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1. The Use of Different Sepsis Risk Stratification Tools on the Wards and in Emergency Departments Uncovers Different Mortality Risks: Results of the Three Welsh National Multicenter Point-Prevalence Studies

Author

Harry J. A. Unwin, MBBCh, BSc, Maja Kopczynska, MBBCh, BSc, Richard Pugh, FRCA, Laura J. P. Tan, MBBS, BSc, Christian P. Subbe, MD, Gemma Ellis, MSc, Paul Morgan, FRCA, Peter Havalda, MD, Ben Sharif, MBBCh, John Burke, MSc, Tamas Szakmany, MD, PhD, FCCM, on behalf of Welsh Digital Data Collection Platform (WDDCP) Collaborators, Maria Hobrok, Moriah Thomas, Annie Burden, Nadia Youssef, Katherine Carnegie, Helena Colling-Sylvester, Natasha Logier, Meshari Alsaeed, Hannah Williams, Arfa Ayob, Nor Farzana, Sweta Parida, David Lawson, Emily Evans, Laura Jane Davis, Billie Atkins, Llywela Wyn Davies, Lee Sanders-Crook, Steffan Treharne Seal, Alice Cains, Richard Pugh, Katy Crisp, Sarah Venning, Ella Sykes, Stephanie Narine, Georgia Parry, Emily Angela Dillon, Qi Zhuang Siah, Ting Yang, Tyler Jones, Parvathi Thara, Emma Wood, Lara Wirt, Georgina St Pier, Richard Betts, Kyriaki Mitsaki, Mari Tachweed Pierce, Sioned Davies, Yakeen Hafouda, Erin Ifan, Grace Lacey, Francesca Mitchell, John Lynch, Michal Mazur, Lezia D’Souza, Bethan Ponting, Terrance Lau, Ruairidh Kerrigan, Lucy Morgan, Roshan Vindla, Claudia Zeicu, Becky James, Amirah Amin Ariff, Wan Binti Wan Azzlan, Charlotte Collins, Elizabeth Wickens, Alisa Norbee, Aliya Zulkefli, Thomas Haddock, Megan Thomas, Matthew Lee, Miriam Cynan, Nik-Syakirah Nik Azis, Imogen Hay, Catherine Russell, Margriet Vreugdenhil, Mustafa Abdimalik, Joseph Davies, Peter Havalda, Angharad Evans, Kate Robertson, Grace Gitau, Mei-yin Gruber, Thomas Telford, Anas Qarout, Naomi Nandra, Hannah Garrard, James Cutler, Rhiannon Tammy Jones, Amy Prideaux, Timothy Spence, Sarah Hardie, Harriet Seymour, Sam Willis, Matthew Warlow, Shanali Thanthilla, Thomas Downs, Nina Foley, Chad McKeown, Akshita Dandawate, Holleh Shayan-Arani, Ellie Taylor, Oliver Kyriakides, Rachel Price, Ffion Haf Mackey, Emily Haines, Samuel Chun, Nilarnti Vignarajah, Tessa Chamberlain, Dongying Zhao, Nayanatara Nadeesha T Tantirige, Naomi Dennehey, Georgina Evans, John Watts, Ceri Battle, Ryan Jones, Selina Jones, Charlotte James, James O’Hanlon, Isabella Bridges, Bethany Hughes, Leo Polchar, Elise Bisson, Charlotte Mykura, Lara Money, Joshua McKenna, Sarah Kinsman, Demiana Hanna, Emily Baker, Harrison Sprague, Liam Sharma, Tom Pontin, Emma Shore, Tamara Hughes, Sam Nightingale, Philby Baby, Matthew Shield, Alice Cross, Jenna Boss, Olivia Ross, George Ashton, Kimaya Pandit, Daniel Davies, Cameron Garbutt, Charlotte Johnston, Marcus Cox, Chantal Roberts, Alessia Waller, Laura Heekin, Kathy Wang, Rhianna Church, Shrina Patel, Marianne Broderick, Hannah Whillis, Daniel Craig Hathaway, Emel Yildirim, Caitlin Atkins, Elin Walters, Carys Durie, Robert James Hamilton Sinnerton, Benjamin Tanner, Julimar Abreu, Kiran Bashir, Vincent Hamlyn, Amelia Tee, Zoe Ann Hinchcliffe, Rita Otto, Georgie Covell, Megan Stone, Victoria Maidman, Katherine Godfray, Rhidian Caradine, Hannah Beetham, Adanna Nicole Anomneze-Collins, Jeanette Tan, Yasmina Abdelrazik, Azizah Khan, Nabihah Malik, Aidan Clack, Lewis Oliva, Tyler Thomas, Adam George Mounce, Anoopama Ramjeeawon, Ndaba Mtunzi, Duncan Soppitt, Jay Hale, Jack Wellington, Robert Buchanan Ross, Danielle Lis, Rebecca Parsonson, Jude Joseph-Gubra, Ajitha Arunthavarajah, Jessica Nicholas, Aaron Harris, Henry Atkinson, Jessica Webster, Tim Burnett, Josephine Raffan Gowar, Sam DeFriend, Jasmine Whitaker, Elizabeth Beasant, Luis Macchiavello, Danyal Usman, Abdullah Mahdi, Tiffany Ye Tze Shan, Nick Savill, Jennifer Gee, Lizzie Hodges, Ami Desai, Hannah Rossiter, Matthew Taylor, Kevin Pinto, Eleanor Hartley, Oscar Emanuel, Rhiannon Long, Megan Selby, Elilis Wardle, Alexandra Urquhart, Jack Barrington, Matthew Ashman, Elizabeth Adcock, Amelia Dickinson, Rebecca Jordache, Rym Chafai El Alaoui, Sophie Stovold, Sam Vickery, Nia Jones, Alice O’Donnell, Monty Cuthbert, Osa Eghosa, Muhammad Karim, Lowri Williams, Louise Tucker, Tom Downs, Rebecca Walford, Annabelle Hook, Adam Mounce, Emily Eccles, Ross Edwards, Kirtika Ramesh, Charlie Hall, Maria Lazarou, Rhidian Jones, Katy McGillian, Hari Singh Bhachoo, Zoe The, Vithusha Inpahas, Ruchi Desai, Yusuf Cheema, Andrew Hughes, Olivia Cranage, Felicity Bee, Khalid Osman, Humza Khan, Jennifer Pitt, Charlotte Pickwick, Jorge Carter, Fiona Andrew, Naseera Seedat, Roshni Patel, Megan Walker, Alicia Boam, Jessica Randall, Beth Bowyer, Josh Edwards, Natasha Jones, Emma Walker, Ailsa MacNaught, Swagath Balachandran, Abbie Shipley, Jennifer Louise Kent, Samuel Tilley, Bethany Davies, Emma Withers, Krishna Parmar, Lucie Webber, Angelica Sharma, Amy Handley, Alexandra Gordon, Lucy