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1. Thrombectomy for anterior circulation stroke beyond 6 h from time last known well (AURORA): a systematic review and individual patient data meta-analysis

Author

Scott C. Brown, J Mocco, Santiago Ortega-Gutierrez, David S Liebeskind, Ashutosh P Jadhav, Mayank Goyal, Diogo C Haussen, Tudor G Jovin, Fabricio O Lima, Marc Ribó, Adnan H. Siddiqui, Bijoy K Menon, Ron Budzik, Raul G Nogueira, Michael P. Marks, Sheila Cristina Ouriques Martins, Stephanie Kemp, Vincent Costalat, Andrew M. Demchuk, Xabier Urra, Maarten G Lansberg, Michael D. Hill, Gregory W. Albers, and Jeremy J Heit

Subjects
medicine.medical_specialty, business.industry, Endovascular Procedures, MEDLINE, General Medicine, Odds ratio, Patient data, Postoperative Hemorrhage, Neurovascular bundle, medicine.disease, Time-to-Treatment, Treatment Outcome, Modified Rankin Scale, Patient level data, Internal medicine, Meta-analysis, medicine, Humans, Thrombotic Stroke, business, Stroke, Cerebral Hemorrhage, Randomized Controlled Trials as Topic, Thrombectomy
Abstract

Trials examining the benefit of thrombectomy in anterior circulation proximal large vessel occlusion stroke have enrolled patients considered to have salvageable brain tissue, who were randomly assigned beyond 6 h and (depending on study protocol) up to 24 h from time last seen well. We aimed to estimate the benefit of thrombectomy overall and in prespecified subgroups through individual patient data meta-analysis.We did a systematic review and individual patient data meta-analysis between Jan 1, 2010, and March 1, 2021, of randomised controlled trials of endovascular stroke therapy. In the Analysis Of Pooled Data From Randomized Studies Of Thrombectomy More Than 6 Hours After Last Known Well (AURORA) collaboration, the primary outcome was disability on the modified Rankin Scale (mRS) at 90 days, analysed by ordinal logistic regression. Key safety outcomes were symptomatic intracerebral haemorrhage and mortality within 90 days.Patient level data from 505 individuals (n=266 intervention, n=239 control; mean age 68·6 years [SD 13·7], 259 [51·3%] women) were included from six trials that met inclusion criteria of 17 screened published randomised trials. Primary outcome analysis showed a benefit of thrombectomy with an unadjusted common odds ratio (OR) of 2·42 (95% CI 1·76-3·33; p0·0001) and an adjusted common OR (for age, gender, baseline stroke severity, extent of infarction on baseline head CT, and time from onset to random assignment) of 2·54 (1·83-3·54; p0·0001). Thrombectomy was associated with higher rates of independence in activities of daily living (mRS 0-2) than best medical therapy alone (122 [45·9%] of 266 vs 46 [19·3%] of 238; p0·0001). No significant difference between intervention and control groups was found when analysing either 90-day mortality (44 [16·5%] of 266 vs 46 [19·3%] of 238) or symptomatic intracerebral haemorrhage (14 [5·3%] of 266 vs eight [3·3%] of 239). No heterogeneity of treatment effect was noted across subgroups defined by age, gender, baseline stroke severity, vessel occlusion site, baseline Alberta Stroke Program Early CT Score, and mode of presentation; treatment effect was stronger in patients randomly assigned within 12-24 h (common OR 5·86 [95% CI 3·14-10·94]) than those randomly assigned within 6-12 h (1·76 [1·18-2·62]; pThese findings strengthen the evidence for benefit of endovascular thrombectomy in patients with evidence of reversible cerebral ischaemia across the 6-24 h time window and are relevant to clinical practice. Our findings suggest that in these patients, thrombectomy should not be withheld on the basis of mode of presentation or of the point in time of presentation within the 6-24 h time window.Stryker Neurovascular.

Published
2022

2. Estimating the early impact of the US COVID-19 vaccination programme on COVID-19 cases, emergency department visits, hospital admissions, and deaths among adults aged 65 years and older: an ecological analysis of national surveillance data

Author

Ryan E. Wiegand, Jennifer R. Verani, Michael Sheppard, David H. Walker, Farida B. Ahmad, Jennifer L. Kriss, Kamil E. Barbour, B Casey Lyons, Emma S. Jones, Daniel C. Payne, Deborah L. Dee, Robert N. Anderson, Hannah E. Reses, Lucy A McNamara, Sharoda Dasgupta, Stephanie J. Schrag, Meredith McMorrow, Rachel M Burke, Alison M. Binder, Jennifer Adjemian, Andrea J. Sharma, and Loren Rodgers

Subjects
Male, COVID-19 Vaccines, Surveillance data, Coronavirus disease 2019 (COVID-19), Population, Patient Admission, Humans, Medicine, Mortality, Ecological analysis, education, Aged, Aged, 80 and over, education.field_of_study, business.industry, Incidence, Incidence (epidemiology), Vaccination, Comment, COVID-19, General Medicine, Emergency department, Hospitals, United States, Vaccination coverage, Female, Emergency Service, Hospital, business, Demography
Abstract

Summary Background In the USA, COVID-19 vaccines became available in mid-December, 2020, with adults aged 65 years and older among the first groups prioritised for vaccination. We estimated the national-level impact of the initial phases of the US COVID-19 vaccination programme on COVID-19 cases, emergency department visits, hospital admissions, and deaths among adults aged 65 years and older. Methods We analysed population-based data reported to US federal agencies on COVID-19 cases, emergency department visits, hospital admissions, and deaths among adults aged 50 years and older during the period Nov 1, 2020, to April 10, 2021. We calculated the relative change in incidence among older age groups compared with a younger reference group for pre-vaccination and post-vaccination periods, defined by the week when vaccination coverage in a given age group first exceeded coverage in the reference age group by at least 1%; time lags for immune response and time to outcome were incorporated. We assessed whether the ratio of these relative changes differed when comparing the pre-vaccination and post-vaccination periods. Findings The ratio of relative changes comparing the change in the COVID-19 case incidence ratio over the post-vaccine versus pre-vaccine periods showed relative decreases of 53% (95% CI 50 to 55) and 62% (59 to 64) among adults aged 65 to 74 years and 75 years and older, respectively, compared with those aged 50 to 64 years. We found similar results for emergency department visits with relative decreases of 61% (52 to 68) for adults aged 65 to 74 years and 77% (71 to 78) for those aged 75 years and older compared with adults aged 50 to 64 years. Hospital admissions declined by 39% (29 to 48) among those aged 60 to 69 years, 60% (54 to 66) among those aged 70 to 79 years, and 68% (62 to 73), among those aged 80 years and older, compared with adults aged 50 to 59 years. COVID-19 deaths also declined (by 41%, 95% CI –14 to 69 among adults aged 65–74 years and by 30%, –47 to 66 among those aged ≥75 years, compared with adults aged 50 to 64 years), but the magnitude of the impact of vaccination roll-out on deaths was unclear. Interpretation The initial roll-out of the US COVID-19 vaccination programme was associated with reductions in COVID-19 cases, emergency department visits, and hospital admissions among older adults. Funding None.

Published
2022

3. Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation

Author

Ricardo Cohen, Ildiko Lingvay, Carel W. le Roux, and Priya Sumithran

Subjects
medicine.medical_specialty, Population, MEDLINE, Disease, Type 2 diabetes, Quality of life (healthcare), Risk Factors, Weight loss, Intervention (counseling), Weight Loss, medicine, Humans, Hypoglycemic Agents, Obesity, Intensive care medicine, education, education.field_of_study, business.industry, General Medicine, medicine.disease, Obesity Management, Diabetes Mellitus, Type 2, Quality of Life, medicine.symptom, business, Goals
Abstract

Obesity is now recognised as a disease that is associated with serious morbidity and increased mortality. One of its main metabolic complications is type 2 diabetes, as the two conditions share key pathophysiological mechanisms. Weight loss is known to reverse the underlying metabolic abnormalities of type 2 diabetes and, as such, improve glucose control; loss of 15% or more of bodyweight can have a disease-modifying effect in people with type 2 diabetes, an outcome that is not attainable by any other glucose-lowering intervention. Furthermore, weight loss in this population exerts benefits that extend beyond glycaemic control to improve risk factors for cardiometabolic disease and quality of life. We review the evidence supporting the role of weight loss in the management of type 2 diabetes and propose that many patients with type 2 diabetes would benefit from having a primary weight-centric approach to diabetes treatment. We discuss the logistical challenges to implementing a new weight-centric primary treatment goal in people with type 2 diabetes.

Published
2022

4. Hypertrophic cardiomyopathy: a practical approach to guideline directed management

Author

Steve R. Ommen and Christopher Semsarian

Subjects
medicine.medical_specialty, Myosin Heavy Chains, business.industry, Specialty, MEDLINE, Hypertrophic cardiomyopathy, Guidelines as Topic, General Medicine, Guideline, Cardiomyopathy, Hypertrophic, medicine.disease, Echocardiography, Humans, Medicine, Genetic Predisposition to Disease, Carrier Proteins, business, Intensive care medicine, Cardiac Myosins
Abstract

Hypertrophic cardiomyopathy, one of the most common genetic cardiovascular conditions, will be encountered by nearly every health-care provider regardless of specialty. In 2020, new hypertrophic cardiomyopathy management guidelines were published, updating and evolving preceding versions. This Seminar provides a concise review and practical guide to the updated recommendations for patients with hypertrophic cardiomyopathy.

Published
2021

5. Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: an adaptive, single-centre, single-blind, randomised, controlled trial

Author

N. Bryce Robinson, Irbaz Hameed, Mario Gaudino, Marc Gillinov, Tommaso Sanna, Stephen E. Fremes, Mohamed Rahouma, Christopher Lau, Karla V. Ballman, Lisa Q. Rong, Filippo Crea, John D. Puskas, Antonino Di Franco, Palacs Investigators, Katia Audisio, Massimo Massetti, Leonard N. Girardi, Niv Ad, Joanna Chikwe, Giovanni J. Soletti, J. Michael DiMaio, and Pierre Voisine

Subjects
Male, Aortic valve, medicine.medical_specialty, Population, Pericardial effusion, Pericardial Effusion, Postoperative Complications, medicine.artery, Atrial Fibrillation, Ascending aorta, medicine, Humans, Prospective Studies, Cardiac Surgical Procedures, education, Stroke, education.field_of_study, business.industry, Atrial fibrillation, General Medicine, Length of Stay, Middle Aged, medicine.disease, Cardiac surgery, Surgery, Treatment Outcome, medicine.anatomical_structure, Cardiothoracic surgery, Pericardiectomy, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Female, New York City, business
Abstract

Summary Background Atrial fibrillation is the most common complication after cardiac surgery and is associated with extended in-hospital stay and increased adverse outcomes, including death and stroke. Pericardial effusion is common after cardiac surgery and can trigger atrial fibrillation. We tested the hypothesis that posterior left pericardiotomy, a surgical manoeuvre that drains the pericardial space into the left pleural cavity, might reduce the incidence of atrial fibrillation after cardiac surgery. Methods In this adaptive, randomised, controlled trial, we recruited adult patients (aged ≥18 years) undergoing elective interventions on the coronary arteries, aortic valve, or ascending aorta, or a combination of these, performed by members of the Department of Cardiothoracic Surgery from Weill Cornell Medicine at the New York Presbyterian Hospital in New York, NY, USA. Patients were eligible if they had no history of atrial fibrillation or other arrhythmias or contraindications to the experimental intervention. Eligible patients were randomly assigned (1:1), stratified by CHA2DS2-VASc score and using a mixed-block randomisation approach (block sizes of 4, 6, and 8), to posterior left pericardiotomy or no intervention. Patients and assessors were blinded to treatment assignment. Patients were followed up until 30 days after hospital discharge. The primary outcome was the incidence of atrial fibrillation during postoperative in-hospital stay, which was assessed in the intention-to-treat (ITT) population. Safety was assessed in the as-treated population. This study is registered with ClinicalTrials.gov, NCT02875405, and is now complete. Findings Between Sept 18, 2017, and Aug 2, 2021, 3601 patients were screened and 420 were included and randomly assigned to the posterior left pericardiotomy group (n=212) or the no intervention group (n=208; ITT population). The median age was 61·0 years (IQR 53·0–70·0), 102 (24%) patients were female, and 318 (76%) were male, with a median CHA2DS2-VASc score of 2·0 (IQR 1·0–3·0). The two groups were balanced with respect to clinical and surgical characteristics. No patients were lost to follow-up and data completeness was 100%. Three patients in the posterior left pericardiotomy group did not receive the intervention. In the ITT population, the incidence of postoperative atrial fibrillation was significantly lower in the posterior left pericardiotomy group than in the no intervention group (37 [17%] of 212 vs 66 [32%] of 208 [p=0·0007]; odds ratio adjusted for the stratification variable 0·44 [95% CI 0·27–0·70; p=0·0005]). Two (1%) of 209 patients in the posterior left pericardiotomy group and one ( Interpretation Posterior left pericardiotomy is highly effective in reducing the incidence of atrial fibrillation after surgery on the coronary arteries, aortic valve, or ascending aorta, or a combination of these without additional risk of postoperative complications. Funding None

Published
2021

6. Chronic myeloid leukaemia

Author

Carolina Pavlovsky, Jorge E. Cortes, and Susanne Saußele

Subjects
medicine.medical_specialty, business.industry, Psychological intervention, MEDLINE, Antineoplastic Agents, General Medicine, Treatment goals, Disease, Chronic myeloid leukaemia, Progression-Free Survival, Natural history, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, Life expectancy, Humans, Medicine, Adverse effect, business, Intensive care medicine, Protein Kinase Inhibitors, Bone Marrow Transplantation
Abstract

Tyrosine-kinase inhibitors have changed the natural history of chronic myeloid leukaemia in such a way that patients with adequate access to these agents, who are properly managed, and who respond well to this treatment can expect a near-normal life expectancy. Achieving this goal requires an adequate understanding of the patient's treatment goals, careful monitoring for the achievement of optimal response hallmarks, implementation of proper interventions according to the attainment of such endpoints, adequate recognition and management of adverse events, and acknowledgment of the relevance of comorbidities. Treatment with tyrosine-kinase inhibitors, once considered lifelong, has become terminable for at least some patients, and promising new agents are emerging for those whose disease does not respond to any of the multiple therapeutic options currently available. If these advances reach all patients with chronic myeloid leukaemia, cure might eventually become a reality in most instances.

Published
2021

7. The Lancet and Financial Times Commission on governing health futures 2030: growing up in a digital world

Author

Nanjira Sambuli, Louise Holly, Ran D. Balicer, Soumya Swaminathan, Lan Xue, Emanuele Capobianco, Andrzej Ryś, Miranda Wolpert, Aferdita Bytyqi, Olivia Banner, Enow Awah Georges Stevens, Anurag Agrawal, Dario Piselli, Jeanette Vega Morales, Michael Adelhardt, Christian Franz, Lipsa Panda, Ilona Kickbusch, Andrew Wyckoff, Dykki Settle, Robert D. Smith, Whitney Gray, Njide Ndili, Christopher Fabian, Micaela Neumann, Brian Li Han Wong, Deborah Lupton, Rohinton P. Medhora, and Amandeep Singh Gill

Subjects
Digital Technology, business.industry, Climate Change, Health Policy, Biomedical Technology, MEDLINE, COVID-19, Accounting, Disruptive Technology, General Medicine, Commission, Global Health, Political science, Humans, business, Futures contract, Forecasting
Published
2021

8. Non-pharmaceutical interventions, vaccination, and the SARS-CoV-2 delta variant in England: a mathematical modelling study

Author

Neil M. Ferguson, Divya Thekke Kanapram, Pablo N Perez-Guzman, Katy A. M. Gaythorpe, Marc Baguelin, Raphael Sonabend, Thomas Rawson, Edward Knock, Azra C. Ghani, Natsuko Imai, Bimandra A Djaafara, Wes Hinsley, Richard G. FitzJohn, Anne Cori, Lilith K Whittles, John A. Lees, Erik M. Volz, Medical Research Council (MRC), National Institute for Health Research, International Society for Infectious Diseases, and Medical Research Council

Subjects
Delta, Government, Science & Technology, business.industry, Psychological intervention, General Medicine, SCOTLAND, Herd immunity, law.invention, Vaccination, Medicine, General & Internal, Transmission (mechanics), law, General & Internal Medicine, Pandemic, Credible interval, Medicine, business, Life Sciences & Biomedicine, 11 Medical and Health Sciences, Demography
Abstract

Summary Background England's COVID-19 roadmap out of lockdown policy set out the timeline and conditions for the stepwise lifting of non-pharmaceutical interventions (NPIs) as vaccination roll-out continued, with step one starting on March 8, 2021. In this study, we assess the roadmap, the impact of the delta (B.1.617.2) variant of SARS-CoV-2, and potential future epidemic trajectories. Methods This mathematical modelling study was done to assess the UK Government's four-step process to easing lockdown restrictions in England, UK. We extended a previously described model of SARS-CoV-2 transmission to incorporate vaccination and multi-strain dynamics to explicitly capture the emergence of the delta variant. We calibrated the model to English surveillance data, including hospital admissions, hospital occupancy, seroprevalence data, and population-level PCR testing data using a Bayesian evidence synthesis framework, then modelled the potential trajectory of the epidemic for a range of different schedules for relaxing NPIs. We estimated the resulting number of daily infections and hospital admissions, and daily and cumulative deaths. Three scenarios spanning a range of optimistic to pessimistic vaccine effectiveness, waning natural immunity, and cross-protection from previous infections were investigated. We also considered three levels of mixing after the lifting of restrictions. Findings The roadmap policy was successful in offsetting the increased transmission resulting from lifting NPIs starting on March 8, 2021, with increasing population immunity through vaccination. However, because of the emergence of the delta variant, with an estimated transmission advantage of 76% (95% credible interval [95% CrI] 69–83) over alpha, fully lifting NPIs on June 21, 2021, as originally planned might have led to 3900 (95% CrI 1500–5700) peak daily hospital admissions under our central parameter scenario. Delaying until July 19, 2021, reduced peak hospital admissions by three fold to 1400 (95% CrI 700–1700) per day. There was substantial uncertainty in the epidemic trajectory, with particular sensitivity to the transmissibility of delta, level of mixing, and estimates of vaccine effectiveness. Interpretation Our findings show that the risk of a large wave of COVID-19 hospital admissions resulting from lifting NPIs can be substantially mitigated if the timing of NPI relaxation is carefully balanced against vaccination coverage. However, with the delta variant, it might not be possible to fully lift NPIs without a third wave of hospital admissions and deaths, even if vaccination coverage is high. Variants of concern, their transmissibility, vaccine uptake, and vaccine effectiveness must be carefully monitored as countries relax pandemic control measures. Funding National Institute for Health Research, UK Medical Research Council, Wellcome Trust, and UK Foreign, Commonwealth and Development Office.

Published
2021

9. Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study

Author

Jane Hawdon, Jennifer Jardine, Tina Harris, Ipek Gurol-Urganci, Asma Khalil, Jan van der Meulen, Kate Walker, Kirstin Webster, and Patrick Muller

Subjects
inequality, Inequality, media_common.quotation_subject, socioeconomic deprivation, Ethnic group, Body Mass Index, fetal growth restriction, Cohort Studies, Pregnancy, medicine, Humans, Social determinants of health, Socioeconomic status, Minority Groups, media_common, Fetal Growth Retardation, Singleton, business.industry, Smoking, Pregnancy Outcome, preterm birth, General Medicine, Stillbirth, medicine.disease, England, Socioeconomic Factors, ethnicity, Premature Birth, Gestation, stillbirth, Female, business, Demography, Cohort study
Abstract

Socioeconomic deprivation and minority ethnic background are risk factors for adverse pregnancy outcomes. We aimed to quantify the magnitude of these socioeconomic and ethnic inequalities at the population level in England.In this cohort study, we used data compiled by the National Maternity and Perinatal Audit, based on birth records from maternity information systems used by 132 National Health Service hospitals in England, linked to administrative hospital data. We included women who gave birth to a singleton baby with a recorded gestation between 24 and 42 completed weeks. Terminations of pregnancy were excluded. We analysed data on stillbirth, preterm birth (37 weeks of gestation), and fetal growth restriction (FGR; liveborn with birthweight3rd centile by the UK definition) in England, and compared these outcomes by socioeconomic deprivation quintile and ethnic group. We calculated attributable fractions for the entire population and specific groups compared with least deprived groups or White women, both unadjusted and with adjustment for smoking, body-mass index (BMI), and other maternal risk factors.We identified 1 233 184 women with a singleton birth between April 1, 2015, and March 31, 2017, of whom 1 155 981 women were eligible and included in the analysis. 4505 (0·4%) of 1 155 981 births were stillbirths. Of 1 151 476 livebirths, 69 175 (6·0%) were preterm births and 22 679 (2·0%) were births with FGR. Risk of stillbirth was 0·3% in the least socioeconomically deprived group and 0·5% in the most deprived group (p0·0001), risk of a preterm birth was 4·9% in the least deprived group and 7·2% in the most deprived group (p0·0001), and risk of FGR was 1·2% in the least deprived group and 2·2% in the most deprived group (p0·0001). Population attributable fractions indicated that 23·6% (95% CI 16·7-29·8) of stillbirths, 18·5% (16·9-20·2) of preterm births, and 31·1% (28·3-33·8) of births with FGR could be attributed to socioeconomic inequality, and these fractions were substantially reduced when adjusted for ethnic group, smoking, and BMI (11·6% for stillbirths, 11·9% for preterm births, and 16·4% for births with FGR). Risk of stillbirth ranged from 0·3% in White women to 0·7% in Black women (p0·0001); risk of preterm birth was 6·0% in White women, 6·5% in South Asian women, and 6·6% in Black women (p0·0001); and risk of FGR ranged from 1·4% in White women to 3·5% in South Asian women (p0·0001). 11·7% of stillbirths (95% CI 9·8-13·5), 1·2% of preterm births (0·8-1·6), and 16·9% of FGR (16·1-17·8) could be attributed to ethnic inequality. Adjustment for socioeconomic deprivation, smoking, and BMI only had a small effect on these ethnic group attributable fractions (13·0% for stillbirths, 2·6% for preterm births, and 19·2% for births with FGR). Group-specific attributable fractions were especially high in the most socioeconomically deprived South Asian women and Black women for stillbirth (53·5% in South Asian women and 63·7% in Black women) and FGR (71·7% in South Asian women and 55·0% in Black women).Our results indicate that socioeconomic and ethnic inequalities were responsible for a substantial proportion of stillbirths, preterm births, and births with FGR in England. The largest inequalities were seen in Black and South Asian women in the most socioeconomically deprived quintile. Prevention should target the entire population as well as specific minority ethnic groups at high risk of adverse pregnancy outcomes, to address risk factors and wider determinants of health.Healthcare Quality Improvement Partnership.

