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1. The Societal Value of the Modern Zoo: A Commentary on How Zoos Can Positively Impact on Human Populations Locally and Globally

Author

Phillip J. Greenwell, Lisa M. Riley, Ricardo Lemos de Figueiredo, James E. Brereton, Andrew Mooney, and Paul E. Rose

Subjects
General Medicine
Abstract

Modern zoos and aquariums have evolved greatly since the end of the Second World War, to become centres of conservation excellence and scientific institutions for the study of animal behaviour, ecology, husbandry management. Whilst the impact of zoos and aquariums to biodiversity conservation, population management and advancement of species care is well documented, their positive impacts on society (including the communities that they are located within) is less well known. The four established aims of the modern zoo—Conservation, Education, Recreation (Engagement) and Research—provide a strong foundation for wider review and critique of the societal value of zoos and aquariums. This article synthesises what such value may be, and how it could be measured, from a systematic review of the literature pertaining to each of these four established aims. It also recommends areas of future scientific inquiry to further study the wider impact of zoos on their local communities and on human populations and behaviour more generally. Including Wellbeing as a fifth aim of the modern zoo would also cement their wider societal value. Further scrutiny of the societal value of the modern zoo enhances the value of the zoo’s living collection and the green spaces that it manages to provide accessibility to biodiversity and nature-centric education essential to long-term, planetary friendly human behaviour change.

Published
2023

3. What’s Black and White and Pink All Over? Lesser Flamingo Nocturnal Behaviour Captured by Remote Cameras

Author

Paul E. Rose, Jess Chapman, James E. Brereton, and Lisa M. Riley

Subjects
lesser flamingo, welfare, nocturnal behaviour, remote monitoring, husbandry evidence, General Medicine
Abstract

The study of animal behaviour is important for the development of husbandry and management practices for zoo-housed species. Yet, data are typically only collected during daylight hours, aligning with human work schedules rather than animal activity patterns. To remedy this, 24 h data collection is needed. This study investigated the behaviour of a captive flock of lesser flamingos to understand temporal changes in their time-activity patterns. Two remote camera traps were placed around the birds’ outdoor enclosure and one within the indoor house. Counts of birds visible within specific enclosure zones were recorded from photographic data. Behaviour was defined as active or inactive, and modified Spread of Participation Index (SPI) was used to calculate enclosure zone occupancy. Results indicated that lesser flamingos are active overnight, and to a similar amount as in the daytime. Proportions of birds observed as active were significantly higher at later times of the day (i.e., dusk) when compared to the number of active birds in the morning. Enclosure usage was diverse and indoor and outdoor zones could be used by different numbers of birds at different times of the day. Variation in enclosure usage may indicate the changing needs of the flamingos when housed indoors overnight and when they have night-time access to an outdoor enclosure. This research has identified the need for further research into the nocturnal behaviour and space use of lesser flamingos and suggests the need for 24 h research in captive birds, and other zoo-held species, especially when species are locked indoors or face behavioural restriction overnight due to biosecurity measures surrounding zoonoses outbreaks, e.g., Avian Influenza.

Published
2022

5. Data Resource Profile: The Global Health and Population Project on Access to Care for Cardiometabolic Diseases (HPACC)

Author

Jennifer Manne-Goehler, Michaela Theilmann, David Flood, Maja E Marcus, Glennis Andall-Brereton, Kokou Agoudavi, William Andres Lopez Arboleda, Krishna K Aryal, Brice Bicaba, Pascal Bovet, Luisa Campos Caldeira Brant, Garry Brian, Grace Chamberlin, Geoffrey Chen, Albertino Damasceno, Maria Dorobantu, Matthew Dunn, Cara Ebert, Farshad Farzadfar, Mongal Singh Gurung, David Guwatudde, Corine Houehanou, Dismand Houinato, Nahla Hwalla, Jutta M Adelin Jorgensen, Khem B Karki, Demetre Labadarios, Nuno Lunet, Deborah Carvalho Malta, João S Martins, Mary T Mayige, Roy Wong McClure, Sahar Saeedi Moghaddam, Kibachio J Mwangi, Omar Mwalim, Bolormaa Norov, Sarah Quesnel-Crooks, Sabrina Rhode, Jacqueline A Seiglie, Abla Sibai, Bahendeka K Silver, Lela Sturua, Andrew Stokes, Adil Supiyev, Lindiwe Tsabedze, Zhaxybay Zhumadilov, Lindsay M Jaacks, Rifat Atun, Justine I Davies, Pascal Geldsetzer, Sebastian Vollmer, and Till W Bärnighausen

