Prognostication using SpO(2)/FiO(2) in invasively ventilated ICU patients with ARDS due to COVID-19-Insights from the PRoVENT-COVID study

Background: The SpO(2)/FiO(2) is a useful oxygenation parameter with prognostic capacity in patients with ARDS. We investigated the prognostic capacity of SpO(2)/FiO(2) for mortality in patients with ARDS due to COVID-19. Methods: This was a post-hoc analysis of a national multicenter cohort study in invasively ventilated patients with ARDS due to COVID-19. The primary endpoint was 28-day mortality. Results: In 869 invasively ventilated patients, 28-day mortality was 30.1%. The SpO(2)/FiO(2) on day 1 had no prognostic value. The SpO(2)/FiO(2) on day 2 and day 3 had prognostic capacity for death, with the best cut-offs being 179 and 199, respectively. Both SpO(2)/FiO(2) on day 2 (OR, 0.66 [95%-CI 0.46-0.96]) and on day 3 (OR, 0.70 [95%-CI 0.51-0.96]) were associated with 28-day mortality in a model corrected for age, pH, lactate levels and kidney dysfunction (AUROC 0.78 [0.76-0.79]). The measured PaO2/FiO(2) and the PaO2/FiO(2) calculated from SpO(2)/FiO(2) were strongly correlated (Spearman's r = 0.79). Conclusions: In this cohort of patients with ARDS due to COVID-19, the SpO(2)/FiO(2) on day 2 and day 3 are independently associated with and have prognostic capacity for 28-day mortality. The SpO(2)/FiO(2) is a useful metric for risk stratification in invasively ventilated COVID-19 patients. (C) 2021 The Authors. Published by Elsevier Inc

Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest

Background In patients with out‐of‐hospital cardiac arrest without ST‐segment elevation, immediate coronary angiography did not improve clinical outcomes when compared with delayed angiography in the COACT (Coronary Angiography After Cardiac Arrest) trial. Whether 1 of the 2 strategies has benefits in terms of health care resource use and costs is currently unknown. We assess the health care resource use and costs in patients with out‐of‐hospital cardiac arrest. Methods and Results A total of 538 patients were randomly assigned to a strategy of either immediate or delayed coronary angiography. Detailed health care resource use and cost‐prices were collected from the initial hospital episode. A generalized linear model and a gamma distribution were performed. Generic quality of life was measured with the RAND‐36 and collected at 12‐month follow‐up. Overall total mean costs were similar between both groups (EUR 33 575±19 612 versus EUR 33 880±21 044; P=0.86). Generalized linear model: (β, 0.991; 95% CI, 0.894–1.099; P=0.86). Mean procedural costs (coronary angiography and percutaneous coronary intervention, coronary artery bypass graft) were higher in the immediate angiography group (EUR 4384±3447 versus EUR 3028±4220; P<0.001). Costs concerning intensive care unit and ward stay did not show any significant difference. The RAND‐36 questionnaire did not differ between both groups. Conclusions The mean total costs between patients with out‐of‐hospital cardiac arrest randomly assigned to an immediate angiography or a delayed invasive strategy were similar during the initial hospital stay. With respect to the higher invasive procedure costs in the immediate group, a strategy awaiting neurological recovery followed by coronary angiography and planned revascularization may be considered. Registration URL: https://trialregister.nl; Unique identifier: NL4857

Autoantibodies against type I IFNs in patients with life-threatening COVID-19

Interindividual clinical variability in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is vast. We report that at least 101 of 987 patients with life-threatening coronavirus disease 2019 (COVID-19) pneumonia had neutralizing immunoglobulin G (IgG) autoantibodies (auto-Abs) against interferon-w (IFN-w) (13 patients), against the 13 types of IFN-a (36), or against both (52) at the onset of critical disease; a few also had auto-Abs against the other three type I IFNs. The auto-Abs neutralize the ability of the corresponding type I IFNs to block SARS-CoV-2 infection in vitro. These auto-Abs were not found in 663 individuals with asymptomatic or mild SARS-CoV-2 infection and were present in only 4 of 1227 healthy individuals. Patients with auto-Abs were aged 25 to 87 years and 95 of the 101 were men. A B cell autoimmune phenocopy of inborn errors of type I IFN immunity accounts for life-threatening COVID-19 pneumonia in at least 2.6% of women and 12.5% of men

