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  • 1
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    Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study
    Springer Science and Business Media LLC ; 2022
    In:  Critical Care Vol. 26, No. 1 ( 2022-09-13)
    Details
    In: Critical Care, Springer Science and Business Media LLC, Vol. 26, No. 1 ( 2022-09-13)
    Abstract: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10] ), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11] ), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18] ). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30] ). Conclusions In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.
    Type of Medium: Online Resource
    ISSN: 1364-8535
    URL: Article
    DOI: 10.1186/s13054-022-04155-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2051256-9
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  • 2
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    ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19
    Springer Science and Business Media LLC ; 2022
    In:  Scientific Data Vol. 9, No. 1 ( 2022-07-30)
    Details
    In: Scientific Data, Springer Science and Business Media LLC, Vol. 9, No. 1 ( 2022-07-30)
    Abstract: The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use.
    Type of Medium: Online Resource
    ISSN: 2052-4463
    URL: Article
    DOI: 10.1038/s41597-022-01534-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2775191-0
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  • 3
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    Cold atoms in space: community workshop summary and proposed road-map
    Springer Science and Business Media LLC ; 2022
    In:  EPJ Quantum Technology Vol. 9, No. 1 ( 2022-12)
    Details
    In: EPJ Quantum Technology, Springer Science and Business Media LLC, Vol. 9, No. 1 ( 2022-12)
    Abstract: We summarise the discussions at a virtual Community Workshop on Cold Atoms in Space concerning the status of cold atom technologies, the prospective scientific and societal opportunities offered by their deployment in space, and the developments needed before cold atoms could be operated in space. The cold atom technologies discussed include atomic clocks, quantum gravimeters and accelerometers, and atom interferometers. Prospective applications include metrology, geodesy and measurement of terrestrial mass change due to, e.g., climate change, and fundamental science experiments such as tests of the equivalence principle, searches for dark matter, measurements of gravitational waves and tests of quantum mechanics. We review the current status of cold atom technologies and outline the requirements for their space qualification, including the development paths and the corresponding technical milestones, and identifying possible pathfinder missions to pave the way for missions to exploit the full potential of cold atoms in space. Finally, we present a first draft of a possible road-map for achieving these goals, that we propose for discussion by the interested cold atom, Earth Observation, fundamental physics and other prospective scientific user communities, together with the European Space Agency (ESA) and national space and research funding agencies.
    Type of Medium: Online Resource
    ISSN: 2662-4400 , 2196-0763
    URL: Article
    DOI: 10.1140/epjqt/s40507-022-00147-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2784501-1
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  • 4
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    Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis
    Springer Science and Business Media LLC ; 2022
    In:  Critical Care Vol. 26, No. 1 ( 2022-12)
    Details
    In: Critical Care, Springer Science and Business Media LLC, Vol. 26, No. 1 ( 2022-12)
    Abstract: The role of neuromuscular blocking agents (NMBAs) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is not fully elucidated. Therefore, we aimed to investigate in COVID-19 patients with moderate-to-severe ARDS the impact of early use of NMBAs on 90-day mortality, through propensity score (PS) matching analysis. Methods We analyzed a convenience sample of patients with COVID-19 and moderate-to-severe ARDS, admitted to 244 intensive care units within the COVID-19 Critical Care Consortium, from February 1, 2020, through October 31, 2021. Patients undergoing at least 2 days and up to 3 consecutive days of NMBAs (NMBA treatment), within 48 h from commencement of IMV were compared with subjects who did not receive NMBAs or only upon commencement of IMV (control). The primary objective in the PS-matched cohort was comparison between groups in 90-day in-hospital mortality, assessed through Cox proportional hazard modeling. Secondary objectives were comparisons in the numbers of ventilator-free days (VFD) between day 1 and day 28 and between day 1 and 90 through competing risk regression. Results Data from 1953 patients were included. After propensity score matching, 210 cases from each group were well matched. In the PS-matched cohort, mean (± SD) age was 60.3 ± 13.2 years and 296 (70.5%) were male and the most common comorbidities were hypertension (56.9%), obesity (41.1%), and diabetes (30.0%). The unadjusted hazard ratio (HR) for death at 90 days in the NMBA treatment vs control group was 1.12 (95% CI 0.79, 1.59, p  = 0.534). After adjustment for smoking habit and critical therapeutic covariates, the HR was 1.07 (95% CI 0.72, 1.61, p  = 0.729). At 28 days, VFD were 16 (IQR 0–25) and 25 (IQR 7–26) in the NMBA treatment and control groups, respectively (sub-hazard ratio 0.82, 95% CI 0.67, 1.00, p  = 0.055). At 90 days, VFD were 77 (IQR 0–87) and 87 (IQR 0–88) (sub-hazard ratio 0.86 (95% CI 0.69, 1.07; p  = 0.177). Conclusions In patients with COVID-19 and moderate-to-severe ARDS, short course of NMBA treatment, applied early, did not significantly improve 90-day mortality and VFD. In the absence of definitive data from clinical trials, NMBAs should be indicated cautiously in this setting.
