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1. Early ultrasound for diagnosis and treatment of vascular adverse events with hyaluronic acid fillers

Author: Peter J. Velthuis, Leonie W Schelke, J. Kadouch, A. Swift, and Dermatology
Subjects: medicine.medical_specialty, business.industry, Ultrasound, Treatment outcome, Dermatology, Ultrasound guided, Surgery, 030207 dermatology & venereal diseases, 03 medical and health sciences, Safety profile, chemistry.chemical_compound, 0302 clinical medicine, chemistry, Hyaluronidase, Duplex (building), 030220 oncology & carcinogenesis, Hyaluronic acid, Medicine, Adverse effect, business, medicine.drug
Abstract: Background: Hyaluronic acid fillers are known for a reliable safety profile, but complications do occur, even serious vascular adverse events. Objective: To improve the treatment outcome after a vascular adverse event with use of hyaluronic acid filler treatments.Methods: Duplex ultrasonography is used to detect the hyaluronic acid filler causing the intra-arterial obstruction. Results: If treated in time, 1 single treatment of ultrasonographically guided injections of hyaluronidase into the filler deposit will prevent skin necrosis. Conclusion: Because the use of duplex ultrasonography adds extra essential information, its use may become an integral part of the prevention and treatment of injection adverse events.
Published: 2023

2. LUCAS: A highly accurate yet simple risk calculator that predicts survival of COVID-19 patients using rapid routine tests

Author: Surajit Ray, Simonne Weeks, J W Fanstone, Louise MacKenzie, Bart Vorselaars, Michail Mamalakis, Andrew J. Swift, and Abhirup Banerjee
Subjects: medicine.medical_specialty, Past medical history, Quartile, business.industry, Emergency medicine, Cohort, medicine, Risk assessment, Logistic regression, business, Triage, Confidence interval, Predictive modelling
Abstract: BackgroundThere is an urgent need to develop a simplified risk tool that enables rapid triaging of SARS CoV-2 positive patients during hospital admission, which complements current practice. Many predictive tools developed to date are complex, rely on multiple blood results and past medical history, do not include chest X ray results and rely on Artificial Intelligence rather than simplified algorithms. Our aim was to develop a simplified risk-tool based on five parameters and CXR image data that predicts the 60-day survival of adult SARS CoV-2 positive patients at hospital admission.MethodsWe analysed the NCCID database of patient blood variables and CXR images from 19 hospitals across the UK contributed clinical data on SARS CoV-2 positive patients using multivariable logistic regression. The initial dataset was non-randomly split between development and internal validation dataset with 1434 and 310 SARS CoV-2 positive patients, respectively. External validation of final model conducted on 741 Accident and Emergency admissions with suspected SARS CoV-2 infection from a separate NHS Trust which was not part of the initial NCCID data set.FindingsThe LUCAS mortality score included five strongest predictors (lymphocyte count, urea, CRP, age, sex), which are available at any point of care with rapid turnaround of results. Our simple multivariable logistic model showed high discrimination for fatal outcome with the AUC-ROC in development cohort 0.765 (95% confidence interval (CI): 0.738 - 0.790), in internal validation cohort 0.744 (CI: 0.673 - 0.808), and in external validation cohort 0.752 (CI: 0.713 - 0.787). The discriminatory power of LUCAS mortality score was increased slightly when including the CXR image data (for normal versus abnormal): internal validation AUC-ROC 0.770 (CI: 0.695 - 0.836) and external validation AUC-ROC 0.791 (CI: 0.746 - 0.833). The discriminatory power of LUCAS and LUCAS + CXR performed in the upper quartile of pre-existing risk stratification scores with the added advantage of using only 5 predictors.InterpretationThis simplified prognostic tool derived from objective parameters can be used to obtain valid predictions of mortality in patients within 60 days SARS CoV-2 RT-PCR results. This free-to-use simplified tool can be used to assist the triage of patients into low, moderate, high or very high risk of fatality and is available athttps://mdscore.net/.Summary boxWhat is already known on this topic?Clinical prediction models such as NEWS2 is currently used in practice as mortality risk assessment. In a rapid response to support COVID-19 patient assessment and resource management, published risk tools and models have been found to have a high risk of bias and therefore cannot be translated into clinical practice.What this study adds?A newly developed and validated risk tool (LUCAS) based on rapid and routine blood tests predicts the mortality of patients infected with SARS-CoV-2 virus. This prediction model has both high and robust predictive power and has been tested on an external set of patients and therefore can be used to effectively triage patients when resources are limited. In addition, LUCAS can be used with chest imaging information and NEWS2 score.
Published: 2023

3. Clinically Significant and Comorbid Anxiety and Depression Symptoms Predict Severe Respiratory Exacerbations in Smokers: A Post Hoc Analysis of the COPDGene and SPIROMICS Cohorts

Author: Anand S. Iyer, Trisha M. Parekh, Jacqueline O’Toole, Surya P. Bhatt, Michelle N. Eakin, Jerry A. Krishnan, Abebaw M. Yohannes, Prescott G. Woodruff, Christopher B. Cooper, Richard E. Kanner, Nicola A. Hanania, Mark T. Dransfield, Elizabeth A. Regan, Karin F. Hoth, Victor Kim, James D. Crapo, Edwin K. Silverman, Barry J. Make, Terri Beaty, Ferdouse Begum, Peter J. Castaldi, Michael Cho, Dawn L. DeMeo, Adel R. Boueiz, Marilyn G. Foreman, Eitan Halper-Stromberg, Lystra P. Hayden, Craig P. Hersh, Jacqueline Hetmanski, Brian D. Hobbs, John E. Hokanson, Nan Laird, Christoph Lange, Sharon M. Lutz, Merry-Lynn McDonald, Margaret M. Parker, Dmitry Prokopenko, Dandi Qiao, Phuwanat Sakornsakolpat, Emily S. Wan, Sungho Won, Juan Pablo Centeno, Jean-Paul Charbonnier, Harvey O. Coxson, Craig J. Galban, MeiLan K. Han, Eric A. Hoffman, Stephen Huries, Francine L. Jacobson, Philip F. Judy, Ella A. Kazerooni, Alex Kluiber, David A. Lynch, Pietro Nardelli, John D. Newell, Aleena Notary, Andrea Oh, James C. Ross, Raul San José Estépar, Joyce Schroeder, Jered Sieren, Berend C. Stoel, Juerg Tschirren, Edwin Van Beek, Bram van Ginneken, Eva van Rikxoort, Gonzalo Vegas Sanchez-Ferrero, Lucas Veitel, George R. Washko, Carla G. Wilson, Robert Jensen, Douglas Everett, Jim Crooks, Katherine Pratte, Matt Strand, Gregory Kinney, Kendra A. Young, Jessica Bon, Alejandro A. Diaz, Barry Make, Susan Murray, Elizabeth Regan, Xavier Soler, Russell P. Bowler, Katerina Kechris, Farnoush Banaei-Kashani, Jeffrey L. Curtis, Perry G. Pernicano, Nicola Hanania, Mustafa Atik, Aladin Boriek, Kalpatha Guntupalli, Elizabeth Guy, Amit Parulekar, Craig Hersh, George Washko, R. Graham Barr, John Austin, Belinda D’Souza, Byron Thomashow, Neil MacIntyre, H. Page McAdams, Robert Wise, Robert Brown, Nadia N. Hansel, Karen Horton, Allison Lambert, Los Angeles, Richard Casaburi, Alessandra Adami, Matthew Budoff, Hans Fischer, Janos Porszasz, Harry Rossiter, William Stringer, Amir Sharafkhaneh, Charlie Lan, Christine Wendt, Brian Bell, Ken M. Kunisaki, Russell Bowler, Richard Rosiello, David Pace, Gerard Criner, David Ciccolella, Francis Cordova, Chandra Dass, Gilbert D’Alonzo, Parag Desai, Michael Jacobs, Steven Kelsen, A. James Mamary, Nathaniel Marchetti, Aditi Satti, Kartik Shenoy, Robert M. Steiner, Alex Swift, Irene Swift, Maria Elena Vega-Sanchez, Mark Dransfield, William Bailey, Anand Iyer, Hrudaya Nath, J. Michael Wells, Douglas Conrad, Andrew Yen, Alejandro P. Comellas, John Newell, Brad Thompson, Ella Kazerooni, Wassim Labaki, Craig Galban, Dharshan Vummidi, Joanne Billings, Abbie Begnaud, Tadashi Allen, Frank Sciurba, Divay Chandra, Carl Fuhrman, Joel Weissfeld, Antonio Anzueto, Sandra Adams, Diego Maselli-Caceres, Mario E. Ruiz, and Harjinder Singh
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Comorbid anxiety, business.industry, Internal medicine, Post-hoc analysis, Medicine, Respiratory system, business, Depressive symptoms
Published: 2022

4. The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers

Author: Divay Chandra, Aman Gupta, Gregory L. Kinney, Carl R. Fuhrman, Joseph K. Leader, Alejandro A. Diaz, Jessica Bon, R. Graham Barr, George Washko, Matthew Budoff, John Hokanson, Frank C. Sciurba, James D. Crapo, Edwin K. Silverman, Barry J. Make, Elizabeth A. Regan, Terri Beaty, Ferdouse Begum, Adel R. Boueiz, Peter J. Castaldi, Michael Cho, Dawn L. DeMeo, Marilyn G. Foreman, Eitan Halper-Stromberg, Lystra P. Hayden, Craig P. Hersh, Jacqueline Hetmanski, Brian D. Hobbs, John E. Hokanson, Nan Laird, Christoph Lange, Sharon M. Lutz, Merry-Lynn McDonald, Margaret M. Parker, Dmitry Prokopenko, Dandi Qiao, Phuwanat Sakornsakolpat, Emily S. Wan, Sungho Won, Mustafa Al Qaisi, Harvey O. Coxson, Teresa Gray, MeiLan K. Han, Eric A. Hoffman, Stephen Humphries, Francine L. Jacobson, Philip F. Judy, Ella A. Kazerooni, Alex Kluiber, David A. Lynch, John D. Newell, James C. Ross, Raul San Jose Estepar, Joyce Schroeder, Jered Sieren, Douglas Stinson, Berend C. Stoel, Juerg Tschirren, Edwin Van Beek, Bram van Ginneken, Eva van Rikxoort, Carla G. Wilson, Robert Jensen, Jim Crooks, Douglas Everett, Camille Moore, null Strand, John Hughes, Gregory Kinney, Katherine Pratte, Kendra A. Young, Surya Bhatt, Carlos Martinez, Susan Murray, Xavier Soler, Farnoush Banaei-Kashani, Russell P. Bowler, Katerina Kechris, Jeffrey L. Curtis, Perry G. Pernicano, Nicola Hanania, Mustafa Atik, Aladin Boriek, Kalpatha Guntupalli, Elizabeth Guy, Amit Parulekar, Craig Hersh, John Austin, Belinda D’Souza, Byron Thomashow, Neil MacIntyre, H. Page McAdams, Lacey Washington, Charlene McEvoy, Joseph Tashjian, Robert Wise, Robert Brown, Nadia N. Hansel, Karen Horton, Allison Lambert, Nirupama Putcha, Richard Casaburi, Alessandra Adami, Hans Fischer, Janos Porszasz, Harry Rossiter, William Stringer, Michael E. DeBakey, Amir Sharafkhaneh, Charlie Lan, Christine Wendt, Brian Bell, Ken M. Kunisaki, Eugene Berkowitz, Gloria Westney, Russell Bowler, Richard Rosiello, David Pace, Gerard Criner, David Ciccolella, Francis Cordova, Chandra Dass, Gilbert D’Alonzo, Parag Desai, Michael Jacobs, Steven Kelsen, Victor Kim, A. James Mamary, Nathaniel Marchetti, Aditi Satti, Kartik Shenoy, Robert M. Steiner, Alex Swift, Irene Swift, Maria Elena Vega-Sanchez, Mark Dransfield, William Bailey, Surya P. Bhatt, Anand Iyer, Hrudaya Nath, J. Michael Wells, Joe Ramsdell, Paul Friedman, Andrew Yen, Alejandro P. Comellas, Karin F. Hoth, John Newell, Brad Thompson, Ella Kazerooni, Carlos H. Martinez, Joanne Billings, Abbie Begnaud, Tadashi Allen, Frank Sciurba, Carl Fuhrman, Joel Weissfeld, Antonio Anzueto, Sandra Adams, Diego Maselli-Caceres, and Mario E. Ruiz
Subjects: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Coronary Artery Disease, Critical Care and Intensive Care Medicine, COPD: Original Research, Coronary artery disease, 03 medical and health sciences, FEV1/FVC ratio, 0302 clinical medicine, Functional residual capacity, Risk Factors, Internal medicine, medicine, Humans, Lung volumes, 030212 general & internal medicine, Myocardial infarction, Lung, Subclinical infection, COPD, business.industry, Smoking, Organ Size, Middle Aged, respiratory system, medicine.disease, Coronary Vessels, United States, Respiratory Function Tests, respiratory tract diseases, Airway Obstruction, Plethysmography, Biological Variation, Population, Pulmonary Emphysema, 030228 respiratory system, Asymptomatic Diseases, Cohort, Cardiology, Airway Remodeling, Female, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business
Abstract: BACKGROUND: Smokers manifest varied phenotypes of pulmonary impairment. RESEARCH QUESTION: Which pulmonary phenotypes are associated with coronary artery disease (CAD) in smokers? STUDY DESIGN AND METHODS: We analyzed data from the University of Pittsburgh COPD Specialized Center for Clinically Oriented Research (SCCOR) cohort (n = 481) and the Genetic Epidemiology of COPD (COPDGene) cohort (n = 2,580). Participants were current and former smokers with > 10 pack-years of tobacco exposure. Data from the two cohorts were analyzed separately because of methodologic differences. Lung hyperinflation was assessed by plethysmography in the SCCOR cohort and by inspiratory and expiratory CT scan lung volumes in the COPDGene cohort. Subclinical CAD was assessed as the coronary artery calcium score, whereas clinical CAD was defined as a self-reported history of CAD or myocardial infarction (MI). Analyses were performed in all smokers and then repeated in those with airflow obstruction (FEV(1) to FVC ratio, < 0.70). RESULTS: Pulmonary phenotypes, including airflow limitation, emphysema, lung hyperinflation, diffusion capacity, and radiographic measures of airway remodeling, showed weak to moderate correlations (r < 0.7) with each other. In multivariate models adjusted for pulmonary phenotypes and CAD risk factors, lung hyperinflation was the only phenotype associated with calcium score, history of clinical CAD, or history of MI (per 0.2 higher expiratory and inspiratory CT scan lung volume; coronary calcium: OR, 1.2; 95% CI, 1.1-1.5; P = .02; clinical CAD: OR, 1.6; 95% CI, 1.1-2.3; P = .01; and MI in COPDGene: OR, 1.7; 95% CI, 1.0-2.8; P = .05). FEV(1) and emphysema were associated with increased risk of CAD (P < .05) in models adjusted for CAD risk factors; however, these associations were attenuated on adjusting for lung hyperinflation. Results were the same in those with airflow obstruction and were present in both cohorts. INTERPRETATION: Lung hyperinflation is associated strongly with clinical and subclinical CAD in smokers, including those with airflow obstruction. After lung hyperinflation was accounted for, FEV(1) and emphysema no longer were associated with CAD. Subsequent studies should consider measuring lung hyperinflation and examining its mechanistic role in CAD in current and former smokers.
Published: 2021

5. LUCAS: development and validation of a simple mortality risk calculator that predicts 60-day survival of adult SARS-CoV-2 positive patients at hospital admission using rapid routine tests

Author: Surajit Ray, Andrew Swift, Joseph W. Fanstone, Abhirup Banerjee, Michail Mamalakis, Bart Vorselaars, Louise S. Mackenzie, and Simonne Weeks
Subjects: Past medical history, medicine.medical_specialty, business.industry, Logistic regression, Triage, Confidence interval, law.invention, Calculator, Quartile, law, Cohort, Emergency medicine, medicine, business, Point of care
Abstract: Background: There is an urgent need to develop a simplified risk tool that enables rapid triaging of SARS CoV-2 positive patients during hospital admission, which complements current practice. Many predictive tools developed to date are complex, rely on multiple blood results and past medical history, do not include chest X ray results and rely on Artificial Intelligence rather than simplified algorithms. Our aim was to develop a simplified risk-tool based on five parameters and CXR image data that predicts the 60-day survival of adult SARS CoV-2 positive patients at hospital admission. Methods: We analysed the NCCID database of patient blood variables and CXR images from 19 hospitals across the UK contributed clinical data on SARS CoV-2 positive patients using multivariable logistic regression. The initial dataset was non-randomly split between development and internal validation dataset with 1434 and 310 SARS CoV-2 positive patients, respectively. External validation of final model conducted on 741 Accident and Emergency admissions with suspected SARS CoV-2 infection from a separate NHS Trust which was not part of the initial NCCID data set. Findings: The LUCAS mortality score included five strongest predictors (lymphocyte count, urea, CRP, age, sex), which are available at any point of care with rapid turnaround of results. Our simple multivariable logistic model showed high discrimination for fatal outcome with the AUC-ROC in development cohort 0.765 (95% confidence interval (CI): 0.738 - 0.790), in internal validation cohort 0.744 (CI: 0.673 - 0.808), and in external validation cohort 0.752 (CI: 0.713 - 0.787). The discriminatory power of LUCAS mortality score was increased slightly when including the CXR image data (for normal versus abnormal): internal validation AUC-ROC 0.770 (CI: 0.695 - 0.836) and external validation AUC-ROC 0.791 (CI: 0.746 - 0.833). The discriminatory power of LUCAS and LUCAS + CXR performed in the upper quartile of pre-existing risk stratification scores with the added advantage of using only 5 predictors. Interpretation: This simplified prognostic tool derived from objective parameters can be used to obtain valid predictions of mortality in patients within 60 days SARS CoV-2 RT-PCR results. This free-to-use simplified tool can be used to assist the triage of patients into low, moderate, high or very high risk of fatality and is available at https://mdscore.net/. Funding Statement: EPSRC Impact Acceleration account fund EP/R511705/1; AS is funded by a Wellcome Trust fellowship 205188/Z/16/Z; University of Brighton COVID-19 Research Urgency Fund. Declaration of Interests: All researchers declare no competing interests. Ethics Approval Statement: De-identified and pseudo-anonymised patient data were obtained from data sets which were approved by the ethics committee as part of the existing Cardiac MRI Database NHS REC IRAS Ref: 222349 and University of Brighton REC (8011).
Published: 2023

6. A data-driven disease progression model of fluid biomarkers in genetic frontotemporal dementia

Author: Ione O.C. Woollacott, Cristina Polito, Philip Van Damme, Mathieu Vandenbulcke, Rose Bruffaerts, Diana Duro, Chiara Fenoglio, David M. Cash, Maria Rosário Almeida, Sonja Schönecker, C. Ferreira, Sónia Afonso, Matthis Synofzik, Sara Prioni, Marta Cañada, Mikel Tainta, Miguel Tábuas-Pereira, Christin Andersson, Caroline Graff, Miguel Castelo-Branco, Enrico Premi, Håkan Thonberg, Fabrizio Tagliavini, Rachelle Shafei, Benjamin Bender, Ana Gorostidi, Maria João Leitão, Jennifer M. Nicholas, Elise G.P. Dopper, Silvana Archetti, Esther E. Bron, Ana Verdelho, Ron Keren, Isabel Santana, Christen Shoesmith, Pietro Tiraboschi, Sergi Borrego-Écija, Michela Pievani, Sandro Sorbi, Rick van Minkelen, Hans-Otto Karnath, Albert Lladó, Caroline V. Greaves, Jaume Olives, Alessandro Padovani, Miren Zulaica, Giuliano Binetti, Martin Rosser, Pedro Rosa-Neto, Vesna Jelic, Alexander Gerhard, Rosa Rademakers, Sandra E. Black, Wiro J. Niessen, Tobias Hoegen, Rhian S Convery, Janne M. Papma, Maria Carmela Tartaglia, Emily Todd, Adrian Danek, Rita Guerreiro, Robart Bartha, Linn Öijerstedt, Giuseppe Di Fede, Sebastien Ourselin, Núria Bargalló, James B. Rowe, Christopher C Butler, Giorgio G. Fumagalli, Valentina Bessi, Alberto Benussi, Nick C. Fox, Beatriz Santiago, Ekaterina Rogaeva, Alazne Gabilondo, Giacomina Rossi, Mircea Balasa, David L. Thomas, Benedetta Nacmias, Veronica Redaelli, Anna Antonell, Vikram Venkatraghavan, Jonathan D. Rohrer, Jackie M. Poos, Yolande A.L. Pijnenburg, Lieke H.H. Meeter, Carlo Wilke, Sandra V. Loosli, Elio Scarpini, Tobias Langheinrich, Alina Díez, Elisa Semler, Elizabeth Finger, Begoña Indakoetxea, Jessica L. Panman, Carolyn Timberlake, Gemma Lombardi, Luisa Benussi, Morris Freedman, Barbara Borroni, Ricardo Taipa, Johannes Levin, Thomas E. Cope, Paul M. Thompson, Giorgio Giaccone, Valentina Cantoni, Arabella Bouzigues, Jose Bras, Serge Gauthier, Andrea Arighi, Stefan Klein, Fermin Moreno, Markus Otto, Georgia Peakman, Emma L. van der Ende, David F. Tang-Wai, Sarah Anderl-Straub, Jason D. Warren, Alexandre de Mendonça, Camilla Ferrari, Elisabeth Wlasich, Catharina Prix, Michele Veldsman, Raquel Sánchez-Valle, Sara Mitchell, Carolina Maruta, Robert Laforce, Paola Caroppo, Jorge Villanua, Imogen J Swift, Harro Seelaar, Henrik Zetterberg, Simon Mead, Simon Ducharme, Myriam Barandiaran, Katrina M. Moore, John C. van Swieten, Gabriel Miltenberger, Mario Masellis, Timothy Rittman, Lize C. Jiskoot, Daniela Galimberti, Rik Vandenberghe, Carolin Heller, Stefano Gazzina, Aitana Sogorb-Esteve, Roberto Gasparotti, Martina Bocchetta, Neurology, Amsterdam Neuroscience - Neurodegeneration, Repositório da Universidade de Lisboa, Radiology & Nuclear Medicine, and Neurosurgery
Subjects: Oncology, medicine.medical_specialty, Medizin, tau Proteins, Disease, medicine.disease_cause, frontotemporal dementia, biomarker, disease progression model, event-based modelling, neurofilament light chain, Biomarkers, C9orf72 Protein, Complement C1q, Cross-Sectional Studies, Disease Progression, Glial Fibrillary Acidic Protein, Humans, Longitudinal Studies, Mutation, Frontotemporal Dementia, diagnosis [Frontotemporal Dementia], Settore BIO/13 - Biologia Applicata, C9orf72, Internal medicine, Medicine, ddc:610, genetics [C9orf72 Protein], genetics [Frontotemporal Dementia], business.industry, medicine.disease, Astrogliosis, genetics [tau Proteins], Cohort, Biomarker (medicine), Neurology (clinical), Sample collection, business, Frontotemporal dementia
Abstract: © The Author(s) (2021). Published by Oxford University Press on behalf of the Guarantors of Brain. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/ by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com, Several CSF and blood biomarkers for genetic frontotemporal dementia have been proposed, including those reflecting neuroaxonal loss (neurofilament light chain and phosphorylated neurofilament heavy chain), synapse dysfunction [neuronal pentraxin 2 (NPTX2)], astrogliosis (glial fibrillary acidic protein) and complement activation (C1q, C3b). Determining the sequence in which biomarkers become abnormal over the course of disease could facilitate disease staging and help identify mutation carriers with prodromal or early-stage frontotemporal dementia, which is especially important as pharmaceutical trials emerge. We aimed to model the sequence of biomarker abnormalities in presymptomatic and symptomatic genetic frontotemporal dementia using cross-sectional data from the Genetic Frontotemporal dementia Initiative (GENFI), a longitudinal cohort study. Two-hundred and seventy-five presymptomatic and 127 symptomatic carriers of mutations in GRN, C9orf72 or MAPT, as well as 247 non-carriers, were selected from the GENFI cohort based on availability of one or more of the aforementioned biomarkers. Nine presymptomatic carriers developed symptoms within 18 months of sample collection ('converters'). Sequences of biomarker abnormalities were modelled for the entire group using discriminative event-based modelling (DEBM) and for each genetic subgroup using co-initialized DEBM. These models estimate probabilistic biomarker abnormalities in a data-driven way and do not rely on previous diagnostic information or biomarker cut-off points. Using cross-validation, subjects were subsequently assigned a disease stage based on their position along the disease progression timeline. CSF NPTX2 was the first biomarker to become abnormal, followed by blood and CSF neurofilament light chain, blood phosphorylated neurofilament heavy chain, blood glial fibrillary acidic protein and finally CSF C3b and C1q. Biomarker orderings did not differ significantly between genetic subgroups, but more uncertainty was noted in the C9orf72 and MAPT groups than for GRN. Estimated disease stages could distinguish symptomatic from presymptomatic carriers and non-carriers with areas under the curve of 0.84 (95% confidence interval 0.80-0.89) and 0.90 (0.86-0.94) respectively. The areas under the curve to distinguish converters from non-converting presymptomatic carriers was 0.85 (0.75-0.95). Our data-driven model of genetic frontotemporal dementia revealed that NPTX2 and neurofilament light chain are the earliest to change among the selected biomarkers. Further research should investigate their utility as candidate selection tools for pharmaceutical trials. The model's ability to accurately estimate individual disease stages could improve patient stratification and track the efficacy of therapeutic interventions., This study was supported in the Netherlands by two Memorabel grants from Deltaplan Dementie (The Netherlands Organisation for Health Research and Development and Alzheimer Nederland; grant numbers 733050813,733050103 and 733050513), the Bluefield Project to Cure Frontotemporal Dementia, the Dioraphte foundation (grant number 1402 1300), the European Joint Programme—Neurodegenerative Disease Research and the Netherlands Organisation for Health Research and Development (PreFrontALS: 733051042, RiMod-FTD: 733051024); V.V. and S.K. have received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 666992 (EuroPOND). E.B. was supported by the Hartstichting (PPP Allowance, 2018B011); in Belgium by the Mady Browaeys Fonds voor Onderzoek naar Frontotemporale Degeneratie; in the UK by the MRC UK GENFI grant (MR/M023664/1); J.D.R. is supported by an MRC Clinician Scientist Fellowship (MR/M008525/1) and has received funding from the NIHR Rare Disease Translational Research Collaboration (BRC149/NS/MH); I.J.S. is supported by the Alzheimer’s Association; J.B.R. is supported by the Wellcome Trust (103838); in Spain by the Fundació Marató de TV3 (20143810 to R.S.V.); in Germany by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany’s Excellence Strategy within the framework of the Munich Cluster for Systems Neurology (EXC 2145 SyNergy—ID 390857198) and by grant 779357 ‘Solve-RD’ from the Horizon 2020 Research and Innovation Programme (to MS); in Sweden by grants from the Swedish FTD Initiative funded by the Schörling Foundation, grants from JPND PreFrontALS Swedish Research Council (VR) 529–2014-7504, Swedish Research Council (VR) 2015–02926, Swedish Research Council (VR) 2018–02754, Swedish Brain Foundation, Swedish Alzheimer Foundation, Stockholm County Council ALF, Swedish Demensfonden, Stohnes foundation, Gamla Tjänarinnor, Karolinska Institutet Doctoral Funding and StratNeuro. H.Z. is a Wallenberg Scholar.
Published: 2022