Subjects
Metabolic Syndrome, Risk Factors, Cardiovascular Diseases, Epidemiology, Humans, General Medicine, Global Health, Health Services Accessibility
Published
2022

7. The Role of AI Model Documentation in Translational Science: A Scoping Review (Preprint)

Author

Tracey A Brereton, Momin M Malik, Mark A Lifson, Jason D Greenwood, Kevin J Peterson, and Shauna M Overgaard

Subjects
General Medicine
Abstract

BACKGROUND Despite the potential of artificial intelligence/machine learning (AI/ML)-based medical modeling software (MMS) to revolutionize healthcare, the anticipated benefits have yet to be realized due to acknowledged gaps in translation. These gaps stem partly from the fragmentation of processes and resources to support MMS transparent documentation. Consequently, the absence of transparent reporting hinders the provision of evidence to support the implementation of MMS in clinical practice, thereby serving as a significant barrier to the successful translation of software from research settings to clinical practice. OBJECTIVE This study aimed to scope the current landscape of AI/ML-based MMS documentation practices and elucidate the function of documentation in facilitating the translation of ethical and explainable MMS into clinical workflows. METHODS A scoping review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed was searched using MeSH key concepts of AI/ML, ethical considerations, and explainability to identify publications detailing AI/ML-based MMS documentation, in addition to snowball sampling of selected reference lists. To include the possibility of implicit documentation practices not explicitly labeled as such, we did not use “documentation” as a key concept but as an inclusion criterion. A two-stage screening process (title and abstract screening and full-text review) was conducted by an independent reviewer. A data extraction template was utilized to record publication-related information, barriers to developing ethical and explainable MMS, available standards, regulations, frameworks, or governance strategies related to documentation, and recommendations for documentation for papers that met inclusion criteria. RESULTS Of the total 115 papers retrieved, 21 (18%) articles met the requirements for inclusion. Ethics and explainability were investigated in the context of AI/ML-based MMS documentation and translation. Data detailing the current state and challenges and recommendations for future work were synthesized. Notable themes defining the current state and challenges that required thorough review included bias, accountability, governance, and interpretability. Recommendations identified within the literature to address present barriers call for a proactive evaluation of MMS, multidisciplinary collaboration, adherence to investigation and validation protocols, transparency and traceability requirements, and guiding standards and frameworks that enhance documentation efforts and support the translation of AI/ML-based MMS. CONCLUSIONS The ability of MMS to deliver on expectations is dependent on resolving barriers to translation, including those identified within this scoping review related to bias, accountability, governance, and interpretability. Our findings suggest that transparent strategic documentation, aligning translational science and regulatory science, will support the translation of MMS by coordinating communication and reporting and reducing translational barriers, thereby furthering the adoption of MMS. CLINICALTRIAL

Published
2023

9. Which index should I use? A comparison of indices for enclosure use studies

Author

Eduardo J. Fernandez and James E. Brereton

Subjects
Index (economics), Occupancy, electivity index, Enclosure, spread of participation index, General Medicine, Single measure, Identification (information), QL1-991, post occupancy evaluation, enclosure use, Statistics, Entropy (energy dispersal), entropy, Zoology, Mathematics
Abstract

Enclosure use assessments have gained popularity as one of the tools for animal welfare assessments and Post Occupancy Evaluations. There are now a plethora of studies and enclosure use indices available in published literature, and identification of the most appropriate index for each research question is often challenging. The benefits and limitations of four different enclosure use indices; Original and Modified Spread of Participation Index, Entropy, and Electivity Index were compared. Three artificial data sets were developed to represent the challenges commonly found in animal exhibits, and these indices were applied to these contrived enclosure settings. Three of the indices (Original SPI, Modified SPI, and Entropy) were used to assess a single measure of enclosure use variability. When zones within an exhibit were comparable in size, all three indices performed similarly. However, with less equal zone sizes, Modified SPI outperformed Original SPI and Entropy, suggesting that the Modified formula was more useful for assessing overall enclosure use variability under such conditions. Electivity Index assessed the use of individual zones, rather than the variability of use across the entire exhibit, and therefore could not be compared directly to the other three indices. This index is therefore most valuable for assessing individual resources, especially after exhibit modifications.