Allen, Rebecca Paddock, Harriet Penney, Lopa Banerjee, Chloe Victoria Vanderpump, Kate Harding, John Burke, Orsolya Minik, Nia Jarrett, Ellie Rowe, Adanna Anomneze-Collins, Harry Griffiths, Sarah Pengelly, Ffion Bennett, Ahmed Bilal, Abdullah El-badawey, Bethan Ellis, Luke Cook, Harriet Elizabeth Valentine Maine, Kiri Armstrong, Hannah Beresford, Timia Raven-Gregg, Tom Liddell-Lowe, Caitlin Ong, Harriet Reed, Frederika Alice St John, Weronika Julia Kozuch, Isabelle Ray, Irukshi Anuprabha Silva, Sin Ting Natalie Cheng, Umme-Laila Ali, Noreena Syed, Luke Murphy, Thomas Grother, Harry Smith, Rachel Watson, Omar Marei, Emma Kirby, Anna Gilfedder, Lydia Maw, Sarah O’Connor, Charlotte Maden, Helena Jones, Hazel Preston, Nur Amirah Binti Maliki, Mark Zimmerman, Jessica Webber, Llewelyn Jones, Rebecca Phillips, Lauren McCarthy, Emily Hubbard, Leo Duffy, Abigail Guerrier Sadler, Tamas Szakmany, Owen Richards, Charles King, Charlotte Killick, Yusuf Chema, Kavita Shergill, Yi Huen, Lillian Lau, Hannah Mustafa Ali, Lucas Wilcock, Molly Timlin, Ayeesha Rela, Daniel Smith, Sarah Ireland, Jennifer Evans, Nayanatara Poobalan, Jessica Pearce, Thivya V Vadiveloo, Zoe Black, Daniel Elis Samuel, Humaira Hussain, Joanna Hawkins, Zeid Atiyah, Rebecca Creamer, Maham Zafar, Ahmad Almazeedi, Hannah Brunnock, Zain Nasser, Mekha Jeyanthi, Poorya Moghbel, Katie Kwan, Isobel Sutherland, Frank Davis, Abigail Rogers, Zhao Xuan Tan, Clare Chantrill, Amal Robertson, Jonathan Foulkes, Rahana Khanam, Jomcy John, Sarah Hannah Meehan, Huria Metezai, Hannah Dawson, Navrhinaa Vadivale, Camilla Lee, Amrit Dhadda, Sian Cleaver, Genna Logue, Joy Inns, Isabel Jones, Robyn Howcroft, Carys Gilbert, Matthew Bradley, Louise Pike, Rachel Keeling, Charldré Banks, Eleanor Cochrane, James McFadyen, Matthew Mo, Emily Ireland, Esme Brittain, Ihssen Laid, Charlotte Green, Adriel Mcforrester, Xuong Michelle Ly, Mariana Nalbanti, Raven Joseph, Jack Tagg, David Purchase, Pan Myat, Ayako Niina, Tyler Joshua Jones, Lowri Hughes Thomas, Natalie Hoyle, Patrick Benc, Ellen Davies, Meng-Chieh Wu, David Fellows, Sam Tilley, Eloise Baxendale, Karishma Khan, Andrew Forrester, Oliver Moore, Hse Juinn Lim, Aimee Owen, Faris Hussain, Nima-banu Allybocus, Maneha Sethi, Harry Waring, Adeel Khan, Claire Smith, Nicholas Doyle, Mohammad Yahya Amjad, Luke Galloway, Paul Morgan, Gemma Ellis, Robert Lundin, Haamed Al Hassan, Bethan Markall, Namratha Kaur, Emmanuel Onyango, Heather Beard, Elliot Field, Ellen Nelson-Rowe, Lizzie Adcock, Amelia Stoddart, Frederika St John, Mathoorika Sivananthan, Rhys Jones, Sung Yeon Kwak, Lily Farakish, Holly Rhys-Ellis, Kate Moss, Tallulah Ray, Tessa David, Talea Roberts, Annie Quy, Aniket Paranjape, Nutchanun Poolworaluk, Mary Keast, Si Liang Yao, Dion Manning, Isobel Irwin, Umair Asim, Emelia Boggon, Ibrahim Alkurd, Genevieve Lawerece, Jade Brown, Emily Murphy, Evie Lambert, Jeremy Guilford, Beth Payne, Mariam Almulaifi, Arwel Poacher, Sashiananthan Ganesananthan, Berenice Cunningham-Walker, Chloe Spooner, Akanksha Kiran, Nabeegh Nadeem, Vidhi Unadkat, Esme Sparey, David Li, Jessica Smith, India Corrin, Amit Kurani, Paul McNulty, Ceri Brown, Wojciech Groblewski, Szilvia Szoke, Amelia Redman, Esther McKeag, Anastasia Donnir, Gaautham Ravishangar, Emanuela Howard, Charlotte Salmon, Sara Tanatova, Jasmine Kew, Megan Eilis Clark, Ellen Hannay, Olesya Godsafe, Christina Houghton, Francesca Lavric, Rachel Mallinson, Chris Littler, Harsha Reddy, Andrew Campbell, Benedict Soo, Rachel Evans, Georgina Donowho, Alexandra Cawthra, Maddison Davies, Matthew Lawrence Ashman, Jamie Scriven, James Vautrey, Shannon Seet, Imogen Britton, Abigail Hodgson, Emma Twohey, Joseph Robbins, Vanessa Yeo Yung Ling, Kimiya Asjadi, Carven Chin Yee Shean, Zoe McCarroll, Oritseweyimi Amatotsero, Hei Man Priscilla Chan, John Ng Cho Hui, Antonia Ashaye, Josephine Acheampong, Ayowade Adeleye, Saber Ahmed, Alexandra Chrysostomou, Harry Unwin, Eshen Ang, Niamh McSwiney, Yin Yin Lim, Zong Xuan Lee, Svetlana Kulikouskaya, Nur Zulkifili, Sheryl Lim, Lim Xin, Adiya Urazbayeva, Nur Haslina Ahmad Hanif, Yau Ke Ying, Alice Coleclough, Eilis Higgins, Naomi Spencer, Tze Gee Ng, Sam Booth, Stephanie Wai Yee Ng, Christian P Subbe, Isabella Patterson, Wen Li Chia, Abdullah Mukit, Hei Yi Vivian Pak, Felicity Lock, Mariana Nalmpanti, Shôn Alun Thomas, Tanisha Burgher, Alfred Wei Zhen Yeo, Siwan Powell Jones, Charlie Miles, Millicent Perry, Holly Burton, Katharine Powell, Luthfun Nessa, Aalaa Fadlalla, Rhian Morgan, Elizabeth Hodges, Amelia Heal, Chloe Scott, Alice Tayler, Thomas Chandy, Abduahad Taufik, James Cochrane, Samuel Willis, Sieh Yen Heng, Alex Cooper, Henrik Graf von der Pahlen, Isabella Talbot, Robin Gwyn Roberts, Jessica Sharma Smith, Aisling Sweeney, Cerian Roberts, Laura Bausor, Chania, Daniah Thomas, Elen Wyn Puw, Ronan A Lyons, and Judith E Hall