7. Lymphadenectomy for high-grade endometrial cancer: Does it impact lymph node recurrence?

Author: Marcus Q. Bernardini, Lauren Philp, Eshetu G. Atenafu, Lilian T. Gien, Brenna E. Swift, and N. Malkani
Subjects: medicine.medical_specialty, medicine.medical_treatment, Urology, medicine, Humans, Prospective Studies, Prospective cohort study, Lymph node, Neoplasm Staging, Proportional hazards model, business.industry, Endometrial cancer, Cancer, General Medicine, medicine.disease, Endometrial Neoplasms, Log-rank test, Dissection, medicine.anatomical_structure, Oncology, Lymphatic Metastasis, Lymph Node Excision, Female, Surgery, Lymphadenectomy, Lymph Nodes, Neoplasm Recurrence, Local, business
Abstract: Introduction The diagnostic role of lymph node (LN) assessment is established in endometrial cancer. Our study assesses whether surgical removal of metastatic LNs has oncologic benefit in high-grade endometrial cancer. Materials and methods High-grade endometrial cancer cases (2000–2010) were collected from two tertiary cancer centres. In patients with at least one positive LN, recurrence free survival (RFS) was compared by the number of LNs removed. Factors predicting nodal recurrence (NR) were explored. Univariate statistical analyses by log rank test and multivariable cox proportional hazards model were performed using SAS version 9.4. Results Of 570 patients identified, 334 patients underwent staging lymphadenectomy, 74 (22.2%) patients had at least one positive LN. The median RFS with at least one positive lymph node was 87.1 months (95% CI ≥ 14.3) when greater than 15 LNs were removed, compared to 16.9 months (95% CI, 13.6–35.6) and 17.3 months (95% CI, 8.5–39.8) when 5–15 and less than 5 LNs were removed, respectively (p = 0.02). In the cohort of 570 patients, there were 167 disease recurrences with location described on imaging, 98 (58.7%) had a NR and 69 (41.3%) recurred at other sites. Multivariable modeling identified that only positive LNs at surgical staging predicted NR (HR 3.8, 95% CI 1.4–10.2). Conclusion In high-grade endometrial cancer, positive LNs predict NR, and RFS is longer with a more extensive LN dissection in women with positive LNs. Future prospective studies should evaluate the oncologic benefit of surgical removal of metastatic LNs in high-grade endometrial cancer.
Published: 2022

8. The accuracy of intraoperative frozen section examination of sentinel lymph nodes in squamous cell cancer of the vulva

Author: Brenna E. Swift, Lilian T. Gien, Rachel Kupets, R. Osborne, Andra Nica, Allan Covens, Melissa Tigert, Carlos Parra-Herran, and D Vicus
Subjects: Adult, medicine.medical_specialty, medicine.medical_treatment, Groin, Disease-Free Survival, Vulva, Cohort Studies, Biopsy, medicine, Frozen Sections, Humans, Neoadjuvant therapy, Aged, Retrospective Studies, Aged, 80 and over, Frozen section procedure, Intraoperative Care, medicine.diagnostic_test, Vulvar Neoplasms, business.industry, Sentinel Lymph Node Biopsy, Obstetrics and Gynecology, Frozen Section Diagnosis, Vulvar cancer, Middle Aged, medicine.disease, Tumor Burden, medicine.anatomical_structure, Oncology, Neoplasm Micrometastasis, Carcinoma, Squamous Cell, Lymph Node Excision, Vulvectomy, Lymphadenectomy, Female, Radiotherapy, Adjuvant, Radiology, Neoplasm Recurrence, Local, Sentinel Lymph Node, business
Abstract: Objectives: To measure the diagnostic accuracy of intraoperative frozen section examination of sentinel lymph nodes (SLN) in vulvar cancer and to describe associated patient outcomes. Methods: This retrospective cohort study included patients with invasive squamous cell carcinoma of the vulva who underwent SLN biopsy with intraoperative frozen section at one cancer centre from Jan 2008 - Feb 2020. Exclusion criteria were tumor size >4cm, multifocal tumor, palpable groin lymph nodes and neoadjuvant therapy. The SLN procedure was performed by injection of the primary vulvar tumor or scar with technetium-99m, ICG and/or blue dye. We compared the intraoperative SLN frozen section diagnosis and the paraffin section report for concordance. Recurrence location was described and recurrence free survival (RFS) was compared using the Kaplan-Meier method. Results: A total of 173 patients (258 groins) met inclusion and exclusion criteria. On frozen section, there were 36/258 positive groins on frozen section and 222 negative groins. On final pathology, there were 39/258 positive groin nodes: 30 macro-metastases, 7 micro-metastases, 2 isolated tumor cells (ITCs). There were 219 negative groins. The sensitivity and specificity for frozen section detecting any metastatic disease compared to final pathology, was 89.7% and 99.5%, respectively. The positive-predictive value (PPV) was 97.2% and the negative-predictive-value (NPV) was 98.2%. There were 4 cases of false negative frozen section where final pathology revealed two cases of ITCs, 1 micro-metastasis and 1 macro-metastasis. A total of 30 patients (17.3%) underwent a full inguinal femoral lymphadenectomy during the same operation due to the frozen section results and avoided a second operation. A total of 2 patients (1.2%) required a second operation for lymphadenectomy due to false negative results on frozen section. Median (range) follow up was 38.0 (1-137.8) months. Median RFS was 14.9 (3.6 to 98.2) months. There were 46 recurrences in the study population, of which 29 were confined to the vulva, 9 groin recurrences and 8 distant recurrences. Among patients with a negative SLN biopsy on both frozen section and final pathology, there were 10 (3.9 %) groin and/or distant recurrences. A total of 6 nodal recurrences were ipsilateral, 1 was contralateral, 2 were bilateral and 1 recurrence was distant. After exclusion of patients with local recurrence only, the RFS at 3 years was 91.6% (95% CI 86.2-97.4%) for patients with negative SLN on frozen section and 64.6% (95% CI 46.5-89.7%) for positive SLN on frozen section. On final pathology, patients with negative SLN had a 3-year RFS of 91.7% (95% CI 86.3-97.4%), macro-metastases 58.4% (95% CI 38.5-87.7%), and micro-metastases/ITCs was 100%. Conclusions: Intraoperative frozen section of SLNs in vulvar cancer is an accurate intraoperative guide to determine if complete inguinal femoral lymphadenectomy should be performed. SLN biopsy reduced the need for a second surgical procedure and does not appear to compromise patient outcomes.
Published: 2022

9. Safety, immunogenicity, and efficacy of a COVID-19 vaccine (NVX-CoV2373) co-administered with seasonal influenza vaccines: an exploratory substudy of a randomised, observer-blinded, placebo-controlled, phase 3 trial

Author: Seth Toback, Eva Galiza, Catherine Cosgrove, James Galloway, Anna L Goodman, Pauline A Swift, Sankarasubramanian Rajaram, Alison Graves-Jones, Jonathan Edelman, Fiona Burns, Angela M Minassian, Iksung Cho, Lakshmi Kumar, Joyce S Plested, E Joy Rivers, Andreana Robertson, Filip Dubovsky, Greg Glenn, Paul T Heath, Roy L. Soiza, Robin Brittain-Long, Chiara Scicluna, Carole Edwards, Lynn Mackay, Mariella D'Allesandro, Amy Nicol, Karen Norris, Sandra Mann, Heather Lawrence, Ruth Valentine, Marianne Elizabeth Viljoen, Carol H. Pretswell, Helen Nicholls, Imrozia Munsoor, Agnieszka Meyrick, Christina Kyriakidou, Shalini Iyengar, Arham Jamal, Nick Richards, Helen Price, Bridie Rowbotham, Danielle Bird, Karen Smith, Olga Littler, Kirsty Fielding, Anna Townsend-Rose, Karen Miller, Jessica Davis, Alison Elliot-Garwood, Lauren Trottier, Paul Edwards, Margaret McFarland, Orod Osanlou, Laura Longshaw, Jane Stockport, Lynne Grundy, Katharine Lucy Broad, Karen Regan, Kim Storton, Declan Ryan-Wakeling, Brad Wilson, Malathy Munisamy, John Wright, Anil Shenoy, Beverley English, Lucy Brear, Paola Cicconi, Marta Boffito, Ana Milinkovic, Ruth Byrne, Roya Movahedi, Rosalie Housman, Naveed Kara, Ellen Brown, Andrea Cipriani, Mary-Jane Attenburrow, Katharine A. Smith, Jonathan Packham, Geoff Sparrow, Richard Smith, Josephine M. Rosier, Khalid Saja, Nyasha Nago, Brian Camilleri, Anita Immanuel, Mike Hamblin, Rawlings Osagie, Mahalakshmi Mohan, Hilary Floyd, Suzanne Goddard, Sanjay Mutgi, John Evans, Sean McKeon, Neringa Vilimiene, Rosavic Chicano, Rachel Hayre, Alice Pandaan, Catherine Henshall, Sonia Serrano, Andrea Mazzella, Thurkka Rajeswaran, Moncy Mathew, Karen Bisnauthsing, Laura Bremner, Henry Fok, Franca Morselli, Paola Cinardo, Blair Merrick, Lucy Sowole, Samantha Broadhead, Natalie Palmer, Jessica Cordle, Jaimie Wilson Goldsmith, Enya Cooney, Beth Jackson, Thilina Jayatilleke, Zelda Cheng, Toby Helliwell, Adrian Chudyk, Rafaela Giemza, John Lord Villajin, Noah Yogo, Esther Makanju, Pearl Dulawan, Deepak Nagra, April Buazon, Alice Russell, Georgie Bird, Amardeep Heer, Rex Sarmiento, Balraj Sanghera, Melanie Mullin, Adam Champion, Aisling Bevan, Kinzah Iqbal, Alshia Johnson, Rebecca Clark, Sarah Shaw, Steven Shaw, Amanda Chalk, Martin Lovatt, Caroline Lillicrap, Angela Parker, Jan Hansel, Zhi Wong, Galvin Gan, Eyad Tuma, Jane Minton, Jennifer Murira, Razan Saman, Alistair Hall, Kyra Holliday, Zara Khan, James Calderwood, George Twigg, Helena Baker, Julie Corrigan, Katy Houseman, Subhra Raguvanshi, Dominic Heining, Jake Weddell, Liz Glaves, Kim Thompson, Francis Davies, Ruth Lambley Burke, Emma C. Thomson, Dinesh Saralaya, Lisa Berry, Nancy Hopewell, Leigh Gerdes, Mihaela Pacurar, Saul N. Faust, Jeremy Turner, Christopher Jeanes, Adele Cooper, Jocelyn Keshet-Price, Lou Coke, Melissa Cambell-Kelly, Ketan Dhatariya, Claire Williams, Georgina Marks, James Sudbury, Lisa Rodolico, Judy Bradley, Sharon Carr, Roisin Martin, Angelina Madden, Paul Biagioni, Sonia McKenna, Alison Clinton, Maurice O'Kane, Justin Carter, Matthew Dewhurst, Bill Wetherill, Thandiwe Hoggarth, Katrina Lennon Collins, Marie Chowdhury, Adil Nathoo, Anna Heinen, Orla MacDonald, Claudia Hurducas, Liliana Cifuentes, Harjeevan Gill, Andy Gibson, Raha West, Jane Ewing, Rachel Blacow, John Haughney, Jonathan MacDonald, John Paul Seenan, Stewart Webb, Colin O'Leary, Scott Muir, Beth White, Neil Ritchie, Daniel F. McAuley, Jonathan Stewart, Mariella D'Alessandro, Nicki Lakeman, Laura Purandare, Duncan Browne, David Tucker, Peter Luck, Angharad Everden, Lisa Trembath, Michael Visick, Nick Morley, Laura Reid, Helen Chenoweth, Kirsty Maclean, Ray P. Sheridan, Tom Burden, Craig Francis Lunt, Shirley Todd, Stephanie Estcourt, Jasmine Marie Pearce, Suzanne Wilkins, Cathryn Love-Rouse, Eva Torok-Pollok, Mike Youle, Sara Madge, Danielle Solomon, Aarti Nandani, Janet M. North, Nargis Hemat, Rachel Newport, Philip A. Kalra, Chukwuma Chukwu, Olivia Wickens, Vikki O'Loughlin, Hema Mistry, Louise Harrison, Robert Oliver, Anne-Marie Peers, Jess Zadik, Katie Doyle, David R. Chadwick, Kerry Colling, Caroline Wroe, Marie Branch, Alison Chilvers, Sarah Essex, Mark Stone, Alberto San Francisco Ramos, Emily Beales, Olivia Bird, Zsofia Danos, Hazel Fofie, Cecilia Hultin, Sabina Ikram, Fran Mabesa, Aoife Mescall, Josyanne Pereira, Jennifer Pearce, Natalina Sutton, Emma Snashall, David Neil Baxter, Sara Bennett, Debbie Suggitt, Kerry Hughes, Wiesia Woodyatt, Lynsey Beacon, Alissa Kent, Chris Cooper, Milan Rudic, Simon Tunstall, Matthew Jackson, Claire Hombersley, Patrick Moore, Rebecca Cutts, Andrew Higham, Marwan Bukhari, Mohamed Elnaggar, Michelle Glover, Fiona Richardson, Alexandra Dent, Shahzeb Mirza, Rajiv Ark, Jennie Han, Suzy V. Hope, Philip J. Mitchelmore, Rostam Osanlou, Andrew Freedman, Alison Cooper, Katherine Burton, Kashyap Katechia, Michael Barrett, Jo Salkeld, Natalie Hill, Nathaniel Lee, Jon Perkins, and Polly Fox
Subjects: Adult, Pulmonary and Respiratory Medicine, Trivalent influenza vaccine, medicine.medical_specialty, COVID-19 Vaccines, Adolescent, Influenza vaccine, Population, Placebo, Young Adult, Immunogenicity, Vaccine, Double-Blind Method, Internal medicine, Humans, Medicine, education, Adverse effect, Aged, education.field_of_study, Reactogenicity, SARS-CoV-2, business.industry, COVID-19, Articles, Middle Aged, Vaccine efficacy, Vaccination, Influenza Vaccines, Seasons, business
Abstract: Background The safety and immunogenicity profile of COVID-19 vaccines when administered concomitantly with seasonal influenza vaccines have not yet been reported. We therefore aimed to report the results of a substudy within a phase 3 UK trial, by evaluating the safety, immunogenicity, and efficacy of NVX-CoV2373 when co-administered with licensed seasonal influenza vaccines. Methods We did a planned exploratory substudy as part of the randomised, observer-blinded, placebo-controlled, phase 3 trial of the safety and efficacy of the COVID-19 vaccine (NVX-CoV2373) by co-administrating the influenza vaccine at four study hospitals in the UK. Approximately, the first 400 participants meeting the main study entry criteria—with no contraindications to influenza vaccination—were invited to join the substudy. Participants of the main study were randomly assigned (1:1) to receive two intramuscular injections of either NVX-CoV2373 (5 μg) or placebo (normal saline) 21 days apart; participants enrolled into the substudy were co-vaccinated with a single (0·5 mL) intramuscular, age-appropriate (quadrivalent influenza cell-based vaccine [Flucelvax Quadrivalent; Seqirus UK, Maidenhead] for those aged 18–64 years and adjuvanted trivalent influenza vaccine [Fluad; Seqirus UK, Maidenhead] for those ≥65 years), licensed, influenza vaccine on the opposite deltoid to that of the first study vaccine dose or placebo. The influenza vaccine was administered in an open-label manner and at the same time as the first study injection. Reactogenicity was evaluated via an electronic diary for 7 days after vaccination in addition to monitoring for unsolicited adverse events, medically attended adverse events, and serious adverse events. Immunogenicity was assessed with influenza haemagglutination inhibition and SARS-CoV-2 anti-spike protein IgG assays. Vaccine efficacy against PCR-confirmed, symptomatic COVID-19 was assessed in participants who were seronegative at baseline, received both doses of study vaccine or placebo, had no major protocol deviations affecting the primary endpoint, and had no confirmed cases of symptomatic COVID-19 from the first dose until 6 days after the second dose (per-protocol efficacy population). Immunogenicity was assessed in participants who received scheduled two doses of study vaccine, had a baseline sample and at least one post-vaccination sample, and had no major protocol violations before unmasking (per-protocol immunogenicity population). Reactogenicity was analysed in all participants who received at least one dose of NVX-CoV2373 or placebo and had data collected for reactogenicity events. Safety was analysed in all participants who received at least one dose of NVX-CoV2373 or placebo. Comparisons were made between participants of the substudy and the main study (who were not co-vaccinated for influenza). This study is registered with ClinicalTrials.gov, number NCT04583995. Findings Between Sept 28, 2020, and Nov 28, 2020, a total of 15 187 participants were randomised into the main phase 3 trial, of whom 15 139 received treatment (7569 received dose one of NVX-CoV2373 and 7570 received dose one of placebo). 431 participants were co-vaccinated with a seasonal influenza vaccine in the substudy (217 received NVX-CoV2373 plus the influenza vaccine and 214 received placebo plus the influenza vaccine). In general, the substudy participants were younger, more racially diverse, and had fewer comorbid conditions than those in the main study. Reactogenicity events were more common in the co-administration group than in the NVX-CoV2373 alone group: tenderness (113 [64·9%] of 174 vs 592 [53·3%] of 1111) or pain (69 [39·7%] vs 325 [29·3%]) at injection site, fatigue (48 [27·7%] vs 215 [19·4%]), and muscle pain (49 [28·3%] vs 237 [21·4%]). Incidences of unsolicited adverse events, treatment-related medically attended adverse events, and serious adverse events were low and balanced between the co-administration group and the NVX-CoV2373 alone group. No episodes of anaphylaxis or deaths were reported within the substudy. Co-administration resulted in no change to influenza vaccine immune response although a reduction in antibody responses to the NVX-CoV2373 vaccine was noted. NVX-CoV2373 vaccine efficacy in the substudy (ie, participants aged 18 to
Published: 2022

10. The REPAIR Study

Author: Andrew J. Peacock, Anton Vonk Noordegraaf, Nicolas Martin, Nazzareno Galiè, Adam Torbicki, J. Tim Marcus, David G. Kiely, Olga Moiseeva, Stephan Rosenkranz, Ahmed Tawakol, Emmanuelle Cottreel, Andrew J. Swift, and Richard N. Channick
Subjects: medicine.medical_specialty, business.industry, Hemodynamics, medicine.disease, Structure and function, chemistry.chemical_compound, chemistry, Internal medicine, cardiovascular system, medicine, Cardiology, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Cardiology and Cardiovascular Medicine, Ventricular remodeling, Cardiac magnetic resonance, business, Macitentan
Abstract: Objectives The REPAIR (Right vEntricular remodeling in Pulmonary ArterIal hypeRtension) study evaluated the effect of macitentan on right ventricular (RV) and hemodynamic outcomes in patie...
Published: 2022

11. Label-Free Classification of Bacterial Extracellular Vesicles by Combining Nanoplasmonic Sensors With Machine Learning

Author: Neil G. R. Broderick, Colin L. Hisey, Mohammadrahim Kazemzadeh, Simon Swift, Kamran Zargar-Shoshtari, Weiliang Xu, and Priscila Dauros-Singorenko
Subjects: chemistry.chemical_classification, business.industry, Biomolecule, Machine learning, computer.software_genre, Extracellular vesicles, Microvesicles, chemistry, Single species, Homogeneous, Artificial intelligence, Purification methods, Electrical and Electronic Engineering, business, computer, Biosensor, Instrumentation, Label free
Abstract: Bacterial extracellular vesicles (EVs) are nanoscale lipid-enclosed packages that are released by bacteria cells and shuttle various biomolecules between bacteria or host cells. They are implicated in playing several important roles, from infectious disease progression to maintaining proper gut health, however the tools available to characterise and classify them are limited and impractical for many applications. Surface-enhanced Raman Spectroscopy (SERS) provides a promising means of rapidly fingerprinting bacterial EVs in a label-free manner by taking advantage of plasmonic resonances that occur on nanopatterned surfaces, effectively amplifying the inelastic scattering of incident light. In this study, we demonstrate that by applying machine learning algorithms to bacterial EV SERS spectra, EVs from cultures of the same bacterial species Escherichia coli can be classified by strain, culture conditions, and purification method. While these EVs are highly purified and homogeneous compared to complex samples, the ability to classify them from a single species demonstrates the incredible power of SERS when combined with machine learning, and the importance of considering these parameters in future applications. We anticipate that these findings will play a crucial role in developing the laboratory and clinical utility of bacterial EVs, such as the label-free, noninvasive, and rapid diagnosis of infections without the need to culture samples from blood, urine, or other fluids.
Published: 2022

12. Health Insurance Payer Type and Ethnicity Are Associated with Cancer Clinical Trial Enrollment Among Adolescents and Young Adults

Author: Juneko E. Grilley Olson, Melissa Matson, Catherine L Swift, Allison M. Deal, Rebecca D Sullenger, Andrew B. Smitherman, and Lauren Lux
Subjects: Adult, Male, Adolescent, Ethnic group, Language barrier, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Neoplasms, Health insurance, Ethnicity, Medicine, Humans, 030212 general & internal medicine, Registries, Young adult, Clinical Trials as Topic, Insurance, Health, business.industry, Cancer, Hispanic or Latino, Original Articles, medicine.disease, humanities, Cancer registry, Clinical trial, Oncology, 030220 oncology & carcinogenesis, Relative risk, Pediatrics, Perinatology and Child Health, Female, Patient Participation, business, Demography
Abstract: Purpose: Adolescents and young adults (AYAs) have experienced inferior improvements in cancer survival outcomes. One potential explanation is the low rate of enrollment in cancer clinical trials. While the reasons behind this are multifactual, sociodemographic factors are probably contributory. We examined the impact of factors such as insurance type and race/ethnicity on clinical trial enrollment among AYAs treated for cancer at an academic medical center. Methods: We identified AYAs (ages 15-39 years) treated for cancer at the University of North Carolina between April 2014 and April 2019. Cancer registry data were linked to electronic health record data to associate treatment and sociodemographic factors with clinical trial enrollment. A multivariable log-binomial model was used to estimate adjusted risk ratios. Results: In a 5-year period, 1574 AYA patients were identified, 59% female, 21% non-Hispanic Black and 9% Hispanic. Overall, 37% of AYAs participated in any clinical trial and 14% enrolled on a therapeutic trial. When compared to publicly insured AYAs, those with private insurance [adjusted RR: 1.52, 95% CI: 1.05-2.22] or with no insurance [adjusted RR: 2.12, 95% CI: 1.34-3.33] were more likely to enroll in a therapeutic clinical trial. Hispanic AYAs were less likely to enroll [adjusted RR: 0.50, 95% CI: 0.27-0.93] when compared to non-Hispanic White patients. Conclusions: Rates of clinical trial enrollment among AYAs vary based on health insurance type and race/ethnicity, suggesting possible disparities in access. Attention to resource, cultural, and language barriers may improve trial enrollment and cancer outcomes among vulnerable AYA subpopulations.
Published: 2023

13. Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Author: Obbina Abani, Ali Abbas, Fatima Abbas, Mustafa Abbas, Sadia Abbasi, Hakam Abbass, Alfie Abbott, Nabeel Abdallah, Ashraf Abdelaziz, Mohamed Abdelfattah, Bushra Abdelqader, David Abdo, Basir Abdul, Althaf Abdul Rasheed, Ajibode Abdulakeem, Rezan Abdul-Kadir, Amina Abdulle, Abdulfatahi Abdulmumeen, Rasheed Abdul-Raheem, Niyaz Abdulshukkoor, Kula Abdusamad, Yazeed Abed El Khaleq, Mai Abedalla, Abeer Ul Amna Abeer Ul Amna, Katrina Abernethy, Adebanke Aboaba, Hani Abo-Leyah, Ahmed Abou-Haggar, Mahmoud Abouibrahim, Miriam Abraham, Tizzy Abraham, Abraheem Abraheem, Judith Abrams, Hyacinth-John Abu, Ahmed Abu-Arafeh, Syed M Abubacker, Akata Abung, Yaa Aceampong, Amaka Achara, Devikumar Acharya, Sarah Acheampong, Janet Acheson, Andres Acosta, Catherine Acton, Jacqueline Adabie-Ankrah, Sara Adair, Fiona Adam, Matthew Adam, Huzaifa Adamali, Carol Adams, Charlotte Adams, Kate Adams, Lisa Adams, Richard Adams, Tim Adams, Kirsty Adcock, Jemaimah Addai, Ade Adebiyi, Ken Adegoke, Vicki Adell, Debo Ademokun, Sherna Adenwalla, Oluwasegun A Adesemoye, Emmanuel O Adewunmi, Joyce Adeyemi, Rina Adhikary, Gabrielle Adkins, Adnan Adnan, John Aeron-Thomas, Debbie Affleck, Dominic Affron, Carmel Afnan, Muhammad Afridi, Zainab A Aftab, Meenakshi Agarwal, Rachel Agbeko, Chris Agbo, Penny Agent, Sunil Aggarwal, Arameh Aghababaie, Shafana Ahamed Sadiq, Mohamed H Ahammed Nazeer, Humayun Ahmad, Mohammad Ahmad, Syed Ahmad, Asim Ahmed, Bilal Ahmed, Forizuddin Ahmed, Hamze Ahmed, Iram Ahmed, Irshad Ahmed, Khaled Ahmed, Liban Ahmed, Mahin Ahmed, Maria C Ahmed, Muhammad S Ahmed, Naseer Ahmed, Nausheen Ahmed, Osama Ahmed, Rajia A Ahmed, Rizwan Ahmed, Saif Ahmed, Sammiya Ahmed, Sara Ahmed, Sophia Ahmed, Syed Ahmed, Syed Haris Ahmed, Roa Ahmed Ali, Sana Ahmed, Sana Ahmer, Dhiraj Ail, Mark Ainsworth, Giulia Airoldi, Myriam Aissa, Lindianne Aitken, Bini Ajay, Francis Ajeneye, Abdulakeem Ajibode, Ayesha Ajmi, Tahir Akbar, Naim Akhtar, Nasim Akhtar, Nauman Akhtar, Suha Akili, Oludoyinsola Akindolie, Yinka Akinfenwa, Olugbenga Akinkugbe, Ibrahim Akinpelu, Olajide Akinwumiju, Olugbenro Aktinade, Ahmad Al Aaraj, Asma Al Balushi, Majd Al Dakhola, Aladdin Al Swaifi, Eslam Al-Abadi, Narendra Aladangady, Ayaz Alam, Sajid Alam, Abbas Al-Asadi, Karina Al-Asadi, Kyriaki Alatzoglou, Manaf Al-Bayati, Paul Albert, Lorraine Albon, Gemma Alcorn, Stephen Alcorn, Aggie Aldana, David Alderdice, Rayan Aldouri, Jonathan Aldridge, Nicolas Aldridge, Ana Alegria, Alison Alexander, John Alexander, Peter D G Alexander, Charlotte Alford, Julyan Al-Fori, Laith Alghazawi, Bahij Al-Hakim, Shams Al-Hity, Ali Ali, Asad Ali, Fawzia R Ali, Hoodo Ali, Jawad Ali, Mariam Ali, Mohammad Ali, Nayab Ali, Oudai Ali, Sabira Ali, Sakina Ali, Syed Ali, Abid Alina, Fine Aliyuda, Katrin Alizadeh, Maithem Al-Jibury, Saba Al-Juboori, Majid Al-Khalil, Moutaz Alkhusheh, Allameddine Allameddine, Fiona Allan, Rachel Allan, Alison Allanson, Robert Allcock, Beverley Allen, Eireann Allen, Jess Allen, Kerry Allen, Laura Allen, Louise Allen, Poppy Allen, Rebecca Allen, Sam Allen, Sharon Allen, Simon Allen, Kathryn Allison, Bethan Allman, Lynne Allsop, Hassan Al-Moasseb, Magda Al-Obaidi, Lina Alomari, Akram Al-Rabahi, Bahar Al-Ramadhani, Zayneb Al-Saadi, Inji Alshaer, Rustam Al-Shahi Salman, Warkaq Al-Shamkhani, Bashar Al-Sheklly, Sara Altaf, Mary Alvarez, Balaal Alyas, Maysaa Alzetani, Susan Amamou, Noor Amar, Sakkarai Ambalavanan, Sarah-Jayne Ambler, Robert Ambrogetti, Chris Ambrose, Amir Ameen, Kenneth Amenyah, Maria R Amezaga, Allison Amin, Amina Amin, Kanish Amin, Syed Amin, Tara Amin, Amjad Amjad, Neelma Amjad, Mariam Ammoun, Victoria Amosun, Khaled Amsha, Pugh Amy, Atul Anand, Rekha Anand, Samantha Anandappa, Julie Anderson, Kevin Anderson, Laura Anderson, Michelle Anderson, Nicola Anderson, Rachel Anderson, Rory Anderson, Wendy Anderson, Prematie Andreou, Angela Andrews, Antonette Andrews, Jill Andrews, Susan Andrews, Gregory Andrikopoulos, Kanayochukwu Aneke, Andrew Ang, Wan Wei Ang, Tammy Angel, Aramburo Angela, Paola Angelini, Lazarus Anguvaa, Oleg Anichtchik, Millicent Anim-Somuah, Krishnan Aniruddhan, Jessica Annett, Patrick J Anstey, Rebekah Anstey, Alpha Anthony, Aaron Anthony-Pillai, Philip Antill, Zhelyazkova Antonina, Varghese Anu, Muhammad Anwar, George Apostolides, Aristeidis Apostolopoulos, Sarah Appleby, Diane Appleyard, Maia Far Aquino, Bianca Araba, Samuel Aransiola, Mariana Araujo, Emily Arbon, Ann Archer, Denise Archer, Simon Archer, Christian Ardley, Ana-Maria Arias, Ryoki Arimoto, Charlotte Arkley, Charlotte Armah, Ilianna Armata, Adam Armitage, Ceri Armstrong, Maureen Armstrong, Sonia Armstrong, Sylvia Armstrong-Fisher, Philippa Armtrong, Heike Arndt, Clare Arnison-Newgass, David Arnold, Rachael Arnold, Sarah Arnott, Dhawal Arora, Kavan Arora, Pardeep Arora, Rishi Arora, Andrea Arroyo, Arslam Arter, Ayush Arya, Rita Arya, Denisa Asandei, Adeeba Asghar, Catherine Ashbrook-Raby, Glen Ashby, Helen Ashby, Jan Ashcroft, John Ashcroft, Samuel Ashcroft, Deborah Asher, Ayesha Ashfaq, Ben Ashford, Suhail Ashgar, Abdul Ashish, Sally Ashman-Flavell, Sundar Ashok, Abd-El-Aziz Ashour, Muhammad Z Ashraf, Saima Ashraf, Mohammad B Ashraq, Deborah Ashton, Susan Ashton, Andrew Ashworth, Rebecca Ashworth, Arshia Aslam, Harshini Asogan, Abigail Asquith, Atif Asrar, Omar Assaf, Raine Astin-Chamberlain, Richard Athay-Hunt, Deborah Athorne, Billie Atkins, Christopher Atkins, Stacey Atkins, John Atkinson, Vicki Atkinson, Brygitta Atraskiewicz, Claire Atterbury, Abdul Ahmad Attia, Rita Atugonza, Paula Aubrey, Avinash Aujayeb, Aye Chan Thar Aung, Hnin Aung, Kyaw Thu Aung, Ni Aung, Yin Aung, Zaw Myo Aung, Emily Austin, Karen Austin, Abdusshakur Auwal, Miriam Avery, Joanne Avis, Georgina Aviss, Cristina Avram, Paula Avram, Gabriel Awadzi, Atia Awan, Aszad Aya, Eman Ayaz, Amanda Ayers, Jawwad Azam, Mohammed Azharuddin, Ghazala Aziz, N Aziz, Ali Azkoul, Ashaari Azman Shah, Giada Azzopardi, Hocine Azzoug, Fiyinfoluwa Babatunde, Melvin Babi, Babiker Babiker, Gayna Babington, Matthew Babirecki, Marta Babores, Adetona O Babs-Osibodu, Sammy Bacciarelli, Roudi Bachar, Gina Bacon, Jenny Bacon, Bibi Badal, Gurpreet R Badhan, Shreya Badhrinarayanan, Joseph P Bae, Sibel Bafekr Mishamandani, Alice Baggaley, Amy Baggott, Graham Bagley, Dinesh Bagmane, Lynsey Bagshaw, Kasra Bahadori, James Bailey, Katie Bailey, Lindsey Bailey, Liz Bailey, Morgan Bailey, Pippa Bailey, Sarah Bailey, Stephen Bailey, Hamish Baillie, J Kenneth Baillie, Jennifer Bain, Sanchia Baines, Vikram Bains, Aimi Baird, David Baird, Susan Baird, Tracy Baird, Yolanda Baird, Aiysha Bajandouh, Charles Baker, Emma Baker, Evelyn Baker, Johanne Baker, Josephine Baker, Kenneth Baker, Rebecca Baker, Terri-Anne Baker, Victoria Baker, Hugh Bakere, Nawar Bakerly, Michelle Baker-Moffatt, Nauman Bakhtiar, Panos Bakoulas, Julie Balaam, Niranjan Balachandran, Andrea Balan, Theodosios Balaskas, Madhu Balasubramaniam, Alison Balcombe, Alexander Baldwin, Ashley Baldwin, Caron Baldwin, Danielle Baldwin, Rebekah Baldwin-Jones, James Balfour, Gagan Bali, Sonya Balkee, Ceri Ball, Kasia Ballard, Amy Ballinger, Ismael Balluz, Craig Balmforth, Emese Balogh, Amir Baluwala, Gabby Bambridge, Alasdair Bamford, Amy Bamford, Peter Bamford, Adefunke Bamgboye, Elizabeth Bancroft, Hollie Bancroft, Tanya Bancroft, Joyce Banda, Krishna Bandaru, Srini Bandi, Nageswar Bandla, Somaditya Bandyopadhyam, Amit Banerjee, Millie Banerjee, Ritwik Banerjee, Harrison Banks, Lauren Banks, Luke Banks, Paul Banks, Oliver Bannister, Bharat Bansal, Robert Banthorpe, Laura Banton, Mariamma Baptist, Tanya Baqai, Ananya Mouli Baral, Desislava Baramova, Alex Barber, Russel Barber, Emma Barbon, Miriam Barbosa, Monica Barbosa, Jamie Barbour, Alexander Barclay, Claire Barclay, George Bardsley, Stephanie Bareford, Shahedal Bari, Amy Barker, Debbie Barker, Helen Barker, Joseph Barker, Leon Barker, Oliver Barker, Kerry Barker-Williams, Sinha Barkha, Juliana Barla, Gavin Barlow, Richard Barlow, Valerie Barlow, James Barnacle, Alex Barnard, Debi Barnes, Nicky Barnes, Theresa Barnes, Calum Barnetson, Amy Barnett, Matthew Barnett, Ashton Barnett-Vanes, William Barnsley, Andrew Barr, David Barr, Shaney Barratt, Manuella Barrera, Amy Barrett, Fiona Barrett, Jessica Barrett, Joe Barry, Jazz Bartholomew, Claire Bartlett, Georgina Bartlett, Greg Barton, Jill Barton, Lorna Barton, Rachael Barton, Rosaleen Baruah, Sonia Baryschpolec, Archana Bashyal, Betsy Basker, Ayten Basoglu, Gilda Bass, John Bassett, G Bassett, Chris Bassford, Pavinder Bassi, Betsy Bassis, Bengisu Bassoy, Victoria Bastion, Anupam Basumatary, Tristan Bate, Harry J Bateman, Ian Bateman, Kathryn Bateman, Vhairi Bateman, Eleanor Bates, Hayley Bates, Michelle Bates, Simon Bates, Sally Batham, Ana Batista, Amit Batla, Dushyant Batra, Donna Batty, Harry Batty, Thomas Batty, Peter Baughan, Miranda Baum, Carina Bautista, Fareha Bawa, Fatima S Bawani, Simon Bax, Lydia Baxter, Matt Baxter, Nicola Baxter, Zachary Baxter, Hannah Bayes, Charlotte Baylem, Lee Bayliss, Eileen Bays, Farid Bazari, Rohit Bazaz, Ahmad Bazli, Laura Beacham, Wendy Beadles, Philip Beak, Andy Beale, Kirk Beard, Jack Bearpark, Karen Beaumont, Dawn Beaumont-Jewell, Theresa Beaver, Sarah Beavis, Christy Beazley, Sarah Beck, Virginia Beckett, Rosie Beckitt, Heidi Beddall, Seonaid Beddows, Deborah Beeby, Gail Beech, Michelle Beecroft, Sally Beer, Jane Beety, Gabriela Bega, Alison Begg, Susan Begg, Sara Beghini, Ayesha Begum, Salman Begum, Selina Begum, Teresa Behan, Jasmine Beharry, Roya Behrouzi, Jon Beishon, Claire Beith, James Belcher, Holly Belfield, Katherine Belfield, Ajay Belgaumkar, Dina Bell, Gareth Bell, Gill Bell, Gillian Bell, Joshua Bell, Lauren Bell, Louise Bell, Nicholas Bell, Pippa Bell, Stephanie Bell, Jennifer L Bell, Jennifer Bellamu, Mary Bellamy, Arianna Bellini, Amanda Bellis, Fionn Bellis, Lesley Bendall, Naveena Benesh, Nicola Benetti, Leonie Benham, Guy Benison-Horner, Alexander Bennett, Ann Bennett, Caroline Bennett, Christopher Bennett, Gillian 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Bintcliffe, Catherine Birch, Jenny Birch, Louann Birch, Janet Birchall, Katherine Birchall, Sam Bird, Sumedha Bird, Charndip Biring, Mark Birt, Raquel Bisa, Kilanalei Bishop, Linda Bishop, Lisa Bishop, Karen Bisnauthsing, Nibedan Biswas, Sahar Biuk, Karen Blachford, Ethel Black, Helen Black, Karen Black, Mairead Black, Polly Black, Hayley Blackgrove, Bethan Blackledge, Joanne Blackler, Samantha Blackley, Helen Blackman, Stuart Blackmore, Caroline Blackstock, Loraine Blackwood, Francesca Blakemore, Helen Blamey, Alison Bland, Sujata Blane, Simon Blankley, Mary Blanton, Parry Blaxill, Jenny Blaxland, Katie Blaylock, Jane Blazeby, Carol Blears, Natalie Blencowe, Donna Blofield, Ben Bloom, Jack Bloomfield, Angela Bloss, Hannah Bloxham, Louise Blundell, Andrew Blunsum, Mark Blunt, Ian Blyth, Kevin Blyth, Andrew Blythe, Karen Blythe, Marilyn Boampoaa, Boniface Bobie, Karen Bobruk, Pritesh Bodalia, Neena Bodasing, Tanya Bodenham, Sherin Bodh, Gabriele Boehmer, Marta Boffito, Kristyna Bohmova, 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Cameron, Sheena Cameron, Christian Camm, Renee F D Cammack, Alison Campbell, Amy Campbell, Barbara Campbell, Bridget Campbell, Debbie Campbell, Helen Campbell, Hilary Campbell, Jonathan Campbell, Mark Campbell, Robyn Campbell, Wynny Campbell, Quentin Campbell Hewson, Julie Camsooksai, Ana Canabarro, Lisa Canclini, Shaula Mae Candido, Janie Candlish, Cielito Caneja, Johnathon Cann, Ruby Cannan, Emma Cannon, Michael Cannon, Petra Cannon, Vivienne Cannons, Jane Cantliff, Ben Caplin, Santino Capocci, Noemi Caponi, Angelika Capp, Anne Capps-Jenner, Thomas Capstick, Ishmael Carboo, Nuria Cardenas, Mary Cardwell, Rachel Carey, Simon Carley, Tammy Carlin, Andrew Carlton, Samantha Carmichael, Mandy Carnahan, Rebecca Carnegie, Charlotte Caroline, Emily Carpenter, Jodi Carpenter, David Carr, Sharon Carr, Anna Carrasco, Samantha Carrington, Zoe Carrington, Paul Carroll, Caroline Carron, Anne Carstairs, Jonathan Carter, Michael Carter, Moira Carter, Paul Carter, Penny Carter, Steven Carter, Simon 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Eric Chiang, Angela Chiapparino, Rosavic Chicano, Zviedzo A Chikwanha, Sam Chilcott, Phillipa Chimbo, KokWai Chin, Wen Jie Chin, Rumbidzai Chineka, Amol Chingale, Karen Chinn, Vashira Chiroma, Heather Chisem, Claire Chisenga, Ben Chisnall, Carolyn Chiswick, Sunder Chita, Nihil Chitalia, Matthew Chiu, Brenda Chivima, Catherine Chmiel, Soha Choi, Willy Choon Kon Yune, Vandana Choudhary, Sarah Choudhury, Bing-Lun Chow, Fateha Chowdhury, Mahibbur Chowdhury, Shahid Chowdhury, Victoria Christenssen, Peter Christian, Alexander Christides, Fiona Christie, Daniel Christmas, Thereza Christopherson, Mark Christy, Paris Chrysostomou, Yunli Chua, Shabs Chucha, Dip Chudgar, Richard Chudleigh, Srikanth Chukkambotla, Michael E Chukwu, Izu Chukwulobelu, Chi Y Chung, Ben Church, Elaine Church, Sara R Church, David Churchill, Nicole Cianci, Nick Ciccone, Paola Cicconi, Paola Cinardo, Zdenka Cipinova, Bessie Cipriano, Sarah Clamp, Melanie Clapham, Edel Clare, Sarbjit Clare, Andrew Clark, Charlotte Clark, Diane Clark, Felicity Clark, Gabrielle Clark, James Clark, Katherine Clark, Kaylea Clark, Louise Clark, Lucy Clark, Matthew Clark, Patricia Clark, Richard Clark, Thomas Clark, Wendy Clark, Zoe Clark, Andrea Clarke, Heather Clarke, Mark Clarke, Paul Clarke, Robert Clarke, Roseanne Clarke, Samantha Clarke, Sarah Clarke, Sheron Clarke, Tracy Clarke, Andrew Clarkson, Alleyna Claxton, Kate Clay, Elizabeth Clayton, Olivia Clayton, Jill Clayton-Smith, Chris Cleaver, Carlota Clemente de la Torre, Jayne Clements, Suzanne Clements, Francesca Clemons, Lee Clifford, Lynne Clifford, Rachael Clifford, Sarah Clifford, Amelia Clive, Jonathan Clouston, Samantha Clueit, Andrea Clyne, Michelle Coakley, Peter G L Coakley, Tony Coates, Kathryn Cobain, Alexandra Cochrane, Patricia Cochrane, Maeve Cockerell, Helen Cockerill, Shirley Cocks, Rachel Codling, Adam Coe, Samantha Coetzee, David Coey, Danielle Cohen, Jonathan Cohen, Oliver Cohen, Mike Cohn, Louise Coke, Olutoyin Coker, Nicholas Colbeck, Roghan 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Dearden, Alison Deary, Catherine Deas, Samuel Debbie, Gabor Debreceni, Vashist Deelchand, Matthew Deeley, Joanne Deery, Emmanuel Defever, Raji Dehulia, Max Deighton, Manuela Del Forno, Arnold Dela Rosa, Lisa Delaney, Amanda Dell, Carrie Demetriou, David DeMets, Jane Democratis, Jacqueline Denham, Emmanuelle Denis, Laura Denley, Craig Denmade, Kathy Dent, Martin Dent, Elise Denton, Tom Denwood, Nishigandh Deole, Darshita Depala, Maria Depante, Randle Derbyshire, Susan Dermody, Amisha Desai, Asmita Desai, Purav Desai, Sanjeev Deshpande, Vai Deshpande, Brendan Devine, Sirjana Devkota, Nicola Dewland, Prakash Dey, Vishal Dey, Rogin Deylami, Jazz Dhaliwal, Kevin Dhaliwal, Jas Dhalliwal, Mandeep Dhanda, Sundip Dhani, Amandeep Dhanoa, Mili Dhar, Devesh Dhasmana, Aman Dhesi, Ekanjali Dhillon, Reiss Dhillon, Pamela Diamond, Priya Dias, Stephanie Diaz, Kayleigh Diaz-Pratt, Debbie Dickerson, Pamela Dicks, Stuart Dickson, Julie Dijo, Sean Dillane, Sarah Diment, Paul Dimitri, Maria Dineen, ThaiHa Dinh, Tri Dinh, Alex Dipper, Laura Dirmantaite, Lisa Ditchfield, Sarah Diver, Lavanya Diwakar, Caroline Dixon, Giles Dixon, Stephen Dixon-Mould, Brice Djeugam, Petr Dlouhy, Laurence Dobbie, Marinela Dobranszky Oroian, Charlotte Dobson, Lee Dobson, Marie Docherty, David Dockrell, James Dodd, Jackie Dodds, Rebecca Dodds, Steve Dodds, Richi Dogra, Erin Doherty, Warren Doherty, Yumiko Doi, Iain Doig, Eleanor Doke, Daniel Dolan, Mark Dolman, Rozzie Dolman, Lisa Donald, Callum Donaldson, Christopher Donaldson, Denise Donaldson, Gillian Donaldson, Kate Donaldson, Joanne Donnachie, Christopher Donnelly, Eilish Donnelly, Ronan Donnelly, Aravindhan Donohoe, Gemma Donohoe, Bryan Donohue, Sinead Donton, Emma Dooks, Grainne Doran, Kane Dorey, Sharon Dorgan, Amanda Dornan, Moonira Dosani, Davinder Dosanjh, Paula Dospinescu, Katie Douglas, Jonathan Douse, Lucy Dowden, Michelle Dower, Kerry Dowling, Sud Dowling, Nicola Downer, Charlotte Downes, Rob Downes, Thomas Downes, Damian Downey, Philippa Downey, Robert Downey, Louise Downs, Simon Dowson, Cornel Dragan, Cristina Dragomir, Cristina Dragos, Maire Drain, Chelsea Drake, Victoria Drew, Olivia Drewett, Celine Driscoll, Helena Drogan, Nikki Drogman, Graham Drummond, Ronald Druyeh, Simon Drysdale, An Du Thinh, Hazel Dube, Judith Dube, Ophias Dube, Stephen Duberley, Hayley Duckles-Leech, Nicola Duff, Emma Duffield, Sam Duff-Miller, Helen Duffy, Lionel Dufour, Annette Duggan, Helen Duggan, Parveen Dugh, Janice Duignan, Mick Duley, Simon Dummer, Andrew Duncan, Christopher Duncan, Fullerton Duncan, Gregory Duncan, Stephanie Dundas, Alessia Dunn, Charlotte Dunn, Damian Dunn, Laura Dunn, Paul Dunn, Charlene Dunne, Karen Dunne, Fiona Dunning, Aidan Dunphy, Venkat Duraiswamy, Beatriz Duran, Ingrid DuRand, Steve Durgacharan, Natalie Duric, Alison Durie, Emily Durie, Hannah Durrington, Haris Duvnjak, Akshay Dwarakanath, Laasya Dwarakanath, Ellen Dwyer, Claudia Dyball, Lee Dyble, Kristyn Dyer, Harvey Dymond, Tom Dymond, Chris Eades, Laura 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Evison, Penny Eyton-Jones, Jacqueline Faccenda, Leila Fahel, Youstina Fahmay, Sara Fairbairn, Terry Fairbairn, Andy Fairclough, Louise Fairlie, Mark Fairweather, Anne Fajardo, Naomi Falcone, Euan Falconer, Jonathan Falconer, John Fallon, Andrea Fallow, David Faluyi, Victoria Fancois, Qayyum Farah, Novin Fard, Amr Farg, Margaret Farinto, Adam Farmer, Katie Farmer, Toni Farmery, Samantha Farnworth, Faiyaz Farook, Hadia Farooq, Sidrah Farooq, Fiona Farquhar, Karen Farrar, Aaron Farrell, Barbara Farrell, James Farthing, Syeda Farzana, Rahmatu Fasina, Azam Fatemi, Mina Fatemi, Nibah Fatimah, Maria Faulkner, Saul N Faust, Joe Fawke, Sinmidele Fawohunre, Abul Fazal, Kelly Feane, Simon Fearby, Alex Feben, Federico Fedel, Daria Fedorova, James Feely-Henderson, Christopher Fegan, Mae Felongco, Lynsey Felton, Tim Felton, Kate Fenlon, Andrea Fenn, Isabelle Fenner, Ciara Fenton, Melisa Fenton, Cameron Ferguson, Jenny Ferguson, Kathryn Ferguson, Katie Ferguson, Stephanie Ferguson, Susan Ferguson, Susie Ferguson, Victoria Ferguson, Denzil Fernandes, Candida Fernandez, Eduardo Fernandez, Maria Fernandez, Sonia Fernandez Lopez, Callum Jeevan Fernando, Ahmed Feroz, Pietro Ferranti, Thais Ferrari Gersogamo, Eleanor Ferrelly, Alexandra Ferrera, Emma Ferriman, Nicholas Fethers, Ben Field, Janet Field, Rebecca Field, Karen Fielder, Lindsey Fieldhouse, Andra Fielding, Julie Fielding, Len Fielding, Sarah Fielding, Asma Fikree, Sarah Ann Filson, Sarah Finbow, Debbie Finch, Joanne Finch, Laurie Finch, Joanne Finden, Natalie Fineman, Lauren Finlayson, Adam Finn, Joanne Finn, Clare Finney, Sofia Fiouni, Jo Fiquet, Dani Fisher, Emily Fisher, James Fisher, Neil Fisher, Meadow Fisher Crisp, Daniel Fishman, Krystofer Fishwick, Lorraine Fitzgerald, Chloe Fitzpatrick-Creamer, Jan Flaherty, Michael Flanagan, Charles Flanders, Cathy Flatters, Julie Fleming, Lucy Fleming, Paul Fleming, William Flesher, Alison Fletcher, Jonathan Fletcher, Lucy Fletcher, Simon Fletcher, Sophie Fletcher, Karen Flewitt, Christopher Flood, Ian Floodgate, Vincent Florence, Sharon Floyd, Kelly Flynn, Rachel Flynn, Sara Flynn, Claire Foden, Adama Fofana, Georgina Fogarty, Claire Foley, Paul Foley, Linda Folkes, Daniela Mock Font, Evodian Fonyonga, Aiwyne Foo, Jane Foo, Andrew Foot, Jayne Foot, Jane Forbes, Jamie Ford, Kathy Ford, Jennifer Foreman, Caroline Fornolles, Adam Forrest, Ellie Forsey, Miranda Forsey, Thomas Forshall, Elliot Forster, Julian Forton, Emily Foster, Joseph Foster, Rachel A Foster, Tracy Foster, Theodora Foukanelli, Angela Foulds, Ian Foulds, Folakemi Fowe, Emily Fowler, Robert Fowler, Stephen Fowler, Caroline Fox, Claire Fox, Daniel Fox, Heather Fox, Jonathan Fox, Lauren Fox, Natalie Fox, Olivia Fox, Simon Fox, Sarah-Jane Foxton, Yasin Fozdar, Rebecca Frake, Alex Francioni, Olesya Francis, Rebecca Francis, Sarah Francis, Theodora Francis-Bacon, Jason Frankcam, Helen Frankland, Gayle Franklin, Jessica Franklin, Darron Franks, Catherine Fraser, Laura Fraser, Sharon Frayling, Martyn Fredlund, Matthew Free, Carol Freeman, Elaine Freeman, Hannah Freeman, Nicola Freeman, Clare Freer, Ian Freestone, Eleanor French, Matthew Frise, Renate Fromson, Claire Froneman, Adam Frosh, John Frost, Victoria Frost, Oliver Froud, Rachel Frowd, Arun Fryatt, Jake Fryer, Janet Fu, Bridget Fuller, Liz Fuller, Neil Fuller, Tracy Fuller, Duncan Fullerton, Jenny Fullthorpe, Carrie Fung, Gayle Fung, Sarah Funnell, John Furness, Charlene Furtado, Andrew Fyfe, Nytianandan G, Elizabeth Gabbitas, Claire Gabriel, Diana Gabriel, Hadiza Gachi, Rose Gad, Joshua Gahir, Sarveen Gajebasia, Katarzyna Gajewska-Knapik, Zacharoula Galani, Christopher Gale, Hugo Gale, Rebecca Gale, Swetha Gali, Karen Galilee, Bernadette Gallagher, Jude Gallagher, Rosie Gallagher, William Gallagher, Joanne Galliford, Catherine Galloway, Chris Galloway, Emma Galloway, Jacqui Galloway, James Galloway, Laura Gamble, Liz Gamble, Brian Gammon, Jaikumar Ganapathi, Ramesh Ganapathy, Kaminiben Gandhi, Sarah Gandhi, Usha Ganesh, Abrar Gani, Emma-James Garden, Antoni D Gardener, Emma Gardiner, Jill Gardiner, Michael Gardiner, Phil Gardiner, Siobhan Gardiner, Caroline Gardiner-Hill, Jonathan Gardner, Mark Garfield, Atul Garg, Nathan Garlick, Justin Garner, Lucie Garner, Zoe Garner, Kimberley Garnett, Robert Garney, Rosaline Garr, Michael Garstka, Peter Gartan, Florence Garty, Rachel Gascoyne, Hyeriju Gashau, Noha Gasmalseed, Michaela Gaspar, Aoife Gatenby, Erin Gaughan, Alok Gaurav, Mariana Gavrila, Jane Gaylard, Emma Gaywood, Catherine Geddie, Alison Geddis, Ian Gedge, Sarah Gee, Minerva Gellamucho, Karzan Gelly, Leila Gelmon, Sandra Gelves-Zapata, Gemma Genato, Susan Gent, Natalie Geoghegan, Chloe George, Sam George, Tina George, Simon Georges, Domonique Georgiou, Peter Gerard, Leigh Gerdes, Louise Germain, Helen Gerrish, Abel Getachew, Louise Gethin, Hisham Ghanayem, Amardeep Ghattaoraya, Anca Gherman, Alison Ghosh, Justin Ghosh, Sudhamay Ghosh, Sarra Giannopoulou, Malick Gibani, Andrew Gibb, Ben Gibbison, Kerry Gibbons, Alex Gibson, Bethan Gibson, Kimberley Gibson, Kirsty Gibson, Sian Gibson, Cat Gilbert, Jeanette Gilbert, Joanne Gilbert, Kayleigh Gilbert, Sean Gilchrist, Benjamin Giles, Mandy Gill, Rose Gill, Lynne Gill, Paul Gillen, Annelies Gillesen, Katherine Gillespie, Matt Gillespie, Elizabeth Gillham, Andrew Gillian, Deborah Gilliland, Robert Gillott, Danielle Gilmour, Kate Gilmour, Theodora Giokanini-Royal, Anna Gipson, Joanna Girling, Rhian Gisby, Angelena Gkioni, Aikaterini Gkoritsa, Effrossyni Gkrania-Klotsas, Amy Gladwell, James Glanville, Jessica Glasgow, Susannah Glasgow, Jon Glass, Lynn Glass, Sharon Glaysher, Lisa Gledhill, Ana Glennon, John Glover, Kyle Glover, Jan Glover Bengtsson, Chevanthy Gnanalingam, Julie Goddard, Wendy Goddard, Emily Godden, Jo Godden, Gillian Godding, Emma Godson, Gerry Gogarty, Sukanya Gogoi, Aiky Goh, Rebeca Goiriz, Sriya Gokaraju, Philip Gold, Raphael Goldacre, Arthur Goldsmith, Portia Goldsmith, Darren Gomersall, Lucia Gomez, Raquel Gomez-Marcos, Ali Gondal, Celia Gonzalez, Jack Goodall, Bob Goodenough, Laura Goodfellow, James Goodlife, Camelia Goodwin, Elizabeth Goodwin, Jayne Goodwin, Paula Goodyear, Rajiv Gooentilleke, Sharif Goolam-Hossen, Michelle Goonasekara, Sheila Gooseman, Shameer Gopal, Peter Gordon, Sally Gordon, Hugh Gorick, Caitlin Gorman, Claire Gorman, Stuart Gormely, Diana Gorog, Jan Gorry, Michelle Gorst, Thomas Gorsuch, Jayshreebahen Gosai, Rebecca Gosling, Sally Gosling, Georgina Gosney, Vanessa Goss, Dzintars Gotham, Naomi Gott, Elizabeth Goudie, Amanda Gould, Angela Gould, Susan Gould, Lysander Gourbault, Anna Gouveia, Abha Govind, Sharon Gowans, Girish Gowda, Rohit Gowda, Pauline Gowdy, Hannah Gower, Thomas Gower, Pankaj Goyal, Sunil Goyal, Sushant Goyal, Beverley Graham, Clive Graham, Jane Graham, Jonathan Graham, Justin Graham, Libby Graham, Sharon Graham, Matthew Graham-Brown, Julia Grahamslaw, Gianluca Grana, Tracyanne Grandison, Louis Grandjean, Alison Grant, Ann Grant, David Grant, Matthew Grant, Pauleen Grant, Rhys Gravell, Jenny Graves, Alasdair Gray, Catherine Gray, Georgina Gray, Harriet Gray, Ingrid Gray, Jackie Gray, Karen Gray, Nicola Gray, Sebastian Gray, Alan Grayson, Patricia Grealish, Fiona Greaves, Jack Greaves, Paul Greaves, Charlotte Green, Christopher Green, David Green, Frederick Green, Grace Green, Joel Green, Marie Green, Nicola Green, Stacey Green, Teresa Green, Diarra Greene, Philippa Greenfield, Alan Greenhalgh, Maraneka Greenslade, Daniel Greenwood, Sandra Greer, James Gregory, Jane Gregory, Katie Gregory, Tamsin Gregory, James Gregson, Jill Greig, Julia Greig, Rebecca Grenfell, Teena Grenier, Susan Grevatt, Glaxy Grey, Andrew Gribbin, Amy Gribble, Beverley Grice, Natasha Grieg, Douglas Grieve, Ben Griffin, Denise Griffin, Mel Griffin, Sian Griffith, Alexandra Griffiths, Andrew Griffiths, Daniel Griffiths, David Griffiths, Donna Griffiths, Isabel Griffiths, Mark Griffiths, Nicola Griffiths, Oliver Griffiths, Sarah Griffiths, Sharon Griffiths, Yvonne Griffiths, Sofia Grigoriadou, Steph Grigsby, Paul Grist, Stephen Grist, Evelina Grobovaite, Clarissa Grondin, Rachel Groome, Liliana Grosu, Jenny Grounds, Margaret Grout, Helen Grover, Jayne Groves, Neil Grubb, Julie Grundy, Francesca Guarino, Sharada Gudur, Sharazeq Guettari, Shivang Gulati, Vikas Gulia, Pumali Gunasekera, Malin Gunawardena, Kirun Gunganah, Jessica Gunn, Emma Gunter, Alok Gupta, Atul Gupta, Rajeev Gupta, Richa Gupta, Rishi Gupta, Tarun Gupta, Vineet Gupta, Ankur Gupta-Wright, Victoria Guratsky, Alvyda Gureviciute, Sambasivarao Gurram, Bhawana Gurung, Shraddha Gurung, Hazel Guth, Ruth Habibi, Berkin Hack, Pamela Hackney, Christian Hacon, Aiman Haddad, Denise Hadfield, Michalis Hadjiandreou, Nikolaos Hadjisavvas, Leah Hadzik, Anna Haestier, Nauman Hafiz, Rana Hafiz-Ur-Rehman, Javed Hafsa, Samantha Hagan, Jack W Hague, Rosemary Hague, Kate Haigh, Christina Haines, Scott Hainey, Morton Hair, Brigid Hairsine, Juraj Hajnik, Anne Haldeos, Writaja Halder, Jennie Hale, Carmel Halevy, Paul Halford, William Halford, Alistair Hall, Anthony Hall, Claire Hall, Elizabeth Hall, Emma Hall, Fiona Hall, Helen Hall, Jennifer Hall, Kathryn Hall, Bill Hall, Jan Hallas, Kyle Hallas, Charles Hallett, Becky-Lee Halls, Heather Halls, Maryam Hamdollah-Zadeh, Bilal Hameed, Imran Hamid, Mohamad Hamie, Bethany Hamilton, Fergus Hamilton, Leigh Hamilton, Nicola Hamilton, Ruth Hamlin, Eleanor Hamlyn, Beatrice Hammans, Shirley Hammersley, Kate Hammerton, Bev Hammond, Leah Hammond, Sara Hammond, Fiona Hammonds, Ibrahim Hamoodi, Karen Hampshire, Elizabeth Hampson, Jude Hampson, Lucy Hampson, Ozan Hanci, Ian Hancock, Sadiyah Hand, Jasmine Handford, Soran Handrean, Sarah Haney, Sheharyar Hanif, E Hanison, Alison Hanlon, Jennifer Hannah, Amy Hannington, Merhej Hannun, Aidan Hanrath, Anita Hanson, Jane Hanson, Kathryn Hanson, Steve Hanson, Helen Hanwell, Mazhar Ul Haq, Ala Haqiqi, Monjurul Haque, Lesley Harden, Zoe Harding, Simon Hardman, Joanna Hardy, Kumar Haresh, Rachel Harford, Beverley Hargadon, Carolyn Hargreaves, Emily Hargreaves, James Hargreaves, Alice Harin, Mohammed Haris, Edward Harlock, Sandra Harlow, Paula Harman, Tracy Harman, Mark Harmer, Muhammad A Haroon, Charlie Harper, Fiona Harper, Heather Harper, Melanie Harper, Peter Harper, Rosemary Harper, Sarah Harrhy, Sian Harrington, Yasmin Harrington-Davies, Jade Harris, Jess Harris, John Harris, Laura Harris, Marie-Clare Harris, Naomi Harris, Nichola Harris, Sophie Harris, Alex Harrison, David Harrison, Julie Harrison, Laura Harrison, Melanie Harrison, Rowan Harrison, Susie Harrison, Thomas Harrison, Wendy Harrison, Elizabeth Harrod, Ciaran Hart, Dominic Hart, Lisa Hartley, Rosemary Hartley, Ruth Hartley, Tom Hartley, William Hartrey, Phillipa Hartridge, Stuart Hartshorn, Heli Harvala, Alice Harvey, Angela Harvey, Max Harvey, Catherine Harwood, Helen Harwood, Brigitte Haselden, Kazi Hashem, Mohammed Hashimm, Tadaaki Hashimoto, Imranullah Hashmi, Sarah Haskins, Zena Haslam, Adil Hassan, Ali Hassan, Wagae UI Hassan, Waqar Ul Hassan, Sapna Hassasing, Jane Hassell, Philip Hassell, Alex Hastings, Bethany Hastings, Janice Hastings, Stephanie Hatch, Jonathan Hatton, Sheryl Haviland, May Havinden-Williams, Stefan Havlik, Daniel B Hawcutt, Kadean Hawes, Liz Hawes, Nicola Hawes, Annie Hawkins, Catherine Hawkins, Nancy Hawkins, Tanya Hawkins, Dan Hawley, Ed Hawley-Jones, Edward Haworth, Cathy Hay, Amna Hayat, Jamal Hayat, Mohamed-Riyal Hayathu, Tamsin Haydon, Anne Hayes, Jonas Hayes, Kate Hayes, Melony Hayes, Vanessa Hayes, Fiona Hayes, Patrick Hayle, Chloe Haylett, Antara Hayman, Melanie Hayman, Matthew Haynes, Richard Haynes, Rachel Hayre, Sarah Haysom, James Hayward, Patrick Haywood, Tracy Hazelton, Phoebe Hazenberg, Zhengmai He, Elizabeth Headon, Carrie Heal, Brendan Healy, Amy Hearn, Angela Heath, Rowan Heath, Diane Heaton, Kerry Hebbron, Gemma Hector, Andy Hedges, Katrine Hedges, Cheryl Heeley, Elaine Heeney, Rajdeep Heire, Ulla Hemmila, Cassie Hemmings, Scott Hemphill, Deborah Hemsley, Abigail Henderson, Jennifer Henderson, Steven Henderson, Lee Hennen, Kathryn Hennessy, Natalie Hennesy, Carol Ann Henry, Joanne Henry, Karol Henry, Lavinia Henry, Margo Henry, Natalie Henry, David Henshall, Mike Herbert, Gillian Herdman, Rosaleen Herdman-Grant, Morag Herkes, Emma Heron, Kay Heron, William Herrington, Emilia Heselden, Peta Heslop, Sharnie Beth Hesson, Simon Hester, Emily Hetherington, Joseph Hetherington, Chamila Hettiarachchi, Pramodh Hettiarachchi, Hayley Hewer, John Hewertson, Anna Hewetson, Sue Hewins, Jacqueline Hewitson, Claire Hewitt, Davina Hewitt, Richard Hewitt, Robert Heyderman, Nicolette Heydon, Mathis Heydtmann, Joseph Heys, Jonathan Heywood, Gareth Heywood-Beldon, Meg Hibbert, John Hickey, Naomi Hickey, Peter Hickey, Alex Hicks, Jenny Hicks, Rosie Hicks, Scott Rory Hicks, Daniel Higbee, Lucy Higgins, Andrew Higham, Martin Highcock, Judith Highgate, Mondy Hikmat, Alison Hill, Amanda Hill, Helen Hill, Joanne Hill, Lisa Hill, Martin Hill, Phoebe Hill, Uta Hill, Annette Hilldrith, Elizabeth Hillerby, Catherine Hillman-Cooper, Elisabeth Hilton, Zoe Hilton, Sarah Hinch, Marcus Hinde, Andrew Hindle, Alice Hindmarsh, Paul Hine, Kim Hinshaw, Clare Hird, Alison Hirst, Jemma Hives, Benson Ho, Michaela Hoare, David Hobden, Gill Hobden, Maria Hobrok, Simon Hobson, Renate Hodge, Simon Hodge, Lesley Hodgen, Holly Hodgkins, Louise Hodgkinson, Sally Hodgkinson, David Hodgson, Helen Hodgson, Luke Hodgson, Sheila Hodgson, Gemma Hodkinson, Kenneth Hodson, Matthew Hogben, Lucy Hogg, Lee Hoggett, Abigail Holborow, Catherine Holbrook, Catherine Holden, Melinda Holden, Thomas Holder, Niels Holdhof, Hannah Holdsworth, Lisa Holland, Maureen Holland, Nicky Holland, Marie Hollands, Elizabeth Holliday, Nina Holling, Gillian Hollis, Laszlo Hollos, Linda Holloway, Simon Holloway, Marcus Hollyer, Amy Holman, Ann Holmes, Benjamin Holmes, Megan Holmes, Raphael Holmes, Rebecca Holmes, Kelly Holroyd, Caroline Holt, Lyndsey Holt, Siobhan Holt, Susie Holt, Alexandra Holyome, Marie Home, Toni Home, Renate Homewood, Kate Hong, Laura Hontoria del Hoyo, Clare Hooper, Sarah Hoosdally, Samantha Hope, Susan Hope, Bridget Hopkins, Peter W Horby, Stephanie Horler, Anil Hormis, Daniel Hornan, Nicola Hornby, Zoey Horne, Latoya Horsford, Megan Horsford, Mark Horsford, Valana Horsham, Alexander Horsley, Ashley Horsley, Elizabeth Horsley, Sarah Horton, Nicola Horton-Turner, Jane Hosea, Toby Hoskins, Muhammad S Hossain, Rashed Hossain, Leanne Hostler, Maxine Hough, Sarah Hough, Brittany Houghton, Catherine Houghton, Iain Houghton, Kathryn Houghton, Rebecca Houlihan, Angela Houston, Hamish Houston, Tawedzegwa Hove, Roseanna Hovvels, Lee How, Laura Howaniec, Laura Howard, Linda Howard, Lucy Howard, Sarah Howard, Stuart Howard, Richard Howard-Griffin, Alison Howarth, Diane Howarth, Serena Howe, Mark Howells, Lyn Howie, Kerry Howlett, Sophie Howlett, Joanne Hoyle, Josh Hrycaiczuk, Naing Zaya Htoon, Su Htwe, Ying Hu, Chiang Ooi Huah Huah, Abby Huckle, Shahzya Huda, Alison Hudak, Lisa Hudig, Alex Hudson, Cara Hudson, Heather Hudson, Peter Hudson, Oli Hudson, Alison Hufton, Connor Huggins, Alistair Hughes, Eithne Hughes, Emma Hughes, Gareth Hughes, Heather Hughes, Luke Hughes, Rachel Hughes, Rebecca Hughes, Samantha Hughes, Stephen Hughes, Vikki Hughes, Wesley Hughes, Lukas Huhn, Ching Hui, Ruth Hulbert, Diana Hull, Grace Hull, Robert Hull, Amanda Hulme, Peter Hulme, Wendy Hulse, George Hulston, Ryan Hum, Laura Humber, Megan Hume, Charlotte Humphrey, Ismay Humphreys, Alasdair Humphries, Joanne Humphries, Lena Hunold, Fiona Hunt, Kristen Hunt, Luke Hunt, Sophie Hunt, Al Hunter, Alexandra Hunter, Isobel