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The genetic make-up of an individual contributes to the susceptibility and response to viral infection. Although environmental, clinical and social factors have a role in the chance of exposure to SARS-CoV-2 and the severity of COVID-191,2, host genetics may also be important. Identifying host-specific genetic factors may reveal biological mechanisms of therapeutic relevance and clarify causal relationships of modifiable environmental risk factors for SARS-CoV-2 infection and outcomes. We formed a global network of researchers to investigate the role of human genetics in SARS-CoV-2 infection and COVID-19 severity. Here we describe the results of three genome-wide association meta-analyses that consist of up to 49,562 patients with COVID-19 from 46 studies across 19 countries. We report 13 genome-wide significant loci that are associated with SARS-CoV-2 infection or severe manifestations of COVID-19. Several of these loci correspond to previously documented associations to lung or autoimmune and inflammatory diseases3,4,5,6,7. They also represent potentially actionable mechanisms in response to infection. Mendelian randomization analyses support a causal role for smoking and body-mass index for severe COVID-19 although not for type II diabetes. The identification of novel host genetic factors associated with COVID-19 was made possible by the community of human genetics researchers coming together to prioritize the sharing of data, results, resources and analytical frameworks. This working model of international collaboration underscores what is possible for future genetic discoveries in emerging pandemics, or indeed for any complex human disease.
Da in der heutigen Zeit Metadaten auch in der bibliothekarischen Erschließung eine wesentliche Rolle spielen und diese dann durch das Internet in der ganzen Welt genutzt werden können, ist es erforderlich, ein international anerkanntes Regelwerk zu schaffen, das einheitliche Strukturen aufweist und möglichst einfach gehalten ist. Ziel dieser Arbeit ist es, die Auswirkungen des für diese Vorgaben geschaffenen Dublin-Core-Sets auf die bibliothekarische Arbeit zu untersuchen. Dabei wird sowohl auf die historische Entwicklung als auch die einzelnen Elemente des Dublin-Core-Sets eingegangen. Darüber hinaus wird untersucht, welche Rolle Bibliotheken im Hinblick auf die wachsende Präsenz der elektronisch verfügbaren Dokumente spielen und wie diese Metadaten für Bibliotheken, Bibliotheksverbünde sowie Hochschulnetze genutzt werden können. Schwerpunkt der Arbeit bildet dann die Anwendung von Dublin-Core in ausgewählten Projekten, sowie ein Vergleich der Nutzung von Metadaten nach Dublin-Core in diesen Projekten. Die daraus resultierende Frage, in wie weit sich Dublin-Core als Standard zur Erschließung von Metadaten etablieren konnte, steht dann im Mittelpunkt der Betrachtung des darauffolgenden Kapitels. Zum Abschluss der Arbeit soll dann geprüft werden, ob Dublin-Core in der Lage ist, den o.g. Forderungen Rechnung zu tragen. Darüber hinaus werden Perspektiven für die Zukunft bezüglich des Einsatzes von Dublin-Core kurz angerissen.
Background: In intensive care units (ICU) octogenarians become a routine patients group with aggravated therapeutic and diagnostic decision-making. Due to increased mortality and a reduced quality of life in this high-risk population, medical decision-making a fortiori requires an optimum of risk stratification. Recently, the VIP-1 trial prospectively observed that the clinical frailty scale (CFS) performed well in ICU patients in overall-survival and short-term outcome prediction. However, it is known that healthcare systems differ in the 21 countries contributing to the VIP-1 trial. Hence, our main focus was to investigate whether the CFS is usable for risk stratification in octogenarians admitted to diversified and high tech German ICUs.
Methods: This multicentre prospective cohort study analyses very old patients admitted to 20 German ICUs as a sub-analysis of the VIP-1 trial. Three hundred and eight patients of 80 years of age or older admitted consecutively to participating ICUs. CFS, cause of admission, APACHE II, SAPS II and SOFA scores, use of ICU resources and ICU- and 30-day mortality were recorded. Multivariate logistic regression analysis was used to identify factors associated with 30-day mortality.
Results: Patients had a median age of 84 [IQR 82–87] years and a mean CFS of 4.75 (± 1.6 standard-deviation) points. More than half of the patients (53.6%) were classified as frail (CFS ≥ 5). ICU-mortality was 17.3% and 30-day mortality was 31.2%. The cause of admission (planned vs. unplanned), (OR 5.74) and the CFS (OR 1.44 per point increase) were independent predictors of 30-day survival.
Conclusions: The CFS is an easy determinable valuable tool for prediction of 30-day ICU survival in octogenarians, thus, it may facilitate decision-making for intensive care givers in Germany.
Trial registration: The VIP-1 study was retrospectively registered on ClinicalTrials.gov (ID: NCT03134807) on May 1, 2017.