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

OBJECTIVES:. To compare the performance of Sequential Organ Failure Assessment, systemic inflammatory response syndrome, Red Flag Sepsis, and National Institute of Clinical Excellence sepsis risk stratification tools in the identification of patients at greatest risk of mortality from sepsis in nonintensive care environments. DESIGN:. Secondary analysis of three annual 24-hour point-prevalence study periods. SETTING:. The general wards and emergency departments of 14 acute hospitals across Wales. Studies were conducted on the third Wednesday of October in 2017, 2018, and 2019. PATIENTS:. We screened all patients presenting to the emergency department and on the general wards. MEASUREMENTS AND MAIN RESULTS:. We recruited 1,271 patients, of which 724 (56.9%) had systemic inflammatory response syndrome greater than or equal to 2, 679 (53.4%) had Sequential Organ Failure Assessment greater than or equal to 2, and 977 (76.9%) had Red Flag Sepsis. When stratified according to National Institute of Clinical Excellence guidelines, 450 patients (35.4%) were in the “High risk” category in comparison with 665 (52.3%) in “Moderate to High risk” and 156 (12.3%) in “Low risk” category. In a planned sensitivity analysis, we found that none of the tools accurately predicted mortality at 90 days, and Sequential Organ Failure Assessment and National Institute of Clinical Excellence tools showed only moderate discriminatory power for mortality at 7 and 14 days. Furthermore, we could not find any significant correlation with any of the tools at any of the mortality time points. CONCLUSIONS:. Our data suggest that the sepsis risk stratification tools currently utilized in emergency departments and on the general wards do not predict mortality adequately. This is illustrated by the disparity in mortality risk of the populations captured by each instrument, as well as the weak concordance between them. We propose that future studies on the development of sepsis identification tools should focus on identifying predicator values of both the short- and long-term outcomes of sepsis.