Hunter, Karl Hunter, Neil Hunter, George Huntington, Elizabeth Hurditch, Cian Hurley, Katrina Hurley, Mohammed A Husain, Syeda Yusra Husaini, Coralie Huson, Afreen Hussain, Ibraar Hussain, Ifza Hussain, Mohammad Hussain, Muhammad Hussain, Reda Hussain, Sajid Hussain, Samia Hussain, Sanniah Hussain, Wasim Hussain, Yasmin Hussain, Mohammed Hussam El-Din, Raheem Hussein, Rebecca Hussey, Camille Hutchinson, Dorothy Hutchinson, Elizabeth Hutchinson, John Hutchinson, Claire Hutsby, Paula Hutton, Daniella Hydes, Jamie Hyde-Wyatt, Niamh Hynes, Megan Hyslop, Mazen Ibraheim, Abdalla Ibrahim, Ahmed Ibrahim, Asil Ibrahim, Mohamed Ibrahim, Monzeer Ibrahim, Wadah Ibrahim, Adetokunbo I Idowu, Muhammad Idrees, Hina Iftikhar, Mawara Iftikhar, Chukwuemeka Igwe, Mohammad Ijaz, Amaju Ikomi, Clare Iles, Stamatina Iliodromiti, Mary Ilsley, Lorna Ilves, La'ali Imam-Gutierrez, Christopher Imray, Alison Imtiaz, Haider Imtiaz, Claire Ingall, Jack Ingham, Julie Ingham, Rory Ingham, Tejas Ingle, Jennifer Inglis, Anne Ingram, Luke Ingram, Peter Inns, Ken Inweregbu, Andreea A Ionescu, Ana Ionita, Ilian P Iordanov, Anil Ipe, Adil Iqbal, Madiha Iqbal, Mohammed Iqbal, Faisal Iqbal Sait, Jane Ireland, Robert Irons, Mohannad Irshad, Muhammad S Irshad, Janice Irvine, Val Irvine, Pamela Irving, Robert Irving, Mina Ishak, Erica Isherwood, Aminul Islam, Abdurrahman Islim, Ali Ismail, Omar Ismail, Caroline Ison, M'hamedi Israa, Sharon Isralls, Ali Issa, Monica Ivan, Catrina Ivel, Chineze Ivenso, Ashleigh Ivy, Sophie Iwanikiw, Karen Ixer, Menaka Iyer, Mia Iyer, Calum Jack, Amanda Jackson, Anthony Jackson, Ben Jackson, Beth Jackson, Douglas Jackson, Ella Jackson, Hayley Jackson, Helen Jackson, Jane Jackson, Julie Jackson, Karin Jackson, Lauren Jackson, Melanie Jackson, Nicola Jackson, Shane Jackson, Sharon Jackson, Nikita Jacob, Patricia Jacob, Reni Jacob, Nicola Jacques, Terri-Lisa Jacques-Brown, Anisa Jafar, Daniel Jafferji, Ali Jaffery, Chandrashekar Jagadish, Vijay Jagannathan, Sam Jaggard, Mandeep Jagpal, Fernandez R Jaime, Neemisha Jain, Seema Jain, Susan Jain, Sanjay Jaiswal, Danyal Jajbhay, Thomas Jaki, Bintou Jallow, Yusuf Jaly, Sabine Jamal, Zeba Jamal, Yasmin Jameel, Albie James, Christie James, Kate James, Lee James, Linda James, Mark James, Nicholas James, Olivia James, Rebecca James, Ruth James, Tracy James, Jack Jameson, Aaron Jamison, Phoebe Jane, Azara Janmohamed, Sabrina Jansz, Deepa Japp, Lorraine Jappy, Victor Jardim, Catherine Jardine, Emma Jarnell, Ellie Jarvie, Ann Jarvis, Claire Jarvis, Lisa Jarvis, Rosina Jarvis, Patrycja Jastrzebska, Hafsa Javed, Mays Jawad, Lona Jawaheer, Kauky Jawaid, Anu Jayachandran, Dinakaran Jayachandran, Angelina Jayakumar, Deepak Jayaram, Ravi Jayaram, Geeshath Jayasekera, Thilina Jayatilleke, Abi Jayebalan, Saman Jeddi, Vandana Jeebun, Mohammad S Jeelani, Zeynab Jeewa, Emma Jefferson, Katie Jeffery, Helen Jeffrey, Jenni Jeffrey, Rachel Jeffrey, Sue Jeffrey, Nathan Jeffreys, Benjamin Jeffs, Debbie Jegede, Taylor Jemima, Ifan Jenkin, Alison Jenkins, Christopher Jenkins, David Jenkins, Elinor Jenkins, Sarah Jenkins, Sian Jenkins, Stephen Jenkins, Jacqui Jennings, Louise Jennings, Rebecca Jennings, Virginia Jennings, Ellen Jerome, Douglas Jerry, Ellen Jessup-Dunton, Jorge Antonio Jesus Silva, Champa Jetha, Kishan Jethwa, Jeby Jeyachandran, Visuvanathan Jeyakumar, Dharshana Jeyapalan, Shaman Jhanji, Khoo Jian, Zhixin Jiao, Laura Jimenez, Ana Jimenez Gil, Jithin Jith, Teishel Joefield, Navraj Johal, Karine Johannessen, Aisyah Johari, Annie John, Anu John, Navin John, Sarah John, Emma Johns, Margaret Johns, Anne-Marie Johnson, Antoinette Johnson, David Johnson, Emma Johnson, Gillian Johnson, Kathryn Johnson, Katie Johnson, Luke Johnson, Mark Johnson, Nelsonseelan Johnson, Oliver Johnson, Rachel Johnson, Tracy Johnson, Zoe Johnson, Claire Johnston, Janet Johnston, Laura Johnston, Susan Johnston, Victoria Johnston, Dawn Johnstone, Ed Johnstone, Janet Johnstone, Manohar Joishy, Adam Jones, Alistair Jones, Annabel Jones, Ben Jones, Bryony Jones, Carys Jones, Ceri Jones, Charlotte Jones, Christine E Jones, Debra Jones, Emily Jones, Gareth Jones, Geraldine Jones, Hazel Jones, Jac Jones, James Jones, Jamie Jones, Jessica Jones, Jonathon Jones, Julie Jones, Karen Jones, Kate E Jones, Kevin Jones, Laura Jones, Laura M Jones, Lorna Jones, Louise Jones, Mathew Jones, Nicola Jones, Paul Jones, Rhianna Jones, Ruth E Jones, Samantha Jones, Sophie Jones, Stefanie Jones, Steve Jones, Taya Jones, Tim Jones, Tracey Jones, Ramya Jonnalagadda, Rebecca Jordache, Annette Jose, Sanal Jose, Anna Joseph, Joseph Joseph, Rosane Joseph, Sibet Joseph, Dhaara Joshi, Mehul Joshi, Pratichi Joshi, Revati Joshi, Benz Josiah, Tiffany Joyce, Adriel Ju Wen Kwek, Edward Jude, Parminder Judge, Jessica Juhl, Sirisha Jujjavarapu, Mark Juniper, Edmund Juszczak, Deepthi Jyothish, Kasamu Kabiru Dawa, Mark Kacar, Katarina Kacinova, Nikhil Kadam, Rebecca Kahari, Gail Kakoullis, Azad Kala Bhushan, Richard JK Kalayi, Roobala Kaliannan Periyasami, Efthymia Kallistrou, Seika Kalsoom, Elisa Kam, John Kamara, Mohamed Kamara, Ajay Kamath, Prakash Kamath, Ravindra Kamath, Siddharth Arun Kamerkar, Nick Kametas, Musaiwale Kamfose, Arul Kandaswamy, Leia Kane, Osei Kankam, Thogulava Kannan, Abhinav Kant, Vikas Kapil, Ritoo Kapoor, Sonal Kapoor, Sourjya Kar, Janaka Kara, Vasita Kara, Marina Karakantza, Rona Kark, Nicholas Karunaratne, Natashja Kasianczuk, Vidya Kasipandian, Rizwan Kassam, Janarth Kathirgamachelvam, Victoria Katsande, Kulbinder Kaul, Daljit Kaur, Dervinder Kaur, Jasmin Kaur, Jaspreet Kaur, Satvinder Kaur, Zunaira Kausar, Mohammad AA Kawser, Andrea Kay, Sarah Kay, Jossy N Kayappurathu, Callum Kaye, Ahemd Kazeem, Naved Kazi, Sharon Kaznica, Samantha Kearley, Rachel Kearns, Nichola Kearsley, Joanne Keating, John Keating, Liza Keating, Elizabeth Keddie-Gray, Katie Keen, Natalie Keenan, Jonathan Kefas, Stephen Kegg, Laura Keith, Uzoamaka Keke, Tosin Kelani, Joanne Kellett, Jeremy Kellington, Alison Kelly, Conor Kelly, David Kelly, Diane Kelly, Dominic Kelly, Emma Kelly, Laura Kelly, Martin Kelly, Michael Kelly, Rosalind Kelly, Sinead Kelly, Stephen Kelly, Thomas Kelly, Mary Kelly-Baxter, Marketa Keltos, Timothy Kemp, Kelly Kemsley, Alexandra Kendall-Smith, Sarah Kennard, Ann Kennedy, Caroline Kennedy, James Kennedy, Sophie Kennedy-Hay, Julia Kenny, Kelly Kent, Melanie Kent, Lynne Keogan, Alexander Keough, Clement Kerlin, A Kerr, Andrew Kerr, Maria Kerr, Caroline Kerrison, Anthony Kerry, Samantha Kershaw, Helen Kerslake, Ian Kerslake, Helen Kerss, Jocelyn Keshet-Price, Margaret Kevern, Georgina Keyte, Abdul Khadar, Ali Khalid, Muhammad U Khalid, Syed Khalid, Amir Khalil, Asma Khalil, Sijjad Khalil, Abubakar Khan, Ali Khan, Al-Imran Khan, Arham Khan, Asad Khan, Aurangzeb Khan, Burhan Khan, Camran Khan, Fatimah Khan, Kausik Khan, Malik Aamaz Khan, Marria Khan, Mehrunnisha Khan, Mohammad Khan, Mohammed Khan, Nayeem Khan, Omar Khan, Rahe Khan, Rahila Khan, Sabiya Khan, Shabana Khan, Shahul Khan, Shoaib Khan, Tasaduksultan Khan, Waseem Khan, Usman F Khatana, Jibran Khatri, Jyoti Khatri, Hafiza Khatun, Taslima Khatun, Mena Kheia, Jacyntha Khera, Htet Ei Khin, Najaf Khoja, Kiran Khokhar, Jayne Khorsandi, Chloe Khurana, Faith Kibutu, Andrew Kidd, Michelle Kidd, Joe Kidney, Shane Kidney, Will Kieffer, James Kilbane, Caroline Kilby, 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Michelle Lake, Nicki Lakeman, David Lalloo, Fiona Lalloo, Alison Lam, Fiona Lamb, Lucy Lamb, Thomas Lamb, Nick Lambe, Pauline Lambert, Claudia Lameirinhas, Mohammed KG Lami, Abigail Lamikanra, Holly Lamont, Michal Lamparski, Djillali Lamrani, Christine Lanaghan, Rebecca Lanaway, Ivone Lancona-Malcolm, Julia Lancut, Geraldine Landers, Martin J Landray, Matthew Lane, Nicholas Lane, Alidih Lang, Stephen Lang, Daniel Langer, Margaret Langley, Charles Langoya, Emily Langthorne, Taiya Large, Wojciech Lason, Anna Last, Scott Latham, John Latham-Mollart, Afzal Latheef, Darren Latimer, Nang Latt, Carly-Jane Lattimore, Dawn Lau, Eva Lau, Myra Laurenson, Hou Law, Jennifer Law, Jessica Law, Penny Law, Richard Law, Colin Lawler, Mark Lawley, Emma Lawrence, Jo Lawrence, Neil Lawrence, Ryan Lawrie, Jemima Lawson, Joanne Lawson, Louise Lawson, Rebecca Lawton, Michael Lay, Christine Laycock, Reina Layug, Maria Lazo, Vietland Le, Amelia Lea, William Lea, Ian Leadbitter, Thomas Leahy, Richard Lean, Lorna 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Margarit, Georgios Margaritopoulos, Mike Margarson, Fernandez M Maria del Rocio, Teresa Maria Pfyl, Victor Mariano, Helen Maria-Osborn, Ashleigh Maric, Grace Markham, John Markham, Maria Marks, Pamela Marks, Elisabeth Marouzet, Arran Marriott, Cheryl Marriott, Nemonie Marriott, Brian Marsden, Karen Marsden, Paul Marsden, Sarah Marsden, Tracy Marsden, Robyn Marsh, Adam Marshall, Andrew Marshall, Gail Marshall, Henry Marshall, Jaimie Marshall, James Marshall, Jenna Marshall, Nicola Marshall, Riley Marshall, Jennifer Marshall, Samantha Marston, Emmeline Martin, Hayley Martin, Hope Martin, Jane Martin, Karen Martin, Kate Martin, Laila Martin, Michael Martin, Noelia Martin, Tim Martin, Winston Martin, Sarah Martin, Tim Martindale, Marcus Martineau, Alexander Martinez, Lauren Martinez, Jose Carlos Martinez Garrido, Juan Martin-Lazaro, Olivia Martins, Lucas Martins Ferreira, Vijay Kumar Maruthamuthu, Gemma Maryan, Roman Mary-Genetu, Sam Maryosh, Vidan Masani, Diego Maseda, Sheila Mashate, Yasaman Mashhoudi, Al Mashta, Izhaq Masih, Sanna Masih, Nick Maskell, Perry Maskell, Matthew Masoli, Lynn Mason, Rebecca Mason, Richard Mason, Ruth Mason, Claire Mason, Mohammad Masood, Mohammad T Masood, Syed Masood, Syed SME Masood, Aaqib Masud, Lear Matapure, Cristina Matei, Ropafadzo Matewe, Manraj Matharu, Stephy Mathen, Alex Mather, Nicole Mather, Jonathan Mathers, Joanna Matheson, Amal Mathew, Anna Mathew, Moncy Mathew, Verghese Mathew, Caroline Mathews, Jesha Mathews, Kate Mathias, Marion Mathie, Darwin Matila, Wadzanai Matimba-Mupaya, Nashaba Matin, Elina Matisa, Max Matonhodze, Elijah Matovu, Jaysankar Mattappillil, Alison J Matthews, Heather Matthews, Helen Matthews, Sue Matthews, Gwynn Matthias, Fiona Maxton, Adam Maxwell, Gemma Maxwell, Veronica Maxwell, James May, Joanne May, Oliver May, Philippa May, Irving Mayanagao, Matthew Maycock, Graham Mayers, Lee Maynard, Shelley Mayor, Ibreaheim Mazen, Andrea Mazzella, Nyambura Mburu, Mercy Mbwembwe, Martyn McAdam, Eleanor 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McEleavy, Julie McEnerney, Julie McEntee, Evanna McEvoy, Ruth McEwen, Margaret McFadden, Denise McFarland, Margaret McFarland, Rachel McFarland, Erin McGarry, Lorcan McGarvey, Margaret McGarvey, Clodagh McGettigan, Michael McGettrick, Christopher McGhee, Fiona McGill, Sarah McGinnity, Hannah McGivern, Neil McGlinchey, Phil McGlone, Deborah McGlynn, Claire McGoldrick, Clare McGoldrick, Elizabeth McGough, Margaret McGovern, Brendan McGrath, Amanda McGregor, Annemarie McGregor, Cathryn McGuinness, Heather McGuinness, Sean McGuire, Tara McHugh, Caroline McInnes, Neil McInnes, Karen McIntyre, Mhairi McIntyre, Carolyn McKay, Lorna McKay, Conor P McKeag, Madeleine McKee, Joseph McKeever, Shirley McKenna, Donogh McKeogh, Denise Mckeown, Caroline McKerr, Anthony M McKie, Claire Mckie, Laura Mckie, Gerard McKnight, Heather McLachlan, Andrew McLaren, Barbara McLaren, Nicola McLarty, Maria McLaughlin, James McLay, Mary McLeish, Tina McLennan, Lorna McLintock, Stewart McLure, Amanda McMahon, Anne 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Liz Park, Angela Parker, Ben Parker, Carmel Parker, Emma Parker, Fiona Parker, Jacob Parker, Julie Parker, Laura Parker, Lucy Parker, Sara Parker, Sean Parker, Tina Parker, Kirstin Parkin, Anna Parkinson, Jill Parkinson, Lisa Parkinson, Valerie Parkinson, Chetan Parmar, Mamta Parmar, Viraj Parmar, Victoria Parris, Helen C Parry, Siobhan Parslow-Williams, Maria Parsonage, Abigail Parsons, Penny Parsons, Sarah Parsons, Richard Partridge, Kevin Parvin, Kirsten Pass, Lauren Passby, Juan Pastrana, Mital Patal, Sarah Patch, Aamie Patel, Alkesh Patel, Amisha Patel, Dakshesh Patel, Darshna Patel, Hemani Patel, Jaymik Patel, Kamal Patel, Kayur Patel, Kiran Patel, Krish Patel, Manish Patel, Martyn Patel, Mehul Patel, Naleem Patel, Nehalbhai Patel, Prital Patel, Priti Patel, Rebecca Patel, Saagar Patel, Soonie Patel, Trishna Patel, Vishal Patel, Sangeeta Pathak, Nazima Pathan, Alexandra Patience, Donna Patience, Abigail Patrick, Georgie Patrick, Jean Patrick, Simon Patten, Ben Pattenden, Ann Patterson, Charlotte Patterson, Linda Patterson, Molly Patterson, Pauline Patterson, Robert Patterson, Daniel Paul, Janice Paul, Roshni Paul, Leigh Pauls, Stephane Paulus, Amelia Pavely, Susan Pavord, Brendan Payne, David Payne, Elizabeth Payne, Ruth Payne, Tammy Payne, Abby Peacock, Linda Peacock, Louise Peacock, Sarah Peacock, Henry Peake, Rupert Pearse, Andrew Pearson, Daniel Pearson, Harriet Pearson, Karen Pearson, Kirsty Pearson, Samuel A Pearson, Sandra Pearson, Alice Peasley, Hilary Peddie, Russell Peek, Claire Pegg, Suzannah Peglar, Benjamin H Peirce, Claire Pelham, Belinda Pelle, Abigail Pemberton, Melchizedek Penacerrada, Anthony Pender, Carmel Pendlebury, Jessica Pendlebury, Sarah Pendlebury, Rachel Penfold, William Penlington, Catherine Penman, Julie Penman, Rachel Penman, Justin Penner, Kristi Penney, Alistair Penny, James Penny, Justin Pepperell, Huw Peregrine, Adriana Pereira, Ana Pereira, Rita Pereira, Carlota Pereira Dias Alves, Parmi Perera, Elena Perez, Jane Perez, Tanaraj Perinpanathan, Lakshmi Periyasamy, Francesca Perkins, Rachel Perkins, Elizabeth Perritt, Alison Perry, Emily Perry, Meghan Perry, Terrie Perry, Thomas M Perumpral, Guilherme Pessoa-Amorim, Ruth Petch, Lionel Peter, Cecilia Peters, Craig Peters, Jayne Peters, Mark Peters, Steve Peters, Tim Peters, Remy Petersen, Alexandra Peterson, Leon Peto, Iulia Petras, Ilianna Petrou, Boyanka Petrova, Mirela Petrova, Paul Pfeffer, Mysore Phanish, Paul Phelan, Christopher Philbey, Jennifer Philbin, Neil Philips, Alex Phillips, Danielle Phillips, Dylan Phillips, Karen Phillips, Pat Phillips, Rachael Phillips, Katherine Philpott, Marie Phipps, Virach Phongsathorn, Mandeep Phull, Masroor M Phulpoto, Myat TT PI, Sara Pick, James Pickard, Charlotte Pickering, Gillian Pickering, Thomas Pickett, Hayleah Pickford, Joanna Pickles, Benjamin Pickwell-Smith, Natalia Pieniazek, Charlie Piercy, Angelo Pieris, Samia Pilgrim, Paul Anthony Pillai, Zoe Pilsworth, Heather Pinches, Stacey Pinches, Julia Pinder, Kirsty Pine, Muni Tejha Pinjala, Stefania Pintus, Graeme Piper, James Piper, Richard Pipes, Tasneem Pirani, Marcus Pittman, Sally Pitts, Nicolene Plaatjies, Aiden J Plant, Naomi Platt, Robert Pleass, Rutger Ploeg, Laura Plummer, Charles Plumptre, Jonathan Pobjoy, Tatiana Pogreban, Stephen Poku, David Poles, Rachel Pollard, Louisa Pollock, Oluwamayowa Poluyi, Gary John Polwarth, Fiona Pomery, Ponmurugan Ponnusamy, Suresh Ponnusamy, Aravind Ponnuswamy, Inês Ponte Bettencourt dos Reis, Suman Pooboni, Alice Poole, Christopher Poole, Lorraine Poole, Lynda Poole, Michele Poole, Sharon Poon, Tajinder Poonian, Ella Poppitt, Christopher Porada, David Porter, Jo Porter, Linda Porter, Ross Porter, Kelly Postlethwaite, Narayana Pothina, Priyadarshan Potla, Dorota Potoczna, Jason Pott, Alison Potter, Jean Potter, Kenzi Potter, Sarah Potter, Tracey Potter, Elspeth Potton, Joanne B Potts, Julie Potts, Kathryn Potts, Una Poultney, Katherine Poulton, Vanessa Poustie, Geneen Powell, James Powell, Jordan Powell, Deborah Power, Nick Power, Gillian Powter, Joseph Poxon, Robin Poyner, Vidushi Pradhan, Helena Prady, Aalekh Prasad, Krishna Prasad, Maanvi Prasad, Fredy Prasanth Raj, Sangeetha Prasath, Sindhuja Pratheepkumar, Anezka Pratley, Steven Pratt, David Preiss, Claire Prendergast, Lynn Prentice, Peter Prentice, Verity Prescott, Laura Presland, Catharine Prest, Stephen Preston, Martha Pretorius, Natalie Prevatt, Sandra Prew, Ashley Price, Carly Price, Claire Price, David Price, Elizabeth Price, Nathan Price, Vivien Price, Nicole Priddee, Anne Priest, Kate Priestley, Jimena Prieto, Lorraine Primrose, Clare Prince, Judith Prince, Laura Prince, Janet Pring, Shirley Pringle, Veronika Pristopan, Kelly Pritchard, Lucy Pritchard, Rhys Pritchard, Simon Pritchard, Verma Priyash, Andrew Procter, Clare Proctor, Rebecca Proudfoot, Ben Prudon, David Pryor, Solomon Pudi, Joanne Pugh, Lawrence Pugh, Mark T Pugh, Nichola Pugh, Richard Pugh, Veronika Puisa, Kirandip Punia, Saleel Punnilath Abdulsamad, Laura Purandare, Claire Purcell, Corrina Purdue, Bally Purewal, Molly Pursell, Gregory Purssord, Sarah Purvis, Kathryn Puxty, Zoe Puyrigaud, Michael Pynn, Tariq Qadeer, Mohammad Qayum, Corrine Quah, Sheena Quaid, Nathaniel Quail, Charlotte Quamina, Donna Quashie, Alice Quayle, Eleanor Quek, Siobhan Quenby, Xinyi Qui, Vanessa Quick, Julie Quigley, Juan-Carlos Quijano-Campos, Andrew Quinn, Tom Quinn, Amy Quirk, Quratulain Quratulain, Danya Qureshi, Ehsaan Qureshi, Hafiz Qureshi, Hasanain Qureshi, Khadija Qureshi, Nawaz Qureshi, Qurratulain Qurratulain, Saad Qutab, Muhammad S Rabbani, Syed Rabbani, Wayne Rabin, Simon Rabinowicz, Madalina Raceala, Raissa Rachman, Laura Rad, Jane Radford, Liz Radford, Jayachandran Radhakrishnan, Cecillia Rafique, Jethin Rafique, Muhammad Rafique, Ravi Ragatha, Aiswarya Raghunathan, Abigail Raguro, Shankho D Raha, Sana Rahama, Karen Rahilly, Faisal Rahim, Abdul H Rahimi, Haseena R Rahimi, Muhammad Rahman, Salim Ur Rahman, Sharon Rainey, Lenka Raisova, Arjun Raj, Pradeep Rajagopalan, Nithy Rajaiah, Arvind Rajasekaran, Aylur Rajasri, Thurkka Rajeswaran, Jyothi Rajeswary, Jeyanthy Rajkanna, Gayathri Rajmohan, Ruth Rallan, David Ralphs, Katherine Ralston, Maximilian Ralston, Matsa Ram, Balaji Ramabhadran, Fathima Ramali, Mohamed Ramali, Athimalaipet Ramanan, Shashikira Ramanna, Maheshi Ramasamy, Dhanishta Ramdin, Jozel Ramirez, Mylah Ramirez, Geshwin Ramnarain, Lidia Ramos, Shanthi Ramraj, Alex Ramshaw, Aleem Rana, Ghulam F Rana, Rehman Rana, Abby Rand, James Rand, Helen Randall, Harpal Randheva, Poonam Ranga, Manmeet Rangar, Harini Rangarajan, Sameer Ranjan, Poormina Ranka, Rajesh Rankhelawon, Haley Ranton, Anita Rao, Sandhya Rao, Sanjay Rao, Deepak Rao, Anuja Rasarathnam, Alia Rashid, Khalid Rashid, Simbisai Ratcliff, Sam Ratcliffe, Sophy Ratcliffe, Sanjeev Rath, Mohmad I Rather, Selina Rathore, Aravinden Ratnakumar, Jonathan Ratoff, Deepa Rattehalli, Jason Raw, Hywel Rawlins, Gautam Ray, Michelle Ray, Adam Raymond-White, Dana Raynard, 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Anand Shah, Bhavni Shah, Momin Shah, Neil Shah, Pallav Shah, Priyank Shah, Qasim Shah, Sarfaraz H Shah, Snehal Shah, Suraj Shah, Syed Shah, Wajid Shah, Saarma Shahad, Sousan Shahi, Sipan Shahnazari, Muhammad Shahzeb, Aisha Shaibu, Zara Shaida, Amina Y Shaikh, Maliha Shaikh, Rajit Shail, Mariya Shaji, Muhammad Shakeel, Korah Shalan, Nadia Shamim, Kazi Shams, Alison Shanahan, Thomas Shanahan, Shaminie Shanmugaranjan, Hamed Sharaf, Muhammad Sharafat, Asir Sharif, Ajay Sharma, Akhilesh Sharma, Ash Sharma, Bhawna Sharma, Mona Sharma, Ojasvi Sharma, Poonam Sharma, Rajeev Sharma, Sanjeev Sharma, Sarkhara Sharma, Shriv Sharma, Sonal Sharma, Alexander Sharp, Charles Sharp, Gemma Sharp, Paula Sharratt, Phoebe Sharratt, Katherine Sharrocks, Emma Sharrod, Christopher Shaw, Daisy Shaw, David Shaw, Deborah Shaw, Joanne Shaw, Jonathan Shaw, Lisa Shaw, Tomos G Shaw, Anna Shawcross, Jill Shawe, Lou Shayler, Khuram Shazad, Sophy Shedwell, Jonathan Sheffield, Zak Shehata, Arshiya Sheik, Asif Sheikh, 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Harriet Smith, Hazel Smith, Helen Smith, Jacky Smith, Janice Smith, Jessica Smith, Juliet Smith, Karen Smith, Kate Smith, Kathryn Smith, Katie Smith, Kelly Smith, Kerry Smith, Lara Smith, Linda Smith, Lisa Smith, Loren Smith, Maria Smith, Mel Smith, Oliver Smith, Rachel Smith, Rebecca Smith, Richard Smith, Ruth Smith, Sally Smith, Samantha Smith, Stacey Smith, Stephanie Smith, Susan Smith, Imogen Smith, John Smith, Gemma Smithson, Sue Smolen, Sara Smuts, Naoise Smyth, Annette Snell, David Snell, Luke Snell, Beng So, Michelle Soan, Toluleyi Sobande, Alberto Sobrino Diaz, Basit Sohail, Bina Sohail, Herminder Sohal, Roy Soiza, Mary Sokolowski, Olajumoke Solademi, Krishma Solanki, Babak Soleimani, Amanda Solesbury, Reanne Solly, Louise Solomon, Subash Somalanka, Chandrashekaraiah Somashekar, Raj Sonia, Shiu-Ching Soo, Deepti Sood, Pavandeep Soor, Germanda Soothill, Jennifer Soren, Youssef Sorour, Apina Sothinathan, Pragalathan Sothirajah, Najwa Soussi, Donna Southam, David Southern, Iain 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Toohey, Kirsty Topham, Mathew Topping, Ruhaif Tousis, Peter Tovey, Gareth Towersey, Jason Towler, Jill Townley, Alain Townsend, Chris Townsend, Richard Tozer, Claire Tranter, Helen Tranter, Jonathan Trattles, Christopher Travill, Sarah Traynor, Karis Treuberg, Mike Trevett, Ascanio Tridente, Sanchia Triggs, Fiona Trim, Thomas Trimble, Alex Trimmings, Tom Trinick, Sven Troedson, Emily Tropman, Amy Trotter, Madeleine Trowsdale Stannard, Nigel Trudgill, Maria Truslove, Shaun Trussell, Tariq Trussell, Sara Tryon, Kyriaki Tsakiridou, Christine Tsang, Hoi Pat Tsang, Peter Tsang, Tan Tsawayo, Kyriaki Karali Tsilimpari, Georgios Tsinaslanidis, Simon Tso, Sally Tucker, Victoria Tuckley, Caroline Tuckwell, Aisha Tufail, Redmond Tully, Grace Tunesi, Saidat Turawa, Killiam Turbitt, Anna Turco, Krystyna Turek, Rezon Turel, Tolga Turgut, Claudia Turley, Alison Turnbull, Aine Turner, Ash Turner, Charlotte Turner, David Turner, Frances Turner, Gail Turner, Kate Turner, Kelly Turner, Louise Turner, Lucy Turner, Marc Turner, Mark Turner, Patricia Turner, Ruth Turner, Sally Turner, Samantha Turner, Susan Turner, Victoria Turner, Sharon Turney, Jon Turvey, Conor Tweed, David Tweed, Rebecca Twemlow, Emma Twohey, Bhavya Tyagi, Vedang Tyagi, Abigail Tyer, Jayne Tyler, Jennifer Tyler, Alison Tyzack, Petros Tzavaras, Mohammad S Uddin, Ruhama Uddin, Ruzena Uddin, Salamat Ullah, Sana Ullah, Sanda Ullah, Athavan Umaipalan, Judith Umeadi, Akudo Umeh, Wilfred Umeojiako, Ben Ummat, Charlotte Underwood, Jonathan Underwood, Laura Unitt, Adam Unsworth, Jasvinder Uppal, Veerpal S Uppal, James Uprichard, Gerry Upson, Masood Ur Rasool, Alison Uriel, Sebastian Urruela, Hiromi Uru, Miranda Usher, Rebecca Usher, Alex UsherRea, Andrew Ustianowski, Jane Uttley, Linda C Vaccari, Uddhav Vaghela, Abhay Vaidya, Bernardas Valecka, Jennifer Valentine, Balan Valeria, Pramodh Vallabhaneni, Pedro Valle Vallines, Luke Vamplew, Ekaterini Vamvakiti, Joannis Vamvakopoulos, Maud van de Venne, Alex van der Meer, Nora van der Stelt, Joseph Vance-Daniel, Rama Vancheeswaran, Caryn Vander Riet, Samuel I Vandeyoon, Padma Vankayalapati, Piyush Vanmali, Chloe Vansomeren, William Van't Hoff, Sejal Vara, Kate Vardigans, Stehen J Vardy, Anu Varghese, Maria Varghese, William Varney, Giulia Varnier, Valeria Vasadi, Olivia Vass, Vimal Vasu, Vasanthi Vasudevan, Manu Vatish, Heloyes Vayalaman, Christopher Vaz, Niki Veale, Sachuda Veerasamy, Bar Velan, Swati Velankar, Luxmi Velauthar, Neyme Veli, Nicola Vella, Anitha Velusamy, Ian Venables, Mavi Venditti, David Veniard, Ramya Venkataramakrishnan, Richard Venn, Robert Venn, Lyn Ventilacion, Joanne Vere, Mark Veres, Stefania Vergnano, Will Verling, Amit Verma, Rachel Vernall, Britney Vernon, Mark Vertue, Jerik Verula, Natalie Vethanayagam, Lucy Veys, Carinna Vickers, Saji Victor, Jennifer Vidler, Wayne Vietri, Bavithra Vijayakumar, Vinod Warrier Vijayaraghavan Nalini, Brigita Vilcinskaite, Neringa Vilimiene, Sudharkar Vimalanathan, Lynn Vinall, Sylvia Vinay, Latha Vinayakarao, Rachel Vincent, Rosie Vincent, Pritpal Virdee, Emma Virgilio, Abdullah M Virk, Elisa Visentin, Jeyakumar Visuvanathan, Karunakaran Vithian, Sorice Vittoria, Elena Vlad, Ben Vlies, Alain Vuylsteke, Eleftheria Vyras, Richard Wach, Beverley Wadams, Susan Wadd, Natalia Waddington, Kirsten Wadsworth, Syed EI Wafa, Daniel Wagstaff, Lynda Wagstaff, Dalia Wahab, Zaroug Wahbi, Abiodun Waheed Adigun, Sawan Waidyanatha, Rachel Wake, Alice Wakefield, William Wakeford, Michelle Wakelin, Fiona Wakinshaw, Andrew Walden, Jane Walden, Lorna Walding, Alexandria Waldron, Gemma Walker, Harriet Walker, Ian Walker, Jasmine Walker, Kevin Walker, Kim Walker, Linda Walker, Marie T Walker, Olivia Walker, Rachel Walker, Rebecca Walker, Susan Walker, Derek Wallbank, Rebecca Wallbutton, Jessica Wallen, Karl Wallendszus, Arabella Waller, Fiona Waller, Rosemary Waller, Gabiel Wallis, Gabriel Wallis, Louise Wallis, Donna Walsh, Elizabeth Walsh, Livia Walsh, Deborah Walstow, Daniel Walter, Alex Walters, Holt Walters, James Walters, Jocelyn Walters, Eileen Walton, Lucy Walton, Olivia Walton, Sharon Walton, Susan Walton, Mandy Wan, Thin Wan, Mary Wands, Rachel Wane, Frank Wang, Nick Wang, Ran Wang, Deborah Warbrick, Samantha Warburton, Deborah Ward, Emma Ward, Joanna Ward, Karen Ward, Luke Ward, Nicola Ward, Rachael Ward, Rebecca Ward, Thomas Ward, Tom Ward, Scott A Warden, Adele Wardle, Karen Wardle, Steve Wardle, Hassan Wardy, Scott Waring, Jenny Warmington, Ben Warner, Christian Warner, Lewis Warnock, Sarah Warran, Jade Warren, Lisa Warren, Yolanda Warren, Hannah Warren-Miell, Gill Warwick, Charlotte Washington, Helen Wassall, Hazel J Watchorn, Holly Waterfall, Abby Waters, Donald Waters, Mark Waterstone, Catherine Watkins, Catrin Watkins, Eleanor Watkins, Karen Watkins, Lynn Watkins, Nick Watkins, Abigail Watson, Adam JR Watson, Ekaterina Watson, Eleanor Watson, Paul Watson, Rebecca Watson, Robert Watson, Sandra Watson, Malcolm Watters, Donna Watterson, Daniel Watts, John Watts, Merlin Watts, Victoria Waugh, Emma Wayman, Akhlaq Wazir, Mark Weatherhead, Nick Weatherly, Paul Weaver, Hayley Webb, Kathryn Webb, Kylie Webb, Stephen Webb, Cheryl Websdale, Deborah Webster, Ian Webster, Tim Webster, Kathleen Wedgeworth, Ling Wee, Rebecca Weerakoon, Thanuja Weerasinghe, Janaka Weeratunga, Maria Weetman, Shuying Wei, Immo Weichert, Hugh Welch, James Welch, Leanne Welch, Steven Welch, Samantha Weller, Lucy Wellings, Brian Wells, Susan Wellstead, Berni Welsh, Richard Welsh, Ingeborg Welters, Rachael Welton, Lauren Wentworth, Kate Wesseldine, James Wesson, Jim Wesson, Adam West, Magdelena West, Raha West, Ruth West, Sophie West, Luke Western, Ruth Westhead, Heather Weston, Alice Westwood, Bill Wetherill, Sharon Wheaver, Helen Wheeler, Ben Whelan, Matthew Whelband, Amanda Whileman, Alison Whitcher, Abbie White, Andrew White, Benjamin White, Christopher White, Duncan White, Emily White, James White, Jonathan White, Katie White, Marie White, Nick White, Sarah White, Sonia White, Stephen White, Tracey White, Catherine Whitehead, Anne Whitehouse, Claire Whitehouse, Tony Whitehouse, Julia Whiteley, Sophie Whiteley, Victoria Whiteside, Drew Whitley, Kaitlyn Whitley, Gabriel Whitlingum, David Whitmore, Elizabeth Whittaker, Lindsay Whittam, Andrew Whittingham Hirst, Ashley Whittington, Helen Whittle, Robert Whittle, Suzanne Whyte, Eunice Wiafe, Lou Wiblin, John Widdrington, Jason Wieboldt, Hannah Wieringa, Cornelia Wiesender, Laura Wiffen, Andrew Wight, Christopher Wignall, Danielle Wilcock, Emma Wilcock, Louise Wilcox, Laura Wild, Stephen Wild, Michael Wilde, Peter Wilding, Ritchie Wildman, Tracey Wildsmith, Joe Wileman, Donna Wiles, Joy Wiles, Kate Wiles, Elva Wilhelmsen, Thomas Wiliams, Chloe Wilkes, Janet Wilkie, David Wilkin, Hannah Wilkins, Joy Wilkins, Suzanne Wilkins, Helen Wilkinson, Holly Wilkinson, Iain Wilkinson, Lesley Wilkinson, Martin Wilkinson, Nicola Wilkinson, Sophia Wilkinson, Susan Wilkinson, Tim Wilkinson, Sylvia Willetts, Aimee Williams, Alexandra Williams, Alison Williams, Angharad Williams, Ava Williams, Carl Williams, Caroline V Williams, Claire Williams, Dewi Williams, Gail Williams, Gemma Williams, Gina Williams, Hannah Williams, James Williams, Jayne Williams, Jennie Williams, John Williams, Joseph Williams, Karen Williams, Kathryn Williams, Marie Williams, Matthew Williams, Patricia Williams, Penny Williams, Rachael Williams, Rupert Williams, Samson Williams, Sarah Williams, Sophie Williams, Tamanna Williams, Annie Williamson, Cath Williamson, Catherine Williamson, Dawn Williamson, James D Williamson, Rachel Williamson, Helen Williamson, Bruce Willian, Elizabeth Willis, Emily Willis, Heather Willis, Herika Willis, Joanna Willis, Laura Willmott, Louise Wills, Lucy Willsher, Catherine Willshire, Francesca Willson, Alison Wilson, Andrea Wilson, Antoinette Wilson, Billy Wilson, Catherine Wilson, Eve Wilson, James Wilson, Karen Wilson, Kate Wilson, Lucinda Wilson, Mark Wilson, Matthew Wilson, Toni Wilson, Evie Wiltsher, Marlar Win, Tin Win, Wut Yee Win Win, Lucinda Winckworth, Laura Winder, Piers Winder, Phillip Windrum, Kerry Winham-Whyte, Helen Winmill, Simon Winn, Carmen Winpenny, Helen Winslow, Helen Winter, Jonathan Winter, Pascal Winter, Barbara Winter-Goodwin, Stephen Wisdom, Matthew Wise, Martin Wiselka, Rebecca Wiseman, Sophie Wiseman, Steven Wishart, Holly Wissett, Eric Witele, Nicholas Withers, Janet Wittes, Donna Wixted, Therese Wodehouse, Will Wolf, Nicola Wolff, Kirsten Wolffsohn, Rebecca Wolf-Roberts, Magda Wolna, Elena Wolodimeroff, Adam Wolstencroft, Alan Wong, Charlotte Wong, Chi-Hung Wong, Edwin Wong, Jessica Sue Yi Wong, Kit Y Wong, Lee Wong, Mei Yin Wong, Nick Wong, Sam Wong, Yun Man Wong, Amanda Wood, Caroline Wood, Carrie Anne Wood, Dianne Wood, Fiona Wood, Hannah Wood, Jennifer Wood, Joe Wood, Julia Wood, Kathryn Wood, Lisa Wood, Louise Wood, Michelle Wood, Stephen Wood, Tracy Wood, Ursula Wood, Katharine Woodall, Rebecca Woodfield, Christopher Woodford, Elizabeth Woodford, Jill Woodford, Luke Woodford, Louise Woodhead, Timothy Woodhead, Philip Woodland, Marc Woodman, Debra Woods, Jane Woods, Katherine Woods, Sarah Woods, Zoe Woodward, Rachel Wookey, Megan Woolcock, Gemma Wooldridge, Rebecca Woolf, Chris Woollard, Christopher Woollard, Louisa Woollen, Emma Woolley, Jade Woolley, Daniel Woosey, Dan Wootton, Joanne Wootton, Daniel Worley, Stephy Worton, Jonathan Wraight, Maria Wray, Tim Wreford-Bush, Joanne Wren, Kim Wren, Lynn Wren, Caroline Wrey Brown, Catherine Wright, Demi Wright, Francesca Wright, Imogen Wright, Lee Wright, Lianne Wright, Pete Wright, Rachel Wright, Rebecca Wright, Stephanie Wright, Tim Wright, Caroline Wroe, Hannah Wroe, Henry Wu, Peishan Wu, Pensee Wu, Jonathan Wubetu, Retno Wulandari, Craig Wyatt, Frederick Wyn-Griffiths, Inez Wynter, Bindhu Xavier, Arnold Xhikola, Zhongyang Xia, Huiyuan Xiao, Masseh Yakubi, May Yan, Freda Yang, Yingjia Yang, Michael Yanney, Woei Lin Yap, Nabil Yaqoob, Naairah Yaqub, Salima Yasmin, Bryan Yates, David Yates, Edward Yates, Helen Yates, Julie Yates, Mark Yates, Charlotte Yearwood Martin, Andrew Yeatman, Khin Yein, Fiona Yelnoorkar, Peter Yew, Kawai Yip, Laura Ylquimiche, Laura Ylquimiche Melly, Inez Ynter, H Yong, Jemma Yorke, Jasmine Youens, Abdel Younes Ibrahim, Eoin Young, Gail Young, Louise Young, Richard Young, Asfand Yousafzar, Sajeda Youssouf, Ahmed Yousuf, Chrissie Yu, Bernard Yung, Daniel Yusef, Said Yusef, Intekhab Yusuf, Anna-Sophia Zafar, Silvia Zagalo, Su Zaher, Aqsa Zahoor, Kareem Zaki, Nabhan Zakir, Kasia Zalewska, Ane Zamalloa, Mohsin Zaman, Raisa Zaman, Shakir Zaman, Julie Zamikula, Louise Zammit, Marie Zammit-Mangion, Lynn Zarb, Esther Zebracki, Daniel Zehnder, Lisa Zeidan, Marian Zelman, Xiaobei Zhao, Dongling Zheng, Doreen Zhu, Madiha Zia, Omar Zibdeh, Rabia Zill-E-Huma, Ei Thankt Zin, Veronica Zindonda, Eleanor Zinkin, Vivian Zinyemba, Christos Zipitis, Arkadiusz Zmierczak, Azam Zubir, Roslin Zuha, Naz Zuhra, Rasha Zulaikha, Sabrina Zulfikar, Carol Zullo, Ana Zuriaga-Alvaro, Will Zuurbier, Sheba Zyengi, and University of St Andrews. School of Medicine
Subjects: Male, Convalescent plasma, medicine.medical_treatment, 030204 cardiovascular system & hematology, Antibodies, Viral, Rate ratio, 0302 clinical medicine, RA0421, RA0421 Public health. Hygiene. Preventive Medicine, Medicine, Hospital Mortality, 030212 general & internal medicine, 11 Medical and Health Sciences, Aged, 80 and over, Medicine(all), Mortality rate, Covid19, Articles, 3rd-DAS, General Medicine, Middle Aged, Hospitals, Treatment Outcome, Female, Open label, Coronavirus Infections, Life Sciences & Biomedicine, RM, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), 03 medical and health sciences, Medicine, General & Internal, SDG 3 - Good Health and Well-being, General & Internal Medicine, Internal medicine, Humans, In patient, Pandemics, COVID-19 Serotherapy, Aged, Mechanical ventilation, Science & Technology, SARS-CoV-2, business.industry, Significant difference, Immunization, Passive, COVID-19, Length of Stay, NIS, R1, Respiration, Artificial, United Kingdom, RM Therapeutics. Pharmacology, RECOVERY Collaborative Group, business
Abstract: Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research.
Published: 2021