    Type of Medium: Online Resource
    ISSN: 1364-8535
    URL: Article
    DOI: 10.1186/s13054-022-03983-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2051256-9
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  • 5
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    Surveillance and Genomic Analysis of Third-Generation Cephalosporin-Resistant and Carbapenem-Resistant Klebsiella pneumoniae Complex in Germany
    MDPI AG ; 2022
    In:  Antibiotics Vol. 11, No. 10 ( 2022-09-21), p. 1286-
    Details
    In: Antibiotics, MDPI AG, Vol. 11, No. 10 ( 2022-09-21), p. 1286-
    Abstract: To analyse the epidemiology and population structure of third-generation cephalosporin-resistant (3GCR) and carbapenem-resistant (CR) Klebsiella pneumoniae complex isolates, patients were screened for rectal colonisation with 3GCR/CR K. pneumoniae complex on admission to six German university hospitals (2016–2019). Also collected were 3GCR/CR and susceptible K. pneumoniae isolates from patients with bloodstream infections (2016–2018). Whole-genome sequencing was performed followed by multilocus sequencing typing (MLST), core-genome MLST, and resistome and virulome analysis. The admission prevalence of 3GCR K. pneumoniae complex isolates during the 4-year study period was 0.8%, and 1.0 bloodstream infection per 1000 patient admissions was caused by K. pneumoniae complex (3GCR prevalence, 15.1%). A total of seven K. pneumoniae complex bloodstream isolates were CR (0.8%). The majority of colonising and bloodstream 3GCR isolates were identified as K. pneumoniae, 96.7% and 98.8%, respectively; the remainder were K. variicola and K. quasipneumoniae. cgMLST showed a polyclonal population of colonising and bloodstream isolates, which was also reflected by MLST and virulome analysis. CTX-M-15 was the most prevalent extended-spectrum beta-lactamase, and 29.7% of the colonising and 48.8% of the bloodstream isolates were high-risk clones. The present study provides an insight into the polyclonal 3GCR K. pneumoniae population in German hospitals.
    Type of Medium: Online Resource
    ISSN: 2079-6382
    URL: Article
    DOI: 10.3390/antibiotics11101286
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2681345-2
    SSG: 15,3
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  • 6
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    Select Whole-Cell Biofilm-Based Immunogens Protect against a Virulent Staphylococcus Isolate in a Stringent Implant Model of Infection
    MDPI AG ; 2022
    In:  Vaccines Vol. 10, No. 6 ( 2022-05-24), p. 833-
    Details
    In: Vaccines, MDPI AG, Vol. 10, No. 6 ( 2022-05-24), p. 833-
    Abstract: Many microbes of concern to human health remain without vaccines. We have developed a whole-microbe inactivation technology that enables us to rapidly inactivate large quantities of a pathogen while retaining epitopes that were destroyed by previous inactivation methods. The method that we call UVC-MDP inactivation can be used to make whole-cell vaccines with increased potency. We and others are exploring the possibility of using improved irradiation-inactivation technologies to develop whole-cell vaccines for numerous antibiotic-resistant microbes. Here, we apply UVC-MDP to produce candidate MRSA vaccines which we test in a stringent tibia implant model of infection challenged with a virulent MSRA strain. We report high levels of clearance in the model and observe a pattern of protection that correlates with the immunogen protein profile used for vaccination.