Published
2021
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2. Sepsis-related deaths in the at-risk population on the wards: attributable fraction of mortality in a large point-prevalence study

Author

Maja Kopczynska, Ben Sharif, Sian Cleaver, Naomi Spencer, Amit Kurani, Camilla Lee, Jessica Davis, Carys Durie, Jude Joseph-Gubral, Angelica Sharma, Lucy Allen, Billie Atkins, Alex Gordon, Llewelyn Jones, Amy Noble, Matthew Bradley, Henry Atkinson, Joy Inns, Harriet Penney, Carys Gilbert, Rebecca Walford, Louise Pike, Ross Edwards, Robyn Howcroft, Hazel Preston, Jennifer Gee, Nicholas Doyle, Charlotte Maden, Claire Smith, Nik Syakirah Nik Azis, Navrhinaa Vadivale, Tamas Szakmany, and Welsh Digital Data Collection Platform Collaborators

Subjects
Sepsis, Critical care, Frailty, Mortality, Medicine, Biology (General), QH301-705.5, Science (General), Q1-390
Abstract

Abstract Objective Sepsis mortality is reported to be high worldwide, however recently the attributable fraction of mortality due to sepsis (AFsepsis) has been questioned. If improvements in treatment options are to be evaluated, it is important to know what proportion of deaths are potentially preventable or modifiable after a sepsis episode. The aim of the study was to establish the fraction of deaths directly related to the sepsis episode on the general wards and emergency departments. Results 839 patients were recruited over the two 24-h periods in 2016 and 2017. 521 patients fulfilled SEPSIS-3 criteria. 166 patients (32.4%) with sepsis and 56 patients (17.6%) without sepsis died within 90 days. Out of the 166 sepsis deaths 12 (7.2%) could have been directly related to sepsis, 28 (16.9%) possibly related and 96 (57.8%) were not related to sepsis. Overall AFsepsis was 24.1%. Upon analysis of the 40 deaths likely to be attributable to sepsis, we found that 31 patients (77.5%) had the Clinical Frailty Score ≥ 6, 28 (70%) had existing DNA-CPR order and 17 had limitations of care orders (42.5%).

Published
2018
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3. Prevalence of Vertebral Fractures in CTPA’s in Adults Aged 75 and Older and Their Association with Subsequent Fractures and Mortality

Author

Llewelyn Jones, Sukhdev Singh, Chris Edwards, Nimit Goyal, and Inder Singh

Subjects
vertebral fracture, incidental, mortality, osteoporosis, Geriatrics, RC952-954.6
Abstract

Identifying vertebral fractures is prudent in the management of osteoporosis and the current literature suggests that less than one-third of incidental vertebral fractures are reported. The aim of this study is to determine the prevalence of reported and unreported vertebral fractures in computerized tomography pulmonary angiograms (CTPA) and their relevance to clinical outcomes. All acutely unwell patients aged 75 or older who underwent CTPAs were reviewed retrospectively. 179 CTPAs were reviewed to identify any unreported vertebral fractures. A total of 161 were included for further analysis. Of which, 14.3% (23/161) were reported to have a vertebral fracture, however, only 8.7% (14/161) of reports used the correct terminology of ‘fracture’. On subsequent review, an additional 19.3% (31/161) were noted to have vertebral fractures. Therefore, the overall prevalence of vertebral fractures was 33.5% (54/161). A total of 22.2% (12/54) of patients with a vertebral fracture on CTPA sustained a new fragility fracture during the follow-up period (4.5 years). In comparison, a significantly lower 10.3% (11/107) of patients without a vertebral fracture developed a subsequent fragility fracture during the same period (p = 0.04). Overall mortality during the follow-up period was significantly higher for patients with vertebral fractures (68.5%, 37/54) as compared to those without (45.8%, 49/107, p = 0.006). Vertebral fractures within the elderly population are underreported on CTPAs. The significance of detecting incidental vertebral fractures is clear given the increased rates of subsequent fractures and mortality. Radiologists and physicians alike must be made aware of the importance of identifying and treating incidental, vertebral fragility fractures.

Published
2020
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4. Predictive Value of Physiological Values and Symptom Scores for Exacerbations in Bronchiectasis and Chronic Obstructive Pulmonary Disease With Frequent Exacerbations: Longitudinal Observational Cohort Study

Author

Thomas Llewelyn Jones, Claire Roberts, Scott Elliott, Sharon Glaysher, Ben Green, Janis K Shute, and Anoop J Chauhan

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Medical technology, R855-855.5
Abstract

BackgroundCOPD (chronic obstructive pulmonary disease) and bronchiectasis are common, and exacerbations contribute to their morbidity and mortality. Predictive factors for the frequency of future exacerbations include previous exacerbation frequency and airway colonization. Earlier treatment of exacerbations is likely to reduce severity. ObjectiveThis study tested the hypothesis that, in a population with bronchiectasis, COPD, or both who have frequent exacerbations and airway colonization, changes in symptom scores or physiological variables within 10 days prior to an exacerbation would allow the prediction of the event. MethodsWe performed a 6-month, longitudinal, observational, cohort study among 30 participants with bronchiectasis, COPD, or both; at least 2 exacerbations per year; and colonization with Pseudomonas aeruginosa or Haemophilus influenzae. Daily symptom and physiological data were collected, comprising pulse rate, blood pressure, oxygen saturation, peak flow rate, step count, weight, and temperature. Exacerbations (defined as the onset of new antibiotic use for respiratory symptoms) were collected, and predictive values for abnormal values in the 10 days prior to an exacerbation were calculated. ResultsA total of 30 participants were recruited, collecting a total of 39,534 physiological and 25,334 symptom data points across 5358 participant-days; these included 78 exacerbations across 27 participants, with the remaining 3 participants not having exacerbations within the 6-month observation period. Peak flow rate, oxygen saturation, and weight were significantly different at the point of exacerbation (all P