14. Evaluation of a rural undergraduate nursing student employment model

Author: Yaghma Masood, Brad Hodge, Nadia DeVecchi, Virginia Dickson-Swift, Craig Phillips, Amanda Kenny, Kenny, Amanda, Dickson-Swift, Virginia, DeVecchi, Nadia, Phillips, Craig, Hodge, Brad, and Masood, Yaghma
Subjects: Medical education, Government, evaluation, 030504 nursing, business.industry, Rural health, education, transition, Context (language use), Focus group, nursing student, 03 medical and health sciences, 0302 clinical medicine, Hospitality, undergraduate nurses, Health care, Workforce, employment models, rural health, 030212 general & internal medicine, Rural Nursing, 0305 other medical science, Psychology, business, General Nursing
Abstract: Background Developing a sustainable rural nursing workforce is key to good rural health outcomes, but nursing recruitment and retention is a significant challenge. Internationally, there is a body of literature that describes undergraduate nursing student employment models. There is, however, a lack of robust evaluation of these models as a workforce strategy. Aim The aim of this study was to evaluate an undergraduate nursing student employment model implemented in a rural context. Methods A mixed-methods design was used with a well-established process evaluation framework. Data collection methods included monthly online surveys, blogs, focus groups, individual interviews, and client experience surveys. Findings Paid employment models are a workforce strategy for rural health services and staff are mostly supportive. For students, engaging in healthcare employment was seen as more advantageous than other forms of employment, such as hospitality and retail. Patients/clients rated the model highly. There were significant challenges with balancing university commitments with service requirements, issues related to scope of the role, and concerns around ongoing funding of the model. Discussion The rural undergraduate student of nursing employment role was implemented as planned with key findings primarily supporting the benefits of the role. Conclusion While there is ongoing interest in nursing student employment, there is a paucity of rigorous evaluation of models. This study adds to knowledge on paid employment of nursing students, but longitudinal studies are needed. Robust economic modelling must occur to identify costs and benefits. In Australia, government interest in nursing student employment appears to wax and wane.
Published: 2021