Published
2021

10. A century past the discovery of insulin: global progress and challenges for type 1 diabetes among children and adolescents in low-income and middle-income countries

Author

Zulfiqar A Bhutta, Jean Claude Mbanya, Tanya Narang, George Alleyne, Laura Lewis-Watts, Rehana A Salam, and Apoorva Gomber

Subjects
Adolescent, Developing country, Disease, History, 21st Century, Global Burden of Disease, Life Expectancy, Universal Health Insurance, Development economics, Pandemic, medicine, Humans, Hypoglycemic Agents, Insulin, Disease management (health), Child, Human resources, Developing Countries, Type 1 diabetes, Community engagement, business.industry, Disease Management, General Medicine, History, 20th Century, medicine.disease, Diabetes Mellitus, Type 1, Child, Preschool, Life expectancy, business
Abstract

Type 1 diabetes is on the rise globally; however, the burden of mortality remains disproportionate in low-income and middle-income countries (LMICs). As 2021 marks 100 years since the discovery of insulin, we revisit progress, global burden of type 1 diabetes trends, and understanding of the pathogenesis and management practices related to the disease. Despite much progress, inequities in access and availability of insulin formulations persist and are reflected in differences in survival and morbidity patterns related to the disease. Some of these inequities have also been exacerbated by health-system challenges during the COVID-19 pandemic. There is a clear opportunity to improve access to insulin and related essential technologies for improved management of type 1 diabetes in LMICs, especially as a part of universal health coverage. These improvements will require concerted action and investments in human resources, community engagement, and education for the timely diagnosis and management of type 1 diabetes, as well as adequate health-care financing. Further research in LMICs, especially those in Africa, is needed to improve our understanding of the burden, risk factors, and implementation strategies for managing type 1 diabetes.

Published
2021

11. Management of disease-related malnutrition for patients being treated in hospital

Author

Philipp Schuetz, Filomena Gomes, Zeno Stanga, Nina Kaegi-Braun, Dileep N. Lobo, and David S. Seres

Subjects
Adult, medicine.medical_specialty, Adult patients, business.industry, Disease related malnutrition, Malnutrition, MEDLINE, General Medicine, medicine.disease, Hospitalization, Nutrition Assessment, Intervention (counseling), Humans, Multimodal treatment, Medicine, Nutrition Therapy, Medical nutrition therapy, business, Cost of care, Intensive care medicine
Abstract

Disease-related malnutrition in adult patients who have been admitted to hospital is a syndrome associated with substantially increased morbidity, disability, short-term and long-term mortality, impaired recovery from illness, and cost of care. There is uncertainty regarding optimal diagnostic criteria, definitions for malnutrition, and how to identify patients who would benefit from nutritional intervention. Malnutrition has become the focus of research aimed at translating current knowledge of its pathophysiology into improved diagnosis and treatment. Researchers are particularly interested in developing nutritional interventions that reverse the negative effects of disease-related malnutrition in the hospital setting. High-quality randomised trials have provided evidence that nutritional therapy can reduce morbidity and other complications associated with malnutrition in some patients. Screening of patients for risk of malnutrition at hospital admission, followed by nutritional assessment and individualised nutritional interventions for malnourished patients, should become part of routine clinical care and multimodal treatment in hospitals worldwide.

Published
2021

12. Redefining β-blocker response in heart failure patients with sinus rhythm and atrial fibrillation: a machine learning cluster analysis

Author

Simrat Gill, Jinming Duan, Victor Roth Cardoso, Emma Jane Bruce, Andrey D. Barsky, Karina V Bunting, Otilia Tica, Georgios V. Gkoutos, Marcus Flather, Luke T. Slater, Alastair R. Mobley, Saisakul Chernbumroong, Dipak Kotecha, Xiaoxia Wang, John A. Williams, Andrew J.S. Coats, Furqan Aziz, Samantha C. Pendleton, Andreas Karwath, cardAIc group, and The Beta-blockers in Heart Failure Collaborative

Subjects
Heart Failure, medicine.medical_specialty, Ejection fraction, Intention-to-treat analysis, business.industry, Adrenergic beta-Antagonists, Atrial fibrillation, Articles, General Medicine, Odds ratio, medicine.disease, Placebo, Machine Learning, Text mining, Double-Blind Method, Internal medicine, Heart failure, Atrial Fibrillation, Cardiology, Humans, Medicine, Sinus rhythm, business, RC
Abstract

Background:\ud Mortality remains unacceptably high in patients with heart failure and reduced left ventricular ejection fraction (LVEF) despite advances in therapeutics. We hypothesised that a novel artificial intelligence approach could better assess multiple and higher-dimension interactions of comorbidities, and define clusters of β-blocker efficacy in patients with sinus rhythm and atrial fibrillation.\ud Methods:\ud Neural network-based variational autoencoders and hierarchical clustering were applied to pooled individual patient data from nine double-blind, randomised, placebo-controlled trials of β blockers. All-cause mortality during median 1·3 years of follow-up was assessed by intention to treat, stratified by electrocardiographic heart rhythm. The number of clusters and dimensions was determined objectively, with results validated using a leave-one-trial-out approach. This study was prospectively registered with ClinicalTrials.gov (NCT00832442) and the PROSPERO database of systematic reviews (CRD42014010012).\ud Findings:\ud 15 659 patients with heart failure and LVEF of less than 50% were included, with median age 65 years (IQR 56–72) and LVEF 27% (IQR 21–33). 3708 (24%) patients were women. In sinus rhythm (n=12 822), most clusters demonstrated a consistent overall mortality benefit from β blockers, with odds ratios (ORs) ranging from 0·54 to 0·74. One cluster in sinus rhythm of older patients with less severe symptoms showed no significant efficacy (OR 0·86, 95% CI 0·67–1·10; p=0·22). In atrial fibrillation (n=2837), four of five clusters were consistent with the overall neutral effect of β blockers versus placebo (OR 0·92, 0·77–1·10; p=0·37). One cluster of younger atrial fibrillation patients at lower mortality risk but similar LVEF to average had a statistically significant reduction in mortality with β blockers (OR 0·57, 0·35–0·93; p=0·023). The robustness and consistency of clustering was confirmed for all models (p

Published
2021

13. Cardiopulmonary resuscitation in special circumstances

Author

Michael Parr, Theresa M. Olasveengen, Peter Paal, Lance B Becker, Jasmeet Soar, Katherine Berg, Qingbian Ma, and Sharon Einav

Subjects
medicine.medical_specialty, Resuscitation, Defibrillation, medicine.medical_treatment, Pregnancy Complications, Cardiovascular, Electric Countershock, Hypothermia, Return of spontaneous circulation, Asphyxia, Postoperative Complications, Pregnancy, medicine, Humans, Cardiopulmonary resuscitation, Intraoperative Complications, Intensive care medicine, Anaphylaxis, Personal Protective Equipment, SARS-CoV-2, business.industry, COVID-19, General Medicine, medicine.disease, Cardiopulmonary Resuscitation, Heart Arrest, Pulmonary embolism, Shock (circulatory), Practice Guidelines as Topic, cardiovascular system, Wounds and Injuries, Female, Return of Spontaneous Circulation, medicine.symptom, Pulmonary Embolism, business, Out-of-Hospital Cardiac Arrest
Abstract

Cardiopulmonary resuscitation prioritises treatment for cardiac arrests from a primary cardiac cause, which make up the majority of treated cardiac arrests. Early chest compressions and, when indicated, a defibrillation shock from a bystander give the best chance of survival with a good neurological status. Cardiac arrest can also be caused by special circumstances, such as asphyxia, trauma, pulmonary embolism, accidental hypothermia, anaphylaxis, or COVID-19, and during pregnancy or perioperatively. Cardiac arrests in these circumstances represent an increasing proportion of all treated cardiac arrests, often have a preventable cause, and require additional interventions to correct a reversible cause during resuscitation. The evidence for treating these conditions is mostly of low or very low certainty and further studies are needed. Irrespective of the cause, treatments for cardiac arrest are time sensitive and most effective when given early-every minute counts.

Published
2021

14. Considerations in boosting COVID-19 vaccine immune responses

Author

Narendra K. Arora, Ira M. Longini, J. Peter Figueroa, Michael J. Ryan, Hongchao Pan, Alejandro Cravioto, Julian P T Higgins, Marion Gruber, Ana-Maria Henao-Restrepo, Fatema Kazi, Philip R. Krause, Soumya Swaminathan, Helen Rees, Jonathan A C Sterne, Richard Peto, Thomas R. Fleming, Isabelle Boutron, and Rogerio Gaspar

Subjects
2019-20 coronavirus outbreak, COVID-19 Vaccines, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Evidence-Based Medicine/methods, Immunization, Secondary, SARS-CoV-2/immunology, Viewpoint, Immunogenicity, Vaccine, Immune system, Immunity, Humans, Medicine, Pandemics/prevention & control, Pandemics, COVID-19/epidemiology, COVID-19 Vaccines/administration & dosage, Randomized Controlled Trials as Topic, Boosting (doping), Evidence-Based Medicine, SARS-CoV-2, business.industry, Immunogenicity, COVID-19, General Medicine, Observational Studies as Topic, Treatment Outcome, Immunization, Immunology, Immunization, Secondary/methods, business
Published
2021

15. Unguided de-escalation from ticagrelor to clopidogrel in stabilised patients with acute myocardial infarction undergoing percutaneous coronary intervention (TALOS-AMI): an investigator-initiated, open-label, multicentre, non-inferiority, randomised trial

Author

Chan Joon Kim, Mahn-Won Park, Min Chul Kim, Eun-Ho Choo, Byung-Hee Hwang, Kwan Yong Lee, Yun Seok Choi, Hee-Yeol Kim, Ki-Dong Yoo, Doo-Soo Jeon, Eun-Seok Shin, Young-Hoon Jeong, Ki-Bae Seung, Myung Ho Jeong, Hyeon Woo Yim, Youngkeun Ahn, Kiyuk Chang, Yong-Hoon Jeong, Myung Ho Jeon, Ju-Hyeon Oh, Sang Jin Ha, Ju Yeol Baek, Kyung Tae Jung, Joon-Hyung Doh, Won Kim, Dong-Bin Kim, Kwang Soo Cha, Myeong-Ho Yoon, Seung-Ho Hur, Seung-Hwan Lee, Byung-Ryul Cho, Jong-Seon Park, Jin Shin Koh, Sang-Hyun Kim, Jang Hyun Cho, Byung Joo Shim, Sang Wook Kim, Jae-Sik Jang, Kee-Sik Kim, Won-Yong Shin, and Ki-Chul Sung

Subjects
Male, Ticagrelor, medicine.medical_specialty, medicine.medical_treatment, Population, Myocardial Infarction, Hemorrhage, Percutaneous Coronary Intervention, Internal medicine, Republic of Korea, medicine, Clinical endpoint, Humans, cardiovascular diseases, Myocardial infarction, education, Aged, education.field_of_study, Aspirin, business.industry, Dual Anti-Platelet Therapy, Standard treatment, Percutaneous coronary intervention, General Medicine, Middle Aged, medicine.disease, Clopidogrel, Stroke, Treatment Outcome, Female, business, medicine.drug
Abstract

Summary Background In patients with acute myocardial infarction receiving potent antiplatelet therapy, the bleeding risk remains high during the maintenance phase. We sought data on a uniform unguided de-escalation strategy of dual antiplatelet therapy (DAPT) from ticagrelor to clopidogrel after acute myocardial infarction. Methods In this open-label, assessor-masked, multicentre, non-inferiority, randomised trial (TALOS-AMI), patients at 32 institutes in South Korea with acute myocardial infarction receiving aspirin and ticagrelor without major ischaemic or bleeding events during the first month after index percutaneous coronary intervention (PCI) were randomly assigned in a 1:1 ratio to a de-escalation (clopidogrel plus aspirin) or active control (ticagrelor plus aspirin) group. Unguided de-escalation without a loading dose of clopidogrel was adopted when switching from ticagrelor to clopidogrel. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or bleeding type 2, 3, or 5 according to Bleeding Academic Research Consortium (BARC) criteria from 1 to 12 months. A non-inferiority test was done to assess the safety and efficacy of de-escalation DAPT compared with standard treatment. The hazard ratio (HR) for de-escalation versus active control group in a stratified Cox proportional hazards model was assessed for non-inferiority by means of an HR margin of 1·34, which equates to an absolute difference of 3·0% in the intention-to-treat population and, if significant, a superiority test was done subsequently. To ensure statistical robustness, additional analyses were also done in the per-protocol population. This trial is registered at ClinicalTrials.gov, NCT02018055. Findings From Feb 26, 2014, to Dec 31, 2018, from 2901 patients screened, 2697 patients were randomly assigned: 1349 patients to de-escalation and 1348 to active control groups. At 12 months, the primary endpoints occurred in 59 (4·6%) in the de-escalation group and 104 (8·2%) patients in the active control group (pnon-inferiority Interpretation In stabilised patients with acute myocardial infarction after index PCI, a uniform unguided de-escalation strategy significantly reduced the risk of net clinical events up to 12 months, mainly by reducing the bleeding events. Funding ChongKunDang Pharm, Medtronic, Abbott, and Boston Scientific.

Published
2021

16. Brain injury after cardiac arrest

Author

Clifton W. Callaway, Markus B. Skrifvars, Robert W. Neumar, Kirstie L. Haywood, Gisela Lilja, Kelly N. Sawyer, Gavin D. Perkins, Matthew J. Rowland, Jerry P. Nolan, Department of Diagnostics and Therapeutics, and HUS Emergency Medicine and Services

Subjects
medicine.medical_specialty, Resuscitation, THERAPEUTIC HYPOTHERMIA, Time Factors, medicine.medical_treatment, CARDIOVASCULAR CARE SCIENCE, 030204 cardiovascular system & hematology, Targeted temperature management, 2020 INTERNATIONAL CONSENSUS, 03 medical and health sciences, TARGETED TEMPERATURE MANAGEMENT, 0302 clinical medicine, Quality of life (healthcare), QUALITY-OF-LIFE, Intensive care, Intervention (counseling), SUPPORT, medicine, Humans, Survivors, Cardiopulmonary resuscitation, Intensive care medicine, OUTCOMES, Rehabilitation, business.industry, 030208 emergency & critical care medicine, Sequela, General Medicine, 3126 Surgery, anesthesiology, intensive care, radiology, medicine.disease, Cardiopulmonary Resuscitation, 3. Good health, CARDIOPULMONARY-RESUSCITATION, Brain Injuries, Quality of Life, business, WITHDRAWAL, Out-of-Hospital Cardiac Arrest, RC
Abstract

Publisher Copyright: © 2021 Elsevier Ltd As more people are surviving cardiac arrest, focus needs to shift towards improving neurological outcomes and quality of life in survivors. Brain injury after resuscitation, a common sequela following cardiac arrest, ranges in severity from mild impairment to devastating brain injury and brainstem death. Effective strategies to minimise brain injury after resuscitation include early intervention with cardiopulmonary resuscitation and defibrillation, restoration of normal physiology, and targeted temperature management. It is important to identify people who might have a poor outcome, to enable informed choices about continuation or withdrawal of life-sustaining treatments. Multimodal prediction guidelines seek to avoid premature withdrawal in those who might survive with a good neurological outcome, or prolonging treatment that might result in survival with severe disability. Approximately one in three admitted to intensive care will survive, many of whom will need intensive, tailored rehabilitation after discharge to have the best outcomes.

Published
2021

17. Singapore's health-care system

Author

David B. Matchar, Carolyn S.P. Lam, John Wong, C. C. Tan, and Yoong Kang Zee

Subjects
Economic growth, Population ageing, Aging, Singapore, Capacity Building, Primary Health Care, business.industry, Gross Domestic Product, Capacity building, Subsidy, General Medicine, Gross domestic product, Economic interventionism, Health Care Reform, Public hospital, Health care, Healthcare Financing, Humans, Health care reform, Health Facilities, Health Expenditures, business, Noncommunicable Diseases, Delivery of Health Care
Abstract

Since Singapore became an independent nation in 1965, the development of its health-care system has been underpinned by an emphasis on personal responsibility for health, and active government intervention to ensure access and affordability through targeted subsidies and to reduce unnecessary costs. Singapore is achieving good health outcomes, with a total health expenditure of 4·47% of gross domestic product in 2016. However, the health-care system is contending with increased stress, as reflected in so-called pain points that have led to public concern, including shortages in acute hospital beds and intermediate and long-term care (ILTC) services, and high out-of-pocket payments. The main drivers of these challenges are the rising prevalence of non-communicable diseases and rapid population ageing, limitations in the delivery and organisation of primary care and ILTC, and financial incentives that might inadvertently impede care integration. To address these challenges, Singapore's Ministry of Health implemented a comprehensive set of reforms in 2012 under its Healthcare 2020 Masterplan. These reforms substantially increased the capacity of public hospital beds and ILTC services in the community, expanded subsidies for primary care and long-term care, and introduced a series of financing health-care reforms to strengthen financial protection and coverage. However, it became clear that these measures alone would not address the underlying drivers of system stress in the long term. Instead, the system requires, and is making, much more fundamental changes to its approach. In 2016, the Ministry of Health encapsulated the required shifts in terms of the so-called Three Beyonds-namely, beyond health care to health, beyond hospital to community, and beyond quality to value.

Published
2021

18. Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial

Author

Mark Nelson, John Chalmers, Michael Burke, Bruce Neal, Dan Xu, D. Wynne, Ruth Webster, Peter Hay, Shirley Jansen, Armand Edison, Andrew Black, Mark Bloch, Aravinda Thiagalingam, Graham S Hillis, Angalie E Abraham, Kris Rogers, Tim Usherwood, M. Altman, Markus P. Schlaich, Sinjini Biswas, Emily Atkins, Clara K Chow, Janis M. Nolde, Gemma A. Figtree, Anushka Patel, Harry Klimis, Jay Thakkar, Christopher M. Reid, Andrew E. Ajani, Laurent Billot, Revathy Carnagarin, Anthony Rodgers, and Andrew Hung

Subjects
Male, medicine.medical_specialty, Blood Pressure, THERAPY, law.invention, Medicine, General & Internal, Irbesartan, MEDICATION, Double-Blind Method, Randomized controlled trial, law, General & Internal Medicine, Internal medicine, medicine, Bisoprolol, Humans, Amlodipine, AGENTS, 11 Medical and Health Sciences, Antihypertensive Agents, Science & Technology, business.industry, ANTIHYPERTENSIVE COMBINATION, Indapamide, Australia, ASSOCIATION, QUARTET Investigators, General Medicine, Middle Aged, Treatment Outcome, Blood pressure, Tolerability, Pill, Hypertension, PATTERNS, Drug Therapy, Combination, Female, business, Life Sciences & Biomedicine, medicine.drug
Abstract

Treatment inertia is a recognised barrier to blood pressure control, and simpler, more effective treatment strategies are needed. We hypothesised that a hypertension management strategy starting with a single pill containing ultra-low-dose quadruple combination therapy would be more effective than a strategy of starting with monotherapy.QUARTET was a multicentre, double-blind, parallel-group, randomised, phase 3 trial among Australian adults (≥18 years) with hypertension, who were untreated or receiving monotherapy. Participants were randomly assigned to either treatment, that started with the quadpill (containing irbesartan at 37·5 mg, amlodipine at 1·25 mg, indapamide at 0·625 mg, and bisoprolol at 2·5 mg) or an indistinguishable monotherapy control (irbesartan 150 mg). If blood pressure was not at target, additional medications could be added in both groups, starting with amlodipine at 5 mg. Participants were randomly assigned using an online central randomisation service. There was a 1:1 allocation, stratified by site. Allocation was masked to all participants and study team members (including investigators and those assessing outcomes) except the manufacturer of the investigational product and one unmasked statistician. The primary outcome was difference in unattended office systolic blood pressure at 12 weeks. Secondary outcomes included blood pressure control (standard office blood pressure140/90 mm Hg), safety, and tolerability. A subgroup continued randomly assigned allocation to 12 months to assess long-term effects. Analyses were per intention to treat. This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry, ACTRN12616001144404, and is now complete.From June 8, 2017, to Aug 31, 2020, 591 participants were recruited, with 743 assessed for eligibility, 152 ineligible or declined, 300 participants randomly assigned to intervention of initial quadpill treatment, and 291 to control of initial standard dose monotherapy treatment. The mean age of the 591 participants was 59 years (SD 12); 356 (60%) were male and 235 (40%) were female; 483 (82%) were White, 70 (12%) were Asian, and 38 (6%) reported as other ethnicity; and baseline mean unattended office blood pressure was 141 mm Hg (SD 13)/85 mm Hg (SD 10). By 12 weeks, 44 (15%) of 300 participants had additional blood pressure medications in the intervention group compared with 115 (40%) of 291 participants in the control group. Systolic blood pressure was lower by 6·9 mm Hg (95% CI 4·9-8·9; p0·0001) and blood pressure control rates were higher in the intervention group (76%) versus control group (58%; relative risk [RR] 1·30, 95% CI 1·15-1·47; p0·0001). There was no difference in adverse event-related treatment withdrawals at 12 weeks (intervention 4·0% vs control 2·4%; p=0·27). Among the 417 patients who continued, uptitration occurred more frequently among control participants than intervention participants (p0·0001). However, at 52 weeks mean unattended systolic blood pressure remained lower by 7·7 mm Hg (95% CI 5·2-10·3) and blood pressure control rates higher in the intervention group (81%) versus control group (62%; RR 1·32, 95% CI 1·16-1·50). In all randomly assigned participants up to 12 weeks, there were seven (3%) serious adverse events in the intervention group and three (1%) serious adverse events in the control group.A strategy with early treatment of a fixed-dose quadruple quarter-dose combination achieved and maintained greater blood pressure lowering compared with the common strategy of starting monotherapy. This trial demonstrated the efficacy, tolerability, and simplicity of a quadpill-based strategy.National Health and Medical Research Council, Australia.