Published
2024
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5. MISSION ABC: transforming respiratory care through one-stop multidisciplinary clinics – an observational study

Author

Anoop J Chauhan, Thomas Brown, Daniel Neville, Selina Begum, Richard Jackson, Ruth DeVos, Emily Heiden, MARK SANDERS, Hitasha Rupani, Jayne Longstaff, Milan J A Chauhan, Ellie Lanning, Thomas Llewelyn Jones, Mark Amos, Mark Mottershaw, Joanne Micklam, Ben Holdsworth, Jona Baghammar, Kathryn Bannell, Rachel Dominey, Robert Guile, Anthony Leung, Fiona Maxwell, Dave Meehan, Sara Moseley, Marcus Pullen, Kathleen A Rickard, and Matt Whiteman

Subjects
Medicine
Abstract

Objectives The Modern Innovative Solutions to Improve Outcomes in Asthma, Breathlessness and Chronic Obstructive Pulmonary Disease (COPD) (MABC) service aimed to enhance disease management for chronic respiratory conditions through specialist multidisciplinary clinics, predominantly in the community. This study assesses the outcomes of these clinics.Design This study used a prospective, longitudinal, participatory action research approach.Setting The study was conducted in primary care practices across Hampshire, UK.Participants Adults aged 16 years and above with poorly controlled asthma or COPD, as well as those with undifferentiated breathlessness not under specialist care, were included.Interventions Participants received care through the multidisciplinary, specialist-led MABC clinics.Primary and secondary outcome measures Primary outcomes included disease activity, quality of life and healthcare utilisation. Secondary outcomes encompassed clinic attendance, diagnostic changes, patient activation, participant and healthcare professional experiences and cost-effectiveness.Results A total of 441 participants from 11 general practitioner practices were recruited. Ninety-six per cent of participants would recommend MABC clinics. MABC assessments led to diagnosis changes for 64 (17%) participants with asthma and COPD and treatment adjustments for 252 participants (57%). Exacerbations decreased significantly from 236 to 30 after attending the clinics (p

Published
2024
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6. Studies in pianistic sonority, nuance and expression : French performance practices in the piano works of Maurice Ravel

Author

Llewelyn-Jones, Iwan

Subjects
786.2, M Music
Abstract

This thesis traces the development of Maurice Ravel’s pianism in relation to sonority, nuance and expression by addressing four main areas of research that have remained largely unexplored within Ravel scholarship: the origins of Ravel’s pianism and influences to which he was exposed during his formative training; his exploration of innovative pianistic techniques with particular reference to thumb deployment; his activities as performer and teacher, and role in defining a performance tradition for his piano works; his place in the French pianistic canon. Identifying the main research questions addressed in this study, an Introduction outlines the dissertation content, explains the criteria and objectives for the performance component (Public Recital) and concludes with a literature review. Chapter 1 explores the pianistic techniques Ravel acquired during his formative training, and considers how his study of specific works from the nineteenth-century piano repertory shaped and influenced his compositional style and pianism. Chapter 2 discusses Ravel’s implementation of his idiosyncratic ‘strangler’ thumbs as articulators of melodic, harmonic, rhythmic and textural material in selected piano works. Ravel’s role in defining a performance tradition for his piano works as disseminated to succeeding generations of pianists is addressed in Chapter 3, while Chapters 4 and 5 evaluate Ravel’s impact upon twentieth-century French pianism through considering how leading French piano pedagogues and performers responded to his trailblazing piano techniques. It will be shown that through his activities as teacher and performer, as well as composer, Ravel took control of every detail pertaining to his piano works with his meticulously notated scores, piano roll recordings and interpretive guidance imparted to other pianists, thus catalysing performance practices that promulgated a distinctively French twentieth-century pianistic tradition.

Published
2016

8. Predicting survival in malignant pleural mesothelioma using routine clinical and laboratory characteristics

Author

Sumita Kerley, Daniel Neville, Laura Marshall, Sharon Glaysher, Scott Elliott, Lesley Bishop, Thomas Llewelyn Jones, Carole Fogg, Samal Gunatilake, Paul Bassett, David Lodge, Rebecca Stores, Selina Begum, and Anoop Chauhan

Subjects
Pulmonary and Respiratory Medicine, Mesothelioma, medicine.medical_specialty, Multivariate analysis, Lung Neoplasms, Pleural Neoplasms, Chest pain, 03 medical and health sciences, Diseases of the respiratory system, 0302 clinical medicine, Weight loss, Internal medicine, Health Sciences, medicine, asbestos induced lung disease, Humans, 030212 general & internal medicine, Lung cancer, Pathological, Retrospective Studies, RC705-779, business.industry, Pleural mesothelioma, Lung Cancer, Mesothelioma, Malignant, Retrospective cohort study, medicine.disease, 030228 respiratory system, Medicine, medicine.symptom, business, Laboratories
Abstract