15. Preventable deaths from SARS-CoV-2 in England and Wales: a systematic case series of coroners’ reports during the COVID-19 pandemic

Author: Bethan Swift, Georgia C. Richards, David Howard, Jeffrey K Aronson, and Carl Heneghan
Subjects: National health, medicine.medical_specialty, 2019-20 coronavirus outbreak, Wales, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19, General Medicine, State Medicine, England, Cause of Death, Emergency medicine, Pandemic, medicine, Humans, business, Pandemics, Coroners and Medical Examiners
Abstract: ObjectivesTo examine coroners’ Prevention of Future Deaths reports (PFDs) to identify deaths involving SARS-CoV-2 that coroners deemed preventable.DesignConsecutive case series.SettingEngland and Wales.ParticipantsPatients reported in 510 PFDs dated between 01 January 2020 and 28 June 2021, collected from the UK’s Courts and Tribunals Judiciary website using web scraping to create an openly available database,https://preventabledeathstracker.net/.Main outcome measuresConcerns reported by coroners.Public and Patient InvolvementPatients and members of the public were not involved in this study.ResultsSARS-CoV-2 was involved in 23 deaths reported by coroners in PFDs. Twelve deaths were indirectly related to the COVID-19 pandemic, defined as those that were not medically caused by SARS-CoV-2, but were associated with mitigation measures. In 11 cases the coroner explicitly reported that COVID-19 had directly caused death. There was geographical variation in the reporting of PFDs; most (39%) were written by coroners in the North-West of England. The coroners raised 56 concerns, problems in communication being the most common (30%), followed by failure to follow protocols (23%). Organizations in the National Health Service (NHS) were sent the most PFDs (51%), followed by the Government (26%), but responses to PFDs by these organizations were poor.ConclusionsPFDs contain a rich source of information on preventable deaths that has previously been difficult to examine systematically. Our openly available tool (https://preventabledeathstracker.net/) streamlines this process and has identified many concerns raised by coroners that should be addressed during the Government’s inquiry into the handling of the COVID-19 pandemic, so that mistakes made are less likely to be repeated.Study protocol pre-registrationhttps://osf.io/bfypc/Summary boxWhat is already known about this subject?The UK Government has stated that there will be a public inquiry into the handling of the COVID-19 pandemic, to learn lessons for future pandemics.Coroners in England and Wales have a duty to report and communicate information about the deaths they investigate when the coroner believes that action should be taken to prevent future deaths.These reports, called Prevention of Future Death reports (PFDs), had not yet been systematically analysed to identify deaths that occurred during the COVID-19 pandemic.What are the new findings?We created the Preventable Deaths Database (https://preventabledeathstracker.net/) using web scraping to systematically assess PFDs published on the Courts and Tribunal Judiciary website.Between 01 January 2020 and 28 June 2021, one in 20 (4.5%, n=23) PFDs that were published by coroners involved SARS-CoV-2.Coroners raised many concerns about the care of patients in hospitals, care homes, and people in the community during the COVID-19 pandemic, which require action to prevent future deaths.How might it affect clinical practice in the foreseeable future?Preventable deaths that occurred during the COVID-19 pandemic should be referred to the coroner so that an inquest can be performed and a PFD issued, highlightng actions that could be avoided in improving the handling of future pandemics in both the UK and elsewhere.Our tool,https://preventabledeathstracker.net/, can be used by others to examine preventable deaths in England and Wales, and to identify signals for quality improvement to reduce avoidable harms in clinical practice.
Published: 2021

16. Stop the beat to see the rhythm: excitation-contraction uncoupling in cardiac research

Author: Nikki Gillum Posnack, Luther Swift, Crystal M. Ripplinger, and Matthew W. Kay
Subjects: Biomedical Research, Time Factors, Physiology, Cardiovascular research, Action Potentials, Heterocyclic Compounds, 4 or More Rings, Excitation contraction, Rhythm, Heart Rate, Physiology (medical), Optical mapping, Animals, Humans, Medicine, Myocytes, Cardiac, Cells, Cultured, Excitation Contraction Coupling, business.industry, Myocardial Contraction, Voltage-Sensitive Dye Imaging, Cardiovascular physiology, Electrophysiology, Imaging technique, Artifacts, Cardiology and Cardiovascular Medicine, business, Beat (music), Neuroscience, Perspectives
Abstract: Optical mapping is an imaging technique that is extensively used in cardiovascular research, wherein parameter-sensitive fluorescent indicators are used to study the electrophysiology and excitation-contraction coupling of cardiac tissues. Despite many benefits of optical mapping, eliminating motion artifacts within the optical signals is a major challenge, as myocardial contraction interferes with the faithful acquisition of action potentials and intracellular calcium transients. As such, excitation-contraction uncoupling agents are frequently used to reduce signal distortion by suppressing contraction. When compared with other uncoupling agents, blebbistatin is the most frequently used, as it offers increased potency with minimal direct effects on cardiac electrophysiology. Nevertheless, blebbistatin may exert secondary effects on electrical activity, metabolism, and coronary flow, and the incorrect administration of blebbistatin to cardiac tissue can prove detrimental, resulting in erroneous interpretation of optical mapping results. In this “Getting It Right” perspective, we briefly review the literature regarding the use of blebbistatin in cardiac optical mapping experiments, highlight potential secondary effects of blebbistatin on cardiac electrical activity and metabolic demand, and conclude with the consensus of the authors on best practices for effectively using blebbistatin in optical mapping studies of cardiac tissue.
Published: 2021

17. A phase 2 trial of the efficacy and safety of elotuzumab in combination with pomalidomide, carfilzomib and dexamethasone for high-risk relapsed/refractory multiple myeloma

Author: Shahrooz Eshaghian, James R. Berenson, Gary T. Schwartz, Stephen Lim, Robert Vescio, Benjamin Eades, Tanya M. Spektor, Matthew Ghermezi, David Yashar, Daisy Martinez, and Regina A. Swift
Subjects: Oncology, Cancer Research, medicine.medical_specialty, Population, Phases of clinical research, Antibodies, Monoclonal, Humanized, Dexamethasone, chemistry.chemical_compound, Refractory, Internal medicine, Antineoplastic Combined Chemotherapy Protocols, medicine, Humans, Elotuzumab, education, Adverse effect, Multiple myeloma, education.field_of_study, business.industry, Hematology, Pomalidomide, medicine.disease, Carfilzomib, Thalidomide, chemistry, Neoplasm Recurrence, Local, Multiple Myeloma, business, Oligopeptides, medicine.drug
Abstract: High-risk multiple myeloma (MM) continues to have a poor prognosis and remains a therapeutic challenge. This phase 2 study evaluated the efficacy and safety of elotuzumab in combination with pomalidomide, carfilzomib, and low-dose dexamethasone for patients with high-risk relapsed/refractory (RR)MM (NCT03104270). Of 13 enrolled patients, 11 were evaluable for efficacy. Overall response rate and clinical benefit rate were 45.4% and 54.5%, respectively. Deep responses were observed including two complete responses. The novel quadruplet combination was overall well-tolerated, with clinically manageable adverse events. Common adverse events of ≥ grade 3 included lymphopenia (15%), anemia (15%), sepsis (15%), pneumonia (15%), and hypophosphatemia (15%). The novel combination showed promising efficacy and was well tolerated in this heavily pretreated MM population. Even though the study was terminated early prior to completion of enrollment, the results indicate that this may be a promising therapeutic approach for high-risk RRMM patients, which warrants further study.
Published: 2021

18. Myocarditis Following Coronavirus Disease 2019 mRNA Vaccine: A Case Series and Incidence Rate Determination

Author: Yalile Perez, Abinash Virk, Matthew L. Johnson, Avni Y. Joshi, Emily R Levy, Melanie D. Swift, Greg Vanichkachorn, Martin Rodriguez-Porcel, W. Charles Huskins, and Daniel L. Roellinger
Subjects: Adult, Male, Microbiology (medical), medicine.medical_specialty, COVID-19 Vaccines, Myocarditis, Population, Rate ratio, Pericarditis, Internal medicine, Major Article, medicine, Humans, RNA, Messenger, education, Adverse effect, Retrospective Studies, Vaccines, Synthetic, education.field_of_study, business.industry, Incidence, Incidence (epidemiology), COVID-19, medicine.disease, Vaccination, AcademicSubjects/MED00290, Infectious Diseases, vaccine-associated myocarditis, Female, mRNA Vaccines, Diagnosis code, business
Abstract: Background Myocarditis following coronavirus disease 2019 (COVID-19) mRNA vaccines (Pfizer-BioNTech and Moderna) has been increasingly reported. Incidence rates in the general population are lacking, with pericarditis rather than myocarditis diagnostic codes being used to estimate background rates. This comparison is critical for balancing the risk of vaccination with the risk of no vaccination. Methods A retrospective case series was performed using the Mayo Clinic COVID-19 Vaccine Registry. We measured the incidence rate ratio (IRR) for myocarditis temporally related to COVID-19 mRNA vaccination compared with myocarditis in a comparable population from 2016 through 2020. Clinical characteristics and outcomes of the affected patients were collected. A total of 21 individuals were identified, but ultimately 7 patients met the inclusion criteria for vaccine-associated myocarditis. Results The overall IRR of COVID-19–related myocarditis was 4.18 (95% confidence interval [CI], 1.63–8.98), which was entirely attributable to an increased IRR among adult males (IRR, 6.69; 95% CI, 2.35–15.52) compared with females (IRR 1.41; 95% CI, .03–8.45). All cases occurred within 2 weeks of a dose of the COVID-19 mRNA vaccine, with the majority occurring within 3 days (range, 1–13) following the second dose (6 of 7 patients, 86%). Overall, cases were mild, and all patients survived. Conclusions Myocarditis is a rare adverse event associated with COVID-19 mRNA vaccines. It occurs in adult males with significantly higher incidence than in the background population. Recurrence of myocarditis after a subsequent mRNA vaccine dose is not known at this time., The incidence rate ratio of myocarditis following coronavirus disease 2019 mRNA vaccination is significantly increased for adult males. Most cases occurred within 3 days (range, 1–13) following the second vaccine dose. Cases were mild, and there were no deaths.
Published: 2021

19. An inpatient human laboratory study assessing the safety and tolerability, pharmacokinetics, and biobehavioral effect of GET 73 when co-administered with alcohol in individuals with alcohol use disorder

Author: Carolina L. Haass-Koffler, Antonella Loche, Robert M. Swift, Roberto Cacciaglia, Lorenzo Leggio, Roberta Perciballi, and Molly Magill
Subjects: medicine.medical_specialty, Alcohol Drinking, Craving, Alcohol, Alcohol use disorder, Placebo, Affect (psychology), Article, chemistry.chemical_compound, Double-Blind Method, medicine, Humans, Adverse effect, Psychiatry, Pharmacology, Inpatients, business.industry, Alcohol dependence, medicine.disease, Alcoholism, chemistry, Tolerability, medicine.symptom, Laboratories, business
Abstract: RATIONALE. Previous work suggests that GET 73, a novel compound with putative activity on the metabotropic glutamate receptor subtype 5 (mGluR5), may represent a novel pharmacological treatment for alcohol use disorder (AUD). OBJECTIVE. In this study, we investigated the safety, tolerability, pharmacokinetics, and biobehavioral effects of GET 73, when co-administered with alcohol, in individuals with alcohol dependence (AD). METHODS. This was an inpatient, cross-over, randomized, double-blind, placebo-controlled, human laboratory study with non-treatment-seeking, alcohol-dependent individuals. The study used a within-subjects design, with two counterbalanced stages, during which participants received GET 73 and then placebo, or vice versa. During each stage, participants underwent an alcohol interaction session and, on a separate day, an alcohol cue reactivity, followed by an alcohol self-administration session. RESULTS. Safety outcomes of GET 73 were excellent with no serious adverse events, nor adverse events of severe grade. The co-administration of alcohol and GET 73 did not affect the pharmacokinetics of GET 73 or alcohol. GET 73, compared to placebo, did not affect the alcohol-related stimulation effects, but increased the subjective sedative effects of alcohol. GET 73 did not affect alcohol cue-induced craving, or alcohol self-administration in the laboratory. CONCLUSIONS. The study confirms the safety and tolerability of GET 73 when co-administered with alcohol. Although, under this experimental condition, we did not detect an effect on alcohol craving and consumption in the laboratory, additional studies should be conducted administering GET 73 for an extended period in an outpatient setting.
Published: 2021

20. Hereditary haemorrhagic telangiectasia: an overview from an ear, nose and throat perspective

Author: Andrew C. Swift and Richard Green
Subjects: medicine.medical_specialty, medicine.diagnostic_test, business.industry, Ear nose and throat, Normal population, General Medicine, Disease, Nose, Arteriovenous Malformations, Epistaxis, medicine.anatomical_structure, Humans, Medicine, Telangiectasia, Hereditary Hemorrhagic, Genetic Testing, medicine.symptom, business, Intensive care medicine, Telangiectasia, Genetic testing, Patient education, Hereditary haemorrhagic telangiectasia
Abstract: Patients with hereditary haemorrhagic telangiectasia can present with a multitude of symptoms caused by telangiectasia and arteriovenous malformations in the nose, brain, gastrointestinal tract, liver and spinal cord. Clinicians should be aware of the potential diagnosis of hereditary haemorrhagic telangiectasia and how to manage these patients both in the acute and chronic setting. Identifying these patients and optimising their management can help reverse the reduced life expectancy back to that of the normal population.The management of these patients is complex and often requires a multidisciplinary approach, with difficult discussions to be had around screening for arteriovenous malformations and genetic testing. The stepwise management ladder can be used in both the medical and surgical strategies; there are multiple pharmacological and surgical options available, all with their own side effects and risks.Patient education is key to help informed decision making. This article outlines the clinical characteristics of the disease and management options available.
Published: 2021

21. Hereditary haemorrhagic telangiectasia: development of a regional life-course collaborative clinical care pathway

Author: Andrew C. Swift, Richard Green, Emily Anderson, and Malcolm G Semple
Subjects: medicine.medical_specialty, Adolescent, business.industry, Mucocutaneous zone, Genetic disorder, General Medicine, Disease, medicine.disease, Arteriovenous Malformations, Epistaxis, Rare Diseases, London, medicine, Humans, Life course approach, Telangiectasia, Hereditary Hemorrhagic, Clinical care, Lost to follow-up, medicine.symptom, Child, Intensive care medicine, business, Telangiectasia, Hereditary haemorrhagic telangiectasia
Abstract: Hereditary haemorrhagic telangiectasia is a rare, genetic disorder that can present at any age. It is characterised by epistaxis, mucocutaneous telangiectasia and visceral arteriovenous malformations, which can affect multiple organs. Early diagnosis and management reduces the morbidity and mortality associated with the disease.There is a well-established hereditary haemorrhagic telangiectasia clinic in London, and excellent links across Europe via the European Reference Network. However, local coordinated care for patients with hereditary haemorrhagic telangiectasia across the UK can be variable and often absent for children and young people. Some patients travel long distances to receive care in London, while others are referred to local clinicians or lost to follow up entirely.This article presents the experience to date from two regional UK centres (Liverpool and Dundee) where care for patients with hereditary haemorrhagic telangiectasia is being coordinated and streamlined. While there is still a lot to learn, this article highlights some of the successes and challenges identified so far, with suggestions for how these could be addressed.Collaborative regional networks such as these can facilitate the sharing of best practice and ensure that all patients with hereditary haemorrhagic telangiectasia are able to access safe, high-quality care.
Published: 2021

22. The Change of Plane of the Supratrochlear and Supraorbital Arteries in the Forehead-An Ultrasound-Based Investigation

Author: Konstantin Frank, Nirusha Lachman, Vince Bertucci, Diana L. Gavril, Peter J. Velthuis, Leonie W Schelke, Kate Beleznay, Michael Alfertshofer, Arthur Swift, Sebastian Cotofana, and Dermatology
Subjects: Male, Supratrochlear artery, 030230 surgery, Linear array, Injections, 030207 dermatology & venereal diseases, 03 medical and health sciences, Ophthalmic Artery, 0302 clinical medicine, medicine.artery, medicine, Cadaver, Frontalis muscle, Humans, Forehead, Ultrasonography, Plane (geometry), business.industry, Ultrasound, Soft tissue, General Medicine, Anatomy, Supraorbital artery, Middle Aged, medicine.anatomical_structure, Surgery, Female, business
Abstract: Background Injecting soft tissue fillers into the deep plane of the forehead carries the risk of injection-related visual compromise due to the specific course of the arterial vasculature. Objectives The aim of this study was to investigate the 2- and 3-dimensional location of the change of plane of the deep branch of the supratrochlear and supraorbital artery, respectively. Methods A total of 50 patients (11 males and 39 females; mean age, 49.76 [13.8] years, mean body mass index, 22.53 [2.6] kg/m2) were investigated with ultrasound imaging. The total thickness and the distance of the arteries from the skin and bone surface were measured with an 18-MHz broadband compact linear array transducer. Results The deep branch of the supraorbital artery changed plane from deep to superficial to the frontalis muscle at a mean distance of 13 mm (range, 7.0-19.0 mm) in males and at 14 mm (range, 4.0-24.0 mm) in females and for the deep branch of the supratrochlear artery at a mean distance of 14 mm in males and females (range, 10.0-19.0 in males, 4.0-27.0 in females) when measured from the superior orbital rim. Conclusions Based on the ultrasound findings in this study, it seems that the supraperiosteal plane of the upper and lower forehead could be targeted during soft tissue filler injections because the deep branches of both the supraorbital and supratrochlear arteries do not travel within this plane. The superficial plane of the lower forehead, however, should be avoided due to the unpredictability and inconsistent presence of the central and paracentral arteries. Level of Evidence: 4
Published: 2021

23. Biomarkers of Response and Resistance to Palbociclib Plus Letrozole in Patients With ER+/HER2− Breast Cancer

Author: Andrew Dodson, Sophie Perry, Stephen R. D. Johnston, Claire Swift, Shannon Puhalla, Judith M Bliss, Melanie Finnigan, Katherine L. Pogue-Geile, Maggie C.U. Cheang, C. Kent Osborne, Yuan Liu, Lucy Kilburn, Mitch Dowsett, Vera Martins, Samuel A. Jacobs, Mothaffar F. Rimawi, Chris Holcombe, and Nicholas C. Turner
Subjects: Oncology, Cancer Research, medicine.medical_specialty, Postmenopausal women, business.industry, Letrozole, Palbociclib, medicine.disease, Breast cancer, Neoadjuvant treatment, Pharmacodynamics, Internal medicine, Medicine, Biomarker (medicine), In patient, business, medicine.drug
Abstract: Purpose: To determine (i) the relationship between candidate biomarkers of the antiproliferative (Ki67) response to letrozole and palbociclib alone and combined in ER+/HER2− breast cancer; and (ii) the pharmacodynamic effect of the agents on the biomarkers. Experimental Design: 307 postmenopausal women with ER+/HER2− primary breast cancer were randomly assigned to neoadjuvant treatment with letrozole for 14 weeks; letrozole for 2 weeks, then letrozole+palbociclib to 14 weeks; palbociclib for 2 weeks, then letrozole+palbociclib to 14 weeks; or letrozole+palbociclib for 14 weeks. Biopsies were taken at baseline, 2 and 14 weeks and surgery at varying times after stopping palbociclib. Immunohistochemical analyses were conducted for Ki67, c-PARP, ER, PgR, RB1, CCNE1, and CCND1. Results: Higher baselines ER and PgR were significantly associated with a greater chance of complete cell-cycle arrest (CCCA: Ki67 Conclusions: High CCNE1 levels were confirmed as a biomarker of resistance to letrozole+palbociclib. Ki67 recovery within 3–9 days of discontinuing palbociclib indicates incomplete suppression of proliferation during the “off” week of its schedule.
Published: 2021

24. Facial Aesthetic Priorities and Concerns: A Physician and Patient Perception Global Survey

Author: Macrene Alexiades, Jared Jagdeo, Steven H. Dayan, Izolda Heydenrych, W. Grant Stevens, Arthur Swift, Noëlle Sherber, Vandana Chatrath, Sabrina G. Fabi, Jonquille Chantrey, Ligia Colucci, and Sara Sangha
Subjects: Adult, Male, medicine.medical_specialty, Esthetics, media_common.quotation_subject, MEDLINE, Cosmetic Techniques, Treatment goals, Patient satisfaction, Physicians, Surveys and Questionnaires, medicine, Humans, In patient, Quality (business), media_common, business.industry, Mean age, General Medicine, Middle Aged, Skin Aging, Patient perceptions, medicine.anatomical_structure, Phobic Disorders, Family medicine, Forehead, Female, Perception, Surgery, business
Abstract: Background Minimally invasive and noninvasive facial aesthetic treatments are increasingly popular, and a greater understanding of patient perspectives on facial aesthetic priorities is needed. Objectives The authors surveyed facial aesthetic concerns, desires, and treatment goals of aesthetically conscious men and women, and physicians, in 18 countries. Methods This was a global, internet-based survey on desired appearance and experiences with, or interest in, facial aesthetic treatments. Eligible respondents were aesthetically conscious adults (21-75 years). Eligible aesthetic physicians were required to see ≥30 patients per month for aesthetic reasons, have 2 to 30 years of experience in clinical practice, and spend ≥70% of their time in direct patient care. Results A total of 14,584 aesthetically conscious adults (mean age, 41 years; 70% women) and 1315 aesthetic physicians (mean age, 45 years; 68% men) completed the survey. Most respondents (68%) reported that aesthetic procedures should be sought in their 30s to 40s; physicians recommended patients seek treatment earlier. Respondents expressed greatest concern over crow’s feet lines, forehead lines, facial skin issues, hair-related concerns, and under-eye bags or dark circles; in contrast, physicians tended to underestimate concerns about under-eye bags or dark circles, mid-face volume deficits, and skin quality. Although both physicians and respondents cited cost as a major barrier to seeking aesthetic treatments, respondents also emphasized safety, fear of injections or procedure-related pain, and concern about unnatural-looking outcomes. Conclusions This global survey provides valuable insight into facial aesthetic concerns and perspectives that may be implemented in patient education and consultations to improve patient satisfaction following aesthetic treatments.
Published: 2021

25. Differential chemokine alteration in the variants of primary progressive aphasia—a role for neuroinflammation

Author: Jonathan D. Rohrer, Ione O.C. Woollacott, Henrik Zetterberg, Aitana Sogorb-Esteve, Jason D. Warren, and Imogen Swift
Subjects: Male, medicine.medical_specialty, Pathology, Neurology, Immunology, CCL7, Primary progressive aphasia, Cellular and Molecular Neuroscience, Cerebrospinal fluid, Medicine, Humans, CX3CL1, RC346-429, Aged, business.industry, General Neuroscience, Research, Middle Aged, respiratory system, medicine.disease, Aphasia, Primary Progressive, Neuroinflammatory Diseases, Biomarker (medicine), Female, Tauopathy, Neurology. Diseases of the nervous system, Chemokines, business, Biomarkers, Frontotemporal dementia
Abstract: Background The primary progressive aphasias (PPA) represent a group of usually sporadic neurodegenerative disorders with three main variants: the nonfluent or agrammatic variant (nfvPPA), the semantic variant (svPPA), and the logopenic variant (lvPPA). They are usually associated with a specific underlying pathology: nfvPPA with a primary tauopathy, svPPA with a TDP-43 proteinopathy, and lvPPA with underlying Alzheimer’s disease (AD). Little is known about their cause or pathophysiology, but prior studies in both AD and svPPA have suggested a role for neuroinflammation. In this study, we set out to investigate the role of chemokines across the PPA spectrum, with a primary focus on central changes in cerebrospinal fluid (CSF) Methods Thirty-six participants with sporadic PPA (11 svPPA, 13 nfvPPA, and 12 lvPPA) as well as 19 healthy controls were recruited to the study and donated CSF and plasma samples. All patients with lvPPA had a tau/Aβ42 biomarker profile consistent with AD, whilst this was normal in the other PPA groups and controls. We assessed twenty chemokines in CSF and plasma using Proximity Extension Assay technology: CCL2 (MCP-1), CCL3 (MIP-1a), CCL4 (MIP-1β), CCL7 (MCP-3), CCL8 (MCP-2), CCL11 (eotaxin), CCL13 (MCP-4), CCL19, CCL20, CCL23, CCL25, CCL28, CX3CL1 (fractalkine), CXCL1, CXCL5, CXCL6, CXCL8 (IL-8), CXCL9, CXCL10, and CXCL11. Results In CSF, CCL19 and CXCL6 were decreased in both svPPA and nfvPPA compared with controls whilst CXCL5 was decreased in the nfvPPA group with a borderline significant decrease in the svPPA group. In contrast, CCL2, CCL3 and CX3CL1 were increased in lvPPA compared with controls and nfvPPA (and greater than svPPA for CX3CL1). CXCL1 was also increased in lvPPA compared with nfvPPA but not the other groups. CX3CL1 was significantly correlated with CSF total tau concentrations in the controls and each of the PPA groups. Fewer significant differences were seen between groups in plasma, although in general, results were in the opposite direction to CSF, i.e. decreased in lvPPA compared with controls (CCL3 and CCL19), and increased in svPPA (CCL8) and nfvPPA (CCL13). Conclusion Differential alteration of chemokines across the PPA variants is seen in both CSF and plasma. Importantly, these results suggest a role for neuroinflammation in these poorly understood sporadic disorders, and therefore also a potential future therapeutic target.
Published: 2021