Published
2021

19. Immune checkpoint inhibitors in melanoma

Author

James Larkin, Georgina V. Long, and Matteo S. Carlino

Subjects
Autoimmune disease, biology, business.industry, Melanoma, General Medicine, Disease, medicine.disease, Combined Modality Therapy, Immune system, Cancer research, medicine, Adjuvant therapy, biology.protein, Humans, Immunotherapy, Antibody, Nivolumab, Adverse effect, business, Immune Checkpoint Inhibitors
Abstract

Immune checkpoint inhibitors target the dysfunctional immune system, to induce cancer-cell killing by CD8-positive T cells. Immune checkpoint inhibitors, specifically anti-CTLA4 and anti-PD-1 antibodies, have revolutionised the management of many cancers, particularly advanced melanoma, for which tumour regression and long-term durable cancer control is possible in nearly 50% of patients, compared with less than 10% historically. Despite the absence of adequately powered trial data, combined anti-CTLA4 and anti-PD-1 checkpoint inhibition has the highest 5-year overall survival rate of all therapies in advanced melanoma, and has high activity in melanoma brain metastases. A phase 3 study has shown the addition of an anti-LAG3 antibody to nivolumab improves progression-free survival, but its effect on overall survival and how this combination compares to combined anti-CTLA4 and anti-PD-1 checkpoint inhibition is unknown. At present, there are no highly sensitive and specific biomarkers of response to immune checkpoint inhibitors, and clinical factors, such as volume and sites of disease, serum lactate dehydrogenase, and BRAF mutation status, are used to select initial therapy for patients with advanced melanoma. Immune checkpoint inhibitors can induce autoimmune toxicities by virtue of their mechanism of action. These toxicities, termed immune-related adverse events, occur most frequently with combined anti-CTLA4 and anti-PD-1 checkpoint inhibition; can have a variety of presentations; can affect any organ system (most often the skin, colon, endocrine system, and liver); and appear to mimic classic autoimmune diseases. Immune-related adverse events require prompt recognition and management, which may be different from the autoimmune disease it mimics. Immune checkpoint inhibitors appear to be safe for use in patients with HIV, viral hepatitis, and patients with mild-to-moderate pre-existing autoimmune diseases. Patients with organ transplants can respond to immune checkpoint inhibitors but have a high chance of transplant loss. PD-1 inhibitors are now an established standard of care as adjuvant therapy in high-risk resected stage III or IV melanoma. Neoadjuvant checkpoint inhibition for resectable stage III melanoma, which is currently limited to clinical trials, is emerging as a highly effective therapy.

Published
2021

20. Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial

Author

Greg Ginn, Poornima Sood, JoAnn Lindenfeld, Michael R. Zile, Philip B. Adamson, Douglas A. Horstmanshof, Paige Castaneda, Nessa Johnson, Mandeep R. Mehra, Marcel Zughaib, Jean Kelly, Maria Rosa Costanzo, Akshay S. Desai, Samuel F. Sears, Kunjan Bhatt, S.R. Krim, John Henderson, Frank W. Smart, Anique Ducharme, Sara C. Paul, Andrew J. Sauer, and Alan S. Maisel

Subjects
Male, medicine.medical_specialty, Management of heart failure, Hemodynamics, Pulmonary Artery, law.invention, Randomized controlled trial, law, Internal medicine, medicine.artery, Clinical endpoint, Humans, Medicine, Mortality, Aged, Heart Failure, Ejection fraction, business.industry, Hazard ratio, COVID-19, General Medicine, medicine.disease, Electrodes, Implanted, Hospitalization, Heart failure, Remote Sensing Technology, Pulmonary artery, Cardiology, Female, business
Abstract

Summary Background Previous studies have suggested that haemodynamic-guided management using an implantable pulmonary artery pressure monitor reduces heart failure hospitalisations in patients with moderately symptomatic (New York Heart Association [NYHA] functional class III) chronic heart failure and a hospitalisation in the past year, irrespective of ejection fraction. It is unclear if these benefits extend to patients with mild (NYHA functional class II) or severe (NYHA functional class IV) symptoms of heart failure or to patients with elevated natriuretic peptides without a recent heart failure hospitalisation. This trial was designed to evaluate whether haemodynamic-guided management using remote pulmonary artery pressure monitoring could reduce heart failure events and mortality in patients with heart failure across the spectrum of symptom severity (NYHA funational class II–IV), including those with elevated natriuretic peptides but without a recent heart failure hospitalisation. Methods The randomised arm of the haemodynamic-GUIDEed management of Heart Failure (GUIDE-HF) trial was a multicentre, single-blind study at 118 centres in the USA and Canada. Following successful implantation of a pulmonary artery pressure monitor, patients with all ejection fractions, NYHA functional class II–IV chronic heart failure, and either a recent heart failure hospitalisation or elevated natriuretic peptides (based on a-priori thresholds) were randomly assigned (1:1) to either haemodynamic-guided heart failure management based on pulmonary artery pressure or a usual care control group. Patients were masked to their study group assignment. Investigators were aware of treatment assignment but did not have access to pulmonary artery pressure data for control patients. The primary endpoint was a composite of all-cause mortality and total heart failure events (heart failure hospitalisations and urgent heart failure hospital visits) at 12 months assessed in all randomly assigned patients. Safety was assessed in all patients. A pre-COVID-19 impact analysis for the primary and secondary outcomes was prespecified. This study is registered with ClinicalTrials.gov , NCT03387813 . Findings Between March 15, 2018, and Dec 20, 2019, 1022 patients were enrolled, with 1000 patients implanted successfully, and follow-up was completed on Jan 8, 2021. There were 253 primary endpoint events (0·563 per patient-year) among 497 patients in the haemodynamic-guided management group (treatment group) and 289 (0·640 per patient-year) in 503 patients in the control group (hazard ratio [HR] 0·88, 95% CI 0·74–1·05; p=0·16). A prespecified COVID-19 sensitivity analysis using a time-dependent variable to compare events before COVID-19 and during the pandemic suggested a treatment interaction (pinteraction=0·11) due to a change in the primary endpoint event rate during the pandemic phase of the trial, warranting a pre-COVID-19 impact analysis. In the pre-COVID-19 impact analysis, there were 177 primary events (0·553 per patient-year) in the intervention group and 224 events (0·682 per patient-year) in the control group (HR 0·81, 95% CI 0·66–1·00; p=0·049). This difference in primary events almost disappeared during COVID-19, with a 21% decrease in the control group (0·536 per patient-year) relative to pre-COVID-19, virtually no change in the treatment group (0·597 per patient-year), and no difference between groups (HR 1·11, 95% CI 0·80–1·55; p=0·53). The cumulative incidence of heart failure events was not reduced by haemodynamic-guided management (0·85, 0·70–1·03; p=0·096) in the overall study analysis but was significantly decreased in the pre-COVID-19 impact analysis (0·76, 0·61–0·95; p=0·014). 1014 (99%) of 1022 patients had freedom from device or system-related complications. Interpretation Haemodynamic-guided management of heart failure did not result in a lower composite endpoint rate of mortality and total heart failure events compared with the control group in the overall study analysis. However, a pre-COVID-19 impact analysis indicated a possible benefit of haemodynamic-guided management on the primary outcome in the pre-COVID-19 period, primarily driven by a lower heart failure hospitalisation rate compared with the control group. Funding Abbott.

Published
2021

21. Sphingosine 1-phosphate receptor modulators in multiple sclerosis and other conditions

Author

Jeffrey A. Cohen and Marisa P. McGinley

Subjects
Sphingosine 1 Phosphate Receptor Modulators, Ozanimod, Multiple Sclerosis, 030204 cardiovascular system & hematology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Benzyl Compounds, Animals, Humans, Medicine, 030212 general & internal medicine, Receptor, Sphingosine-1-Phosphate Receptors, Clinical Trials as Topic, Oxadiazoles, Sphingosine, Fingolimod Hydrochloride, business.industry, Multiple sclerosis, General Medicine, medicine.disease, Fingolimod, Transplantation, Thiazoles, Siponimod, Immune System Diseases, chemistry, Ponesimod, Indans, Cancer research, Azetidines, Nervous System Diseases, business, Signal Transduction, medicine.drug
Abstract

The sphingosine 1-phosphate (S1P) signalling pathways have important and diverse functions. S1P receptors (S1PRs) have been proposed as a therapeutic target for various diseases due to their involvement in regulation of lymphocyte trafficking, brain and cardiac function, vascular permeability, and vascular and bronchial tone. S1PR modulators were first developed to prevent rejection by the immune system following renal transplantation, but the only currently approved indication is multiple sclerosis. The primary mechanism of action of S1PR modulators in multiple sclerosis is through binding S1PR subtype 1 on lymphocytes resulting in internalisation of the receptor and loss of responsiveness to the S1P gradient that drives lymphocyte egress from lymph nodes. The reduction in circulating lymphocytes presumably limits inflammatory cell migration into the CNS. Four S1PR modulators (fingolimod, siponimod, ozanimod, and ponesimod) have regulatory approval for multiple sclerosis. Preclinical evidence and ongoing and completed clinical trials support development of S1PR modulators for other therapeutic indications.

Published
2021

22. Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study

Author

Ioannis Katsoularis, Anne-Marie Fors Connolly, Paddy Farrington, Osvaldo Fonseca-Rodríguez, and Krister Lindmark

Subjects
Adult, Male, medicine.medical_specialty, Population, Myocardial Infarction, Rate ratio, Risk Assessment, Risk Factors, Internal medicine, medicine, Humans, Registries, Myocardial infarction, Risk factor, education, Pandemics, Stroke, Ischemic Stroke, Cause of death, Sweden, education.field_of_study, SARS-CoV-2, business.industry, Incidence, Incidence (epidemiology), COVID-19, Articles, General Medicine, Odds ratio, Middle Aged, medicine.disease, Female, business
Abstract

Summary Background COVID-19 is a complex disease targeting many organs. Previous studies highlight COVID-19 as a probable risk factor for acute cardiovascular complications. We aimed to quantify the risk of acute myocardial infarction and ischaemic stroke associated with COVID-19 by analysing all COVID-19 cases in Sweden. Methods This self-controlled case series (SCCS) and matched cohort study was done in Sweden. The personal identification numbers of all patients with COVID-19 in Sweden from Feb 1 to Sept 14, 2020, were identified and cross-linked with national inpatient, outpatient, cancer, and cause of death registers. The controls were matched on age, sex, and county of residence in Sweden. International Classification of Diseases codes for acute myocardial infarction or ischaemic stroke were identified in causes of hospital admission for all patients with COVID-19 in the SCCS and all patients with COVID-19 and the matched control individuals in the matched cohort study. The SCCS method was used to calculate the incidence rate ratio (IRR) for first acute myocardial infarction or ischaemic stroke following COVID-19 compared with a control period. The matched cohort study was used to determine the increased risk that COVID-19 confers compared with the background population of increased acute myocardial infarction or ischaemic stroke in the first 2 weeks following COVID-19. Findings 86 742 patients with COVID-19 were included in the SCCS study, and 348 481 matched control individuals were also included in the matched cohort study. When day of exposure was excluded from the risk period in the SCCS, the IRR for acute myocardial infarction was 2·89 (95% CI 1·51–5·55) for the first week, 2·53 (1·29–4·94) for the second week, and 1·60 (0·84–3·04) in weeks 3 and 4 following COVID-19. When day of exposure was included in the risk period, IRR was 8·44 (5·45–13·08) for the first week, 2·56 (1·31–5·01) for the second week, and 1·62 (0·85–3·09) for weeks 3 and 4 following COVID-19. The corresponding IRRs for ischaemic stroke when day of exposure was excluded from the risk period were 2·97 (1·71–5·15) in the first week, 2·80 (1·60–4·88) in the second week, and 2·10 (1·33–3·32) in weeks 3 and 4 following COVID-19; when day of exposure was included in the risk period, the IRRs were 6·18 (4·06–9·42) for the first week, 2·85 (1·64–4·97) for the second week, and 2·14 (1·36–3·38) for weeks 3 and 4 following COVID-19. In the matched cohort analysis excluding day 0, the odds ratio (OR) for acute myocardial infarction was 3·41 (1·58–7·36) and for stroke was 3·63 (1·69–7·80) in the 2 weeks following COVID-19. When day 0 was included in the matched cohort study, the OR for acute myocardial infarction was 6·61 (3·56–12·20) and for ischaemic stroke was 6·74 (3·71–12·20) in the 2 weeks following COVID-19. Interpretation Our findings suggest that COVID-19 is a risk factor for acute myocardial infarction and ischaemic stroke. This indicates that acute myocardial infarction and ischaemic stroke represent a part of the clinical picture of COVID-19, and highlights the need for vaccination against COVID-19. Funding Central ALF-funding and Base Unit ALF-Funding, Region Vasterbotten, Sweden; Strategic funding during 2020 from the Department of Clinical Microbiology, Umea University, Sweden; Stroke Research in Northern Sweden; The Laboratory for Molecular Infection Medicine Sweden.

Published
2021

23. Hot weather and heat extremes: health risks

Author

George Havenith, Sonia I. Seneviratne, Anthony Capon, R. Sari Kovats, Nathan B. Morris, Carolyn Broderick, Jennifer K. Vanos, Arunima Malik, Lars Nybo, Kristie L. Ebi, Wei Ma, Ollie Jay, Peter Berry, Yasushi Honda, and Richard de Dear

Subjects
Hot Temperature, business.industry, Climate Change, Urbanization, Global warming, Climate change, Environmental Exposure, General Medicine, Heat Stress Disorders, Global Warming, Mental health, Occupational safety and health, Occupational Exposure, Environmental health, Humans, Population growth, Environmental science, Morbidity, Mortality, business, Productivity, Physiological Phenomena, Risk management, Sports
Abstract

Hot ambient conditions and associated heat stress can increase mortality and morbidity, as well as increase adverse pregnancy outcomes and negatively affect mental health. High heat stress can also reduce physical work capacity and motor-cognitive performances, with consequences for productivity, and increase the risk of occupational health problems. Almost half of the global population and more than 1 billion workers are exposed to high heat episodes and about a third of all exposed workers have negative health effects. However, excess deaths and many heat-related health risks are preventable, with appropriate heat action plans involving behavioural strategies and biophysical solutions. Extreme heat events are becoming permanent features of summer seasons worldwide, causing many excess deaths. Heat-related morbidity and mortality are projected to increase further as climate change progresses, with greater risk associated with higher degrees of global warming. Particularly in tropical regions, increased warming might mean that physiological limits related to heat tolerance (survival) will be reached regularly and more often in coming decades. Climate change is interacting with other trends, such as population growth and ageing, urbanisation, and socioeconomic development, that can either exacerbate or ameliorate heat-related hazards. Urban temperatures are further enhanced by anthropogenic heat from vehicular transport and heat waste from buildings. Although there is some evidence of adaptation to increasing temperatures in high-income countries, projections of a hotter future suggest that without investment in research and risk management actions, heat-related morbidity and mortality are likely to increase.

Published
2021

24. Protection by vaccination of children against typhoid fever with a Vi-tetanus toxoid conjugate vaccine in urban Bangladesh: a cluster-randomised trial

Author

Firdausi Qadri, Karin Sofia Scherrer, Susan Tonks, Kamrul Islam, Melanie Greenland, Sarah Kelly, Mahzabeen Ireen, P J O’Reilly, Golap Babu, Prasanta Kumar Biswas, Katherine Theiss-Nyland, Shams Uddin Ahmed, Ismail Hossen, Nazmul Hasan Rajib, Kathleen M. Neuzil, Andrew J. Pollard, Merryn Voysey, Nicola Smith, John D. Clemens, Arifuzzaman Khan, Virginia E. Pitzer, Yama F Mujadidi, Xinxue Liu, Nazia Rahman, R Colin-Jones, Faisal Ahmmed, Farhana Khanam, O Mazur, Amirul Islam Bhuiyan, and K. Zaman

Subjects
Male, Pediatrics, medicine.medical_specialty, Adolescent, Population, Typhoid fever, Conjugate vaccine, Tetanus Toxoid, medicine, Humans, Typhoid Fever, Child, Encephalitis, Japanese, education, Adverse effect, Developing Countries, Bangladesh, education.field_of_study, Vaccines, Conjugate, Japanese Encephalitis Vaccines, Tetanus, business.industry, Incidence (epidemiology), Polysaccharides, Bacterial, Typhoid-Paratyphoid Vaccines, Vaccination, Infant, General Medicine, Salmonella typhi, medicine.disease, Child, Preschool, Population study, Female, business
Abstract

Background Typhoid fever remains a major cause of morbidity and mortality in low-income and middle-income countries. Vi-tetanus toxoid conjugate vaccine (Vi-TT) is recommended by WHO for implementation in high-burden countries, but there is little evidence about its ability to protect against clinical typhoid in such settings. Methods We did a participant-masked and observer-masked cluster-randomised trial preceded by a safety pilot phase in an urban endemic setting in Dhaka, Bangladesh. 150 clusters, each with approximately 1350 residents, were randomly assigned (1:1) to either Vi-TT or SA 14-14-2 Japanese encephalitis (JE) vaccine. Children aged 9 months to less than 16 years were invited via parent or guardian to receive a single, parenteral dose of vaccine according to their cluster of residence. The study population was followed for an average of 17·1 months. Total and overall protection by Vi-TT against blood culture-confirmed typhoid were the primary endpoints assessed in the intention-to-treat population of vaccinees or all residents in the clusters. A subset of approximately 4800 participants was assessed with active surveillance for adverse events. The trial is registered at www.isrctn.com, ISRCTN11643110. Findings 41 344 children were vaccinated in April–May, 2018, with another 20 412 children vaccinated at catch-up vaccination campaigns between September and December, 2018, and April and May, 2019. The incidence of typhoid fever (cases per 100 000 person-years) was 635 in JE vaccinees and 96 in Vi-TT vaccinees (total Vi-TT protection 85%; 97·5% CI 76 to 91, pInterpretation Vi-TT provided protection against typhoid fever to children vaccinated between 9 months and less than 16 years. Longer-term follow-up will be needed to assess the duration of protection and the need for booster doses. Funding The study was funded by the Bill & Melinda Gates Foundation.

Published
2021

25. Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study

Author

Marta Gacic-Dobo, Nancy Fullman, Jiawei He, Samir V. Sodha, Stephen S Lim, Reed J. D. Sorensen, Megan F. Schipp, Simon I. Hay, Natalie C. Galles, Jonathan F. Mosser, Ramon Martinez-Piedra, Peng Zheng, M. Carolina Danovaro-Holliday, Martha Velandia-González, Emma Castro, Amanda Deen, Kate Causey, and Aleksandr Y. Aravkin

Subjects
Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Outbreak, Articles, General Medicine, law.invention, Transmission (mechanics), law, Environmental health, Pandemic, Global health, Medicine, East Asia, Measles vaccine, business
Abstract

Summary Background The COVID-19 pandemic and efforts to reduce SARS-CoV-2 transmission substantially affected health services worldwide. To better understand the impact of the pandemic on childhood routine immunisation, we estimated disruptions in vaccine coverage associated with the pandemic in 2020, globally and by Global Burden of Disease (GBD) super-region. Methods For this analysis we used a two-step hierarchical random spline modelling approach to estimate global and regional disruptions to routine immunisation using administrative data and reports from electronic immunisation systems, with mobility data as a model input. Paired with estimates of vaccine coverage expected in the absence of COVID-19, which were derived from vaccine coverage models from GBD 2020, Release 1 (GBD 2020 R1), we estimated the number of children who missed routinely delivered doses of the third-dose diphtheria-tetanus-pertussis (DTP3) vaccine and first-dose measles-containing vaccine (MCV1) in 2020. Findings Globally, in 2020, estimated vaccine coverage was 76·7% (95% uncertainty interval 74·3–78·6) for DTP3 and 78·9% (74·8–81·9) for MCV1, representing relative reductions of 7·7% (6·0–10·1) for DTP3 and 7·9% (5·2–11·7) for MCV1, compared to expected doses delivered in the absence of the COVID-19 pandemic. From January to December, 2020, we estimated that 30·0 million (27·6–33·1) children missed doses of DTP3 and 27·2 million (23·4–32·5) children missed MCV1 doses. Compared to expected gaps in coverage for eligible children in 2020, these estimates represented an additional 8·5 million (6·5–11·6) children not routinely vaccinated with DTP3 and an additional 8·9 million (5·7–13·7) children not routinely vaccinated with MCV1 attributable to the COVID-19 pandemic. Globally, monthly disruptions were highest in April, 2020, across all GBD super-regions, with 4·6 million (4·0–5·4) children missing doses of DTP3 and 4·4 million (3·7–5·2) children missing doses of MCV1. Every GBD super-region saw reductions in vaccine coverage in March and April, with the most severe annual impacts in north Africa and the Middle East, south Asia, and Latin America and the Caribbean. We estimated the lowest annual reductions in vaccine delivery in sub-Saharan Africa, where disruptions remained minimal throughout the year. For some super-regions, including southeast Asia, east Asia, and Oceania for both DTP3 and MCV1, the high-income super-region for DTP3, and south Asia for MCV1, estimates suggest that monthly doses were delivered at or above expected levels during the second half of 2020. Interpretation Routine immunisation services faced stark challenges in 2020, with the COVID-19 pandemic causing the most widespread and largest global disruption in recent history. Although the latest coverage trajectories point towards recovery in some regions, a combination of lagging catch-up immunisation services, continued SARS-CoV-2 transmission, and persistent gaps in vaccine coverage before the pandemic still left millions of children under-vaccinated or unvaccinated against preventable diseases at the end of 2020, and these gaps are likely to extend throughout 2021. Strengthening routine immunisation data systems and efforts to target resources and outreach will be essential to minimise the risk of vaccine-preventable disease outbreaks, reach children who missed routine vaccine doses during the pandemic, and accelerate progress towards higher and more equitable vaccination coverage over the next decade. Funding Bill & Melinda Gates Foundation.