Cocreating Understanding and Value in Distributed Work: How Members of Onsite and Offshore Vendor Teams Give, Make, Demand, and Break Sense

Achieving shared, common, or mutual understandings among geographically dispersed workers is a central concern in the distributed work literature. Nonetheless, little is known yet about the socio-cognitive acts and communication processes involved with synchronizing and cocreating understandings in such settings. Building on a case study of a geographically distributed information systems development project at one of India’s largest offshore vendors, we postulate that knowledge and experience asymmetries, and requirements and task characteristics (such as complexity, instability, ambiguity, and novelty) prompt onsite and offshore team members to engage in acts of sensegiving, sensedemanding, and sensebreaking. This allows them to make sense of their tasks and their environment, and it increases the likelihood that congruent and actionable understandings emerge. Furthermore, it assists them in cocreating novel understandings, especially when acts of sensegiving and sensedemanding are complemented with instances of sensebreaking. Our results contribute to the literature by explaining how distributed team members mitigate problems of understanding, transfer preexisting understandings, and cocreate novel understandings. Acts of sensegiving, sensedemanding, and sensebreaking allow distributed team members to jointly explore and generate value, thereby amplifying the performance of distributed workers

The process of value realization in asymmetric new venture development alliances: Governing the transition from exploration to exploitation

Based on a case study of three asymmetric new venture development (ANVD) alliances, we examine the governance of transitions from exploration to exploitation. We propose that role deficiencies, technological asymmetry, and the presence of a separate venture unit at established firms constitute important initial conditions influencing value realization in ANVD alliances. We further show that role-specific investments act as more appropriate mechanisms than contractual incentives to govern transitions from exploration to exploitation. Jointly, these findings provide new insights into the impact of structural and relational governance mechanisms on value creation in interfirm relationships. (C) 2012 Elsevier B.V. All rights reserved

Worksatisfaction and co-management in a municipal work situation 1979

Explorative research concerning influence and co-management, satisfaction with work, and immaterial working conditions. Satisfaction with own work and working situation / opinions on several existing participatory situations. Background variables: basic characteristics/ organizational membershi

On the Evolution of Trust, Distrust, and Formal Coordination and Control in Interorganizational Relationships: Towards an Integrative Framework.

Number of pages 3

Towards a Dialectic Perspective on Formalization in Interorganizational Relationships: How Alliance Managers Capitalize on the Duality Inherent in Contracts, Rules, and Procedures.

The mainstream literature on contracts, rules and procedures presumes that formalization is directed at coordination and control, and that its influence on performance is contingent upon firm, transaction and contextual characteristics. In response to recent calls for inquiries into dialectics in interorganizational relationships, and in an effort to provide managerial choice with a more prominent position in research on formalization, a complementary perspective is here being developed. We propose a framework in which formalization is presented as a duality, involving trade-offs between its functions and dysfunctions, and eventuating in dialectic tensions with which managers have to cope. In line with this, we argue that researchers should not only be preoccupied with assessing the 'rightness' of governance solutions, but also with the trade-offs and tensions associated with them. Our framework is illustrated by a case study of an alliance between a major European financial services firm and one of the world's leading retailers. The alliance managers in this particular relationship attempted to reduce or capitalize on the tensions associated with formalization by: (1) adopting a semi-structure, in which outcomes were formalized, but behaviour was not; (2) justifying formalization through referring to factors that were beyond their control, and; (3) alternating their emphasis on different requirements by each of the partner firms. The article shows that a dialectic perspective on formalization in interorganizational relationships offers a promising complement to the mainstream literature. Copyright © 2007 SAGE Publications

Mapping the human genetic architecture of COVID-19

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 diseases3–7. 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