26. Successful treatment of prolonged refractory ventricular fibrillation in an anesthetized dog

Author: Bonnie J. Gatson, Vaidehi Paranjape, and Simon Swift
Subjects: Resuscitation, General Veterinary, business.industry, Defibrillation, medicine.medical_treatment, Advanced cardiac life support, Antiarrhythmic agent, Return of spontaneous circulation, medicine.disease, Epinephrine, Anesthesia, Ventricular fibrillation, Pulseless electrical activity, Medicine, business, medicine.drug
Abstract: Objective To describe a case of successful return of spontaneous circulation in an anesthetized dog that developed spontaneous ventricular fibrillation during CPR that was refractory to multiple defibrillation attempts by utilizing pharmacological antiarrhythmic therapy. Case summary Cardiopulmonary arrest occurred during surgical preparation in a 1-year-old German Shepherd Dog under general anesthesia for fluoroscopic implantation of an Amplatz canine duct occluder for treatment of a patent ductus arteriosus. Pulseless electrical activity was initially diagnosed, and resuscitative efforts were immediately initiated, including basic cardiac life support, discontinuation of anesthesia with administration of reversal agents, and low-dose epinephrine administration (0.01 mg/kg, IV). After 10 minutes of CPR, the patient developed ventricular fibrillation and single-dose monophasic defibrillation attempts of escalating energy were performed. Despite these efforts, return of spontaneous circulation was unable to be achieved. However, administration of magnesium sulfate (20 mg/kg, IV) along with an additional single monophasic defibrillation attempt was successful in achieving return of spontaneous circulation. New or unique information provided Under current advanced cardiac life support guidelines, the best resuscitation strategy for refractory ventricular fibrillation, in which the arrhythmia persists despite multiple defibrillation attempts, remains unclear. This is especially true for veterinary patients, where refractory ventricular fibrillation is an uncommon cardiac arrest rhythm. Although guidelines for the use of antiarrhythmic therapy during cardiac arrest are well established in human medicine, evidence-based guidelines to support best practices in companion animals do not exist due to sparse data gathered through experimental studies. Only a few case reports describe successful return of spontaneous circulation following prolonged ventricular fibrillation in clinical veterinary patients. Although the use of magnesium sulfate as an antiarrhythmic agent during refractory ventricular fibrillation has been previously reported in people, this is the first case to our knowledge of refractory ventricular fibrillation in a dog that responded to magnesium sulfate.
Published: 2021

27. Update in Transvaginal Grafts

Author: Steven Swift, Visha Tailor, and Alex Digesu
Subjects: Pelvic organ, medicine.medical_specialty, Tissue engineered, business.industry, Composite mesh, Prolapse surgery, Obstetrics and Gynecology, Surgery, Polypropylene mesh, surgical procedures, operative, Medicine, Narrative review, business, Pop surgery
Abstract: Transvaginal mesh/grafts have been popularized over the past 20 years in an attempt to improve the longevity of traditional vaginal pelvic organ prolapse (POP) surgery. Several national bodies have concluded that the proposed benefits of mesh/graft implantation are outweighed by the significant increase in surgery complications related to these products. As a consequence mesh products for vaginal POP surgery have been withdrawn from use in many countries. This article is a narrative review of newer mesh and graft products including lightweight polypropylene mesh products, biological grafts, hybrid grafts, and tissue engineered grafts.
Published: 2021

28. Evaluating safety in hyaluronic acid lip injections

Author: Sebastian Cotofana, Tyler Safran, Andreas Nikolis, and Arthur Swift
Subjects: Lip augmentation, Filler (packaging), business.industry, Soft tissue, Dentistry, Cosmetic Techniques, General Medicine, Lip, Injections, chemistry.chemical_compound, chemistry, Dermal Fillers, Practice Guidelines as Topic, Hyaluronic acid, Humans, Medicine, Pharmacology (medical), Hyaluronic Acid, business, Randomized Controlled Trials as Topic
Abstract: Soft tissue filler augmentation has become increasingly popular due to its perceived ease and impressive results. Unfortunately, although the results are impressive, so are the reported complications. This article describes complications specific to peri-oral soft tissue filler injection and then discusses evidence-based, anatomic prevention and treatment guidelines.The authors aimed at providing an overview of the complications associated with peri-oral soft tissue filler. Hyaluronic Acid (H.A) fillers may have devastating complications which are oft undisclosed or published. This narrative review aims to describe the various complications and provide preventative strategies.Given the paucity of prospective, randomized clinical trials on the subject and in light of complication underreporting, the authors believe that efficacy and safety literature on the subject is lacking. Injectors must rely on the one strength which exists in the lip literature to date, that is anatomy. The basis of all successful injections is a mandatory understanding of normal as well as variations of vital structures in an area, combined with meticulous injection techniques, deposition of small aliquots of product and the ability to recognize unwanted adverse events early enough to act on them.
Published: 2021

29. Missed opportunities for improving oral health in rural Victoria: The role of municipal public health planning in improving oral health

Author: Leonard A. Crocombe and Virginia Dickson-Swift
Subjects: Rural Population, medicine.medical_specialty, 110505 Oral Medicine and Pathology, FOS: Political science, media_common.quotation_subject, 111799 Public Health and Health Services not elsewhere classified, Oral Health, FOS: Health sciences, Oral health, Promotion (rank), 111708 Health and Community Services, Environmental health, Humans, Medicine, 160508 Health Policy, Water fluoridation, media_common, Community and Home Care, Local Government, 111712 Health Promotion, business.industry, FOS: Clinical medicine, Public health, Public Health, Environmental and Occupational Health, Health Planning, stomatognathic diseases, Health promotion, Content analysis, Local government, Rural area, business
Abstract: Issue addressed: People in rural areas have poorer oral health than their urban counterparts due to a range of factors. Local governments (LGs) have a key role in addressing health issues that impact on local communities. Methods: Publicly available oral health profile (OHP) data and Municipal Public Health and Wellbeing Plans (MPHWPs) (2017-2021) were downloaded from Dental Health Services Victoria and LG websites for 48 Victorian local government areas (LGAs) containing predominately rural areas. OHP data were collated to provide an overview of the oral health status of the communities and a content analysis of the MPHWPs undertaken. Results: Despite poor oral health in rural Victorian LGAs, oral health was not often in MPHWPs. Twenty of the MPHWPs had some mention of oral health but only four included specific actions or strategies that would be used to improve oral health. None of the plans contained any specific targets for action or details of evaluations that might be used to assess success. Conclusions: Poor oral health in rural Victorian communities continues to be demonstrated through local OHPs and is due to modifiable risk factors and poor access to water fluoridation. LGs have a key role to play in improving oral health through utilisation of OHP data in their MPHWPs. So what?: Oral health remains a low priority for LG action. This represents a missed opportunity for prioritising oral health prevention and promotion activities that improve oral health in rural Victoria.
Published: 2021

30. Cardiovascular examination using hand-held cardiac ultrasound

Author: Chris Sawh, Mohamed G. Shiha, Eron Yones, Marcus Flather, James Wardley, Alisdair Ryding, Vassilios S. Vassiliou, Andrew J. Swift, Sam Jenkins, Paul Morris, and Pankaj Garg
Subjects: Cardiac function curve, Left ventricular ejection fraction, medicine.medical_specialty, Heart Diseases, Point-of-Care Systems, Cardiovascular examination, Review Article, 030204 cardiovascular system & hematology, Cardiac Ultrasound, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Intensive care medicine, Ultrasonography, Ejection fraction, Wall motion abnormality, business.industry, Hand held, valvular heart disease, Ultrasound, Left ventricular hypertrophy, Jugular venous pressure, Emergency department, medicine.disease, Valvular heart disease, 3. Good health, Hand-held cardiac ultrasound, Echocardiography, Emergency Service, Hospital, business
Abstract: Echocardiography is the first-line imaging modality for assessing cardiac function and morphology. The miniaturisation of ultrasound technology has led to the development of hand-held cardiac ultrasound (HCU) devices. The increasing sophistication of available HCU devices enables clinicians to more comprehensively examine patients at the bedside. HCU can augment clinical exam findings by offering a rapid screening assessment of cardiac dysfunction in both the Emergency Department and in cardiology clinics. Possible implications of implementing HCU into clinical practice are discussed in this review paper.
Published: 2021

31. Step-free railway station access in the UK: the value of inclusive design

Author: Becky P.Y. Loo, Long Cheng, Frank Witlox, Mengqiu Cao, and Antony Swift
Subjects: Value (ethics), Universal design, Transport equity, Transportation, Commit, 010501 environmental sciences, 01 natural sciences, HV Social pathology. Social and public welfare. Criminology, PEOPLE, 0502 economics and business, Railway station, Marketing, 0105 earth and related environmental sciences, HE1-9990, OLDER, 050210 logistics & transportation, Government, TA1001-1280, business.industry, Mechanical Engineering, 05 social sciences, Reduced mobility, Investment (macroeconomics), Accessibility, United Kingdom, Transportation engineering, TRAVEL, Older and disabled people, Public transport, Earth and Environmental Sciences, JOURNEY, Automotive Engineering, Inclusive design, business, HE Transportation and Communications, WALKING, Transportation and communications, PUBLIC TRANSPORT, Appraisal process
Abstract: Background Despite substantial investment in step-free access at UK railway stations, persons with reduced mobility (PRMs) continue to travel less than their able-bodied counterparts and little is known about the value of step-free access. This research examines the benefits of step-free access and its relationship with rail usage among PRMs, and the wider benefits of railway station accessibility. Methods These issues are explored through a mixed methods approach. Semi-structured interviews with ten key organisations were undertaken, as was an analysis of Senior/Disabled Persons Railcard data from 17 railway stations in Buckinghamshire, each with varying levels of step-free accessibility. Results The results show that the benefits of step-free access extend beyond benefits at the individual level typically associated with those limited to PRMs, and demonstrate the potential to positively affect the society at large economically, environmentally, and socially. The findings also show a positive correlation between the level of step-free accessibility at a railway station and the percentage of PRMs using it. Conclusions This research argues that government and interested stakeholders should commit to expanding the number and coverage of step-free stations throughout the UK. They should ensure that the appraisal process for investment in step-free accessibility appropriately captures both user and non-user benefits.
Published: 2021

32. Response to mRNA vaccination for COVID-19 among patients with multiple myeloma

Author: Samuel D. Stampfer, Aaron J. Feinstein, Haiming Chen, Tracy Green, Scott Jew, Tanya M. Spektor, Sean Bujarski, Marissa-Skye Goldwater, Shahrooz Eshaghian, Elias Aquino, Ning Xu, Bernard Regidor, James R. Berenson, David Daniely, Mingjie Li, Eddie Fung, Kurt Preugschat, and Regina A. Swift
Subjects: Adult, Male, Cancer Research, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Myeloma, Disease, Antibodies, Viral, Article, medicine, Humans, BNT162 Vaccine, Multiple myeloma, Aged, Aged, 80 and over, Public health, Messenger RNA, biology, SARS-CoV-2, business.industry, Vaccination, COVID-19, Hematology, Middle Aged, medicine.disease, Oncology, Immunization, Immunoglobulin G, Spike Glycoprotein, Coronavirus, Immunology, biology.protein, Female, Antibody, Multiple Myeloma, business, 2019-nCoV Vaccine mRNA-1273
Abstract: Multiple myeloma (MM) patients are at higher risk for severe COVID-19. Their mRNA vaccination response against SARS-CoV-2 is unknown. Thus, we analyzed responses to mRNA vaccination against COVID-19 among these patients. Using an ELISA-based assay that detects IgG antibodies to SARS-CoV-2 spike protein, we determined serum antibody levels prior to immunization and 12–21 and 14–21 days following the first and second vaccinations, respectively, with mRNA-1273 (Moderna) or BNT162b2 (Pfizer/BioNTech) among 103 MM patients (96 and 7 with active and smoldering disease, respectively). We stratified patients into clinically relevant responders (>250 IU/mL), partial responders (50–250 IU/mL, which was above pre-COVID-19 background), and nonresponders ( second line of treatment, and among those not in complete remission. Patients who received mRNA-1273 vaccine had higher anti-spike antibody levels than those who were vaccinated with BNT162b2. Thus, most MM patients have impaired responses to mRNA vaccination against COVID-19, and specific clinical and myeloma-related characteristics predict vaccine responsiveness.
Published: 2021

33. Changes in obstetric interventions and preterm birth during COVID‐19: A nationwide study from Iceland

Author: Kristjana Einarsdóttir, Emma Marie Swift, and Helga Zoega
Subjects: induction of labor, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Population, Birth rate, lockdown, COVID‐19, Pregnancy, Earthquakes, medicine, Humans, Original Research Article, education, education.field_of_study, cesarean section, SARS-CoV-2, business.industry, Obstetrics, Confounding, preterm birth, COVID-19, Obstetrics and Gynecology, Gestational age, General Medicine, Stillbirth, Induction of labor, medicine.disease, Hospitals, Premature birth, Communicable Disease Control, Birth, Female, business
Abstract: Introduction Previous evidence has been conflicting regarding the effect of coronavirus disease 2019 (COVID‐19) pandemic lockdowns on obstetric intervention and preterm birth rates. The literature to date suggests potentially differential underlying mechanisms based on country economic setting. We aimed to study these outcomes in an Icelandic population where uniform lockdown measures were implemented across the country. Material and methods The study included all singleton births (n = 20 680) during 2016–2020 identified from the population‐based Icelandic Medical Birth Register. We defined two lockdown periods during March–May and October–December in 2020 according to government implemented nationwide lockdown. We compared monthly rates of cesarean section, induction of labor and preterm birth during lockdown with the same time periods in the 4 previous years (2016–2019) using logit binomial regression adjusted for confounders. Results Our results indicated a reduction in the overall cesarean section rate, which was mainly evident for elective cesarean section, both during the first (adjusted odd ratio [aOR] 0.71, 95% CI 0.51–0.99) and second (aOR 0.72, 95% CI 0.52–0.99) lockdown periods, and not for emergency cesarean section. No change during lockdown was observed in induction of labor. Our results also suggested a reduction in the overall preterm birth rate during the first lockdown (aOR 0.69, 95% CI 0.49–0.97) and in the months immediately following the lockdown (June–September) (aOR 0.67, 95% CI 0.49–0.89). The reduction during the first lockdown was mainly evident for medically indicated preterm birth (although not statistically significant) and the reduction during June–September was mainly evident for spontaneous preterm birth. Conclusions This study suggested a reduction in elective cesarean section during COVID‐19 lockdown, possibly reflecting changes in prioritization of non‐urgent health care during lockdown. We also found a reduction in overall preterm birth during the first lockdown and spontaneous preterm birth following the first lockdown, but further research is needed to shed light on the underlying mechanisms for these findings.
Published: 2021

34. Keats, Peterloo and Seriality

Author: Simon Swift
Subjects: Literature, Seriality (gender studies), Literature and Literary Theory, business.industry, media_common.quotation_subject, Art, business, media_common
Published: 2021

35. Electrical stimulation for pain reduction in hard-to-heal wound healing

Author: Amelia Swift, Robin Martin, Jennifer Smith, and Jeanette Milne
Subjects: Wound Healing, medicine.medical_specialty, Nursing (miscellaneous), business.industry, Pain, Stimulation, Electric Stimulation, Varicose Ulcer, Wound pain, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Pain reduction, Unresolved Issue, medicine, Humans, Patient Compliance, Fundamentals and skills, 030212 general & internal medicine, Wound healing, Intensive care medicine, business
Abstract: Objective: Despite treatment advances over the past 30 years, the societal impact of hard-to-heal wounds is increasingly burdensome. An unresolved issue is wound pain, which can make many treatments, such as compression in venous leg ulcers, intolerable. The aim of this review is to present the evidence and stimulate thinking on the use of electrical stimulation devices as a treatment technology with the potential to reduce pain, improve adherence and thus hard-to-heal wound outcomes. Method: A literature search was conducted for clinical studies up to August 2020 reporting the effects of electrical stimulation devices on wound pain. Devices evoking neuromuscular contraction or direct spinal cord stimulation were excluded. Results: A total of seven publications (three non-comparative and four randomised trials) were identified with four studies reporting a rapid (within 14 days) reduction in hard-to-heal wound pain. Electrical stimulation is more widely known for accelerated healing and is one of the most evidence-based technologies in wound management, supported by numerous in vitro molecular studies, five meta-analyses, six systematic reviews and 30 randomised controlled trials (RCTs). Despite this wealth of supportive evidence, electrical stimulation has not yet been adopted into everyday practice. Some features of electrical stimulation devices may have hampered adoption in the past. Conclusion: As new, pocket-sized, portable devices allowing convenient patient treatment and better patient adherence become more widely available and studied in larger RCTs, the evidence to date suggests that electrical stimulation should be considered part of the treatment options to address the challenges of managing and treating painful hard-to-heal wounds.
Published: 2021

36. Safety and efficacy of UV application for superficial infections in humans: A systematic review and meta-analysis

Author: Sanjay Marasini, Simon J Dean, Simon Swift, Alexis Ceecee Zhang, and Jennifer P. Craig
Subjects: Keratitis, medicine.medical_specialty, business.industry, Standard treatment, Incidence (epidemiology), MEDLINE, Context (language use), Skin infection, medicine.disease, Dermatology, Ultraviolet therapy, United States, 03 medical and health sciences, Ophthalmology, 0302 clinical medicine, Anti-Infective Agents, Meta-analysis, 030221 ophthalmology & optometry, Humans, Medicine, Ultraviolet Therapy, 030212 general & internal medicine, business, Adverse effect
Abstract: Background Ultraviolet (UV) light is naturally antimicrobial, but risks associated with UV overexposure have limited its clinical application. This systematic review evaluates the safety and efficacy of UV light treatment of superficial human infections. Methods MEDLINE, Embase, Cochrane CENTRAL, ANZCTR and US National Library of Medicine were searched (March 25, 2020). Clinical studies applying UV light (200–400 nm) for superficial infections and non-clinical studies evaluating the antimicrobial effects of UV light on human samples were included. Randomised controlled trials (RCTs) and non- RCTs were appraised using the Cochrane risk of bias and the ROBINS-I tools, respectively. Results Eleven RCTs, seven non-RCTs, 24 case studies, and 11 in vitro studies were included. Most clinical studies (34/42) evaluated UVA treatment for microbial keratitis (MK) using cross-linking (UVA-CXL) methods. Six clinical studies assessed UVC; one, UVB; and one, broadband UV for chronic skin infections. Pooled data analysis showed no difference in the time to wound resolution with UVA-CXL relative to standard treatment (mean difference [MD]: −18.20 [95% CI: −39.04 to 2.65] days; p = 0.09). Adverse event incidence was similar to control for UVA-CXL in MK (RR: 0.70 [95%CI: 0.32–1.79]; 5 RCTs) and UVC in skin infections (RR: 0.63 [95%CI: 0.25–1.54]; 2 RCTs). Conclusion Alone or as an adjunct to standard therapy, UV light shows promise as a safe and effective treatment for a wide range of infections. Applications of UV light as an anti-infective agent are deserving of further evaluation, especially in the context of growing antibiotic resistance. Registration PROSPERO registration number CRD42020176510.
Published: 2021

37. Implementing Continuous Quality Improvement in an Integrated Community Urology Practice: Lessons Learned

Author: Sarah Mohedin, Paul Dato, Robert Topp, William J. Catalona, Edward Cohen, Lawrence S. Friedman, Amirali Salmasi, Franklin Gaylis, Christopher J. Kane, Ryan Nasseri, Sadie Swift, Rose Prime, and Christopher B. Anderson
Subjects: Male, medicine.medical_specialty, Quality management, Prostate biopsy, Biopsy, Urology, media_common.quotation_subject, 030232 urology & nephrology, Psychological intervention, MEDLINE, Audit, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Health care, Electronic Health Records, Humans, Medicine, Quality (business), Community Health Services, Practice Patterns, Physicians', Watchful Waiting, media_common, Clinical Audit, medicine.diagnostic_test, Delivery of Health Care, Integrated, business.industry, Medical record, Prostatic Neoplasms, Quality Improvement, United States, 030220 oncology & carcinogenesis, Guideline Adherence, business
Abstract: To determine the effectiveness of 2 different continuous quality improvement interventions in an integrated community urology practice. We specifically assessed the impact of audited physician feedback on improving physicians' adoption of active surveillance for low-risk prostate cancer (CaP) and adherence to a prostate biopsy time-out intervention.The electronic medical records of Genesis Healthcare Partners were analyzed between August 24, 2011 and September 30, 2020 to evaluate the performance of 2 quality interventions: audited physician feedback to improve active surveillance adoption in low-risk CaP patients, and audited physician feedback to promote adherence to an electronic medical records embedded prostate biopsy time-out template. Physician and Genesis Healthcare Partners group adherence to each quality initiative was compared before and after each intervention type using ANOVA testing.For active surveillance, we consistently saw an increase in active surveillance adoption for low risk CaP patients in association with continuous audited feedback (P.001). Adherence to the prostate biopsy time-out template improved when audited feedback was provided (P.001).The implementation of clinical guidelines into routine clinical practice remains challenging and poses an obstacle to the improvement of United States healthcare quality. Continuous quality improvement should be a dynamic process, and in our experience, audited feedback coupled with education is most effective.
Published: 2021

38. Low dose venetoclax in combination with bortezomib, daratumumab, and dexamethasone for the treatment of relapsed/refractory multiple myeloma patients—a single-center retrospective study

Author: Gary T. Schwartz, Marsiye Emamy-Sadr, Tanya M. Spektor, Benjamin Eades, Bernard Regidor, Jessica Wang, Marissa-Skye Goldwater, Shahrooz Eshagian, Sean Bujarski, Regina A. Swift, and James R. Berenson
Subjects: Male, Oncology, medicine.medical_specialty, Salvage therapy, Dexamethasone, Bortezomib, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Refractory, Internal medicine, Antineoplastic Combined Chemotherapy Protocols, medicine, Humans, Multiple myeloma, Aged, Retrospective Studies, Sulfonamides, Venetoclax, business.industry, Antibodies, Monoclonal, Daratumumab, Hematology, General Medicine, Middle Aged, Bridged Bicyclo Compounds, Heterocyclic, medicine.disease, Regimen, Treatment Outcome, chemistry, 030220 oncology & carcinogenesis, Female, Neoplasm Recurrence, Local, Multiple Myeloma, business, 030215 immunology, medicine.drug
Abstract: Venetoclax is a BCL-2 inhibitor currently indicated for use in treating hematologic malignancies with recommended doses ranging from 400 to 600 mg/day. Although currently not FDA-approved to treat multiple myeloma (MM) patients, there is a growing number of reports indicating its efficacy as a salvage therapy for these patients, especially for those with the t(11;14) chromosomal marker. These studies, however, have also indicated that venetoclax given at doses ≥ 400 mg/day can cause serious adverse events (SAEs) especially when administered with bortezomib, commonly related to infections. The purpose of this single-center retrospective study was to determine the efficacy of low dose venetoclax (defined as ≤ 250 mg/day) in combination with low dose bortezomib (defined as 1.0 mg/m2 per dose), daratumumab, and dexamethasone (Dvvd) as a salvage therapy for relapsed/refractory myeloma (RRMM) patients. Twenty-two RRMM patients were given venetoclax orally at doses ranging from 100 to 250 mg daily using this four-drug regimen. While the low doses resulted in reduced venetoclax efficacy among those lacking t(11;14) (overall response rate [ORR] = 31%), those harboring the t(11;14) marker exhibited an ORR of 80%. Notably, this response was without frequent infection-related SAEs as reported in previous studies. Together, the results of this study demonstrate that treatment of t(11;14) positive RRMM patients with Dvvd is both effective and well-tolerated.
Published: 2021

39. Frailty in Patients With Hematologic Malignancies and Those Undergoing Transplantation: A Scoping Review

Author: Roy E. Brown, Lathika Mohanraj, Theresa Swift-Scanlan, and Lana Sargent
Subjects: medicine.medical_specialty, Frailty, business.industry, medicine.medical_treatment, Hematopoietic Stem Cell Transplantation, Hematologic Neoplasms, Hematopoietic stem cell transplantation, Prognosis, medicine.disease, Comorbidity, Transplantation, Problem identification, Included study, medicine, Humans, In patient, Intensive care medicine, business, Radiation treatment planning, Bone Marrow Transplantation
Abstract: Problem identification Although frailty is an important parameter in treatment planning and in predicting prognosis and overall survival among patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation, frailty assessment tools are not standardized in clinical care settings. The purpose of this article is to provide an overview of the literature on frailty assessment tools in these patient populations. Literature search A systematic search of CINAHL®, Embase®, MEDLINE®, PubMed®, and Web of Science was performed using keywords and controlled vocabulary for the concepts "bone marrow transplants," "hematologic neoplasms," and "frailty." Data evaluation Extracted data included study type, diagnosis, transplantation status, frailty tools used, and outcome measures. Synthesis A systematic search resulted in 24 studies that met the inclusion criteria. There were significant differences in how various groups define and assess frailty. Implications for practice Addressing the lack of standardized frailty assessments will assist healthcare providers to routinely integrate frailty measures in clinical assessments to identify those at risk for poor outcomes, improving personalized care.
Published: 2021

40. Ultrasound to Improve the Safety and Efficacy of Lipofilling of the Temples

Author: Leonie W Schelke, Jonathan Kadouch, Arthur Swift, and Dermatology
Subjects: medicine.medical_specialty, 030230 surgery, Injections, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Medical imaging, Humans, Medicine, Adverse effect, Skin, Ultrasonography, business.industry, Ultrasound, Mean age, General Medicine, Middle Aged, Surgery, Safety profile, Autologous fat, Adipose Tissue, Face, Female, Temporal artery, Temporal fossa, business
Abstract: Background Autologous fat is known for a reliable and natural safety profile, but complications do occur—even serious vascular adverse events. Objectives The authors sought to examine doppler-ultrasound (DUS) imaging for the harvesting and subsequent facial implantation of autologous fat tissue. Methods All patients underwent lipofilling treatment of the temporal fosse of the face. DUS examination was performed for preprocedural vascular mapping and imaging of previously injected (permanent) fillers. In addition, the injection of autologous fat was performed DUS-guided. Results Twenty patients (all female; mean age, 57.9 years; range, 35-64 years). DUS examination showed that 16 of the 20 patients (80%) had been injected with resorbable or nonresorbable fillers elsewhere in the past. The temporal artery could be visualized and avoided in all cases. An average of 1.1 cc of autologous fat was injected in the temporal fossa per side. One case of edema and nodules was described, but no other adverse events were reported. Conclusions The utilization of DUS can add valuable information to a lipofilling procedure and should be considered an integral part of a safe lipofilling treatment. Level of Evidence: 4
Published: 2021