Published
2021

26. KTE-X19 for relapsed or refractory adult B-cell acute lymphoblastic leukaemia: phase 2 results of the single-arm, open-label, multicentre ZUMA-3 study

Author

Deepa Jeyakumar, Ryan D. Cassaday, Roch Houot, Chaoling Feng, Dimitrios Tzachanis, Maria R. Baer, John M. Rossi, Patrick J. Stiff, Marion Subklewe, Max S. Topp, Behzad Kharabi Masouleh, Bijal D. Shah, Remus Vezan, Martha Arellano, Olalekan O. Oluwole, Aaron C Logan, William G. Wierda, Kristen M. O'Dwyer, Tong Shen, Monique C. Minnema, Jinghui Dong, Daniel J. DeAngelo, Nicolas Boissel, Mehrdad Abedi, Francesca Milletti, Gary J. Schiller, Thibaut Leguay, Armin Ghobadi, Michael R. Bishop, Yi Lin, Jae H. Park, H. Lee Moffitt Cancer Center and Research Institute, Washington University in Saint Louis (WUSTL), Vanderbilt University [Nashville], Helen Diller Family Comprehensive Cancer Center [San Francisco], Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University of Washington [Seattle], CHU Bordeaux [Bordeaux], The University of Chicago Medicine [Chicago], University Hospital of Würzburg, University of California [San Diego] (UC San Diego), University of California, Mayo Clinic [Rochester], University of Rochester [USA], Emory University [Atlanta, GA], University of Maryland [Baltimore], David Geffen School of Medicine [Los Angeles], University of California [Los Angeles] (UCLA), University of California-University of California, State University of New York at New Paltz (SUNY New Paltz), State University of New York (SUNY), Memorial Sloan Kettering Cancer Center (MSKCC), Ludwig-Maximilians-Universität München (LMU), California State University [Sacramento], University Medical Center [Utrecht], The University of Texas M.D. Anderson Cancer Center [Houston], Dana-Farber Cancer Institute [Boston], Loyola University [Chicago], University of California [Irvine] (UCI), Kite (Gilead), Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], University of California (UC), University of California (UC)-University of California (UC), University of California [Irvine] (UC Irvine), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
Adult, Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, Immunotherapy, Adoptive, 03 medical and health sciences, 0302 clinical medicine, Refractory, Recurrence, Precursor B-Cell Lymphoblastic Leukemia-Lymphoma, Internal medicine, medicine, Clinical endpoint, Humans, 030212 general & internal medicine, education, Survival analysis, Aged, Chemotherapy, education.field_of_study, Receptors, Chimeric Antigen, business.industry, General Medicine, Leukapheresis, Middle Aged, Survival Analysis, Minimal residual disease, 3. Good health, Clinical trial, Treatment Outcome, Female, business
Abstract

International audience; BACKGROUND: Despite treatment with novel therapies and allogeneic stem-cell transplant (allo-SCT) consolidation, outcomes in adult patients with relapsed or refractory B-precursor acute lymphoblastic leukaemia remain poor, underlining the need for more effective therapies. METHODS: We report the pivotal phase 2 results of ZUMA-3, an international, multicentre, single-arm, open-label study evaluating the efficacy and safety of the autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy KTE-X19 in adult patients with relapsed or refractory B-precursor acute lymphoblastic leukaemia. Patients were enrolled at 25 sites in the USA, Canada, and Europe. Eligible patients were aged 18 years or older, with Eastern Cooperative Oncology Group performance status of 0-1, and morphological disease in the bone marrow (>5% blasts). After leukapheresis and conditioning chemotherapy, patients received a single KTE-X19 infusion (1 × 10(6) CAR T cells per kg bodyweight). The primary endpoint was the rate of overall complete remission or complete remission with incomplete haematological recovery by central assessment. Duration of remission and relapse-free survival, overall survival, minimal residual disease (MRD) negativity rate, and allo-SCT rate were assessed as secondary endpoints. Efficacy and safety analyses were done in the treated population (all patients who received a dose of KTE-X19). This study is registered with ClinicalTrials.gov, NCT02614066. FINDINGS: Between Oct 1, 2018, and Oct 9, 2019, 71 patients were enrolled and underwent leukapheresis. KTE-X19 was successfully manufactured for 65 (92%) patients and administered to 55 (77%). The median age of treated patients was 40 years (IQR 28-52). At the median follow-up of 16·4 months (13·8-19·6), 39 patients (71%; 95% CI 57-82, p

Published
2021

27. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study

Author

Bin Cao, Jianwei Wang, Xianguang Wang, Li Chen, Xiaoying Gu, Lixue Huang, Qiongya Wang, Min Liu, Li Guo, Ming Wei, Yeming Wang, Lili Ren, Jiaan Xia, Xia Li, Jiuyang Xu, Yanping Li, Dan Liu, Caihong Li, Fan Xiao, Yanqing Fan, Xueyang Zhang, Ting Yu, Qun Yao, Yali Qu, and Ping Hu

Subjects
Male, Pediatrics, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), MEDLINE, Walk Test, Physical examination, Anxiety, Logistic regression, Pulmonary function testing, Quality of life, medicine, Humans, Longitudinal Studies, Survivors, Lung, Fatigue, Aged, Exercise Tolerance, Muscle Weakness, medicine.diagnostic_test, Depression, SARS-CoV-2, business.industry, COVID-19, Articles, General Medicine, Middle Aged, Cohort, Quality of Life, Female, business, Follow-Up Studies, Cohort study
Abstract

Background The full range of long-term health consequences of COVID-19 in patients who are discharged from hospital is largely unclear. The aim of our study was to comprehensively compare consequences between 6 months and 12 months after symptom onset among hospital survivors with COVID-19. Methods We undertook an ambidirectional cohort study of COVID-19 survivors who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7 and May 29, 2020. At 6-month and 12-month follow-up visit, survivors were interviewed with questionnaires on symptoms and health-related quality of life (HRQoL), and received a physical examination, a 6-min walking test, and laboratory tests. They were required to report their health-care use after discharge and work status at the 12-month visit. Survivors who had completed pulmonary function tests or had lung radiographic abnormality at 6 months were given the corresponding tests at 12 months. Non-COVID-19 participants (controls) matched for age, sex, and comorbidities were interviewed and completed questionnaires to assess prevalent symptoms and HRQoL. The primary outcomes were symptoms, modified British Medical Research Council (mMRC) score, HRQoL, and distance walked in 6 min (6MWD). Multivariable adjusted logistic regression models were used to evaluate the risk factors of 12-month outcomes. Findings 1276 COVID-19 survivors completed both visits. The median age of patients was 59·0 years (IQR 49·0–67·0) and 681 (53%) were men. The median follow-up time was 185·0 days (IQR 175·0–198·0) for the 6-month visit and 349·0 days (337·0–361·0) for the 12-month visit after symptom onset. The proportion of patients with at least one sequelae symptom decreased from 68% (831/1227) at 6 months to 49% (620/1272) at 12 months (p

Published
2021

28. Reducing the health effects of hot weather and heat extremes: from personal cooling strategies to green cities

Author

Anthony Capon, Carolyn Broderick, Peter Berry, Kristie L. Ebi, Wei Ma, Yasushi Honda, Richard de Dear, Jennifer K. Vanos, Arunima Malik, George Havenith, Nathan B. Morris, R. Sari Kovats, Lars Nybo, Ollie Jay, and Sonia I. Seneviratne

Subjects
Poverty, Air conditioning, business.industry, Refugee, Global warming, Psychological intervention, Climate change, General Medicine, Aggravating Factor, business, Environmental planning, Built environment
Abstract

Heat extremes (ie, heatwaves) already have a serious impact on human health, with ageing, poverty, and chronic illnesses as aggravating factors. As the global community seeks to contend with even hotter weather in the future as a consequence of global climate change, there is a pressing need to better understand the most effective prevention and response measures that can be implemented, particularly in low-resource settings. In this Series paper, we describe how a future reliance on air conditioning is unsustainable and further marginalises the communities most vulnerable to the heat. We then show that a more holistic understanding of the thermal environment at the landscape and urban, building, and individual scales supports the identification of numerous sustainable opportunities to keep people cooler. We summarise the benefits (eg, effectiveness) and limitations of each identified cooling strategy, and recommend optimal interventions for settings such as aged care homes, slums, workplaces, mass gatherings, refugee camps, and playing sport. The integration of this information into well communicated heat action plans with robust surveillance and monitoring is essential for reducing the adverse health consequences of current and future extreme heat.

Published
2021

29. Teclistamab, a B-cell maturation antigen × CD3 bispecific antibody, in patients with relapsed or refractory multiple myeloma (MajesTEC-1): a multicentre, open-label, single-arm, phase 1 study

Author

Maria-Victoria Mateos, Jenna D. Goldberg, Ajai Chari, Arnob Banerjee, Lotfi Benboubker, Raluca Verona, Jeffrey R. Infante, Tara Stephenson, Jesús F. San-Miguel, Alfred L. Garfall, Yusri Elsayed, Manisha Bhutani, Hareth Nahi, Lionel Karlin, Niels W.C.J. van de Donk, Suzette Girgis, Saad Z. Usmani, Lixia Pei, Laura Rosiñol, Albert Oriol, Amrita Krishnan, Hematology, AII - Cancer immunology, and CCA - Cancer Treatment and quality of life

Subjects
Male, medicine.medical_specialty, Injections, Subcutaneous, T-Lymphocytes, Neutropenia, Antibodies, Monoclonal, Humanized, Gastroenterology, law.invention, Antineoplastic Agents, Immunological, Randomized controlled trial, Refractory, law, Internal medicine, Antibodies, Bispecific, medicine, Humans, Dosing, B-Cell Maturation Antigen, Adverse effect, Multiple myeloma, Aged, Dose-Response Relationship, Drug, business.industry, General Medicine, Middle Aged, medicine.disease, Cytokine release syndrome, Treatment Outcome, Tolerability, Administration, Intravenous, Female, Neoplasm Recurrence, Local, Multiple Myeloma, business
Abstract

Background There is a need for novel therapies for relapsed or refractory multiple myeloma, and B-cell maturation antigen (BCMA) is a validated target. Teclistamab is a bispecific antibody that binds BCMA and CD3 to redirect T cells to multiple myeloma cells. The aim of the MajesTEC-1 study was to evaluate the safety, tolerability, and preliminary efficacy of teclistamab in patients with relapsed or refractory multiple myeloma. Methods This open-label, single-arm, phase 1 study enrolled patients with multiple myeloma who were relapsed, refractory, or intolerant to established therapies. Teclistamab was administered intravenously (range 0.3-19.2 mu g/kg [once every 2 weeks] or 19.2-720 mu g/kg [once per week]) or subcutaneously (range 80-3000 mu g/kg [once per week]) in different cohorts, with step-up dosing for 38.4 mu g/kg or higher doses. The primary objectives were to identify the recommended phase 2 dose (part one) and characterise teclistamab safety and tolerability at the recommended phase 2 dose (part two). Safety was assessed in all patients treated with at least one dose of teclistamab. Efficacy was analysed in response-evaluable patients (ie, patients who received at least one dose of teclistamab and had at least one post-baseline response evaluation). This ongoing trial is registered with ClinicalTrials.gov, NCT03145181. Findings Between June 8, 2017, and March 29, 2021, 219 patients were screened for study inclusion, and 157 patients (median six previous therapy lines) were enrolled and received at least one dose of teclistamab (intravenous n=84; subcutaneous n=73). 40 patients were administered the recommended phase 2 dose, identified as once per week subcutaneous administration of teclistamab at 1500 mu g/kg, after 60 mu g/kg and 300 mu g/kg step-up doses (median follow-up 6.1 months, IQR 3.6-8.2). There were no dose-limiting toxicities at the recommended phase 2 dose in part one. In the 40 patients treated at the recommended phase 2 dose, the most common treatment-emergent adverse events were cytokine release syndrome in 28 (70%; all grade 1 or 2 events) and neutropenia in 26 (65%) patients (grade 3 or 4 in 16 [40%]). The overall response rate in response-evaluable patients treated at the recommended phase 2 dose (n=40) was 65% (95% CI 48-79); 58% achieved a very good partial response or better. At the recommended phase 2 dose, the median duration of response was not reached. 22 (85%) of 26 responders were alive and continuing treatment after 7.1 months' median follow-up (IQR 5.1-9.1). At the recommended phase 2 dose, teclistamab exposure was maintained above target exposure levels, and consistent T-cell activation was reported. Interpretation Teclistamab is a novel treatment approach for relapsed or refractory multiple myeloma. At the recommended phase 2 dose, teclistamab showed promising efficacy, with durable responses that deepened over time, and was well tolerated, supporting further clinical development. Copyright (C) 2021 Elsevier Ltd. All rights reserved.

Published
2021

30. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial

Author

Ricardo Bruges, Pamela Salman, Ruben Dario Kowalyszyn, M. Li, Lucjan Wyrwicz, Valerie Poulart, Michalis V. Karamouzis, Arinilda Silva Campos Bragagnoli, Roberto Pazo-Cid, Marcelo Garrido, Yelena Y. Janjigian, Tomasz Skoczylas, Lin Shen, Mustapha Tehfe, Kensei Yamaguchi, Ming Lei, Michael Schenker, Thomas Zander, H. Xiao, Erika Hitre, Kynan Feeney, Markus Moehler, Kaoru Kondo, Kohei Shitara, Patricio Eduardo Yanez, Tianshu Liu, Dana Cullen, James M. Cleary, and Jaffer A. Ajani

Subjects
Male, medicine.medical_specialty, Esophageal Neoplasms, medicine.medical_treatment, Ipilimumab, Adenocarcinoma, 030204 cardiovascular system & hematology, Gastroenterology, Capecitabine, 03 medical and health sciences, 0302 clinical medicine, Stomach Neoplasms, Internal medicine, Antineoplastic Combined Chemotherapy Protocols, medicine, Humans, 030212 general & internal medicine, Progression-free survival, Immune Checkpoint Inhibitors, Aged, Chemotherapy, business.industry, General Medicine, Middle Aged, medicine.disease, Progression-Free Survival, Oxaliplatin, Nivolumab, Fluorouracil, Drug Therapy, Combination, Female, Esophagogastric Junction, business, medicine.drug
Abstract

First-line chemotherapy for advanced or metastatic human epidermal growth factor receptor 2 (HER2)-negative gastric or gastro-oesophageal junction adenocarcinoma has a median overall survival (OS) of less than 1 year. We aimed to evaluate first-line programmed cell death (PD)-1 inhibitor-based therapies in gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma. We report the first results for nivolumab plus chemotherapy versus chemotherapy alone.In this multicentre, randomised, open-label, phase 3 trial (CheckMate 649), we enrolled adults (≥18 years) with previously untreated, unresectable, non-HER2-positive gastric, gastro-oesophageal junction, or oesophageal adenocarcinoma, regardless of PD-ligand 1 (PD-L1) expression from 175 hospitals and cancer centres in 29 countries. Patients were randomly assigned (1:1:1 while all three groups were open) via interactive web response technology (block sizes of six) to nivolumab (360 mg every 3 weeks or 240 mg every 2 weeks) plus chemotherapy (capecitabine and oxaliplatin every 3 weeks or leucovorin, fluorouracil, and oxaliplatin every 2 weeks), nivolumab plus ipilimumab, or chemotherapy alone. Primary endpoints for nivolumab plus chemotherapy versus chemotherapy alone were OS or progression-free survival (PFS) by blinded independent central review, in patients whose tumours had a PD-L1 combined positive score (CPS) of five or more. Safety was assessed in all patients who received at least one dose of the assigned treatment. This study is registered with ClinicalTrials.gov, NCT02872116.From March 27, 2017, to April 24, 2019, of 2687 patients assessed for eligibility, we concurrently randomly assigned 1581 patients to treatment (nivolumab plus chemotherapy [n=789, 50%] or chemotherapy alone [n=792, 50%]). The median follow-up for OS was 13·1 months (IQR 6·7-19·1) for nivolumab plus chemotherapy and 11·1 months (5·8-16·1) for chemotherapy alone. Nivolumab plus chemotherapy resulted in significant improvements in OS (hazard ratio [HR] 0·71 [98·4% CI 0·59-0·86]; p0·0001) and PFS (HR 0·68 [98 % CI 0·56-0·81]; p0·0001) versus chemotherapy alone in patients with a PD-L1 CPS of five or more (minimum follow-up 12·1 months). Additional results showed significant improvement in OS, along with PFS benefit, in patients with a PD-L1 CPS of one or more and all randomly assigned patients. Among all treated patients, 462 (59%) of 782 patients in the nivolumab plus chemotherapy group and 341 (44%) of 767 patients in the chemotherapy alone group had grade 3-4 treatment-related adverse events. The most common any-grade treatment-related adverse events (≥25%) were nausea, diarrhoea, and peripheral neuropathy across both groups. 16 (2%) deaths in the nivolumab plus chemotherapy group and four (1%) deaths in the chemotherapy alone group were considered to be treatment-related. No new safety signals were identified.Nivolumab is the first PD-1 inhibitor to show superior OS, along with PFS benefit and an acceptable safety profile, in combination with chemotherapy versus chemotherapy alone in previously untreated patients with advanced gastric, gastro-oesophageal junction, or oesophageal adenocarcinoma. Nivolumab plus chemotherapy represents a new standard first-line treatment for these patients.Bristol Myers Squibb, in collaboration with Ono Pharmaceutical.

Published
2021

31. Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adults

Author

Utibe R. Essien, Mohammed K. Ali, David Guwatudde, Dismand Houinato, Lela Sturua, Cara Ebert, Joseph Kibachio Mwangi, Deborah J. Wexler, Demetre Labadarios, Pascal Geldsetzer, Sarah Crooks, Roy Wong McClure, Felix Teufel, Jacqueline A. Seiglie, Corine Houehanou, Garry Brian, Chea Stanford Wesseh, Michaela Theilmann, Kokou Agoudavi, Mary T Mayige, Omar Mwalim, Bahendeka K Silver, Brice Wilfried Bicaba, Maria Dorobantu, James B. Meigs, Mongal Singh Gurung, Maja E Marcus, William Andres Lopez Arboleda, Pascal Bovet, Andrew Stokes, Rifat Atun, Sebastian Vollmer, Bolormaa Norov, Farshad Farzadfar, Jennifer Manne-Goehler, Sahar Saeedi Moghaddam, Khem Bahadur Karki, Jan-Walter De Neve, Joao S Martins, Jutta M Adelin Jorgensen, Till Bärnighausen, Krishna Kumar Aryal, Glennis Andall-Brereton, Justine Davies, and Gibson B. Kagaruki

Subjects
Adult, Male, medicine.medical_specialty, Diabetes risk, Cross-sectional study, 030209 endocrinology & metabolism, Overweight, Global Health, Article, Body Mass Index, BMI, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Diabetes mellitus, Diabetes Mellitus, Prevalence, medicine, Humans, Obesity, 030212 general & internal medicine, Poisson regression, Developing Countries, Poverty, Glycated Hemoglobin, 2. Zero hunger, OVERWEIGHT, business.industry, Public health, 1. No poverty, General Medicine, Middle Aged, medicine.disease, Health Surveys, 3. Good health, Cross-Sectional Studies, OBESITY, Income, symbols, Female, medicine.symptom, business, WAIST CIRCUMFERENCE, Body mass index, Demography
Abstract

Summary Background The prevalence of overweight, obesity, and diabetes is rising rapidly in low-income and middle-income countries (LMICs), but there are scant empirical data on the association between body-mass index (BMI) and diabetes in these settings. Methods In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 57 LMICs. We identified all countries in which a WHO Stepwise Approach to Surveillance (STEPS) survey had been done during a year in which the country fell into an eligible World Bank income group category. For LMICs that did not have a STEPS survey, did not have valid contact information, or declined our request for data, we did a systematic search for survey datasets. Eligible surveys were done during or after 2008; had individual-level data; were done in a low-income, lower-middle-income, or upper-middle-income country; were nationally representative; had a response rate of 50% or higher; contained a diabetes biomarker (either a blood glucose measurement or glycated haemoglobin [HbA1c]); and contained data on height and weight. Diabetes was defined biologically as a fasting plasma glucose concentration of 7·0 mmol/L (126·0 mg/dL) or higher; a random plasma glucose concentration of 11·1 mmol/L (200·0 mg/dL) or higher; or a HbA1c of 6·5% (48·0 mmol/mol) or higher, or by self-reported use of diabetes medication. We included individuals aged 25 years or older with complete data on diabetes status, BMI (defined as normal [18·5–22·9 kg/m2], upper-normal [23·0–24·9 kg/m2], overweight [25·0–29·9 kg/m2], or obese [≥30·0 kg/m2]), sex, and age. Countries were categorised into six geographical regions: Latin America and the Caribbean, Europe and central Asia, east, south, and southeast Asia, sub-Saharan Africa, Middle East and north Africa, and Oceania. We estimated the association between BMI and diabetes risk by multivariable Poisson regression and receiver operating curve analyses, stratified by sex and geographical region. Findings Our pooled dataset from 58 nationally representative surveys in 57 LMICs included 685 616 individuals. The overall prevalence of overweight was 27·2% (95% CI 26·6–27·8), of obesity was 21·0% (19·6–22·5), and of diabetes was 9·3% (8·4–10·2). In the pooled analysis, a higher risk of diabetes was observed at a BMI of 23 kg/m2 or higher, with a 43% greater risk of diabetes for men and a 41% greater risk for women compared with a BMI of 18·5–22·9 kg/m2. Diabetes risk also increased steeply in individuals aged 35–44 years and in men aged 25–34 years in sub-Saharan Africa. In the stratified analyses, there was considerable regional variability in this association. Optimal BMI thresholds for diabetes screening ranged from 23·8 kg/m2 among men in east, south, and southeast Asia to 28·3 kg/m2 among women in the Middle East and north Africa and in Latin America and the Caribbean. Interpretation The association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines. Funding Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program.

Published
2021

32. Widespread implementation of a low-cost telehealth service in the delivery of antenatal care during the COVID-19 pandemic: an interrupted time-series analysis

Author

Katherine L Brown, Andrea Rindt, Alice Stewart, Kirsten R Palmer, Daniel L. Rolnik, Kerrie Papacostas, Euan M. Wallace, Ryan Hodges, Andrew Stripp, Ben W.J. Mol, Helen Diamandis, Michael Tanner, Miranda Davies-Tuck, Michelle L. Giles, and Rebecca Fradkin

Subjects
medicine.medical_specialty, Pregnancy, Telemedicine, Neonatal intensive care unit, business.industry, Incidence (epidemiology), Obstetrics and Gynecology, General Medicine, Prenatal care, Telehealth, 030204 cardiovascular system & hematology, medicine.disease, Integrated care, Gestational diabetes, 03 medical and health sciences, 0302 clinical medicine, Emergency medicine, Medicine, 030212 general & internal medicine, business
Abstract

Summary Background Little evidence is available on the use of telehealth for antenatal care. In response to the COVID-19 pandemic, we developed and implemented a new antenatal care schedule integrating telehealth across all models of pregnancy care. To inform this clinical initiative, we aimed to assess the effectiveness and safety of telehealth in antenatal care. Methods We analysed routinely collected health data on all women giving birth at Monash Health, a large health service in Victoria (Australia), using an interrupted time-series design. We assessed the impact of telehealth integration into antenatal care from March 23, 2020, across low-risk and high-risk care models. Allowing a 1-month implementation period from March 23, 2020, we compared the first 3 months of telehealth integrated care delivered between April 20 and July 26, 2020, with conventional care delivered between Jan 1, 2018, and March 22, 2020. The primary outcomes were detection and outcomes of fetal growth restriction, pre-eclampsia, and gestational diabetes. Secondary outcomes were stillbirth, neonatal intensive care unit admission, and preterm birth (birth before 37 weeks' gestation). Findings Between Jan 1, 2018, and March 22, 2020, 20 031 women gave birth at Monash Health during the conventional care period and 2292 women gave birth during the telehealth integrated care period. Of 20 154 antenatal consultations provided in the integrated care period, 10 731 (53%) were delivered via telehealth. Overall, compared with the conventional care period, no significant differences were identified in the integrated care period with regard to the number of babies with fetal growth restriction (birthweight below the 3rd percentile; 2% in the integrated care period vs 2% in the conventional care period, p=0·72, for low-risk care models; 5% in the integrated care period vs 5% in the conventional care period, p=0·50 for high-risk care models), number of stillbirths (1% vs 1%, p=0·79; 2% vs 2%, p=0·70), or pregnancies complicated by pre-eclampsia (3% vs 3%, p=0·70; 9% vs 7%, p=0·15), or gestational diabetes (22% vs 22%, p=0·89; 30% vs 26%, p=0·06). Interrupted time-series analysis showed a significant reduction in preterm birth among women in high-risk models (–0·68% change in incidence per week [95% CI −1·37 to −0·002]; p=0·049), but no significant differences were identified in other outcome measures for low-risk or high-risk care models after telehealth integration compared with conventional care. Interpretation Telehealth integrated antenatal care enabled the reduction of in-person consultations by 50% without compromising pregnancy outcomes. This care model can help to minimise in-person interactions during the COVID-19 pandemic, but should also be considered in post-pandemic health-care models. Funding None.