    Type of Medium: Online Resource
    ISSN: 2076-393X
    URL: Article
    DOI: 10.3390/vaccines10060833
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2703319-3
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  • 7
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    Earlier snowmelt may lead to late season declines in plant productivity and carbon sequestration in Arctic tundra ecosystems
    Springer Science and Business Media LLC ; 2022
    In:  Scientific Reports Vol. 12, No. 1 ( 2022-03-21)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 12, No. 1 ( 2022-03-21)
    Abstract: Arctic warming is affecting snow cover and soil hydrology, with consequences for carbon sequestration in tundra ecosystems. The scarcity of observations in the Arctic has limited our understanding of the impact of covarying environmental drivers on the carbon balance of tundra ecosystems. In this study, we address some of these uncertainties through a novel record of 119 site-years of summer data from eddy covariance towers representing dominant tundra vegetation types located on continuous permafrost in the Arctic. Here we found that earlier snowmelt was associated with more tundra net CO 2 sequestration and higher gross primary productivity (GPP) only in June and July, but with lower net carbon sequestration and lower GPP in August. Although higher evapotranspiration (ET) can result in soil drying with the progression of the summer, we did not find significantly lower soil moisture with earlier snowmelt, nor evidence that water stress affected GPP in the late growing season. Our results suggest that the expected increased CO 2 sequestration arising from Arctic warming and the associated increase in growing season length may not materialize if tundra ecosystems are not able to continue sequestering CO 2 later in the season.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-022-07561-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2615211-3
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  • 8
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    Moderne multimodale Konzepte für fortgeschrittene und metastasierte Ösophaguskarzinome
    Hogrefe Publishing Group ; 2022
    In:  Therapeutische Umschau Vol. 79, No. 3-4 ( 2022-04), p. 195-200
    Details
    In: Therapeutische Umschau, Hogrefe Publishing Group, Vol. 79, No. 3-4 ( 2022-04), p. 195-200
    Abstract: Zusammenfassung. Bei lokal fortgeschrittenen Ösophaguskarzinomen hat sich in den Leitlinien die klare Empfehlung zur multimodalen Therapie etabliert. So auch die rein systemische Therapie in der palliativen, metastasierten Situation. Vor dem Hintergrund zunehmender Erfahrung mit multimodalen Konzepten und aber auch von einem parallelen Trend zur stärker personalisierten Tumortherapie kommen vermehrt darüber hinaus reichende Therapieoptionen zum Einsatz. Das jüngste Kapitel hierbei ist der erfolgreiche Einsatz von Antikörpern und Immuncheckpoint-Inhibitoren im adjuvanten, additiven oder palliativen Setting. Auch Salvage-Konzepte und die Salvage-Operation finden Anwendung. Dies sind effiziente Optionen, um aus einer Situation der klinischen Remission und strenger Beobachtung bei Tumorrückfall operativ reagieren zu können. Die limitiert radikalen Operationsverfahren mit Rekonstruktion nach Merendino und dem Double-Tract-Verfahren mit begrenzter Resektion des distalen Ösophagus und proximalen Magens ausschliesslich von abdominal sind eine Option für Hochrisikopatienten oder sehr betagte Patienten. Sie weisen grosse Vorteile bezüglich der operativen Belastung und – insbesondere das Double-Tract-Verfahren – bezüglich der Lebensqualität auf. Auch die oligometastasierte Situation ist Gegenstand laufender Studien. Unter strenger klinischer Beobachtung kann es sinnvoll sein, Patienten mit sehr limitierter Metastasierung nicht grundsätzlich von einem kurativen Konzept auszuschliessen. Hierzu ermutigen zahlreiche Fälle von Langzeitüberlebenden. Im palliativen Setting spielt neben der klassischen Chemotherapie und Best-Supportive-Care auch zunehmend die Immuntherapie eine grosse Rolle und auch hier ist bei gutem Ansprechen grundsätzlich eine Konversion in ein kuratives Konzept möglich. Palliative Ösophagusresektionen bei disseminierter Metastasierung, Infiltration von Wirbelkörpern, Aorta oder Trachea beziehungsweise Hauptbronchien hingegen müssen weiterhin strikt unterbleiben und müssen leider als inkurabel bezeichnet werden.