Published
2022

10. Should Zoo Food Be Chopped for Captive Turacos?

Author

James Edward Brereton and Beth Griffin

Subjects
Tauraco fischeri, Meal, Food intake, Future studies, food preparation, Ecology, biology, Tauraco leucotis, digestive, oral, and skin physiology, Foraging, General Medicine, biology.organism_classification, SF1-1100, Animal culture, Fischer’s Turaco, Toxicology, Turaco, White-cheeked Turaco, chopped food, Whole food, zoo nutrition, zookeeper time, QH540-549.5
Abstract

It is common practice for keepers in zoological collections to provide animals in their care with food that is chopped into small pieces. Anecdotally, it has been suggested that chopped food reduces wastage and reduces aggression from group-housed animals. However, there is limited empirical evidence to support these suggestions. To investigate the effects of food condition (chopped or whole food), a study was undertaken on White-cheeked Turacos (Tauraco leucotis) and Fischer’s Turacos (Tauraco fischeri) at two zoological collections in the United Kingdom. This study investigated the effect of food condition on turaco behaviour, the amount of food eaten, and also the amount of time that keepers required to prepare the diet. There was no significant impact on the amount of food eaten as a result of providing whole food. For Fischer’s Turacos, the whole-food condition significantly increased the prevalence of feeding and foraging behaviour, whilst significantly reducing preening. For White-cheeked Turacos, only feeding and foraging was affected by food condition: no other behaviours were significantly affected by chopped or whole food. Keepers on average saved 151 s per meal when preparing whole-food diets. Overall, this study suggests that changing food presentation from chopped to whole has a limited impact on food intake and behaviour. Providing whole-food items may also save valuable keeper time. Future studies should investigate the impact of feeding whole-food items to a wider range of zoo-housed species.

Published
2021

11. Fatty acid ethyl esters (FAEE) in virgin olive oil: A shorter and full validated approach as an alternative to the EU Official Method

Author

Raquel B. Gómez-Coca, María del Carmen Pérez-Camino, Paul Brereton, Alessandra Bendini, Tullia Gallina Toschi, Wenceslao Moreda, European Commission, and Raquel B. Gomez-Coca, María del Carmen Perez-Camino, Paul Brereton, Alessandra Bendini, Tullia Gallina Toschi, Wenceslao Moreda

Subjects
8122) [Ethyl stearate (PubChem CID], China, Fatty acid ethyl esters (FAEE), Method validation, Fatty Acids, Esters, General Medicine, 12366) [Ethyl palmitate (PubChem CID], Analytical Chemistry, 5363269) [Ethyl oleate (PubChem CID], 5282184) [Ethyl linoleate (PubChem CID], Soft deodorization, Fraud detection, Solvents, Fatty acid ethyl esters (FAEE), Fraud detection, Method validation, OLEUM, olive oil, Soft deodorization, OLEUM, 15609) [Methyl heptadecanoate (PubChem CID], Olive oil, Food Science
Abstract

8 Páginas.-- 5 Tablas.-- 1 Figura, In this work a SPE/GC-FID method, incorporating the use of a 1-g silica cartridge, for the determination of FAEE in olive oils is presented. The procedure has been fully validated, initially 'in-house' and subsequently by an international validation study involving sixteen laboratories from Europe, the United States of America, and China. Key performance parameters of the method are: (1) Linearity in the 10-134 mg/kg range (R2 > 0.999), (2) LOD and LOQ, The authors would like to thank Fera Science Ltd for providing the samples for this study. They would also like to thanks Tassos Koidis for his contribution to the pre-trial and as a technical expert on the methodology, and to Martyna Korytkowska as responsible for day to day liaison with participants and calculation of data. OLEUM “Advanced solutions for assuring the authenticity and quality of olive oil at a global scale” has received funding from the EC within the Horizon 2020 Program (2014–2020), GA no. 635690. The information expressed in this abstract reflects the authors’ views; the EC is not liable for the information contained therein.

Published
2022

12. Estimated effect of increased diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among low-income and middle-income countries: a microsimulation model

Author

Sebastian Vollmer, Pascal Geldsetzer, Jennifer Manne-Goehler, Mary T Mayige, Joao S Martins, Roy A Wong-McClure, Rifat Atun, Garry Brian, Maja-Emilia Marcus, Mongal Singh Gurung, Cara Ebert, Till Bärnighausen, Bolormaa Norov, Michaela Theilmann, David Flood, Kokou Agoudavi, Glennis Andall-Brereton, Pascal Bovet, Justine Davies, Sanjay Basu, Sahar Saeedi Moghaddam, Corine Houehanou, and Farshad Farzadfar

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, medicine.medical_treatment, Population, 030209 endocrinology & metabolism, Global Health, Corrections, Diabetes Complications, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Diabetes mellitus, medicine, Diabetes Mellitus, Humans, 030212 general & internal medicine, Myocardial infarction, education, Stroke, Developing Countries, Dialysis, Aged, Aged, 80 and over, education.field_of_study, Ejection fraction, business.industry, General Medicine, Articles, Middle Aged, Models, Theoretical, medicine.disease, 3. Good health, Cross-Sectional Studies, Blood pressure, Cardiovascular Diseases, Heart failure, Female, Public aspects of medicine, RA1-1270, business, Delivery of Health Care
Abstract