Published
2021

33. Contemporary radiotherapy: present and future

Author

Francine E.M. Voncken, Florence K. Keane, Ravi A. Chandra, and Charles R. Thomas

Subjects
Diagnostic Imaging, medicine.medical_specialty, Radiotherapy, business.industry, medicine.medical_treatment, Disease spectrum, Cancer, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, Systemic therapy, Radiation therapy, 03 medical and health sciences, 0302 clinical medicine, Multidisciplinary approach, Neoplasms, Radiation oncology, Radiation Oncology, medicine, Humans, Medical physics, 030212 general & internal medicine, business
Abstract

Oncology care is increasingly a multidisciplinary endeavour, and radiation therapy continues to have a key role across the disease spectrum in nearly every cancer. However, the field of radiation oncology is still one of the most poorly understood of the cancer disciplines. In this Review, we attempt to summarise and contextualise developments within the field of radiation oncology for the non-radiation oncologist. We discuss advancements in treatment technologies and imaging, followed by an overview of the interplay with advancements in systemic therapy and surgical techniques. Finally, we review new frontiers in radiation oncology, including advances within the metastatic disease continuum, reirradiation, and emerging types of radiation therapy.

Published
2021

34. Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial

Author

Bon-Kwon Koo, Jeehoon Kang, Kyung Woo Park, Tae-Min Rhee, Han-Mo Yang, Ki-Bum Won, Seung-Woon Rha, Jang-Whan Bae, Nam Ho Lee, Seung-Ho Hur, Junghan Yoon, Tae-Ho Park, Bum Soo Kim, Sang Wook Lim, Yoon Haeng Cho, Dong Woon Jeon, Sang-Hyun Kim, Jung-Kyu Han, Eun-Seok Shin, Hyo-Soo Kim, Heesun Lee, Kyoo-Rok Han, Keon-Woong Moon, Seok Kyu Oh, Ung Kim, Moo-Yong Rhee, Doo-Il Kim, Song-Yi Kim, Sung-Yun Lee, Seung Uk Lee, Sang-Wook Kim, Seok Yeon Kim, Hui-Kyung Jeon, Kwang Soo Cha, Sang-Ho Jo, Jae Kean Ryu, Il-Woo Suh, Hyun-Hee Choi, Seoung-Il Woo, In-Ho Chae, Won-Yong Shin, Dae-Kyeong Kim, Ju Hyeon Oh, Myung Ho Jeong, and Yong Hoon Kim

Subjects
medicine.medical_specialty, Aspirin, Acute coronary syndrome, education.field_of_study, business.industry, medicine.medical_treatment, Population, Percutaneous coronary intervention, General Medicine, 030204 cardiovascular system & hematology, Clopidogrel, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Clinical endpoint, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, business, education, Stroke, medicine.drug
Abstract

Background Optimal antiplatelet monotherapy during the chronic maintenance period in patients who undergo coronary stenting is unknown. We aimed to compare head to head the efficacy and safety of aspirin and clopidogrel monotherapy in this population. Methods We did an investigator-initiated, prospective, randomised, open-label, multicentre trial at 37 study sites in South Korea. We enrolled patients aged at least 20 years who maintained dual antiplatelet therapy without clinical events for 6-18 months after percutaneous coronary intervention with drug-eluting stents (DES). We excluded patients with any ischaemic and major bleeding complications. Patients were randomly assigned (1:1) to receive a monotherapy agent of clopidogrel 75 mg once daily or aspirin 100 mg once daily for 24 months. The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium (BARC) bleeding type 3 or greater, in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02044250. Findings Between March 26, 2014, and May 29, 2018, we enrolled 5530 patients. 5438 (98·3%) patients were randomly assigned to either the clopidogrel group (2710 [49·8%]) or to the aspirin group (2728 [50·2%]). Ascertainment of the primary endpoint was completed in 5338 (98·2%) patients. During 24-month follow-up, the primary outcome occurred in 152 (5·7%) patients in the clopidogrel group and 207 (7·7%) in the aspirin group (hazard ratio 0·73 [95% CI 0·59-0·90]; p=0·0035). Interpretation Clopidogrel monotherapy, compared with aspirin monotherapy during the chronic maintenance period after percutaneous coronary intervention with DES significantly reduced the risk of the composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and BARC bleeding type 3 or greater. In patients requiring indefinite antiplatelet monotherapy after percutaneous coronary intervention, clopidogrel monotherapy was superior to aspirin monotherapy in preventing future adverse clinical events. Funding ChongKunDang, SamJin, HanMi, DaeWoong, and the South Korea Ministry of Health and Welfare.

Published
2021

35. Comparing real-time and intermittently scanned continuous glucose monitoring in adults with type 1 diabetes (ALERTT1): a 6-month, prospective, multicentre, randomised controlled trial

Author

Steffen Fieuws, Bart Keymeulen, Margaretha M Visser, Christophe De Block, Chantal Mathieu, Eveline Dirinck, Liesbeth Van Huffel, Nele Myngheer, Frank Nobels, Chris Vercammen, Gerd Vanhaverbeke, Pieter Gillard, Robert Hilbrands, Sara Charleer, Toon Maes, Pathology/molecular and cellular medicine, Diabetes Clinic, and Diabetes Pathology & Therapy

Subjects
Adult, Blood Glucose, Male, Pediatrics, medicine.medical_specialty, type 1 diabetes, Endocrinology, Diabetes and Metabolism, Population, 030204 cardiovascular system & hematology, Hypoglycemia, Minimisation (clinical trials), law.invention, 03 medical and health sciences, Insulin Infusion Systems, 0302 clinical medicine, Belgium, Randomized controlled trial, Quality of life, law, Diabetes mellitus, medicine, Clinical endpoint, Humans, Hypoglycemic Agents, Insulin, Prospective Studies, 030212 general & internal medicine, education, Glycated Hemoglobin, Type 1 diabetes, education.field_of_study, business.industry, Blood Glucose Self-Monitoring, ADULTS, General Medicine, medicine.disease, Diabetes Mellitus, Type 1, Quality of Life, Female, Human medicine, business
Abstract

Background People with type 1 diabetes can continuously monitor their glucose levels on demand (intermittently scanned continuous glucose monitoring [isCGM]), or in real time (real-time continuous glucose monitoring [rtCGM]). However, it is unclear whether switching from isCGM to rtCGM with alert functionality offers additional benefits. Therefore, we did a trial comparing rtCGM and isCGM in adults with type 1 diabetes (ALERTT1). Methods We did a prospective, double-arm, parallel-group, multicentre, randomised controlled trial in six hospitals in Belgium. Adults with type 1 diabetes who previously used isCGM were randomly assigned (1:1) to rtCGM (intervention) or isCGM (control). Randomisation was done centrally using minimisation dependent on study centre, age, gender, glycated haemoglobin (HbA(1c)), time in range (sensor glucose 3.9-10.0 mmol/L), insulin administration method, and hypoglycaemia awareness. Participants, investigators, and study teams were not masked to group allocation. Primary endpoint was mean between-group difference in time in range after 6 months assessed in the intention-to-treat sample. This trial is registered with ClinicalTrials.gov, NCT03772600. Findings Between Jan 29 and July 30, 2019, 269 participants were recruited, of whom 254 were randomly assigned to rtCGM (n=127) or isCGM (n=127); 124 and 122 participants completed the study, respectively. After 6 months, time in range was higher with rtCGM than with isCGM (59.6% vs 51.9%; mean difference 6.85 percentage points [95% CI 4.36-9.34]; p

Published
2021

36. Safety and efficacy of upadacitinib in combination with topical corticosteroids in adolescents and adults with moderate-to-severe atopic dermatitis (AD Up): results from a randomised, double-blind, placebo-controlled, phase 3 trial

Author

Thomas Bieber, Alvina D. Chu, Barbara A. Hendrickson, Xiaofei Hu, Xiaohong Huang, Weily Soong, Jiewei Zeng, Marjolein S. de Bruin-Weller, Jonathan I. Silverberg, Thomas Werfel, Barry Ladizinski, Henrique D. Teixeira, Kenji Kabashima, and Kristian Reich

Subjects
Adult, Male, medicine.medical_specialty, Internationality, Combination therapy, Population, 030204 cardiovascular system & hematology, Placebo, Severity of Illness Index, Eczema Area and Severity Index, Dermatitis, Atopic, law.invention, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Randomized controlled trial, Adrenal Cortex Hormones, law, Internal medicine, Severity of illness, medicine, Humans, Janus Kinase Inhibitors, 030212 general & internal medicine, education, education.field_of_study, Dose-Response Relationship, Drug, business.industry, Janus Kinase 1, General Medicine, Atopic dermatitis, medicine.disease, Clinical trial, Drug Therapy, Combination, Female, business, Heterocyclic Compounds, 3-Ring
Abstract

Systemic therapies are typically combined with topical corticosteroids for the management of moderate-to-severe atopic dermatitis. Upadacitinib is an oral Janus kinase (JAK) inhibitor with greater inhibitory potency for JAK1 than JAK2, JAK3, or tyrosine kinase 2 that is being tested for atopic dermatitis. We aimed to assess the efficacy and safety of upadacitinib plus topical corticosteroids compared with placebo for the treatment of moderate-to-severe atopic dermatitis.In this randomised, double-blind, placebo-controlled, phase 3 trial (AD Up) adults (aged 18-75 years) and adolescents (aged 12-17 years) with chronic atopic dermatitis that was moderate to severe (≥10% of body surface area affected, Eczema Area and Severity Index [EASI] score of ≥16, validated Investigator's Global Assessment for atopic dermatitis [vIGA-AD] score of ≥3, and weekly average Worst Pruritus Numerical Rating Scale score of ≥4 at baseline) were enrolled at 171 clinical centres across 22 countries in the Asia-Pacific region, Europe, the Middle East, North America, and Oceania. Patients were randomly assigned (1:1:1) to receive upadacitinib 15 mg, upadacitinib 30 mg, or placebo once daily, all in combination with topical corticosteroids for 16 weeks. Randomisation was done using an interactive response technology system, stratified by baseline disease severity, geographical region, and age. Study investigators, study site personnel, and patients were masked to study treatment. The coprimary endpoints were the proportion of patients who had achieved at least a 75% reduction in EASI score from baseline (EASI-75) and the proportion of patients who had achieved a vIGA-AD response (defined as a vIGA-AD score of 0 [clear] or 1 [almost clear] with ≥2 grades of improvement from baseline) at week 16. Efficacy was analysed in the intention-to-treat population and safety was analysed in all patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, NCT03568318, and is active, but not recruiting.Between Aug 9, 2018, and Dec 20, 2019, 901 patients were randomly assigned to receive upadacitinib 15 mg plus topical corticosteroids (n=300), upadacitinib 30 mg plus topical corticosteroids (n=297), or placebo plus topical corticosteroids (n=304). At week 16, the proportion of patients who had achieved EASI-75 was significantly higher in the upadacitinib 15 mg plus topical corticosteroid group (194 [65%] of 300 patients) and the upadacitinib 30 mg plus topical corticosteroids group (229 [77%] of 297 patients) than the placebo group (80 [26%] of 304 patients; adjusted difference in EASI-75 response rate vs placebo, 38·1% [95% CI 30·8-45·4] for the upadacitinib 15 mg group and 50·6% [43·8-57·4] for the upadacitinib 30 mg group; p0·0001 for both doses). The proportion of patients who had achieved a vIGA-AD response at week 16 was significantly higher in the upadacitinib 15 mg plus topical corticosteroid group (119 [40%] patients) and upadacitinib 30 mg plus topical corticosteroid group (174 [59%] patients) than the placebo group (33 [11%] patients; adjusted difference in vIGA-AD response vs placebo, 28·5% [22·1-34·9] for the upadacitinib 15 mg group and 47·6% [41·1-54·0] for the upadacitinib 30 mg group; p0·0001 for both doses). During the double-blind period, upadacitinib 15 and 30 mg were well tolerated in combination with topical corticosteroids. The most frequently reported treatment-emergent adverse events (≥5% in any treatment group) were acne, nasopharyngitis, upper respiratory tract infection, oral herpes, elevation of blood creatine phosphokinase levels, headache, and atopic dermatitis. The incidence of acne was higher in the upadacitinib 15 mg (30 [10%] of 300 patients) and upadacitinib 30 mg (41 [14%] of 297 patients) groups than the placebo group (six [2%] of 304 patients). The incidence of adverse events leading to discontinuation of study drug (four [1%] patients in the upadacitinib 15 mg plus topical corticosteroids group, four [1%] patients in the upadacitinib 30 mg plus topical corticosteroids group, and seven [2%] patients in the placebo plus topical corticosteroids group) and serious adverse events (seven [2%] patients, four [1%] patients, and nine [3%] patients) were similar among treatment groups. No deaths were reported in any treatment group.Upadacitinib plus topical corticosteroids was well tolerated and superior to placebo plus topical corticosteroids. Upadacitinib as combination therapy had a positive benefit-risk profile in adults and adolescents with moderate-to-severe atopic dermatitis.AbbVie.

Published
2021

37. The value of vaccine programme impact monitoring during the COVID-19 pandemic

Author

Kathleen M. Neuzil and Justin R. Ortiz

Subjects
Vaccines, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Immunization Programs, SARS-CoV-2, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), MEDLINE, COVID-19, Articles, General Medicine, Impact monitoring, Environmental health, Pandemic, Humans, Medicine, business, Pandemics, Value (mathematics)
Abstract

Background In the USA, COVID-19 vaccines became available in mid-December, 2020, with adults aged 65 years and older among the first groups prioritised for vaccination. We estimated the national-level impact of the initial phases of the US COVID-19 vaccination programme on COVID-19 cases, emergency department visits, hospital admissions, and deaths among adults aged 65 years and older. Methods We analysed population-based data reported to US federal agencies on COVID-19 cases, emergency department visits, hospital admissions, and deaths among adults aged 50 years and older during the period Nov 1, 2020, to April 10, 2021. We calculated the relative change in incidence among older age groups compared with a younger reference group for pre-vaccination and post-vaccination periods, defined by the week when vaccination coverage in a given age group first exceeded coverage in the reference age group by at least 1%; time lags for immune response and time to outcome were incorporated. We assessed whether the ratio of these relative changes differed when comparing the pre-vaccination and post-vaccination periods. Findings The ratio of relative changes comparing the change in the COVID-19 case incidence ratio over the post-vaccine versus pre-vaccine periods showed relative decreases of 53% (95% CI 50 to 55) and 62% (59 to 64) among adults aged 65 to 74 years and 75 years and older, respectively, compared with those aged 50 to 64 years. We found similar results for emergency department visits with relative decreases of 61% (52 to 68) for adults aged 65 to 74 years and 77% (71 to 78) for those aged 75 years and older compared with adults aged 50 to 64 years. Hospital admissions declined by 39% (29 to 48) among those aged 60 to 69 years, 60% (54 to 66) among those aged 70 to 79 years, and 68% (62 to 73), among those aged 80 years and older, compared with adults aged 50 to 59 years. COVID-19 deaths also declined (by 41%, 95% CI –14 to 69 among adults aged 65–74 years and by 30%, –47 to 66 among those aged ≥75 years, compared with adults aged 50 to 64 years), but the magnitude of the impact of vaccination roll-out on deaths was unclear. Interpretation The initial roll-out of the US COVID-19 vaccination programme was associated with reductions in COVID-19 cases, emergency department visits, and hospital admissions among older adults. Funding None.

Published
2022

38. Association of metabolic–bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants

Author

Guowei Kim, David E. Cummings, Marie Loh, Daryl J. Lin, Claire Alexandra Zhen Chew, Jimmy Bok Yan So, Ying Ern Loo, John B. Dixon, Zong Jie Koh, Joseph J. Zhao, Nicholas Syn, Bee Choo Tai, Lee M. Kaplan, Asim Shabbir, and Louis Zizhao Wang

Subjects
medicine.medical_specialty, Population, Bariatric Surgery, 030204 cardiovascular system & hematology, Cohort Studies, 03 medical and health sciences, Life Expectancy, 0302 clinical medicine, Cause of Death, medicine, Humans, Obesity, Prospective Studies, 030212 general & internal medicine, Mortality, education, Prospective cohort study, Survival rate, Proportional Hazards Models, Randomized Controlled Trials as Topic, education.field_of_study, business.industry, Mortality rate, Hazard ratio, Case-control study, General Medicine, Surgery, Survival Rate, Diabetes Mellitus, Type 2, Case-Control Studies, Number needed to treat, Controlled Clinical Trials as Topic, business, Cohort study
Abstract

Metabolic-bariatric surgery delivers substantial weight loss and can induce remission or improvement of obesity-related risks and complications. However, more robust estimates of its effect on long-term mortality and life expectancy-especially stratified by pre-existing diabetes status-are needed to guide policy and facilitate patient counselling. We compared long-term survival outcomes of severely obese patients who received metabolic-bariatric surgery versus usual care.We did a prespecified one-stage meta-analysis using patient-level survival data reconstructed from prospective controlled trials and high-quality matched cohort studies. We searched PubMed, Scopus, and MEDLINE (via Ovid) for randomised trials, prospective controlled studies, and matched cohort studies comparing all-cause mortality after metabolic-bariatric surgery versus non-surgical management of obesity published between inception and Feb 3, 2021. We also searched grey literature by reviewing bibliographies of included studies as well as review articles. Shared-frailty (ie, random-effects) and stratified Cox models were fitted to compare all-cause mortality of adults with obesity who underwent metabolic-bariatric surgery compared with matched controls who received usual care, taking into account clustering of participants at the study level. We also computed numbers needed to treat, and extrapolated life expectancy using Gompertz proportional-hazards modelling. The study protocol is prospectively registered on PROSPERO, number CRD42020218472.Among 1470 articles identified, 16 matched cohort studies and one prospective controlled trial were included in the analysis. 7712 deaths occurred during 1·2 million patient-years. In the overall population consisting 174 772 participants, metabolic-bariatric surgery was associated with a reduction in hazard rate of death of 49·2% (95% CI 46·3-51·9, p0·0001) and median life expectancy was 6·1 years (95% CI 5·2-6·9) longer than usual care. In subgroup analyses, both individuals with (hazard ratio 0·409, 95% CI 0·370-0·453, p0·0001) or without (0·704, 0·588-0·843, p0·0001) baseline diabetes who underwent metabolic-bariatric surgery had lower rates of all-cause mortality, but the treatment effect was considerably greater for those with diabetes (between-subgroup IAmong adults with obesity, metabolic-bariatric surgery is associated with substantially lower all-cause mortality rates and longer life expectancy than usual obesity management. Survival benefits are much more pronounced for people with pre-existing diabetes than those without.None.

Published
2021

39. Neuromodulation for chronic pain

Author

Marc A. Huntoon, María Francisca Elgueta Le Beuffe, Steven P. Cohen, Jee Youn Moon, Helena Knotkova, Clement Hamani, and Eellan Sivanesan

Subjects
Male, medicine.medical_specialty, Deep Brain Stimulation, medicine.medical_treatment, Pain medicine, 030204 cardiovascular system & hematology, Transcranial Direct Current Stimulation, Transcutaneous electrical nerve stimulation, law.invention, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, law, Peripheral Nervous System, Back pain, medicine, Humans, Pain Management, 030212 general & internal medicine, Failed Back Surgery Syndrome, Neurotransmitter Agents, Spinal Cord Stimulation, Transcranial direct-current stimulation, business.industry, Motor Cortex, Chronic pain, General Medicine, medicine.disease, Transcranial Magnetic Stimulation, Neuromodulation (medicine), Brain stimulation, Neuropathic pain, Transcutaneous Electric Nerve Stimulation, Neuralgia, Female, Chronic Pain, medicine.symptom, business
Abstract

Neuromodulation is an expanding area of pain medicine that incorporates an array of non-invasive, minimally invasive, and surgical electrical therapies. In this Series paper, we focus on spinal cord stimulation (SCS) therapies discussed within the framework of other invasive, minimally invasive, and non-invasive neuromodulation therapies. These therapies include deep brain and motor cortex stimulation, peripheral nerve stimulation, and the non-invasive treatments of repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and transcutaneous electrical nerve stimulation. SCS methods with electrical variables that differ from traditional SCS have been approved. Although methods devoid of paraesthesias (eg, high frequency) should theoretically allow for placebo-controlled trials, few have been done. There is low-to-moderate quality evidence that SCS is superior to reoperation or conventional medical management for failed back surgery syndrome, and conflicting evidence as to the superiority of traditional SCS over sham stimulation or between different SCS modalities. Peripheral nerve stimulation technologies have also undergone rapid development and become less invasive, including many that are placed percutaneously. There is low-to-moderate quality evidence that peripheral nerve stimulation is effective for neuropathic pain in an extremity, low quality evidence that it is effective for back pain with or without leg pain, and conflicting evidence that it can prevent migraines. In the USA and many areas in Europe, deep brain and motor cortex stimulation are not approved for chronic pain, but are used off-label for refractory cases. Overall, there is mixed evidence supporting brain stimulation, with most sham-controlled trials yielding negative findings. Regarding non-invasive modalities, there is moderate quality evidence that repetitive transcranial magnetic stimulation does not provide meaningful benefit for chronic pain in general, but conflicting evidence regarding pain relief for neuropathic pain and headaches. For transcranial direct current stimulation, there is low-quality evidence supporting its benefit for chronic pain, but conflicting evidence regarding a small treatment effect for neuropathic pain and headaches. For transcutaneous electrical nerve stimulation, there is low-quality evidence that it is superior to sham or no treatment for neuropathic pain, but conflicting evidence for non-neuropathic pain. Future research should focus on better evaluating the short-term and long-term effectiveness of all neuromodulation modalities and whether they decrease health-care use, and on refining selection criteria and treatment variables.