41. Cardiac-MRI Predicts Clinical Worsening and Mortality in Pulmonary Arterial Hypertension

Author: Christopher S. Johns, Pankaj Garg, David G. Kiely, Jim M. Wild, Faisal Alandejani, Yousef Shahin, Robin Condliffe, Robert A. Lewis, Andrew J. Swift, and Samer Alabed
Subjects: medicine.medical_specialty, PH, pulmonary hypertension, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, LVEDVI, left ventricular end-diastolic volume index, 0302 clinical medicine, Left ventricular Stroke volume index, systematic review, CTD, connective tissue disease, CMR, cardiac magnetic resonance, pulmonary arterial hypertension, IPAH, idiopathic pulmonary arterial hypertension, Internal medicine, cardiac MRI, Risk of mortality, medicine, Radiology, Nuclear Medicine and imaging, CMR, LV, left ventricular, Original Research, RVMI, right ventricular mass index, mPAP, mean pulmonary artery pressure, Ejection fraction, business.industry, RVEDVI, right ventricular end-diastolic volume index, Hazard ratio, PAH, mortality, VMI, ventricular mass index, meta-analysis, RVESVI, right ventricular end-systolic volume index, Meta-analysis, Rv function, Cardiology, prognosis, Risk of death, PAH, pulmonary arterial hypertension, RV, right ventricular, RVEF, right ventricular ejection fraction, Cardiology and Cardiovascular Medicine, Cardiac magnetic resonance, business
Abstract: Objectives This meta-analysis evaluates assessment of pulmonary arterial hypertension (PAH), with a focus on clinical worsening and mortality. Background Cardiac magnetic resonance (CMR) has prognostic value in the assessment of patients with PAH. However, there are limited data on the prediction of clinical worsening, an important composite endpoint used in PAH therapy trials. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Web of Science databases were searched in May 2020. All CMR studies assessing clinical worsening and the prognosis of patients with PAH were included. Pooled hazard ratios of univariate regression analyses for CMR measurements, for prediction of clinical worsening and mortality, were calculated. Results Twenty-two studies with 1,938 participants were included in the meta-analysis. There were 18 clinical worsening events and 8 deaths per 100 patient-years. The pooled hazard ratios show that every 1% decrease in right ventricular (RV) ejection fraction is associated with a 4.9% increase in the risk of clinical worsening over 22 months of follow-up and a 2.2% increase in the risk of death over 54 months. For every 1 ml/m2 increase in RV end-systolic volume index or RV end-diastolic volume index, the risk of clinical worsening increases by 1.3% and 0.7%, respectively, and the risk of mortality increases by 0.9% and 1%. Every 1 ml/m2 decrease in left ventricular end-systolic volume index or left ventricular end-diastolic volume index increased the risk of death by 2.1% and 2.3%. Left ventricular parameters were not associated with clinical worsening. Conclusions This review confirms CMR as a powerful prognostic marker in PAH in a large cohort of patients. In addition to confirming previous observations that RV function and RV and left ventricular volumes predict mortality, RV function and volumes also predict clinical worsening. This study provides a strong rationale for considering CMR as a clinically relevant endpoint for trials of PAH therapies., Central Illustration
Published: 2021

42. Evaluation of healthcare personnel exposures to patients with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) associated with personal protective equipment

Author: Melanie D. Swift, Laura E. Breeher, Caitlin M. Hainy, and Vishal P. Shah
Subjects: Microbiology (medical), medicine.medical_specialty, Epidemiology, Health Personnel, 030501 epidemiology, medicine.disease_cause, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Quarantine, Health care, medicine, Humans, 030212 general & internal medicine, Personal protective equipment, Personal Protective Equipment, Coronavirus, Retrospective Studies, Transmission (medicine), business.industry, SARS-CoV-2, COVID-19, Retrospective cohort study, Confidence interval, Infectious Diseases, Virus Diseases, Relative risk, Emergency medicine, Original Article, 0305 other medical science, business, Delivery of Health Care
Abstract: Objective:Personal protective equipment (PPE) is a critical aspect of preventing the transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in healthcare settings. We aimed to identify factors related to lapses in PPE use that may influence transmission of SARS-CoV-2 from patients to healthcare personnel (HCP).Design:Retrospective cohort study.Setting:Tertiary-care medical center in Minnesota.Participants:In total, 345 HCP who sustained a significant occupational exposure to a patient with coronavirus disease 2019 (COVID-19) from May 13, 2020, through November 30, 2020, were evaluated.Results:Overall, 8 HCP (2.3%) were found to have SARS-CoV-2 infection during their 14-day postexposure quarantine. A lack of eye protection during the care of a patient with COVID-19 was associated with HCP testing positive for SARS-CoV-2 by reverse-transcriptase polymerase chain reaction (RT-PCR) during the postexposure quarantine (relative risk [RR], 10.25; 95% confidence interval [CI], 1.28–82.39; P = .009). Overall, the most common reason for a significant exposure was the use of a surgical face mask instead of a respirator during an aerosol-generating procedure (55.9%). However, this was not associated with HCP testing positive for SARS-CoV-2 during the postexposure quarantine (RR, 0.99; 95% CI, 0.96–1; P = 1). Notably, transmission primarily occurred in units that did not regularly care for patients with COVID-19.Conclusions:The use of universal eye protection is a critical aspect of PPE to prevent patient-to-HCP transmission of SARS-CoV-2.
Published: 2021

43. Mental health among clinicians: what do we know and what can we do?

Author: Mittal Patel, Alex Digesu, and Steven Swift
Subjects: Health Personnel, Urology, media_common.quotation_subject, Anxiety, Burnout, Mental health disorders, 03 medical and health sciences, 0302 clinical medicine, Nursing, medicine, Humans, 030212 general & internal medicine, Burnout, Professional, Depression (differential diagnoses), media_common, Licensure, 030219 obstetrics & reproductive medicine, Health professionals, Depression, business.industry, Taboo, Obstetrics and Gynecology, Patient Acceptance of Health Care, Anxiety Disorders, Mental health, Suicide, Mental Health, Special Contribution, Medical team, medicine.symptom, business
Abstract: Mental health and mental health disorders among clinicians remain a taboo, despite increasing evidence showing the direct impact on medical teams and patient care. This editorial is aimed at increasing awareness of mental issues amongst healthcare professionals, identifying perceived barriers to seeking help, and suggesting ways in which to seek help. Mental health disorders, including anxiety and depression, are prevalent from medical school, leading to increased burnout and suicide risks at later stages of a clinician’s career. There is often a reluctance to seek help, particularly amongst the surgical specialties, caused by self-criticism, lack of convenient access and the potential negative impact on medical licensure. This editorial has been written in loving memory of our colleague, friend and board member Dr. Nikolaus Veit-Rubin, who sadly passed away at the beginning of the year. It is written in the hope of highlighting the importance of maintaining mental wellbeing amongst the medical team, supporting help-seeking behaviour and changing attitudes toward mental health disorders amongst clinicians.
Published: 2021

44. Patient-Reported Outcomes in Inflammatory Bowel Disease: A Measurement of Effect in Research and Clinical Care

Author: Amelia Swift, Jane Fletcher, and Sheldon C. Cooper
Subjects: medicine.medical_specialty, Psychological intervention, Disease, Prom, RC799-869, Inflammatory bowel disease, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Health care, medicine, IBDQ, Intensive care medicine, PROM, Hepatology, business.industry, Gastroenterology, core outcome sets, Diseases of the digestive system. Gastroenterology, medicine.disease, digestive system diseases, female genital diseases and pregnancy complications, HRQOL, Systematic review, disability, quality of life, 030220 oncology & carcinogenesis, Cohort, 030211 gastroenterology & hepatology, business
Abstract: The measurement of outcomes is key in evaluating healthcare or research interventions in inflammatory bowel disease (IBD). In patient-centred care, patient-reported outcome measures (PROMs) are central to this evaluation. In this review, we provide an overview of validated, adult disease-specific PROMs developed for use in IBD. Our aim is to assist clinicians and researchers in selection of PROMs to measure outcomes in their patient cohort. The Consensus-based Standards for the Selection of Health Measurement Instruments database of systematic reviews was the primary resource used to identify PROMs used in IBD. Search terms were ‘Crohn’s disease’, ‘ulcerative colitis’, and ‘IBD’. Seven systematic reviews were identified from this search. In addition, the publication by the IBD Core Outcome Set Working Group was used to identify further PROMs. Three systematic reviews were excluded as they did not meet the inclusion criteria. From the five included systematic reviews, we identified 21 PROMs and their shortened versions. In conclusion, it does not appear that any one PROM is entirely suitable for both research and clinical practice. Overall, the IBDQ-32 is most widely used in research but has the limitation of cost, whereas the IBD-Control has been recommended in the clinical core outcome set.
Published: 2021

45. Linking chondrocyte and synovial transcriptional profile to clinical phenotype in osteoarthritis

Author: Eleftheria Zeggini, D Swift, Julia Steinberg, Roger A. Brooks, Raveen L Jayasuriya, Karan M. Shah, Andreas Fontalis, Jeremy Mark Wilkinson, Andrew McCaskie, Lorraine Southam, M.J. Clark, Steinberg, Julia [0000-0002-0585-2312], Wilkinson, Jeremy Mark [0000-0001-5577-3674], Zeggini, Eleftheria [0000-0003-4238-659X], and Apollo - University of Cambridge Repository
Subjects: Cartilage, Articular, 0301 basic medicine, Pathology, medicine.medical_specialty, MMP1, Immunology, Osteoarthritis, General Biochemistry, Genetics and Molecular Biology, Chondrocyte, Extracellular matrix, Chondrocytes, Inflammation, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, medicine, Extracellular, Humans, Immunology and Allergy, Cell adhesion, 030203 arthritis & rheumatology, business.industry, Cartilage, Synovial Membrane, Blood Proteins, Osteoarthritis, Knee, medicine.disease, Phenotype, ddc, 3. Good health, osteoarthritis, 030104 developmental biology, medicine.anatomical_structure, Cytokines, Female, business
Abstract: ObjectivesTo determine how gene expression profiles in osteoarthritis joint tissues relate to patient phenotypes and whether molecular subtypes can be reproducibly captured by a molecular classification algorithm.MethodsWe analysed RNA sequencing data from cartilage and synovium in 113 osteoarthritis patients, applying unsupervised clustering and Multi-Omics Factor Analysis to characterise transcriptional profiles. We tested the association of the molecularly defined patient subgroups with clinical characteristics from electronic health records.ResultsWe detected two patient subgroups in low-grade cartilage (showing no/minimal degeneration, cartilage normal/softening only), with differences associated with inflammation, extracellular matrix-related and cell adhesion pathways. The high-inflammation subgroup was associated with female sex (OR 4.12, p=0.0024) and prescription of proton pump inhibitors (OR 4.21, p=0.0040). We identified two independent patient subgroupings in osteoarthritis synovium: one related to inflammation and the other to extracellular matrix and cell adhesion processes. A seven-gene classifier including MMP13, APOD, MMP2, MMP1, CYTL1, IL6 and C15orf48 recapitulated the main axis of molecular heterogeneity in low-grade knee osteoarthritis cartilage (correlation ρ=−0.88, p−10) and was reproducible in an independent patient cohort (ρ=−0.85, p−10).ConclusionsThese data support the reproducible stratification of osteoarthritis patients by molecular subtype and the exploration of new avenues for tailored treatments.
Published: 2021

46. Can We Trust the Math? Correlation of Objective Postvoid Residual With Calculated Subtraction Postvoid Residual

Author: Steven Swift, Autumn L. Edenfield, Christine A. Heisler, Heidi W. Brown, Abbi Woll, Sierra M Jansen, and Qianqian Zhou
Subjects: Urology, Urination, Residual, Correlation, symbols.namesake, Postoperative Complications, Predictive Value of Tests, Interquartile range, Secondary analysis, Positive predicative value, Humans, Medicine, Postoperative Period, business.industry, Urinary retention, Subtraction, Obstetrics and Gynecology, Urinary Retention, eye diseases, Pearson product-moment correlation coefficient, symbols, Female, Surgery, sense organs, medicine.symptom, business, Nuclear medicine
Abstract: OBJECTIVE The aim of the study was to determine the accuracy of postvoid residual (PVR) by subtraction as compared with objective measurement by bladder scan or catheterization. METHODS This is a secondary analysis of postoperative patients who underwent avoiding trial by retrograde bladder instillation. Fill volume, spontaneous voided volume, and PVR were objectively measured; PVR was also calculated. Pearson correlation compared PVR by subtraction versus objective measurement. We then defined postoperative urinary retention (POUR) at 3 different PVR values (100 mL, 150 mL, and 200 mL) to compare the sensitivity, specificity, and positive and negative predictive values of subtraction for detecting urinary retention at these 3 thresholds. RESULTS Data were available for 155 patients after urogynecologic surgery. Median PVR by objective measurement was 46 mL (interquartile range = 11-146 mL). Median calculated PVR by subtraction was 10 mL (interquartile range = 0-100 mL). Objective measure and subtraction PVR values were strongly correlated (Pearson coefficient = 0.78, P < 0.001). Using a threshold of 200 mL to define POUR resulted in the highest negative predictive value and the lowest absolute number of both false negatives and false positives. Even using this threshold, 11 (48%) of 23 women with POUR by measurement were misclassified as not having POUR when ascertained by subtraction. CONCLUSIONS Although subtraction PVR correlates well with objective PVR measurement, almost half of women with a PVR volume of greater than 200 mL by objective measurement are miscategorized as voiding normally by subtraction PVR. Based on these findings, reliance on objective PVR measurement in postoperative patients is preferable to subtraction PVR.
Published: 2021

47. The Effect of Aerobic Training and Increasing Nonexercise Physical Activity on Cardiometabolic Risk Factors

Author: Damon L. Swift, Chelsey Solar, Tyara R. Nevels, Joshua E. McGee, Joseph A. Houmard, Angela Clark, Lesley D. Lutes, Patricia Brophy, and Savanna B Brewer
Subjects: Blood Glucose, Male, medicine.medical_specialty, Waist, Physical fitness, Pilot Projects, Physical Therapy, Sports Therapy and Rehabilitation, Fitness Trackers, law.invention, Randomized controlled trial, Weight loss, law, Weight Loss, medicine, Body Fat Distribution, Humans, Insulin, Aerobic exercise, Orthopedics and Sports Medicine, Obesity, Prospective Studies, Exercise physiology, Risk factor, Exercise, business.industry, Cardiometabolic Risk Factors, Middle Aged, Lipids, Confidence interval, Exercise Therapy, Physical therapy, Female, Sedentary Behavior, Waist Circumference, medicine.symptom, business, Physical Conditioning, Human
Abstract: PURPOSE Epidemiological studies suggest that sedentary behavior is an independent risk factor for cardiovascular mortality independent of meeting physical activity guidelines. However, limited evidence of this relationship is available from prospective interventions. The purpose of the present study is to evaluate the combined effect of aerobic training and increasing nonexercise physical activity on body composition and cardiometabolic risk factors. METHODS Obese adults (N = 45) were randomized to 6 months of aerobic training (AERO), aerobic training and increasing nonexercise physical activity (~3000 steps above baseline levels; AERO-PA), or a control (CON) group. The AERO and AERO-PA groups performed supervised aerobic training (3-4 times per week). The AERO-PA group wore Fitbit One accelerometers and received behavioral coaching to increase nonexercise physical activity. RESULTS There was a larger increase in fitness in the AERO-PA group (0.27 L·min-1; confidence interval (CI), 0.16 to 0.40 L·min-1) compared with the AERO group (0.09 L·min-1; CI, -0.04 to 0.22 L·min-1) and the CON group (0.01; CI, -0.11 to 0.12 L·min-1). Although significant findings were not observed in the entire study sample, when the analysis was restricted to participants compliant to the intervention (n = 33), we observed significant reductions in waist circumference, percent weight loss, body fat, 2-h glucose, and 2-h insulin in comparison to the CON group (P < 0.05), but not the AERO group. Furthermore, linear regression models showed that change in steps was associated with 21% and 26% of the variation in percent weight loss and percent fat loss, respectively. CONCLUSIONS Increasing nonexercise physical activity with aerobic training may represent a viable strategy to augment the fitness response in comparison to aerobic training alone and has promise for other health indicators.
Published: 2021

48. SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: a large, multicentre, prospective cohort study (SIREN)

Author: Victoria Jane Hall, Sarah Foulkes, Andre Charlett, Ana Atti, Edward J M Monk, Ruth Simmons, Edgar Wellington, Michelle J Cole, Ayoub Saei, Blanche Oguti, Katie Munro, Sarah Wallace, Peter D Kirwan, Madhumita Shrotri, Amoolya Vusirikala, Sakib Rokadiya, Meaghan Kall, Maria Zambon, Mary Ramsay, Tim Brooks, Colin S Brown, Meera A Chand, Susan Hopkins, N Andrews, A Atti, H Aziz, T Brooks, CS Brown, D Camero, C Carr, MA Chand, A Charlett, H Crawford, M Cole, J Conneely, S D'Arcangelo, J Ellis, S Evans, S Foulkes, N Gillson, R Gopal, L Hall, VJ Hall, P Harrington, S Hopkins, J Hewson, K Hoschler, D Ironmonger, J Islam, M Kall, I Karagiannis, O Kay, J Khawam, E King, P Kirwan, R Kyffin, A Lackenby, M Lattimore, E Linley, J Lopez-Bernal, L Mabey, R McGregor, S Miah, EJM Monk, K Munro, Z Naheed, A Nissr, AM O'Connell, B Oguti, H Okafor, S Organ, J Osbourne, A Otter, M Patel, S Platt, D Pople, K Potts, M Ramsay, J Robotham, S Rokadiya, C Rowe, A Saei, G Sebbage, A Semper, M Shrotri, R Simmons, A Soriano, P Staves, S Taylor, A Taylor, A Tengbe, S Tonge, A Vusirikala, S Wallace, E Wellington, M Zambon, D Corrigan, M Sartaj, L Cromey, S Campbell, K Braithwaite, L Price, L Haahr, S Stewart, ED Lacey, L Partridge, G Stevens, Y Ellis, H Hodgson, C Norman, B Larru, S Mcwilliam, S Winchester, P Cieciwa, A Pai, C Loughrey, A Watt, F Adair, A Hawkins, A Grant, R Temple-Purcell, J Howard, N Slawson, C Subudhi, S Davies, A Bexley, R Penn, N Wong, G Boyd, A Rajgopal, A Arenas-Pinto, R Matthews, A Whileman, R Laugharne, J Ledger, T Barnes, C Jones, D Botes, N Chitalia, S Akhtar, G Harrison, S Horne, N Walker, K Agwuh, V Maxwell, J Graves, S Williams, A O'Kelly, P Ridley, A Cowley, H Johnstone, P Swift, J Democratis, M Meda, C Callens, S Beazer, S Hams, V Irvine, B Chandrasekaran, C Forsyth, J Radmore, C Thomas, K Brown, S Roberts, P Burns, K Gajee, TM Byrne, F Sanderson, S Knight, E Macnaughton, BJL Burton, H Smith, R Chaudhuri, K Hollinshead, RJ Shorten, A Swan, C Favager, J Murira, S Baillon, S Hamer, K Gantert, J Russell, D Brennan, A Dave, A Chawla, F Westell, D Adeboyeku, P Papineni, C Pegg, M Williams, S Ahmad, S Ingram, C Gabriel, K Pagget, G Maloney, J Ashcroft, I Del Rosario, R Crosby-Nwaobi, C Reeks, S Fowler, L Prentice, M Spears, G McKerron, K McLelland-Brooks, J Anderson, S Donaldson, K Templeton, L Coke, N Elumogo, J Elliott, D Padgett, M Mirfenderesky, A Cross, J Price, S Joyce, I Sinanovic, M Howard, T Lewis, P Cowling, D Potoczna, S Brand, L Sheridan, B Wadams, A Lloyd, J Mouland, J Giles, G Pottinger, H Coles, M Joseph, M Lee, S Orr, H Chenoweth, C Auckland, R Lear, T Mahungu, A Rodger, K Penny-Thomas, S Pai, J Zamikula, E Smith, S Stone, E Boldock, D Howcroft, C Thompson, M Aga, P Domingos, S Gormley, C Kerrison, L Marsh, S Tazzyman, L Allsop, S Ambalkar, M Beekes, S Jose, J Tomlinson, A Jones, C Price, J Pepperell, M Schultz, J Day, A Boulos, E Defever, D McCracken, K Gray, A Houston, T Planche, R Pritchard Jones, Diane Wycherley, S Bennett, J Marrs, K Nimako, B Stewart, N Kalakonda, S Khanduri, A Ashby, M Holden, N Mahabir, J Harwood, B Payne, K Court, N Staines, R Longfellow, ME Green, LE Hughes, M Halkes, P Mercer, A Roebuck, E Wilson-Davies, L Gallego, R Lazarus, N Aldridge, L Berry, F Game, T Reynolds, C Holmes, M Wiselka, A Higham, M Booth, C Duff, J Alderton, H Jory, E Virgilio, T Chin, MZ Qazzafi, AM Moody, R Tilley, T Donaghy, K Shipman, R Sierra, N Jones, G Mills, D Harvey, YWJ Huang, J Birch, L Robinson, S Board, A Broadley, C Laven, N Todd, DW Eyre, K Jeffery, S Dunachie, C Duncan, P Klenerman, L Turtle, T De Silva, H Baxendale, JL Heeney, Group, SIREN Study, Dunachie, SJ, Kirwan, Peter [0000-0001-6904-0500], and Apollo - University of Cambridge Repository
Subjects: Adult, Male, medicine.medical_specialty, Health Personnel, 030204 cardiovascular system & hematology, Antibodies, Viral, Lower risk, Asymptomatic, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Pandemic, Health care, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Asymptomatic Infections, Pandemics, SARS-CoV-2, business.industry, Incidence (epidemiology), Public health, COVID-19, Articles, General Medicine, Middle Aged, England, COVID-19 Nucleic Acid Testing, Reinfection, Cohort, Female, medicine.symptom, business, Follow-Up Studies
Abstract: Background Increased understanding of whether individuals who have recovered from COVID-19 are protected from future SARS-CoV-2 infection is an urgent requirement. We aimed to investigate whether antibodies against SARS-CoV-2 were associated with a decreased risk of symptomatic and asymptomatic reinfection. Methods A large, multicentre, prospective cohort study was done, with participants recruited from publicly funded hospitals in all regions of England. All health-care workers, support staff, and administrative staff working at hospitals who could remain engaged in follow-up for 12 months were eligible to join The SARS-CoV-2 Immunity and Reinfection Evaluation study. Participants were excluded if they had no PCR tests after enrolment, enrolled after Dec 31, 2020, or had insufficient PCR and antibody data for cohort assignment. Participants attended regular SARS-CoV-2 PCR and antibody testing (every 2–4 weeks) and completed questionnaires every 2 weeks on symptoms and exposures. At enrolment, participants were assigned to either the positive cohort (antibody positive, or previous positive PCR or antibody test) or negative cohort (antibody negative, no previous positive PCR or antibody test). The primary outcome was a reinfection in the positive cohort or a primary infection in the negative cohort, determined by PCR tests. Potential reinfections were clinically reviewed and classified according to case definitions (confirmed, probable, or possible) and symptom-status, depending on the hierarchy of evidence. Primary infections in the negative cohort were defined as a first positive PCR test and seroconversions were excluded when not associated with a positive PCR test. A proportional hazards frailty model using a Poisson distribution was used to estimate incidence rate ratios (IRR) to compare infection rates in the two cohorts. Findings From June 18, 2020, to Dec 31, 2020, 30 625 participants were enrolled into the study. 51 participants withdrew from the study, 4913 were excluded, and 25 661 participants (with linked data on antibody and PCR testing) were included in the analysis. Data were extracted from all sources on Feb 5, 2021, and include data up to and including Jan 11, 2021. 155 infections were detected in the baseline positive cohort of 8278 participants, collectively contributing 2 047 113 person-days of follow-up. This compares with 1704 new PCR positive infections in the negative cohort of 17 383 participants, contributing 2 971 436 person-days of follow-up. The incidence density was 7·6 reinfections per 100 000 person-days in the positive cohort, compared with 57·3 primary infections per 100 000 person-days in the negative cohort, between June, 2020, and January, 2021. The adjusted IRR was 0·159 for all reinfections (95% CI 0·13–0·19) compared with PCR-confirmed primary infections. The median interval between primary infection and reinfection was more than 200 days. Interpretation A previous history of SARS-CoV-2 infection was associated with an 84% lower risk of infection, with median protective effect observed 7 months following primary infection. This time period is the minimum probable effect because seroconversions were not included. This study shows that previous infection with SARS-CoV-2 induces effective immunity to future infections in most individuals. Funding Department of Health and Social Care of the UK Government, Public Health England, The National Institute for Health Research, with contributions from the Scottish, Welsh and Northern Irish governments.
Published: 2021

49. The prevalence of burnout, risk factors, and job‐related stressors in gastroenterologists: A systematic review

Author: Yock Young Dan, John Ong, Sharon Ong, Carla Swift, Arun Shankar, Michael F. Bath, Yasseen Al-Naeeb, and Wan Yen Lim
Subjects: medicine.medical_specialty, Scopus, PsycINFO, Burnout, Occupational safety and health, Occupational Stress, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Forest plot, Prevalence, medicine, Humans, Emotional exhaustion, Burnout, Professional, Hepatology, business.industry, Gastroenterologists, Stressor, Gastroenterology, 030220 oncology & carcinogenesis, Family medicine, Anxiety, 030211 gastroenterology & hepatology, medicine.symptom, business
Abstract: Background and aimsClinician burnout is an important occupational hazard and the scale of the problem within gastroenterology remains poorly understood. The primary objective of this study was to identify the prevalence of burnout and its symptoms in gastroenterologists. The secondary objective was to identify risk factors and job-related stressors that commonly contribute to burnout in gastroenterologists.MethodsSystematic searches were conducted in PubMed, Scopus, Cochrane and PsycINFO by two reviewers independently for articles published to 1 September 2020. The primary outcome measure was the reported prevalence of burnout in gastroenterologists. The secondary outcome measures were (i) the prevalence of burnout symptoms (emotional exhaustion, depersonalisation and low personal accomplishment) and (ii) the frequency of risk factors and stressors reported in studies. Data were tabulated and meta-analyses were presented as Funnel and Forest plots.ResultsData were extracted from 11 studies. 54.5% (6/11) of these studies reported the prevalence of burnout in gastroenterologists; this ranged from 18.3% to 64.4%. Similar to burnout prevalence, burnout symptoms showed geographical variation and were common in gastroenterologists (up to 63.9%). Factors associated with work volume, age, and female gender were the three most frequently reported risk factors for increased levels of anxiety, stress or burnout in 72.7% (8/11), 54.5% (6/11), and 45.5% (5/11) of studies respectively. Significant methodological and clinical heterogeneity was observed.ConclusionsBurnout and its symptoms are common in gastroenterologists but the syndrome is understudied within the field. Further research and good quality data are needed to help address the problem.Disclose StatementJO is funded by the British Society of Gastroenterology to conduct burnout research in the UK, and the Journal of Gastroenterology and Hepatology Foundation (Australia) to conduct burnout research in Southeast Asia.
Published: 2021

50. Impact of the Coronavirus Disease 2019 (COVID-19) Vaccine on Asymptomatic Infection Among Patients Undergoing Preprocedural COVID-19 Molecular Screening

Author: Benjamin D. Pollock, Aaron J. Tande, Elie F. Berbari, Abinash Virk, Matthew J. Binnicker, Nilay Shah, Melanie D. Swift, Laura E. Breeher, and Gianrico Farrugia
Subjects: Microbiology (medical), Emergency Use Authorization, medicine.medical_specialty, Molecular screening, Coronavirus disease 2019 (COVID-19), business.industry, Retrospective cohort study, 030204 cardiovascular system & hematology, Asymptomatic, law.invention, Vaccination, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Randomized controlled trial, law, Internal medicine, Relative risk, medicine, 030212 general & internal medicine, medicine.symptom, business
Abstract: Background Several vaccines are now available under emergency use authorization in the United States and have demonstrated efficacy against symptomatic COVID-19. Vaccine impact on asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is largely unknown. Methods We conducted a retrospective cohort study of consecutive, asymptomatic adult patients (n = 39 156) within a large US healthcare system who underwent 48 333 preprocedural SARS-CoV-2 molecular screening tests between 17 December 2020 and 8 February 2021. The primary exposure of interest was vaccination with ≥1 dose of an mRNA COVID-19 vaccine. The primary outcome was relative risk (RR) of a positive SARS-CoV-2 molecular test among those asymptomatic persons who had received ≥1 dose of vaccine compared with persons who had not received vaccine during the same time period. RR was adjusted for age, sex, race/ethnicity, patient residence relative to the hospital (local vs nonlocal), healthcare system regions, and repeated screenings among patients using mixed-effects log-binomial regression. Results Positive molecular tests in asymptomatic individuals were reported in 42 (1.4%) of 3006 tests and 1436 (3.2%) of 45 327 tests performed on vaccinated and unvaccinated patients, respectively (RR, .44; 95% CI, .33–.60; P 10 days after the first dose (RR, .21; 95% CI, .12–.37; P 0 days after the second dose (RR, .20; 95% CI, .09–.44; P Conclusions COVID-19 vaccination with an mRNA-based vaccine showed a significant association with reduced risk of asymptomatic SARS-CoV-2 infection as measured during preprocedural molecular screening. Results of this study demonstrate the impact of the vaccines on reduction in asymptomatic infections supplementing the randomized trial results on symptomatic patients.
Published: 2021

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