IntroductionThe prognosis of malignant pleural mesothelioma (MPM) is poor, with a median survival of 8–12 months. The ability to predict prognosis in MPM would help clinicians to make informed decisions regarding treatment and identify appropriate research opportunities for patients. The aims of this study were to examine associations between clinical and pathological information gathered during routine care, and prognosis of patients with MPM, and to develop a 6-month mortality risk prediction model.MethodsA retrospective cohort study of patients diagnosed with MPM at Queen Alexandra Hospital, Portsmouth, UK between December 2009 and September 2013. Multivariate analysis was performed on routinely available histological, clinical and laboratory data to assess the association between different factors and 6-month survival, with significant associations used to create a model to predict the risk of death within 6 months of diagnosis with MPM.Results100 patients were included in the analysis. Variables significantly associated with patient survival in multivariate analysis were age (HR 1.31, 95% CI 1.09 to 1.56), smoking status (current smoker HR 3.42, 95% CI 1.11 to 4.20), chest pain (HR 2.14, 95% CI 1.23 to 3.72), weight loss (HR 2.13, 95% CI 1.18 to 3.72), platelet count (HR 1.05, 95% CI 1.00 to 1.10), urea (HR 2.73, 95% CI 1.31 to 5.69) and adjusted calcium (HR 1.47, 95% CI 1.10 to 1.94). The resulting risk model had a c-statistic value of 0.76. A Hosmer-Lemeshow test confirmed good calibration of the model against the original dataset.ConclusionRisk of death at 6 months in patients with a confirmed diagnosis of MPM can be predicted using variables readily available in clinical practice. The risk prediction model we have developed may be used to influence treatment decisions in patients with MPM. Further validation of the model requires evaluation of its performance on a separate dataset.

Published
2021
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9. Prevalence of Vertebral Fractures in CTPA’s in Adults Aged 75 and Older and Their Association with Subsequent Fractures and Mortality

Author

Inder Singh, Chris Edwards, Nimit Goyal, Llewelyn Jones, and Sukhdev Singh

Subjects
Aging, medicine.medical_specialty, Health (social science), Fragility fracture, business.industry, Osteoporosis, 030209 endocrinology & metabolism, incidental, lcsh:Geriatrics, medicine.disease, mortality, osteoporosis, Article, 030218 nuclear medicine & medical imaging, Surgery, 03 medical and health sciences, lcsh:RC952-954.6, 0302 clinical medicine, Elderly population, medicine, Geriatrics and Gerontology, business, Gerontology, vertebral fracture
Abstract

Identifying vertebral fractures is prudent in the management of osteoporosis and the current literature suggests that less than one-third of incidental vertebral fractures are reported. The aim of this study is to determine the prevalence of reported and unreported vertebral fractures in computerized tomography pulmonary angiograms (CTPA) and their relevance to clinical outcomes. All acutely unwell patients aged 75 or older who underwent CTPAs were reviewed retrospectively. 179 CTPAs were reviewed to identify any unreported vertebral fractures. A total of 161 were included for further analysis. Of which, 14.3% (23/161) were reported to have a vertebral fracture, however, only 8.7% (14/161) of reports used the correct terminology of &lsquo, fracture&rsquo, On subsequent review, an additional 19.3% (31/161) were noted to have vertebral fractures. Therefore, the overall prevalence of vertebral fractures was 33.5% (54/161). A total of 22.2% (12/54) of patients with a vertebral fracture on CTPA sustained a new fragility fracture during the follow-up period (4.5 years). In comparison, a significantly lower 10.3% (11/107) of patients without a vertebral fracture developed a subsequent fragility fracture during the same period (p = 0.04). Overall mortality during the follow-up period was significantly higher for patients with vertebral fractures (68.5%, 37/54) as compared to those without (45.8%, 49/107, p = 0.006). Vertebral fractures within the elderly population are underreported on CTPAs. The significance of detecting incidental vertebral fractures is clear given the increased rates of subsequent fractures and mortality. Radiologists and physicians alike must be made aware of the importance of identifying and treating incidental, vertebral fragility fractures.

Published
2020

10. Sepsis-related deaths in the at-risk population on the wards: attributable fraction of mortality in a large point-prevalence study

Author

Joy Inns, Jessica Davis, Ben Sharif, Amit Kurani, Angelica Sharma, Carys Durie, Nik Syakira Nik Azis, Llewelyn Jones, Harriet Penney, A. Noble, Hazel Preston, Henry Atkinson, Lucy Allen, Charlotte Maden, Jennifer Gee, Billi Atkins, Camilla Lee, Maja Kopczynska, Nicholas Doyle, Carys Gilbert, Rebecca Walford, Sian Cleaver, Navrhinaa Vadivale, R. Edwards, Jude Joseph-Gubral, Naomi Spencer, Matthew Bradley, Robyn Howcroft, Claire Smith, Louise Pike, Alexandra Gordon, and Tamas Szakmany

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Sepsis mortality, Organ Dysfunction Scores, Prevalence, lcsh:Medicine, General Biochemistry, Genetics and Molecular Biology, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Cause of Death, Epidemiology, Patients' Rooms, medicine, Humans, 030212 general & internal medicine, Hospital Mortality, Mortality, lcsh:Science (General), lcsh:QH301-705.5, At-Risk Population, Aged, Aged, 80 and over, Frailty, business.industry, Septic shock, lcsh:R, 030208 emergency & critical care medicine, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Hospitals, United Kingdom, Research Note, Critical care, Cross-Sectional Studies, lcsh:Biology (General), Attributable risk, Emergency medicine, Female, business, Emergency Service, Hospital, lcsh:Q1-390
Abstract