Published
2021

40. Recurrent miscarriage: evidence to accelerate action

Author

Mariëtte Goddijn, Rajinder Kaur, Oonagh Pickering, Phillip R. Bennett, Arri Coomarasamy, Hassan Shehata, Vikki M. Abrahams, Ole Bjarne Christiansen, Debra Bick, Jane Brewin, Chandrika N Wijeyaratne, Abha Maheshwari, Maya Al-Memar, Siobhan Quenby, Olufemi T. Oladapo, Rima K Dhillon-Smith, Tom Bourne, Jan J. Brosens, Rachel Small, Adam J. Devall, Lesley Regan, Argyro Papadopoulou, Raj Rai, Mary D. Stephenson, Ioannis D. Gallos, and Imperial College Healthcare NHS Trust- BRC Funding

Subjects
medicine.medical_specialty, Abortion, Habitual/diagnosis, Pregnancy Complications/diagnosis, MEDLINE, Levothyroxine, 030204 cardiovascular system & hematology, 03 medical and health sciences, Medicine, General & Internal, SUBCLINICAL HYPOTHYROIDISM, 0302 clinical medicine, Pregnancy, General & Internal Medicine, THYROID-DISEASE, Recurrent miscarriage, medicine, Humans, 030212 general & internal medicine, 11 Medical and Health Sciences, Subclinical infection, Lupus anticoagulant, Science & Technology, ANTIBODY-POSITIVE WOMEN, business.industry, General Medicine, POLYCYSTIC-OVARY-SYNDROME, medicine.disease, Mental health, RANDOMIZED-TRIAL, LEVOTHYROXINE TREATMENT, Action (philosophy), Family medicine, CHROMOSOME ANALYSIS, THROMBOPHILIA, Female, Thyroid function, IN-VITRO FERTILIZATION, business, Life Sciences & Biomedicine, PREGNANT-WOMEN, medicine.drug
Abstract

Women who have had repeated miscarriages often have uncertainties about the cause, the likelihood of recurrence, the investigations they need, and the treatments that might help. Health-care policy makers and providers have uncertainties about the optimal ways to organise and provide care. For this Series paper, we have developed recommendations for practice from literature reviews, appraisal of guidelines, and a UK-wide consensus conference that was held in December, 2019. Caregivers should individualise care according to the clinical needs and preferences of women and their partners. We define a minimum set of investigations and treatments to be offered to couples who have had recurrent miscarriages, and urge health-care policy makers and providers to make them universally available. The essential investigations include measurements of lupus anticoagulant, anticardiolipin antibodies, thyroid function, and a transvaginal pelvic ultrasound scan. The key treatments to consider are first trimester progesterone administration, levothyroxine in women with subclinical hypothyroidism, and the combination of aspirin and heparin in women with antiphospholipid antibodies. Appropriate screening and care for mental health issues and future obstetric risks, particularly preterm birth, fetal growth restriction, and stillbirth, will need to be incorporated into the care pathway for couples with a history of recurrent miscarriage. We suggest health-care services structure care using a graded model in which women are offered online health-care advice and support, care in a nurse or midwifery-led clinic, and care in a medical consultant-led clinic, according to clinical needs.

Published
2021

41. Efficacy and safety of voclosporin versus placebo for lupus nephritis (AURORA 1): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial

Author

Dawn J. Caster, Ellen M. Ginzler, Laura Lisk, Robert B Huizinga, Brad H. Rovin, Cristina Arriens, Joshua Kaplan, Neil Solomons, Y K Onno Teng, Juanita Romero-Diaz, Keisha L. Gibson, Simrat Randhawa, Samir V. Parikh, and Sandra V. Navarra

Subjects
Adult, Male, medicine.medical_specialty, Calcineurin Inhibitors, Lupus nephritis, Renal function, 030204 cardiovascular system & hematology, Placebo, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Double-Blind Method, Prednisone, Internal medicine, medicine, Clinical endpoint, Humans, Lupus Erythematosus, Systemic, 030212 general & internal medicine, Glucocorticoids, Aged, business.industry, General Medicine, Middle Aged, Mycophenolic Acid, medicine.disease, Lupus Nephritis, Rheumatology, Voclosporin, Calcineurin, Treatment Outcome, chemistry, Creatinine, Cyclosporine, Female, business, Glomerular Filtration Rate, medicine.drug
Abstract

Background Voclosporin, a novel calcineurin inhibitor approved for the treatment of adults with lupus nephritis, improved complete renal response rates in patients with lupus nephritis in a phase 2 trial. This study aimed to evaluate the efficacy and safety of voclosporin for the treatment of lupus nephritis.Methods This multicentre, double-blind, randomised phase 3 trial was done in 142 hospitals and clinics across 27 countries. Patients with a diagnosis of systemic lupus erythematosus with lupus nephritis according to the American College of Rheumatology criteria, and a kidney biopsy within 2 years that showed class III, IV, or V (alone or in combination with class III or IV) were eligible. Patients were randomly assigned (1: 1) to oral voclosporin (23.7 mg twice daily) or placebo, on a background of mycophenolate mofetil (1 g twice daily) and rapidly tapered low-dose oral steroids, by use of an interactive web response system. The primary endpoint was complete renal response at 52 weeks defined as a composite of urine protein creatinine ratio of 0.5 mg/mg or less, stable renal function (defined as estimated glomerular filtration rate [eGFR] >= 60 mL/min/1.73 m(2) or no confirmed decrease from baseline in eGFR of >20%), no administration of rescue medication, and no more than 10 mg prednisone equivalent per day for 3 or more consecutive days or for 7 or more days during weeks 44 through 52, just before the primary endpoint assessment. Safety was also assessed. Efficacy analysis was by intention-to-treat and safety analysis by randomised patients receiving at least one dose of study treatment. The trial is registered with ClinicalTrials.gov, NCT03021499.Findings Between April 13, 2017, and Oct 10, 2019, 179 patients were assigned to the voclosporin group and 178 to the placebo group. The primary endpoint of complete renal response at week 52 was achieved in significantly more patients in the voclosporin group than in the placebo group (73 [41%] of 179 patients vs 40 [23%] of 178 patients; odds ratio 2.65; 95% CI 1.64-4.27; p

Published
2021

42. Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals

Author

Matthew D. McHugh, Carol Windsor, Linda H. Aiken, Douglas M. Sloane, Patsy Yates, and Clint Douglas

Subjects
Male, medicine.medical_specialty, Personnel Staffing and Scheduling, Staffing, Legislation, Nursing Staff, Hospital, 030204 cardiovascular system & hematology, Rate ratio, Patient Readmission, 03 medical and health sciences, 0302 clinical medicine, Cause of Death, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Aged, Quality of Health Care, business.industry, Health Policy, Nurse staffing, Mortality rate, Nursing research, Australia, General Medicine, Odds ratio, Length of Stay, Middle Aged, Emergency medicine, Female, business
Abstract

Substantial evidence indicates that patient outcomes are more favourable in hospitals with better nurse staffing. One policy designed to achieve better staffing is minimum nurse-to-patient ratio mandates, but such policies have rarely been implemented or evaluated. In 2016, Queensland (Australia) implemented minimum nurse-to-patient ratios in selected hospitals. We aimed to assess the effects of this policy on staffing levels and patient outcomes and whether both were associated.For this prospective panel study, we compared Queensland hospitals subject to the ratio policy (27 intervention hospitals) and those that discharged similar patients but were not subject to ratios (28 comparison hospitals) at two timepoints: before implementation of ratios (baseline) and 2 years after implementation (post-implementation). We used standardised Queensland Hospital Admitted Patient Data, linked with death records, to obtain data on patient characteristics and outcomes (30-day mortality, 7-day readmissions, and length of stay [LOS]) for medical-surgical patients and survey data from 17 010 medical-surgical nurses in the study hospitals before and after policy implementation. Survey data from nurses were used to measure nurse staffing and, after linking with standardised patient data, to estimate the differential change in outcomes between patients in intervention and comparison hospitals, and determine whether nurse staffing changes were related to it.We included 231 902 patients (142 986 in intervention hospitals and 88 916 in comparison hospitals) assessed at baseline (2016) and 257 253 patients (160 167 in intervention hospitals and 97 086 in comparison hospitals) assessed in the post-implementation period (2018). After implementation, mortality rates were not significantly higher than at baseline in comparison hospitals (adjusted odds ratio [OR] 1·07, 95% CI 0·97-1·17, p=0·18), but were significantly lower than at baseline in intervention hospitals (0·89, 0·84-0·95, p=0·0003). From baseline to post-implementation, readmissions increased in comparison hospitals (1·06, 1·01-1·12, p=0·015), but not in intervention hospitals (1·00, 0·95-1·04, p=0·92). Although LOS decreased in both groups post-implementation, the reduction was more pronounced in intervention hospitals than in comparison hospitals (adjusted incident rate ratio [IRR] 0·95, 95% CI 0·92-0·99, p=0·010). Staffing changed in hospitals from baseline to post-implementation: of the 36 hospitals with reliable staffing measures, 30 (83%) had more than 4·5 patients per nurse at baseline, with the number decreasing to 21 (58%) post-implementation. The majority of change was at intervention hospitals, and staffing improvements by one patient per nurse produced reductions in mortality (OR 0·93, 95% CI 0·86-0·99, p=0·045), readmissions (0·93, 0·89-0·97, p0·0001), and LOS (IRR 0·97, 0·94-0·99, p=0·035). In addition to producing better outcomes, the costs avoided due to fewer readmissions and shorter LOS were more than twice the cost of the additional nurse staffing.Minimum nurse-to-patient ratio policies are a feasible approach to improve nurse staffing and patient outcomes with good return on investment.Queensland Health, National Institutes of Health, National Institute of Nursing Research.

Published
2021

43. IL-6 inhibition with ziltivekimab in patients at high atherosclerotic risk (RESCUE): a double-blind, randomised, placebo-controlled, phase 2 trial

Author

G. Kees Hovingh, Larry Lo, Mads D M Engelmann, Paul M. Ridker, Pablo Pergola, Florian M.M. Baeres, Peter Libby, Rescue Investigators, Milana Ivkovic, Michael H. Davidson, Matt Devalaraja, Dominic S. Raj, Douglas Kling, Experimental Vascular Medicine, Vascular Medicine, and ACS - Atherosclerosis & ischemic syndromes

Subjects
Male, medicine.medical_specialty, Injections, Subcutaneous, Population, Inflammation, Disease, 030204 cardiovascular system & hematology, Antibodies, Monoclonal, Humanized, Placebo, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Internal medicine, medicine, Humans, 030212 general & internal medicine, Renal Insufficiency, Chronic, education, Interleukin 6, Aged, education.field_of_study, biology, Interleukin-6, business.industry, Thrombosis, General Medicine, Middle Aged, Atherosclerosis, medicine.disease, C-Reactive Protein, Treatment Outcome, biology.protein, Biomarker (medicine), Female, medicine.symptom, business, Biomarkers, Kidney disease
Abstract

Background: IL-6 has emerged as a pivotal factor in atherothrombosis. Yet, the safety and efficacy of IL-6 inhibition among individuals at high atherosclerotic risk but without a systemic inflammatory disorder is unknown. We therefore addressed whether ziltivekimab, a fully human monoclonal antibody directed against the IL-6 ligand, safely and effectively reduces biomarkers of inflammation and thrombosis among patients with high cardiovascular risk. We focused on individuals with elevated high-sensitivity CRP and chronic kidney disease, a group with substantial unmet clinical need in whom previous studies in inflammation inhibition have shown efficacy for cardiovascular event reduction. Methods: RESCUE is a randomised, double-blind, phase 2 trial done at 40 clinical sites in the USA. Inclusion criteria were age 18 years or older, moderate to severe chronic kidney disease, and high-sensitivity CRP of at least 2 mg/L. Participants were randomly allocated (1:1:1:1) to subcutaneous administration of placebo or ziltivekimab 7·5 mg, 15 mg, or 30 mg every 4 weeks up to 24 weeks. The primary outcome was percentage change from baseline in high-sensitivity CRP after 12 weeks of treatment with ziltivekimab compared with placebo, with additional biomarker and safety data collected over 24 weeks of treatment. Primary analyses were done in the intention-to-treat population. Safety was assessed in all patients who received at least one dose of assigned treatment. The trial is registered with ClinicalTrials.gov, NCT03926117. Findings: Between June 17, 2019, and Jan 14, 2020, 264 participants were enrolled into the trial, of whom 66 were randomly assigned to each of the four treatment groups. At 12 weeks after randomisation, median high-sensitivity CRP levels were reduced by 77% for the 7·5 mg group, 88% for the 15 mg group, and 92% for the 30 mg group compared with 4% for the placebo group. As such, the median pairwise differences in percentage change in high-sensitivity CRP between the ziltivekimab and placebo groups, after aligning for strata, were –66·2% for the 7·5 mg group, –77·7% for the 15 mg group, and –87·8% for the 30 mg group (all p

Published
2021

44. Nociplastic pain: towards an understanding of prevalent pain conditions

Author

Winfried Häuser, Mary Ann Fitzcharles, Steven P. Cohen, Daniel J. Clauw, Chie Usui, and Geoffrey O. Littlejohn

Subjects
Pain modulation, Sensory processing, business.industry, medicine.medical_treatment, Inflammation, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, Bioinformatics, Chronic low back pain, 03 medical and health sciences, 0302 clinical medicine, Nociception, Mood, Fibromyalgia, Neuropathic pain, Medicine, 030212 general & internal medicine, medicine.symptom, business
Abstract

Summary Nociplastic pain is the semantic term suggested by the international community of pain researchers to describe a third category of pain that is mechanistically distinct from nociceptive pain, which is caused by ongoing inflammation and damage of tissues, and neuropathic pain, which is caused by nerve damage. The mechanisms that underlie this type of pain are not entirely understood, but it is thought that augmented CNS pain and sensory processing and altered pain modulation play prominent roles. The symptoms observed in nociplastic pain include multifocal pain that is more widespread or intense, or both, than would be expected given the amount of identifiable tissue or nerve damage, as well as other CNS-derived symptoms, such as fatigue, sleep, memory, and mood problems. This type of pain can occur in isolation, as often occurs in conditions such as fibromyalgia or tension-type headache, or as part of a mixed-pain state in combination with ongoing nociceptive or neuropathic pain, as might occur in chronic low back pain. It is important to recognise this type of pain, since it will respond to different therapies than nociceptive pain, with a decreased responsiveness to peripherally directed therapies such as anti-inflammatory drugs and opioids, surgery, or injections.

Published
2021

45. Safety, tolerability, pharmacokinetics, and pharmacodynamics of concomitant administration of multiple doses of cagrilintide with semaglutide 2·4 mg for weight management: a randomised, controlled, phase 1b trial

Author

David C.W. Lau, Domenica Rubino, Kasper K Berthelsen, Michael T. Lund, Martin Kankam, Altynai Satylganova, and Lone B Enebo

Subjects
Adult, Male, medicine.medical_specialty, Glucagon-Like Peptides, Cmax, 030204 cardiovascular system & hematology, Placebo, Gastroenterology, Injections, law.invention, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Pharmacokinetics, Randomized controlled trial, law, Internal medicine, Weight Loss, medicine, Humans, Obesity, 030212 general & internal medicine, Volume of distribution, business.industry, Semaglutide, General Medicine, Middle Aged, Islet Amyloid Polypeptide, Tolerability, Pharmacodynamics, Drug Therapy, Combination, Female, Anti-Obesity Agents, business
Abstract

Summary Background Cagrilintide, a long-acting amylin analogue, and semaglutide 2·4 mg, a glucagon-like peptide-1 analogue, are both being investigated as options for weight management. We aimed to determine the safety, tolerability, pharmacokinetics, and pharmacodynamics of this drug combination. Methods In this randomised, placebo-controlled, multiple-ascending dose, phase 1b trial, individuals aged 18–55 years with a body-mass index 27·0−39·9 kg/m2 and who were otherwise healthy were recruited from a single centre in the USA. The trial included six sequential overlapping cohorts, and in each cohort eligible participants were randomly assigned (3:1) to once-weekly subcutaneous cagrilintide (0·16, 0·30, 0·60, 1·2, 2·4, or 4·5 mg) or matched placebo, in combination with once-weekly subcutaneous semaglutide 2·4 mg, without lifestyle interventions. In each cohort, the doses of cagrilintide and semaglutide were co-escalated in 4-week intervals to the desired dose over 16 weeks, participants were treated at the target dose for 4 weeks, and then followed up for 5 weeks. Participants, investigators, and the sponsor were masked to treatment assignment. The primary endpoint was number of treatment-emergent adverse events from baseline to end of follow-up. Secondary pharmacokinetic endpoints assessed from day of last dose (week 19) to end of treatment (week 20) were area under the plasma concentration-time curve from 0 to 168 h (AUC0–168 h) and maximum concentration [Cmax] of cagrilintide and semaglutide; exploratory pharmacokinetic endpoints were half-life, time to Cmax [tmax], plasma clearance, and volume of distribution of cagrilintide and semaglutide; and exploratory pharmacodynamic endpoints were changes in bodyweight, glycaemic parameters, and hormones. Safety, pharmacokinetic, and pharmacodynamic endpoints were assessed in all participants who were exposed to at least one dose of study drug. This study is registered with ClinicalTrials.gov, NCT03600480, and is now complete. Findings Between July 25, 2018, and Dec 17, 2019, 285 individuals were screened and 96 were randomly assigned to cagrilintide (0·16–2·4 mg group n=12; 4·5 mg group n=11) or placebo (n=24), in combination with semaglutide 2·4 mg, of whom 95 were exposed to treatment (one patient in 0·60 mg cagrilintide group was not exposed) and included in the safety and full analysis datasets. The mean age was 40·6 years (SD 9·2), 56 (59%) of 95 participants were men and 51 (54%) were Black or African American. Of 566 adverse events reported in 92 participants (69 [97%] of 71 participants assigned to 0·16–4·5 mg cagrilintide and 23 [96%] of 24 assigned to placebo), 207 (37%) were gastrointestinal disorders. Most adverse events were mild to moderate in severity and the proportion of participants with one or more adverse event was similar across treatment groups. Exposure was proportional to cagrilintide dose and did not affect semaglutide exposure or elimination. AUC0–168 h ranged from 926 nmol × h/L to 24 271 nmol × h/L, and Cmax ranged from 6·14 nmol/L to 170 nmol/L with cagrilintide 0·16–4·5 mg. AUC0–168 h ranged from 12 757 nmol × h/L to 15 305 nmol × h/L, and Cmax ranged from 96·4 nmol/L to 120 nmol/L with semaglutide 2·4 mg. Cagrilintide 0·16−4·5 mg had a half-life of 159–195 h, with a median tmax of 24–72 h. Semaglutide 2·4 mg had a half-life of 145–165 h, with a median tmax of 12–24 h. Plasma clearance and volume of distribution for both cagrilintide and semaglutide were similar across treatment groups. At week 20, mean percentage bodyweight reductions were greater with cagrilintide 1·2 and 2·4 mg than with placebo (15·7% [SE 1·6] for cagrilintide 1·2 mg and 17·1% [1·5] for cagrilintide 2·4 mg vs 9·8% [1·2] for pooled placebo cohorts 1–5; estimated treatment difference of −6·0% [95% CI −9·9 to −2·0] for cagrilintide 1·2 mg and −7·4% [−11·2 to −3·5] for cagrilintide 2·4 mg vs pooled placebo), and with cagrilintide 4·5 mg than with matched placebo (15·4% [1·3] vs 8·0% [2·2]; estimated treatment difference −7·4% [−12·8 to −2·1]), all in combination with semaglutide 2·4 mg. Glycaemic parameters improved in all treatment groups, independently of cagrilintide dose. Changes in hormones were similar across treatment groups. Interpretation Concomitant treatment with cagrilintide and semaglutide 2·4 mg was well tolerated with an acceptable safety profile. Future larger and longer trials are needed to fully assess the efficacy and safety of this treatment combination. Funding Novo Nordisk A/S.

Published
2021

46. 18F-fluciclovine-PET/CT imaging versus conventional imaging alone to guide postprostatectomy salvage radiotherapy for prostate cancer (EMPIRE-1): a single centre, open-label, phase 2/3 randomised controlled trial

Author

Mehmet Asim Bilen, Eduard Schreibmann, Viraj A. Master, Olayinka A. Abiodun-Ojo, Ashesh B. Jani, Vishal R. Dhere, Akinyemi A. Akintayo, Raghuveer Halkar, Bruce Hershatter, Bradley C. Carthon, Pretesh Patel, Peter J. Rossi, Omer Kucuk, Mark M. Goodman, Shreyas S. Joshi, Joseph W. Shelton, David M. Schuster, Karen M. Xu, and Subir Goyal

Subjects
Biochemical recurrence, medicine.medical_specialty, Prostatectomy, business.industry, medicine.medical_treatment, Hazard ratio, Cancer, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, Androgen deprivation therapy, Radiation therapy, 03 medical and health sciences, Prostate cancer, 0302 clinical medicine, medicine, Clinical endpoint, 030212 general & internal medicine, Radiology, business
Abstract

Summary Background Molecular imaging is increasingly used to guide treatment decisions and planning in prostate cancer. We aimed to evaluate the role of 18F-fluciclovine-PET/CT in improving cancer control compared with conventional imaging (bone scan and either CT or MRI) alone for salvage postprostatectomy radiotherapy. Methods In EMPIRE-1, a single-centre, open-label, phase 2/3 randomised controlled trial, patients with prostate cancer with detectable PSA after prostatectomy and negative conventional imaging (no extrapelvic or bone findings) were randomly assigned in a 1:1 ratio to radiotherapy directed by conventional imaging alone or to conventional imaging plus 18F-fluciclovine-PET/CT. Computer-generated randomisation was stratified by PSA concentration, adverse pathology indicators, and androgen deprivation therapy intent. In the 18F-fluciclovine-PET/CT group, radiotherapy decisions were rigidly determined by PET findings, which were also used for target delineation. The primary endpoint was 3 year event-free survival, with events defined as biochemical or clinical recurrence or progression, or initiation of systemic therapy, using univariate and multivariable analyses in patients who received radiotherapy. This trial is registered with ClinicalTrials.gov , NCT01666808 and is closed to new participants. Findings From Sept 18, 2012, to March 4, 2019, 165 patients were randomly assigned, with median follow-up of 3·52 years (95% CI 2·98–3·95). PET findings resulted in four patients in the 18F-fluciclovine-PET/CT group having radiotherapy aborted; these patients were excluded from survival analyses. Median survival was not reached (95% CI 35·2–not reached; 33% of 81 patients had events) in the conventional imaging group compared with not reached (95% CI not reached–not reached; 20% of 76 patients) in the 18F-fluciclovine-PET/CT group, and 3 year event-free survival was 63·0% (95% CI 49·2–74·0) in the conventional imaging group versus 75·5% (95% CI 62·5–84·6) for 18F-fluciclovine-PET/CT (difference 12·5; 95% CI 4·3–20·8; p=0·0028). In adjusted analyses, study group (hazard ratio 2·04 [95% CI 1·06–3·93], p=0·0327) was significantly associated with event-free survival. Toxicity was similar in both study groups, with the most common adverse events being late urinary frequency or urgency (37 [46%] of 81 patients in the conventional imaging group and 31 [41%] of 76 in the PET group), and acute diarrhoea (11 [14%] in the conventional imaging group and 16 [21%] in the PET group). Interpretation Inclusion of 18F-fluciclovine-PET into postprostatectomy radiotherapy decision making and planning significantly improved survival free from biochemical recurrence or persistence. Integration of novel PET radiotracers into radiotherapy decisions and planning for prostate cancer patients warrants further study. Funding National Institutes of Health/National Cancer Institute, Blue Earth Diagnostics, and Winship Cancer Institute of Emory University.