    Type of Medium: Online Resource
    ISSN: 0040-5930 , 1664-2864
    URL: Article
    DOI: 10.1024/0040-5930/a001348
    Language: German
    Publisher: Hogrefe Publishing Group
    Publication Date: 2022
    detail.hit.zdb_id: 82044-1
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  • 9
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    Vegetation type is an important predictor of the arctic summer land surface energy budget
    Springer Science and Business Media LLC ; 2022
    In:  Nature Communications Vol. 13, No. 1 ( 2022-10-31)
    Details
    In: Nature Communications, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2022-10-31)
    Abstract: Despite the importance of high-latitude surface energy budgets (SEBs) for land-climate interactions in the rapidly changing Arctic, uncertainties in their prediction persist. Here, we harmonize SEB observations across a network of vegetated and glaciated sites at circumpolar scale (1994–2021). Our variance-partitioning analysis identifies vegetation type as an important predictor for SEB-components during Arctic summer (June-August), compared to other SEB-drivers including climate, latitude and permafrost characteristics. Differences among vegetation types can be of similar magnitude as between vegetation and glacier surfaces and are especially high for summer sensible and latent heat fluxes. The timing of SEB-flux summer-regimes (when daily mean values exceed 0 Wm −2 ) relative to snow-free and -onset dates varies substantially depending on vegetation type, implying vegetation controls on snow-cover and SEB-flux seasonality. Our results indicate complex shifts in surface energy fluxes with land-cover transitions and a lengthening summer season, and highlight the potential for improving future Earth system models via a refined representation of Arctic vegetation types.
    Type of Medium: Online Resource
    ISSN: 2041-1723
    URL: Article
    DOI: 10.1038/s41467-022-34049-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2553671-0
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  • 10
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    Aachener Sturzpass App
    Georg Thieme Verlag KG ; 2022
    In:  Nervenheilkunde Vol. 41, No. 07/08 ( 2022-08), p. 492-496
    Details
    In: Nervenheilkunde, Georg Thieme Verlag KG, Vol. 41, No. 07/08 ( 2022-08), p. 492-496
    Abstract: Stürze sind eine große Herausforderung für Betroffene und das Gesundheitswesen. Die „Aachener Sturzpass App“ ist eine digitale Gesundheitsanwendung, die es älteren Patienten (Personen über 50 Jahre) ermöglicht, ihr individuelles Sturzrisiko selbstständig via Smartphone einzuschätzen und zu überwachen. Die Selbsteinschätzung basiert auf der „Aachener Sturzpräventionsskala“, die aus 3 Schritten besteht. Zunächst beantworten die Patienten 10 standardisierte Ja-Nein-Fragen (positives Kriterium ≥ 5 „Ja“-Antworten). Zweitens wird ein 10 Sekunden andauernder Test des freien Stehens ohne Ausgleichsbewegung durchgeführt (positives Kriterium: Ausgleichsbewegung). Im dritten Schritt schließlich bewerten die Patienten ihr subjektives Sturzrisiko auf einer 10-Punkte-Likert-Skala, ausgehend von einer Erläuterung der positiven Kriterien der Testschritte 1 und 2.
    Type of Medium: Online Resource
    ISSN: 0722-1541 , 2567-5788
    URL: Article
    DOI: 10.1055/a-1844-8089
    RVK:
    XA 10000
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
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