Objective Sepsis mortality is reported to be high worldwide, however recently the attributable fraction of mortality due to sepsis (AFsepsis) has been questioned. If improvements in treatment options are to be evaluated, it is important to know what proportion of deaths are potentially preventable or modifiable after a sepsis episode. The aim of the study was to establish the fraction of deaths directly related to the sepsis episode on the general wards and emergency departments. Results 839 patients were recruited over the two 24-h periods in 2016 and 2017. 521 patients fulfilled SEPSIS-3 criteria. 166 patients (32.4%) with sepsis and 56 patients (17.6%) without sepsis died within 90 days. Out of the 166 sepsis deaths 12 (7.2%) could have been directly related to sepsis, 28 (16.9%) possibly related and 96 (57.8%) were not related to sepsis. Overall AFsepsis was 24.1%. Upon analysis of the 40 deaths likely to be attributable to sepsis, we found that 31 patients (77.5%) had the Clinical Frailty Score ≥ 6, 28 (70%) had existing DNA-CPR order and 17 had limitations of care orders (42.5%). Electronic supplementary material The online version of this article (10.1186/s13104-018-3819-2) contains supplementary material, which is available to authorized users.

Published
2018
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11. MOESM1 of Sepsis-related deaths in the at-risk population on the wards: attributable fraction of mortality in a large point-prevalence study

Author

Kopczynska, Maja, Sharif, Ben, Cleaver, Sian, Spencer, Naomi, Kurani, Amit, Lee, Camilla, Davis, Jessica, Durie, Carys, Joseph-Gubral, Jude, Sharma, Angelica, Allen, Lucy, Atkins, Billie, Gordon, Alex, Llewelyn Jones, Noble, Amy, Bradley, Matthew, Atkinson, Henry, Inns, Joy, Penney, Harriet, Gilbert, Carys, Walford, Rebecca, Pike, Louise, Edwards, Ross, Howcroft, Robyn, Preston, Hazel, Gee, Jennifer, Doyle, Nicholas, Maden, Charlotte, Smith, Claire, Azis, Nik Nik, Navrhinaa Vadivale, and Szakmany, Tamas

Abstract

Additional file 1: Figure S1. Distribution of patient deaths according to their attribution to sepsis episode defined by different sepsis definitions.

Published
2018
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13. Arthritis Deformans

Author

R. Llewelyn Jones

Subjects
Medical education, medicine, Arthritis, Subject (documents), medicine.disease, Psychology
Published
1910
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17. Sedimentation and Economic Prospects of Middle Devonian Winnipegosis Formation of Saskatchewan: ABSTRACT

Author

Llewelyn Jones

Subjects
geography, geography.geographical_feature_category, Evaporite, Lithology, Energy Engineering and Power Technology, Geology, Structural basin, Devonian, Paleontology, chemistry.chemical_compound, Fuel Technology, chemistry, Geochemistry and Petrology, Facies, Earth and Planetary Sciences (miscellaneous), Dolomitization, Carbonate, Reef
Abstract

The Middle Devonian Winnipegosis Formation of Saskatchewan is divisible into upper and lower members on the basis of a regionally developed argillaceous interval which forms the uppermost part of the lower member. The lower member consists of a regionally dolomitized marine carbonate of relatively constant thickness and lithology, attaining a maximum observed thickness of 54 ft. The upper member is a varied marine carbonate sequence, with three major facies developments. In the southwest lies a wedge of lithologically relatively consistent carbonates, reaching a maximum thickness of about 130 ft. along a northwest-trending axis extending through Weyburn and Elbow. In the north and east, bioclastic-pelletoidal carbonate banks with true reef intervals (up to 345 ft. thick), and finely laminated, interbank carbonates (up to 68 ft. thick) occur. The lower member was laid down in a broad epicontinental sea. The relatively shallow, open marine conditions culminated on two occasions in basin-wide, reducing, lagoonal conditions, evidenced by the medial and upper very bituminous argillaceous intervals containing impoverished faunas. The upper member appears to have been deposited in a shallow shelving sea which deepened toward the northeast. Using a regionally developed Amphipora zone as a datum, three pre-Amphipora tectonic-sedimentational regions are discernible: in the southwest, the Elbow-Weyburn basin, subsiding relatively rapidly to accommodate thick, shallow-water carbonates; in the north and east, the comparatively stable Saskatoon shelf, with thin laminated carbonates and basal carbonates of the bank sediments; and the mo e rapidly subsiding Meadow Lake-Sayese basin complex, with similar sediments, except that bank sedimentation was further advanced. In post-Amphipora time, subsidence continued in the north, accelerated in the shelf area to accommodate thick bank accumulations, whereas, in the southwestern basin, carbonate deposition was almost complete. Although no commercial quantities of oil or gas have been found in Saskatchewan, production of oil from the Winnipegosis in the Outlook and Redstone fields of northeastern Montana is encouraging. The occurrence of oil and gas "shows" in some drill-stem tests and of oil staining in the Winnipegosis Formation in Saskatchewan offers further encouragement, especially in the Elbow-Weyburn basin, which is a northwestern extension of the oil-producing facies of northeastern Montana. The presence in the southwestern basin of permeability traps resulting from differential dolomitization and recrystallization, and in the north and east, of important thickening in short distances, associated with variably porous bank carbonates, together with the widespread development of an excellent top seal i the form of the Prairie Evaporite salt or carbonate-anhydrite sequences, provide excellent conditions for the entrapment of hydrocarbons. End_of_Article - Last_Page 1570