Published
2021

47. 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 Bennett, Ian Bennett, Kristopher Bennett, Lorraine Bennett, Sara Bennett, Karen Bennion, Vivienne Benson, Jane Benstead, Andrew Bentley, Dionne Bentley, James Bentley, Ian Benton, Eva Beranova, Matthew Beresford, Colin Bergin, Malin Bergstrom, Jolanta Bernatoniene, Thomas Berriman, Zoe Berry, Marnie Berwick, Kimberley Best, Ans-Mari Bester, Yvonne Beuvink, Emily Bevan, Sarah Bevins, Tom Bewick, Andrew Bexley, Sonay Beyatli, Fenella Beynon, Arjun Bhadi, Sanjay Bhagani, Shiv Bhakta, Rekha Bhalla, Khushpreet Bhandal, Kulbinder Bhandal, Ashwin Bhandari, Sangam Bhandari, Aashutosh Bhanot, Ravina Bhanot, Sruti Bhaskara, Prashanth Bhat, Nikhil Bhatia, Rahul Bhatnagar, Karan Bhatt, Janki Bhayani, Deepika Bhojwani, Salimuzzaman Bhuiyan, Anna Bibby, Fatima Bibi, Naheeda Bibi, Salma Bibi, Tihana Bicanic, Sarah Bidgood, Julie Bigg, Sarah Biggs, Alphonsa Biju, Andras Bikov, Sophie Billingham, Jessica Billings, Carron Bilton, Teodirico Binas, Martin Binney, Alice Binns, Muhammad BinRofaie, Oliver 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, Sumit Bokhandi, Maria Bokhar, Saba Bokhari, Sakina Bokhari, Syed Owais Bokhari, Ambrose Boles, Sarah Bollington, Sam Bolton, Charlotte Bomken, Charlotte Bond, Hayley Bond, Helena Bond, Stuart Bond, Thomas Bond, Alice Bone, Georgia Boniface, Wendy Bonnert, Lizzy Bonney, Leigh Boorman, Catherine Booth, Joanne Borbone, Cameron Borhani, Naomi Borman, Rachel Borrell, Mamu Boshir, Fiona Bottrill, Laura Bough, Hayley Boughton, Zoe Boult, Miriam Bourke, Stephen Bourke, Michelle Bourne, Rachel Bousfield, Lucy Boustred, Darren Bowen, Kaye Bowen, Alexandra Bowes, Amy Bowes, Philip Bowker, Louise Bowman, Simon Bowman, Rachel Bowmer, Angie Bowring, Geoff Bowyer, Helen Bowyer, Carmel Boyd, Jenny Boyd, Laura Boyd, Maxine Boyd, Namoi Boyle, Pauline Boyle, Rosalind Boyle, Louise Boyles, Osman Bozdag, Leanna Brace, David Brack, Charlotte Brackstone, Rob Bradburn, Jodie Bradder, Barry Bradley, Clare Jane Bradley, Pamela Bradley, Patrick Bradley, Paul Bradley, Joanne Bradley-Potts, Lynne Bradshaw, Sarah Bradshaw, Zena Bradshaw, Rebecca Brady, Shirin Brady, Denise Braganza, Suhail Brailsford, Jill Braithwaite, Marie Branch, Thomas Brankin-Frisby, Jamie Brannigan, Louise Brassington, Sophie Brattan, Fiona Bray, Nancy Bray, Angela Brazier, Manny Brazil, Lucy Brear, Tracy Brear, Stephen Brearey, Laura Bremner, Morwenna Brend, Giovanna Bretland, Chris Brewer, Hannah Bridge, Gavin Bridgwood, Hayley Briggs, Mark Briggs, Sara Brigham, John Bright, Chris Brightling, Lutece Brimfield, Elaine Brinkworth, Robin Brittain-Long, Vianne Britten, Terri Brittin, Lauren Broad, Sarah Broad, Rosie Broadhurst, Andrew Broadley, Marie Broadway, Christopher Brockelsby, Megan Brocken, Tomos Brockley, Andrew Broderick, Mary Brodsky, Fiona Brogan, David Broggio, Liz Brohan, Felicity Brokke, Jacob Brolly, David Bromley, Hannah Brooke-Ball, Verity Brooker, Ceri Brookes, Matthew Brookes, Alison Brooks, Karen Brooks, Nicole Brooks, Philip Brooks, Rachel Brooks, Sophie Brooks, Natalie Broomhead, Chloe Broughton, Nathaniel Broughton, Matt Brouns, Marie Browett, Alison Brown, Ammani Brown, Carly Brown, Catrin Brown, Chloe Brown, Elizabeth Brown, Ellen Brown, Heather Brown, Janet Brown, Louise Brown, Niall Brown, Pauline Brown, Rachel Brown, Richard Brown, Robert Brown, Steven Brown, Tom Brown, Wayne Brown, Bria Browne, Charlotte Browne, Duncan Browne, Mitchell Browne, Stephen Brownlee, Alba Brraka, David Bruce, Johanna Bruce, Michelle Bruce, Wojciech Brudlo, Nigel Brunskill, Alan Brunton, Margaret Brunton, Mandy Bryan, Meera Bryant, April Buazon, Maya Buch, Julie Buchan, Ruaridh Buchan, Alexis Buchanan, Ruaridh Buchanan, Danielle Buche, Amanda Buck, Matthew Buckland, Laura Buckley, Philip Buckley, Sarah Buckley, Carol Buckman, Kathleen Buckmire, George Bugg, Ramadan Bujazia, Marwan Bukhari, Shanze Bukhari, Richard Bulbulia, Alex Bull, Damian Bull, Rhian Bull, Thomas Bull, Naomi Bulteel, Kasun Bumunarachchi, Roneleeh Bungue-Tuble, Caroline Burchett, Dorota Burda, Christy Burden, Thomas G Burden, Mika Burgess, Paula Burgess, Richard Burgess, Sophia Burgess, Paula Burgett, Adrian Burman, Sara Burnard, Caroline Burnett, John Burnett, Amanda Burns, Amy Burns, Collette Burns, James Burns, Karen Burns, Samuel Burns, Sarah Burns, Daniel Burrage, Sadie Burrage, Kate Burrows, Claire Burston, Ben Burton, Fiona Burton, Matthew Burton, Angela Busby, Deborah Butcher, Aaron Butler, Jessica Butler, Joanne Butler, Joshua Butler, Lesley Butler, Peter Butler, Susan Butler, Al-Tahoor Butt, Mohammad M Butt, Sophia Butt, Caryl Butterworth, Nicola Butterworth-Cowin, Robert Buttery, Tom Buttle, Heather Button, Daniel Buttress, Jane Byrne, Wendy Byrne, Victoria Byrne-Watts, Eleanor Byworth, Amanda Cabandugama, Ruth Cade, Anthony Cadwgan, Donna Cairney, James Calderwood, Darren Caldow, Moira Caldwell, Giorgio Calisti, Debbie Callaghan, Jennifer Callaghan, Claire Callens, Donaldson Callum, Caroline Calver, Melissa Cambell-Kelly, Tracey Camburn, David R Cameron, Eleanor Cameron, Fraser Cameron, Sarah 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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Chandler, Kim J Chandler, Stuart Chandler, Zoe Chandler, Vikki Chandler-Vizard, Sumit Chandra, Navin Chandran, Badrinathan Chandrasekaran, Cherry Chang, Yvonne Chang, Josephine Chaplin, Graeme Chapman, John Chapman, Katie Chapman, Laura Chapman, Lianne Chapman, Polly Chapman, Timothy Chapman, Lucy Chappell, Linda Chapple, Amanda Charalambou, Bethan Charles, Dianne Charlton, Sally Charlton, Kevin Chatar, Calvin Chatha, Ritesh Chaube, Muhammad YN Chaudhary, Iram Chaudhry, Nazia Chaudhuri, Muhammad Chaudhury, Anoop Chauhan, Ruchi S Chauhan, Vipul Chauhan, Nicola Chavasse, Iknam Chaven, Rosanna Chavez, Vipal Chawla, Maria Cheadle, Lindsay Cheater, James Cheaveau, Charlotte Cheeld, Michelle Cheeseman, Fang Chen, Hui Min Chen, Terence Chen, Lok Yin Cheng, Zhihang Cheng, Helen Chenoweth, Chun How Cheong, Shiney Cherian, Suzanne Cherif, Mary Cherrie, Helen Cheshire, Barry Chesterson, Betty Cheung, Chee Kay Cheung, Elaine Cheung, Michelle Cheung, Claire Cheyne, Swati Chhabra, Wei Ling Chia, 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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Cooper, Chris Cooper, David Cooper, Helen Cooper, Jamie Cooper, Joanne Cooper, Joshua Cooper, Laura Cooper, Lauren Cooper, Nick Cooper, Rowena Cooper, Emma Cooperwaite, Thomas Cope, Sinead Corbet, Carolyn Corbett, John Corcoran, Chris Cordell, Jessica Cordle, Alasdair Corfield, John Corless, Alison Corlett, Joe Cornwell, Michael Cornwell, Diana Corogeanu, Mirella Corredera, Ruth Corrigan, Catherine Corry, Rita Corser, Denise Cosgrove, Tracey Cosier, Patricia Costa, Charlie Coston, Susannah Cotgrove, Zoe Coton, Lisa-Jayne Cottam, Rhiannon Cotter, Donna Cotterill, Alice Cotton, Caroline Cotton, Katy Cotton, Andrew Coull, James Coulson, David Counsell, David Counter, Cherry Coupland, Ellie Courtney, Julia Courtney, Rebecca Cousins, Alexander Cowan, Elena Cowan, Ruth Cowburn, Richard Cowell, Louise Cowen, Steve Cowman, Amanda Cowton, Debra Anne Cox, Ellie Cox, Giles Cox, Karina Cox, Miriam Cox, Karen Coy, Beverly Craig, Victoria Craig, Felicity Craighead, Matthew Cramp, Beverley Crane, 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Davies, Ffyon Davies, Helen Davies, James Davies, Jane Davies, Jeni Davies, Jim Davies, Karen Davies, Kelly Davies, Kim Davies, Louisa Davies, Mark Davies, Matthew Davies, Michelle Davies, Nina Davies, Owen Davies, Patrick Davies, Rachel Davies, Rhys Davies, Ruth Davies, Sarah Davies, Simon Davies, Alison Davis, Gwyneth Davis, Illinos Davis, Julie-Ann Davis, Katherine Davis, Peter Davis, Alexander Davison, Sophia Davison, Mark Davy, Christine Dawe, H Dawe, Mark Dawkins, Danielle Dawson, Elizabeth Dawson, Joy Dawson, Susan Dawson, Tom Dawson, Andrew Daxter, Andrew Day, Helena Day, Jacob Day, Jeremy Day, Lynn Day, Jamie D'Costa, Parijat De, Duneesha de Fonseka, Toni de Freitas, Frederico De Santana Miranda, Eleanor de Sausmarez, Shanika de Silva, Thushan de Silva, Jessica De Sousa, Paulo De Sousa, James de Souza, Anthony de Soyza, Natasha de Vere, Johannes de Vos, Bethan Deacon, Sharon Dealing, Anna Dean, Julie Dean, Katrina Dean, Stephen Dean, Tessa Dean, Jill Deane, James Dear, Effie 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 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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, 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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 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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, Eileen Killen, Susan Kilroy, Bomee Kim, Jee Whang Kim, Sarah Kimber, Andy King, Barbara King, Jennifer King, Kirsten King, Rachel King, Sarah King, Tony King, Victoria King, Emily King-Oakley, Laura Kingsmore, Andy King-Venables, Fiona Kinney, Sidra Kiran, Jeremy Kirk, Jodie Kirk, Daniel Kirkbride, Amy Kirkby, Ian Kirker, Emily Kirkham, Gemma Kirkman, Ursula Kirwan, Kelly Kislingbury, Toby Kitching, Laura Kitto, Lauren Kittridge, Sarah Klaczek, Frieder Kleemann, Susan Kmachia, Chris Knapp, Lucy Knibbs, Alicia Knight, Fraser Knight, Marian Knight, Sarah Knight, Steven Knight, Tom Knight, Ellen Knights, Jane Knights, Toby Knights, Martin Knolle, Carol Knott, Charlotte Knowles, Karen Knowles, Laurence Knowles, Emily Knox, Lucy Knox, Oliver Koch, Ronan Kodituwakku, Gouri Koduri, Aisha Koirata, Eirene Kolakaluri, Magdalena Kolodziej, Eirini Kolokouri, Keith Kolsteren, Samantha Kon, Niladri Konar, Mari Kononen, Athanasios Konstantinidis, Hui Fen Koo, Imogen Koopmans, Emmanuela Kopyj, Laura Korcierz, James Korolewicz, George Koshy, Chris Kosmidis, Jalpa Kotecha, Easwari Kothandaraman, Leonidas Koukouflis, Koushan Kouranloo, Rukhsana Kousar'c, Margarita Kousteni, Maja Kovac, Alex Kozak Eskenazia, Kestutis Krasauskas, Raghu Krishnamurthy, Vinodh Krishnamurthy, Manju Krishnan, Hari Krishnan, Suzanne Krizak, Sean Krupej, Agnieszka Kubisz-Pudelko, Soren Kudsk-Iversen, Aurimas Kudzinskas, Chirag Kukadiya, Nainesha Kulkarni, Aditi Kumar, Mayur Kumar, Ramesh Kumar, Ravi Kumar, Rita Kumar, Rupa Kumar, Satish Kumar, Vimal Kumar, Arun Kundu, Heinke Kunst, Amit Kurani, Mohammed Kurdy, Rincy Kurian, Vimal Kurmars, Cameron Kuronen-Stewart, Ranganai S Kusangaya, Vlad Kushakovsky, Mandy Kuunal, Apexa Kuverji, Amma Kyei-Mensah, Thyra Kyere-Diabour, Moe Kyi, Nyan M Kyi, Laura Kyle, Karali-Tsilimpari Kyriaki, Julius Labao, Louise Lacey, Nikki Lack, Emma Ladlow, Heather Lafferty, Shondipon Laha, Sushil Lahane, Clement Lai, James Lai, Emma Laing, Robert Laing, Inez Laing-Faiers, Emily Laity, 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 Leandro, Darren Leaning, Sandra Leason, Christina Leaver, Marie Anne Ledingham, Emma Lee, Hannah Lee, Irish Lee, Judith Lee, Sam Lee, Shi Han Lee, Simon Lee, Sindy Lee, Stephanie Lee, Tracey Lee, Xiang Lee, Diana Lees, Jennifer Lees, Helen Legge, Julian Leggett, Katie Leigh-Ellis, Kevan Leighton, Nicky Leitch, Eleni Lekoudis, Petula Lemessy, Nicholas Lemoine, Joana Lemos, Irina Lenchuk, Katy Leng, Katrina Lennon, Liz Lennon, Isabel Lentell, Kelly Leonard, Wen Leong, Nicky Leopold, Oskar Lepiarczyk, Isla Leslie, Eleni Lester, Joe Leung, Ullrich Leuschner, Emma Levell, Chris Levett, Alice Lewin, Michaela Lewin, Alison Lewis, David Lewis, Dee Lewis, Georgina Lewis, Gillian Lewis, Joanne Lewis, Joseph Lewis, Kathryn Lewis, Keir Lewis, Leon Lewis, Lisa Lewis, Marissa Lewis, Rob Lewis, Robert Lewis, Catherine Lewis-Clarke, Lorraine Lewis-Prosser, Katherine Lewiston, Adam Lewszuk, Penny Lewthwaite, Samantha Ley, Anna Li, Jenny Li, Angela Liao, Victoria Licence, David Lieberman, Susan Liebeschuetz, Nicky Lightfoot, Patrick Lillie, Ben Lim, Carys Lim, Ee Thong Lim, Ivy Lim, Terence Lim, Wei Shen Lim, Wilson Lim, James Limb, Usha Limbu, Christian Linares, Dermot Linden, Gabriella Lindergard, Kate Lindley, Charlotte Lindsay, Emily Lindsay, Max Lindsay, Helen Lindsay-Clarke, Mirella Ling, Claire Lingam, Linette Linkson, Mike Linney, Louise Linsell, Conrad Lippold, George Lipscomb, Karen Lipscomb, Laura Lipskis, Ana Lisboa, Evangeline Lister, Charlotte Little, Jeff Little, Sam Little, Xuedi Liu, Alexandra Liversidge, Jill Livingstone, Daniel K Llanera, Rhiannon Llewellyn, Martin Llewelyn, Adam Lloyd, Aimee Lloyd, Arwel Lloyd, Oliver Lloyd, Richard Lloyd, Su Lo, David Loader, Cristina Lobato, Maria Lobo-Clarke, Lydianne Lock, Sara Lock, Stephen Lock, Angela Locke, Jacqueline Locke, Thomas Locke, Teresa Lockett, Sandy Lockyer, Jeorghino Lodge, Terrence Lodge, Martina Lofthouse, Tracey Lofting, Heather Loftus, Meg Logan, Chloe Logue, Sook Yin Loh, Siddharth Lokanathan, Kaatje Lomme, Emily London, Gabriella Long, Natalie Long, Bev Longhurst, Mark Longshaw, Jennifer Lonnen, Caroline Lonsdale, Laura Looby, Ronda Loosley, Paola Lopez, Paula Lopez, Robert Lord, Stuart Lord, Laura Lordache, Kieron Loregnard, Catherine Lorenzen, Claire Lorimer, Francesco Loro, Rachel Lorusso, Eva Loutraris, Robert Loveless, Maxine Lovell, Angeliki Loverdou, Huw Lovett, Daniel Loveys, Andrew Low, Jen Mae Low, Alastair Lowe, Caroline Lowe, Catherine Lowe, Emily Lowe, Faye Lowe, Michael Lowe, Linda Lowrey, Richard Lowsby, Vicki Lowthorpe, Emma Loxley, Gamu Lubimbi, Alexandra Lubina Solomon, Georgia Lucas, Jacob Lucas, Alice Lucey, Olivia Lucey, Suzanne Luck, H Luke, Jane Luke, Hayley Lund, Apurva Lunia, Muriel Lunn, Ji Luo, Julia Lussier, Cindy Nisha Luximon, Elisa Ly, Barrie Lyell, Elisavet Lyka, Sarah Lymn, Audrey Lynas, Ceri Lynch, Daniel Lynch, Daniella Lynch, Stephen Lynch, Helen Lyon, Rea-Grace Maamari, Hannah Mabb, Louies Mabelin, Jessica Macaro, Angela Macauley, Kateryna Macconaill, Chloe Macdonald, Stuart MacDonald, Tania MacDonald, Claire Macfadyen, James G Macfarlane, Jill Macfarlane, Laura Macfarlane, Cara MacGuigan, Lisa MacInnes, Iain MacIntyre, Jill MacIntyre, Kirsten Mack, Callum Mackay, Euan Mackay, Laura Mackay, Alexander Mackenzie, Matt Mackenzie, Robert MacKenzie Ross, Ami Mackey, Patricia Mackey, Fiona Mackie, Robert Mackie, Carolyn Mackinlay, Claire Mackintosh, Katherine Mackintosh, Sheila MacLennan, Mary Joan MacLeod, Michael Macmahon, Andrew MacNair, Catherine Macphee, Iain Macpherson, Catriona Macrae, Allan MacRaild, Eilidh MacVean, Alannah Madden, Mary Madden, Norman Madeja, Karen Madgwick, Pradeep Madhivathanan, Madhavi Madhusudhana, Harriet Madiyiko, Alpha Madu, Lorraine Madziva, Marion Mafham, Nick Magee, Frederick Magezi, Tim Maggs, Negar Maghsoodi, Christopher Magier, Marios Magriplis, Kathryn Maguire, Natasha Mahabir, Subramanian Mahadevan-Bava, Anjanie Maharajh, Ajit Mahaveer, Bal Mahay, Kanta Mahay, Hibo Mahdi, Thushika Mahendiran, Siva Mahendran, Sarah Maher, Anistta Maheswaran, Shameera Maheswaran, Tina Maheswaran, Parisa Mahjoob-Afag, Ahmed Mahmood, Farhana Mahmood, Waheed Mahmood, Zahra Mahmood, Hager Mahmoud, Ewan Mahony, Luke Mair, Toluwani Majekdunmi, Kesson Majid, Rupert Major, Jaydip Majumdar, Mohammad KH Majumder, Stephen Makin, Marius Malanca, Hannah Malcolm, Flora Malein, Neeraj Malhan, Ayesha Malik, Gulshan Malik, Mohammed Maljk, Paul Mallett, Petrina Mallinder, Georgia Mallison, Louise Mallon, Edward Malone, Gracie Maloney, Edgar Malundas, Madhu Mamman, Irene Man, Kathy Man, Rossana Mancinelli, Marco Mancuso-Marcello, Tracy Manders, Lauren Manderson, Justin Mandeville, Roope Manhas, Carmen Maniero, Ravi Manikonda, Bobby Mann, Jonathan Manning, Lynne Mannion, Katherine Mansi, Katarina Manso, Dina Mansour, Isheunesu T Mapfunde, Predeesh Mappa, Hemant Maraj, Garikayi Marange, Lisa March, Clare Marchand, Neil Marcus, Maria Marecka, Gomathi Margabanthu, Jordi Margalef, Lavinia 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 McAleese, Helinor McAleese, Paul McAlinden, Audrey McAlpine, Graeme McAlpine, Jonathan McAndrew, Hamish McAuley, Sarah McAuliffe, Claire McBrearty, Carole McBride, Erin McBride, Michael McBuigan, James McBurney, Laura McCabe, Amanda McCairn, Martina McCalmont, Jake McCammon, Nicole McCammon, Conor McCann, Alexandra McCarrick, Brendan McCarron, Eoghan McCarthy, Michelle McCarthy, Natalie McCarthy, Sinead McCaughey, Gareth McChlery, Tara McClay, Beverley McClelland, Declan McClintock, Patricia McCormack, Jacqueline McCormick, Wendy McCormick, Paul McCourt, Jame McCrae, Sharon McCready, Allison McCreath, Gordan McCreath, Helen McCreedy, Louise McCreery, Iain J McCullagh, Josephine McCullagh, Liz McCullagh, Megan McCullagh, Conor McCullough, Katherine McCullough, Nicola McCullough, Sarah McCullough, Fiona McCurrach, Rory McDermott, Katharine McDevitt, Helen McDill, Basil McDonald, Claire McDonald, Debbie McDonald, Rob McDonald, Sam McDonald, Damhnaic McDonald, Rowan McDougall, Irene 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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Melnic, Alice Melville, Julie Melville, Helen Membrey, Mark Mencias, Cheryl Mendonca, Alexander Mentzer, Dan Menzies, Sue Mepham, Oliver Mercer, Pauline Mercer, Arwa Merchant, Fatema Merchant, Mihaela Mercioniu, Megan Meredith, Marta Merida Morillas, Blair Merrick, Jack Merritt, Simon Merritt, Ekta Merwaha, Simon Message, Gabriel Metcalf-Cuenca, Benjamin Metcalfe, Kneale Metcalfe, Stella Metherell, Greg Methven, Alexsandra Metryka, Louise Mew, Simon Meyrick, Nhlanhla Mguni, Atiqa Miah, Jagrul Miah, Nahima Miah, Gabriela Mic, Dariush Micallef, Alice Michael, Angiy Michael, Shery Michael, Vincent Michael, Natalia Michalak, Loredana Michalca-Mason, Claire Michelson, Janet Middle, Hayley Middleton, Jennifer T Middleton, Maeve Middleton, Sophie Middleton, Shelley Mieres, Gail Miflin, Loredana Mihalca-Mason, Theresia Mikolasch, Sarah Milgate, Colin Millar, Ian Millar, Jonathan Millar, David Miller, Johnathan Miller, Lucy Miller, Rachel Miller, Naomi Miller-Biot, Alex Miller-Fik, Louise Millett, Hazel Milligan, Iain Milligan, Caitlin Milliken, Katherine Millington, Samuel Millington, Melanie Milloy, Helen Mills, Janet Mills, Steve Mills, Helen Millward, Rebecca Miln, Alice Milne, Charlotte Milne, Louise Milne, Joanne Milner, Zayar Min, Samuel Mindel, Arron Minhas, Chrissie Minnis, Paul Minnis, Anne Minogue, Jane Minton, Frederico Miranda, Lucy Mires, Taimur Mirza, Anjum Misbahuddin, Aseem Mishra, Biswa Mishra, Eleanor Mishra, Ritu Mishra, Sannidhya Misra, Deena Mistry, Heena Mistry, Nita Mistry, Reena Mistry, Dushyant Mital, Sarah Mitchard, Alan Mitchell, Ben Mitchell, Piers Mitchell, Susan Mitchell, Philip Mitchelmore, Andrew Mitra, Atideb Mitra, Sandip Mitra, Clarisse Mizzi, Gloria Mmadubuko, Emma Moakes, Emma Moatt, Gita Modgil, Abdelrahman Mohamed, Arez Mohamed, Osab Mohamed, Waheed Mohammad, Aliabdulla Mohammed, Omer Mohammed, Yaser NS Mohammed, Bilal A Mohamud, Mahalakshmi Mohan, Amr Moharram, Rachel Moir, Jonathan Mok, Christine Moller-Christensen, Mateus Mollet, Malid Molloholli, Aoife Molloy, April Molloy, Linda Molloy, Andrew Molyneux, Tasnim Momoniat, Holly Monaghan, Josephine Monaghan, Krista Monaghan, Shiva Mongolu, Katelyn Monsell, Mahmoud Montasser, Alan Montgomery, Hugh Montgomery, Prebashan Moodley, Ian Moody, Margaret Moody, Nick Moody, Angela Moon, James Moon, Ji-Hye Moon, Maria Moon, May Moonan, Parvez Moondi, Alex Moore, Carly Moore, Christopher Moore, Davidjar Moore, Faye Moore, Gillian Moore, Hannah Moore, Judith Moore, Laura Moore, Sally Moore, Sonia Moore, Tracy Moore, Rachel Moores, Ed Morab, Jose Morales, Nuria Moramorell, Louise Moran, Grishma Moray, Jeronimo Moreno-Cuesta, Adam Morgan, Amy Morgan, Christine Morgan, Colin Morgan, Jackie Morgan, Lauren Morgan, Leila Morgan, Matthew Morgan, Patrick Morgan, Katie Morgan-Jones, Emily Morgan-Smith, Anna Morley, Thomas Morley, Wendy Morley, Anna Morris, Damian Morris, Fiona Morris, Helen Morris, Juliet Morris, Katie Morris, Laura Morris, Lucy Morris, Mary-Anne Morris, Niall Morris, Paul Morris, Sheila Morris, Susan Morris, Douglas Morrison, Moira Morrison, Mary Morrissey, Anna Morrow, Chantal Morrrell, Franca Morselli, Gordon Mortem, Chelsea Morton, Gordon Morton, Rosna Mortuza, Priti Morzaria, Alison Moss, Charlotte Moss, Rachel Moss, Sarah Moss, Stuart Moss, Nicki Motherwell, Johanna Mouland, Caroline Moulds, Hilary Moulton, Lorraine Mounsey, Elizabeth Mousley, Karen Moxham, Borja Moya, Quberkani Moyo, Eunice Mshengu, Sheila Mtuwa, Ali Muazzam, Iqtedar A Muazzam, Nykki Muchenje, Dalia Mudawi, Girish Muddegowda, Imran Mugal, Ahsan Mughal, Javaid Muglu, Javed Muhammad, Alison Muir, Carol Muir, Martin Muir, Dipak Mukherjee, Syed Asim Ali Mukhtar, Denise Mukimbiri, Tshinupay Mukwa, Peter Mulgrew, Ben Mulhearn, Arafat Mulla, Dee Mullan, Dileepkumar Mullasseril Kutten, Niall Mullen, Rosemary Mullett, Sandra Mulligan, Barbara Mullin, Joanne Mullings, Lana Mumelj, Andrew Mumford, Sarah Mumford, Mohammed Munavvar, Henry Munby, Anne-Marie Munro, Sheila Munt, Nafissah Munu, McDonald Mupudzi, Arshid Murad, Oluwatosin H Muraina, Koteshwara Muralidhara, Diane Murdoch, Mhairi Murdoch, Jennifer Murira, Alison Murphy, Carl Murphy, Emily Murphy, Fidelma Murphy, Gail Murphy, Jo Murphy, Peter Murphy, Sheenagh Murphy, Simon Murphy, Clare Murray, David Murray, Eleanor Murray, Katie Murray, Kenneth Murray, Lisa Murray, Lorna Murray, Tracey Murray, Eoin Murtagh, Mithun Murthy, Catherine Murton, Rosie Murton, Neeka Muru, Rosemary Musanhu, Maimuna Mushabe, Kaiser Mushtaq, Omaisa Mushtaq, Ahmed M Mustafa, Elhaytham Mustafa, Mustafa Mustafa, Ibrahim Mustapha, Zhain Mustufvi, Callum Mutch, Eric Mutema, Balakumar Muthukrishnan, Sheree Mutton, Natasha Muzengi, Memory Mwadeyi, Bettina Mwale, Esther Mwaura, Raji Myagerimath, Alice Myers, Sam Myers, Khin Swe Myint, Yadee Myint, Libor Myslivecek, Helen Nabakka, Evelyn Nadar, Iftikhar Nadeem, Moosa Nadheem, Asma Naeem, Hassan Naeem, Salman Naeem, Samraiz Nafees, Mohamed Nafei, Parminder Naga, Thapas Nagarajan, Imrun Nagra, Deepak Nagra, Mina Naguib, Kirushthiga Naguleswaran, K Shonit Nagumantry, Kevin Naicker, Sarveshni Naidoo, Gireesha Naik, Rishi Naik, Samir Naik, Devu S Nair, Rajiv Nair, Tanushree Nair, Jay Naisbitt, Kerry Naismith, Sri Nallapareddy, Soum Nallapeta, Arumugan Nallasivan, Uttam Nanda, Aarti Nandani, Ali Raza Naqvi, Asadullah Naqvi, Sara Naqvi, Shruthi Narayan, Sophia Nasa, Dominic Nash, Nader Nasheed, Abdul Nasimudeen, Umer Nasir, Marwan Nassari, Tahir Nasser, Anushka Natajaran, Anuja Natarajan, Geetha Natarajan, Nalin Natarajan, Nikhila Natarajan, Rajkumar Natarajan, Noel Nathaniel, Mala Nathvani, Priyan Nathwani, George Nava, Neena Navaneetham, Jeya Navaratnam, Helen Navarra, Sadaf Naveed, John Navin, Khuteja Nawaz, Sarfaraz Nawaz, Shasta Nawaz, Bonilla Nayar, Suzanne Naylor, Moez Nayyar, Farrah Naz, Mobeena Naz, Salima Nazarali, Babak Nazari, S Nazir, Sehar Nazir, Dumisani Ncomanzi, Onyine Ndefo, Alan Neal, Elaine Neary, Mostafa Negmeldin, Paula Neill, Hector E Neils, Avideah Nejad, Louise Nel, Marie Nelson, Richard Nelson, Scott Nelson, Rajesh Nemane, Samiksha Nepal, Daniel Nethercott, Kimberley Netherton, Kimberley Nettleton, Claire-Michelle Neville, Tracy Nevin, Josephine Newanji, Alison Newby, Angela Newby, David Newby, Tracy Newcombe, Charlotte Newman, Diana Newman, Julie Newman, Oscar Newman, Richard Newman, Tabitha Newman, Thomas Newman, Rachel Newport, Claire Newsam, Christopher Newson, Maria Newton, Anthony YKC Ng, Ka Wing Ng, Maxine Ng, Sarah Ng, Wee Jin Ng, Thomas Ngan, Gabriel CE Ngui, Alice Ngumo, Caoimhe Nic Fhogartaigh, Nathalie Nicholas, Philip Nicholas, Rachel Nicholas, Teresa Nicholas, Donna Nicholls, Lisa Nicholls, Alice Nicholson, Anne Nicholson, Annette Nicholson, Janet Nicholson, Ian Nickson, Eileen Nicol, Elizabeth Nicol, Rebecca Nicol, Pantelis Nicola, Antony Nicoll, Pantzaris Nikolaos, Georgii Nikonovich, Annette Nilsson, Kofi Nimako, Louise Nimako, Camus Nimmo, Preethy Ninan, Mahesh Nirmalan, Muhammad Nisar, Toby Nisbett, Aksinya Nisha James, Sabaahat Nishat, Tomoko Nishiyama, Sara Nix, Jennifer Nixon, Maxine Nixon, Khwaja Nizam Ud Din, Maria Nizami, Josephine Nnadi, Lyrics Noba, Harriet Noble, Hsu Noe, Jerry Nolan, Zahid Noor, Zaid Noori, Jamie Norgrave, Louis Norman, Rachel Norman, Karen Norris, Lillian Norris, Sally Ann Nortcliffe, Fiona North, Julie North, Thomas North, Julie Northcote, John Northfield, Samantha Northover, Jurgens Nortje, Donna Norton, Rowen Norton, Holly Notman, Khalid Nourein, Timea Novak, Tony Noyce, Alan Noyon, Arlene Nubi, Mohamed Nugdallah, Anne Marie Nugent, Justine Nugent, Kribashnie Nundlall, Kieran Nunn, Michelle Nunn, Jane Nunnick, Yvonne Nupa, Zubeir Nurgat, Kelly Nwankiti, Eugenia Nweje, Godfrey Nyamugunduru, Maggie Nyirenda, Kerry Nyland, Daire O Shea, Ruth O'Donnell, Chloe O'Hara, Kevin O'Reilly, William O'Rourke, Caroline Oakley, Begho Obale, Clements Oboh, Andrew O'Brien, Clare O'Brien, Julie O'Brien, Kirsty O'Brien, Linda O'Brien, Marese O'Brien, Neale O'Brien, Rachel O'Brien, Sarah O'Brien, Tracey O'Brien, Emma O'Bryan, Ross Obukofe, Christopher O'Callaghan, Lorcan O'Connell, Maria O'Connell, Tadg OConnor, Chris O'Connor, Grainne O'Connor, Miranda Odam, Sam Oddie, Sharon Oddy, Rosie O'Dea, Yejide Odedina, Krishma Odedra, Sven W Odelberg, Natasha Odell, Omolola Oderinde, Jessica Odone, Catherine O'Donovan, Dapo Odumeru, Stephen O'Farrell, Pamela Offord, Tanwa Ogbara, Catherine Ogilvie, Ciaran O'Gorman, Oluwatomilola Ogunkeye, Udeme Ohia, Shinjali Ohja, Ohiowele Ojo, Mark O'Kane, Tolu Okeke, Eleanor OKell, Alicia Okines, Iheoma Okpala, Ernest Okpo, Maryanne Okubanjo, Ché Okyne-Turkson, Raphael Olaiya, Tim Old, Jane Oldham, Gregory Oleszkiewicz, Marta Oliveira, Annie Oliver, Catherine Oliver, Jesse Oliver, Martyn Oliver, Zoe Oliver, Nurudeen O Olokoto, Folusho Olonipile, Olumide Olufuwa, Olatomiwa Olukoya, Akinlolu Oluwole-Ojo, Laura O'Malley, Maryam Omar, Zohra Omar, Nimca Omer, Abi Omojola, Helen Omuco, Bronagh O'Neill, Connaire O'Neill, Lauran O'Neill, Chon Sum Ong, Chidera Onyeagor, Huah C Ooi, Amin Oomatia, Maria Opena, Richard Oram, Chloe Orchard, Christy Ord, Jonathan Ord, Charlotte O'Reilly, Lola Orekoya, Devaki O'Riordan, Sean O'Riordan, Amy Orme, Hannah Orme, Dave Ormrod, Charlotte Orr, Sarah Orr, Christopher Orton, Anna Osadcow, Rawlings Osagie, Rostam Osanlou, Lynn Osborne, Nigel Osborne, Rebecca Osborne, Wendy Osborne, William Osborne, Charles Osbourne, Jennifer Osei-Bobie, Mandy O'Shea, Joseph Osman, Wa'el Osman, Bashir Osman, G Osoata, Marlies Ostermann, Eoin O'Sullivan, Susan O'Sullivan, Noor Otey, Otheroro K. Otite, Marie O'Toole, Natalie Outten, Rachel Owen, Stephanie Owen, Emma Owens, Susan Owens, Yetunde Owoseni, Michael Owston, Ruth Oxlade, Feray Ozdes, Jamie Pack, Sophie Packham, Piotr Paczko, Grace Padden, Anand Padmakumar, Iain Page, Nickolas Page, Valerie Page, Jodi Paget, Katherine Pagett, Lee Paisley, Susie Pajak, Angela Pakozdi, Soubhik Pal, Sushi Pal, April Palacios, Vishnu B Palagiri Sai, Vadivu Palaniappan, Priya Palanivelu, Adrian Palfreeman, Shehan Palihavadana, Deepshikha Palit, Alistair Palmer, Lorna Palmer, Lynne Palmer, Ian Pamphlett, Anmol Pandey, Nithya Pandian, Krishnaa Pandya, Tej Pandya, Alice Panes, Yee Wei Pang, Laura Pannell, Kanwar Pannu, Sathianathan Panthakalam, Charles T Pantin, Norman Pao, Helen Papaconstantinou, Padmasayee Papineni, Marina Pappa, Kitty Paques, Kerry Paradowski, Vinay Parambil, Supathum Paranamana, Siddhant Parashar, Ian Parberry, Ana Parejasanchez, Amy Parekh, Dhruv Parekh, Louise Parfitt, Helen Parfrey, Omi Parikh, Gemma Parish, John Park, 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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, 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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, Benjamin Rayner, Nicola Rayner, Amy Raynsford, Salman Razvi, Zarine Razvi, Kerry Read, Sarah Read, Ajay Reddy, Anvesh Reddy, Harsha Reddy, Radhika Reddy, Ravi Reddy, Aine Redfern-Walsh, Alex Redome, Joan Redome, Michelle Reece, Anna Reed, John Reed, Andrew Rees, Grace Rees, Ian Rees, James Rees, Martyn Rees, Sarah Rees, Stephanie Rees, Tabitha Rees, Fiona Regan, Karen Regan, Susan Regan, Kanchan Rege, Ahmed Rehan, A Rehman, Shoib Rehman, Zainab Rehman, Ada Reid, Andrew Reid, Jennifer Reid, Jeremy Reid, Sharon Reid, Mkyla Reilly, Robert Reilly, Shonagh Reilly, Christina Reith, Alda Remegoso, Dinakaran Rengan, Stephen Renshaw, Remya Renu Vattekkat, Henrik Reschreiter, Mark Revels, Glynis Rewitzky, Charles Reynard, Dominic Reynish, Peter Reynolds, Piero Reynolds, Jonathan Rhodes, Naghma Riaz, Emily Rice, Matthew Rice, Emily Rich, Mel Rich, Alison Richards, Debbie Richards, Emma Richards, Liz Richards, Patricia Richards, Suzanne Richards, Carol Richardson, Celia Richardson, Eric 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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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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, 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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, 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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

48. Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data

Author

Farid Khan, Frederick J. Angulo, Nati Brooks, Gabriel Mircus, Kaijie Pan, Meir Smaja, Sharon Alroy-Preis, Jo Southern, Luis Jodar, John M McLaughlin, Eric J. Haas, Emilia Anis, David L. Swerdlow, Shepherd Roee Singer, and Yeheskel Levy

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, COVID-19 Vaccines, Adolescent, Coronavirus disease 2019 (COVID-19), Prevalence, Department of Error, 030204 cardiovascular system & hematology, Mass Vaccination, Asymptomatic, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pandemic, Humans, Medicine, RNA, Messenger, 030212 general & internal medicine, Israel, Young adult, Asymptomatic Infections, Pandemics, BNT162 Vaccine, Aged, Aged, 80 and over, SARS-CoV-2, business.industry, Incidence, Incidence (epidemiology), COVID-19, General Medicine, Middle Aged, Hospitalization, Vaccination, Population Surveillance, Female, Observational study, medicine.symptom, business
Abstract

Summary Background Following the emergency use authorisation of the Pfizer–BioNTech mRNA COVID-19 vaccine BNT162b2 (international non-proprietary name tozinameran) in Israel, the Ministry of Health (MoH) launched a campaign to immunise the 6·5 million residents of Israel aged 16 years and older. We estimated the real-world effectiveness of two doses of BNT162b2 against a range of SARS-CoV-2 outcomes and to evaluate the nationwide public-health impact following the widespread introduction of the vaccine. Methods We used national surveillance data from the first 4 months of the nationwide vaccination campaign to ascertain incident cases of laboratory-confirmed SARS-CoV-2 infections and outcomes, as well as vaccine uptake in residents of Israel aged 16 years and older. Vaccine effectiveness against SARS-CoV-2 outcomes (asymptomatic infection, symptomatic infection, and COVID-19-related hospitalisation, severe or critical hospitalisation, and death) was calculated on the basis of incidence rates in fully vaccinated individuals (defined as those for whom 7 days had passed since receiving the second dose of vaccine) compared with rates in unvaccinated individuals (who had not received any doses of the vaccine), with use of a negative binomial regression model adjusted for age group (16–24, 25–34, 35–44, 45–54, 55–64, 65–74, 75–84, and ≥85 years), sex, and calendar week. The proportion of spike gene target failures on PCR test among a nationwide convenience-sample of SARS-CoV-2-positive specimens was used to estimate the prevelance of the B.1.1.7 variant. Findings During the analysis period (Jan 24 to April 3, 2021), there were 232 268 SARS-CoV-2 infections, 7694 COVID-19 hospitalisations, 4481 severe or critical COVID-19 hospitalisations, and 1113 COVID-19 deaths in people aged 16 years or older. By April 3, 2021, 4 714 932 (72·1%) of 6 538 911 people aged 16 years and older were fully vaccinated with two doses of BNT162b2. Adjusted estimates of vaccine effectiveness at 7 days or longer after the second dose were 95·3% (95% CI 94·9–95·7; incidence rate 91·5 per 100 000 person-days in unvaccinated vs 3·1 per 100 000 person-days in fully vaccinated individuals) against SARS-CoV-2 infection, 91·5% (90·7–92·2; 40·9 vs 1·8 per 100 000 person-days) against asymptomatic SARS-CoV-2 infection, 97·0% (96·7–97·2; 32·5 vs 0·8 per 100 000 person-days) against symptomatic COVID-19, 97·2% (96·8–97·5; 4·6 vs 0·3 per 100 000 person-days) against COVID-19-related hospitalisation, 97·5% (97·1–97·8; 2·7 vs 0·2 per 100 000 person-days) against severe or critical COVID-19-related hospitalisation, and 96·7% (96·0–97·3; 0·6 vs 0·1 per 100 000 person-days) against COVID-19-related death. In all age groups, as vaccine coverage increased, the incidence of SARS-CoV-2 outcomes declined. 8006 of 8472 samples tested showed a spike gene target failure, giving an estimated prevalence of the B.1.1.7 variant of 94·5% among SARS-CoV-2 infections. Interpretation Two doses of BNT162b2 are highly effective across all age groups (≥16 years, including older adults aged ≥85 years) in preventing symptomatic and asymptomatic SARS-CoV-2 infections and COVID-19-related hospitalisations, severe disease, and death, including those caused by the B.1.1.7 SARS-CoV-2 variant. There were marked and sustained declines in SARS-CoV-2 incidence corresponding to increasing vaccine coverage. These findings suggest that COVID-19 vaccination can help to control the pandemic. Funding None.

Published
2021

49. Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda

Author

Purnima Menon, Cesar G. Victora, Giovanna Gatica-Domínguez, Parul Christian, Robert E. Black, and Luis Paulo Vidaletti

Subjects
Adult, medicine.medical_specialty, Social Determinants of Health, Mothers, Developing country, 030204 cardiovascular system & hematology, Child Nutrition Disorders, Body Mass Index, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Global health, Humans, Medicine, 030212 general & internal medicine, Social determinants of health, Child, Developing Countries, Poverty, Wasting, business.industry, Public health, Malnutrition, General Medicine, medicine.disease, Breast Feeding, Educational Status, Female, medicine.symptom, business, Breast feeding
Abstract

13 years after the first Lancet Series on maternal and child undernutrition, we reviewed the progress achieved on the basis of global estimates and new analyses of 50 low-income and middle-income countries with national surveys from around 2000 and 2015. The prevalence of childhood stunting has fallen, and linear growth faltering in early life has become less pronounced over time, markedly in middle-income countries but less so in low-income countries. Stunting and wasting remain public health problems in low-income countries, where 4·7% of children are simultaneously affected by both, a condition associated with a 4·8-times increase in mortality. New evidence shows that stunting and wasting might already be present at birth, and that the incidence of both conditions peaks in the first 6 months of life. Global low birthweight prevalence declined slowly at about 1·0% a year. Knowledge has accumulated on the short-term and long-term consequences of child undernutrition and on its adverse effect on adult human capital. Existing data on vitamin A deficiency among children suggest persisting high prevalence in Africa and south Asia. Zinc deficiency affects close to half of all children in the few countries with data. New evidence on the causes of poor growth points towards subclinical inflammation and environmental enteric dysfunction. Among women of reproductive age, the prevalence of low body-mass index has been reduced by half in middle-income countries, but trends in short stature prevalence are less evident. Both conditions are associated with poor outcomes for mothers and their children, whereas data on gestational weight gain are scarce. Data on the micronutrient status of women are conspicuously scarce, which constitutes an unacceptable data gap. Prevalence of anaemia in women remains high and unabated in many countries. Social inequalities are evident for many forms of undernutrition in women and children, suggesting a key role for poverty and low education, and reinforcing the need for multisectoral actions to accelerate progress. Despite little progress in some areas, maternal and child undernutrition remains a major global health concern, particularly as improvements since 2000 might be offset by the COVID-19 pandemic.

Published
2021

50. 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

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