temperature limit for a wide range of pressures at zero magnetic field. The absolute attenuation was determined by direct transmission of sound pulses. Compared to the bulk fluid, our results revealed a drastically different behavior in attenuation, which is consistent with theoretical accounts with gapless excitations and a collision drag effect.

Phosphorus-31 MAS NMR investigations of pyridine stabilized dithiomonometaphosphoryl halides.

Phosphorus-31 magic-angle spinning NMR spectroscopy was chosen in order to study a series of N-donor stabilized dithiomonometaphosphoryl halides (F, Cl, and Br) and to extract structural and bonding information from their spectra. Additionally, an unusual line splitting was observed in the 31P MAS NMR spectra of pyridine dithiomonometaphosphoryl chloride (Py-->PS2Cl) and the analogous bromide (Py-->PS2Br). It is shown that this effect is due to a residual dipolar coupling between phosphorus and chlorine or bromine, respectively. This work is to our knowledge the first observation of this effect between P and Br in 31P MAS NMR spectra.

IGFBP-1 and glycodelin serum levels before and after hysterectomy with and without bilateral oophorectomy in premenopausal women.

OBJECTIVES: The aim of our study was to investigate the role of the intact endometrium and ovaries for serum levels of insulin-like growth factor binding protein-1 (IGFBP-1) and glycodelin. STUDY DESIGN: In 35 premenopausal patients with a planned hysterectomy, serum measurements of IGFBP-1 and glycodelin were done before surgery and 1, 3, 5, and 10 days after surgery. Patients were divided into three groups according to the kind and time of operation: (1) hysterectomy with bilateral adnexectomy in the luteal phase and (2) hysterectomy without adnexectomy in the follicular phase or (3) the luteal phase. RESULTS: IGFBP-1-we could not show any differences in IGFBP-1 serum levels before and after hysterectomy with or without bilateral oophorectomy. Glycodelin-hysterectomized and oophorectomized patients showed decreasing serum levels up to day 3. After day 5, circulating concentrations of glycodelin increased continuously but remained below pre-operative levels. In both non-adnexectomized groups we saw a reduction up to day 5 but a rise at day 10. None of the results reached statistical significance. CONCLUSION: The results indicate that endometrium and ovary are not the only sources of IGFBP-1 and glycodelin.

Anticardiolipin antibodies in ectopic pregnancies.

BACKGROUND: Anticardiolipin auto-antibodies are known to be inflicted in recurrent pregnancy losses and other adverse outcomes of pregnancy. However, their role in extrauterine pregnancies is unknown. OBJECTIVE: To clarify the association between anticardiolipin antibodies and extrauterine pregnancies. PATIENTS AND METHODS: About 30 patients with ectopic pregnancies confirmed histologically and 40 control subjects with intrauterine pregnancies were studied. Mean duration of pregnancy was 38 and 39 days, respectively. Serum levels of IgG, IgA, and IgM antibodies against cardiolipin were measured. In addition, measurements of human chorionic gonadotropin (beta hCG) and progesterone were made. RESULTS: Mean levels of IgA and IgM but not IgG antibodies were significantly higher in patients with ectopic pregnancies than in normal pregnant women. Distribution frequency histograms revealed that a subgroup of ectopic pregnancies exhibit antibody titers corresponding to that of intrauterine pregnancies, and others showing elevated levels. Markedly elevated antibody levels were observed in patients having low levels of beta hCG and/or progesterone. CONCLUSION: In view of the inflammatory events associated with some cases of ectopic pregnancies, elevated levels of anticardiolipin auto-antibodies may give clues to pathogenesis. Determination of IgM antibodies may help discriminate ectopic pregnancies with auto-immune pathogenesis from those caused by other factors.

Tris(tert-butyl)phosphine sulfide, a phosphine sulfide with three bulky substituents.

The title compound, C12H27PS, has crystallographic C3 symmetry. The bond angles at phosphorus are tetrahedral [C--P--S 109.31 (12) degrees and C--P--C 109.63 (12) degrees ] and the P--C bond length is 1.899 (4) A. The shortest intermolecular contacts exist between methyl H atoms and the S atom (3.09, 3.12 and 3.28 A). A survey of various phosphine sulfides containing three equal ligands (Me3PS, Et3PS, Cy3PS, tBu3PS, etc.) shows the influence of substituents with different steric demand on the geometry at phosphorus and on the P--C bond length.