Published
1965
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19. Studies in pianistic sonority, nuance and expression: French performance practices in the piano works of Maurice Ravel

Author

Llewelyn-Jones, Iwan

Subjects
M1
Abstract

This thesis traces the development of Maurice Ravel’s pianism in relation to sonority, nuance and expression by addressing four main areas of research that have remained largely unexplored within Ravel scholarship: the origins of Ravel’s pianism and influences to which he was exposed during his formative training; his exploration of innovative pianistic techniques with particular reference to thumb deployment; his activities as performer and teacher, and role in defining a performance tradition for his piano works; his place in the French pianistic canon. Identifying the main research questions addressed in this study, an Introduction outlines the dissertation content, explains the criteria and objectives for the performance component (Public Recital) and concludes with a literature review. Chapter 1 explores the pianistic techniques Ravel acquired during his formative training, and considers how his study of specific works from the nineteenth-century piano repertory shaped and influenced his compositional style and pianism. Chapter 2 discusses Ravel’s implementation of his idiosyncratic ‘strangler’ thumbs as articulators of melodic, harmonic, rhythmic and textural material in selected piano works. Ravel’s role in defining a performance tradition for his piano works as disseminated to succeeding generations of pianists is addressed in Chapter 3, while Chapters 4 and 5 evaluate Ravel’s impact upon twentieth-century French pianism through considering how leading French piano pedagogues and performers responded to his trailblazing piano techniques. It will be shown that through his activities as teacher and performer, as well as composer, Ravel took control of every detail pertaining to his piano works with his meticulously notated scores, piano roll recordings and interpretive guidance imparted to other pianists, thus catalysing performance practices that promulgated a distinctively French twentieth-century pianistic tradition.

20. Studies in pianistic sonority, nuance and expression: French performance practices in the piano works of Maurice Ravel

Author

Llewelyn-Jones, Iwan and Llewelyn-Jones, Iwan

Abstract

This thesis traces the development of Maurice Ravel’s pianism in relation to sonority, nuance and expression by addressing four main areas of research that have remained largely unexplored within Ravel scholarship: the origins of Ravel’s pianism and influences to which he was exposed during his formative training; his exploration of innovative pianistic techniques with particular reference to thumb deployment; his activities as performer and teacher, and role in defining a performance tradition for his piano works; his place in the French pianistic canon. Identifying the main research questions addressed in this study, an Introduction outlines the dissertation content, explains the criteria and objectives for the performance component (Public Recital) and concludes with a literature review. Chapter 1 explores the pianistic techniques Ravel acquired during his formative training, and considers how his study of specific works from the nineteenth-century piano repertory shaped and influenced his compositional style and pianism. Chapter 2 discusses Ravel’s implementation of his idiosyncratic ‘strangler’ thumbs as articulators of melodic, harmonic, rhythmic and textural material in selected piano works. Ravel’s role in defining a performance tradition for his piano works as disseminated to succeeding generations of pianists is addressed in Chapter 3, while Chapters 4 and 5 evaluate Ravel’s impact upon twentieth-century French pianism through considering how leading French piano pedagogues and performers responded to his trailblazing piano techniques. It will be shown that through his activities as teacher and performer, as well as composer, Ravel took control of every detail pertaining to his piano works with his meticulously notated scores, piano roll recordings and interpretive guidance imparted to other pianists, thus catalysing performance practices that promulgated a distinctively French twentieth-century pianistic tradition.

21. Studies in pianistic sonority, nuance and expression: French performance practices in the piano works of Maurice Ravel

Author

Llewelyn-Jones, Iwan and Llewelyn-Jones, Iwan

Abstract

This thesis traces the development of Maurice Ravel’s pianism in relation to sonority, nuance and expression by addressing four main areas of research that have remained largely unexplored within Ravel scholarship: the origins of Ravel’s pianism and influences to which he was exposed during his formative training; his exploration of innovative pianistic techniques with particular reference to thumb deployment; his activities as performer and teacher, and role in defining a performance tradition for his piano works; his place in the French pianistic canon. Identifying the main research questions addressed in this study, an Introduction outlines the dissertation content, explains the criteria and objectives for the performance component (Public Recital) and concludes with a literature review. Chapter 1 explores the pianistic techniques Ravel acquired during his formative training, and considers how his study of specific works from the nineteenth-century piano repertory shaped and influenced his compositional style and pianism. Chapter 2 discusses Ravel’s implementation of his idiosyncratic ‘strangler’ thumbs as articulators of melodic, harmonic, rhythmic and textural material in selected piano works. Ravel’s role in defining a performance tradition for his piano works as disseminated to succeeding generations of pianists is addressed in Chapter 3, while Chapters 4 and 5 evaluate Ravel’s impact upon twentieth-century French pianism through considering how leading French piano pedagogues and performers responded to his trailblazing piano techniques. It will be shown that through his activities as teacher and performer, as well as composer, Ravel took control of every detail pertaining to his piano works with his meticulously notated scores, piano roll recordings and interpretive guidance imparted to other pianists, thus catalysing performance practices that promulgated a distinctively French twentieth-century pianistic tradition.

24. The Welsh Mint

Author

Llewelyn Jones

Subjects
Economics and Econometrics, Welsh, language, language.human_language
Published
1926
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