Summary: Background: Given the increasing prevalence of diabetes in low-income and middle-income countries (LMICs), we aimed to estimate the health and cost implications of achieving different targets for diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among LMICs. Methods: We constructed a microsimulation model to estimate disability-adjusted life-years (DALYs) lost and health-care costs of diagnosis, treatment, and control of blood pressure, dyslipidaemia, and glycaemia among people with diabetes in LMICs. We used individual participant data—specifically from the subset of people who were defined as having any type of diabetes by WHO standards—from nationally representative, cross-sectional surveys (2006–18) spanning 15 world regions to estimate the baseline 10-year risk of atherosclerotic cardiovascular disease (defined as fatal and non-fatal myocardial infarction and stroke), heart failure (ejection fraction of

Published
2021

13. 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

15. Dynamics of bacterial and archaeal communities during horse bedding and green waste composting

Author

Vanessa Grenier, Emmanuel Gonzalez, Nicholas JB Brereton, and Frederic E. Pitre

Subjects
General Neuroscience, General Medicine, General Agricultural and Biological Sciences, General Biochemistry, Genetics and Molecular Biology
Abstract

Organic waste decomposition can make up substantial amounts of municipal greenhouse emissions during decomposition. Composting has the potential to reduce these emissions as well as generate sustainable fertilizer. However, our understanding of how complex microbial communities change to drive the chemical and biological processes of composting is still limited. To investigate the microbiota associated with organic waste decomposition, initial composting feedstock (Litter), three composting windrows of 1.5 months (Young phase), 3 months (Middle phase) and 12 months (Aged phase) old, and 24-month-old mature Compost were sampled to assess physicochemical properties, plant cell wall composition and the microbial community using 16S rRNA gene amplification. A total of 2,612 Exact Sequence Variants (ESVs) included 517 annotated as putative species and 694 as genera which together captured 57.7% of the 3,133,873 sequences, with the most abundant species being Thermobifida fusca, Thermomonospora chromogena and Thermobifida bifida. Compost properties changed rapidly over time alongside the diversity of the compost community, which increased as composting progressed, and multivariate analysis indicated significant variation in community composition between each time-point. The abundance of bacteria in the feedstock is strongly correlated with the presence of organic matter and the abundance of plant cell wall components. Temperature and pH are the most strongly correlated parameters with bacterial abundance in the thermophilic and cooling phases/mature compost respectively. Differential abundance analysis revealed 810 ESVs annotated as species significantly varied in relative abundance between Litter and Young phase, 653 between the Young and Middle phases, 1182 between Middle and Aged phases and 663 between Aged phase and mature Compost. These changes indicated that structural carbohydrates and lignin degrading species were abundant at the beginning of the thermophilic phase, especially members of the Firmicute and Actinobacteria phyla. A high diversity of species capable of putative ammonification and denitrification were consistently found throughout the composting phases, whereas a limited number of nitrifying bacteria were identified and were significantly enriched within the later mesophilic composting phases. High microbial community resolution also revealed unexpected species which could be beneficial for agricultural soils enriched with mature compost or for the deployment of environmental and plant biotechnologies. Understanding the dynamics of these microbial communities could lead to improved waste management strategies and the development of input-specific composting protocols to optimize carbon and nitrogen transformation and promote a diverse and functional microflora in mature compost.

Published
2023

16. The Regional Coupled Suite (RCS-IND1): application of a flexible regional coupled modelling framework to the Indian region at kilometre scale

Author

Juan Manuel Castillo, Huw W. Lewis, Akhilesh Mishra, Ashis Mitra, Jeff Polton, Ashley Brereton, Andrew Saulter, Alex Arnold, Segolene Berthou, Douglas Clark, Julia Crook, Ananda Das, John Edwards, Xiangbo Feng, Ankur Gupta, Sudheer Joseph, Nicholas Klingaman, Imranali Momin, Christine Pequignet, Claudio Sanchez, Jennifer Saxby, and Maria Valdivieso da Costa

Subjects
Earth Sciences, General Medicine, Atmospheric Sciences
Abstract

A new regional coupled modelling framework is introduced – the Regional Coupled Suite (RCS). This provides a flexible research capability with which to study the interactions between atmosphere, land, ocean, and wave processes resolved at kilometre scale, and the effect of environmental feedbacks on the evolution and impacts of multi-hazard weather events. A configuration of the RCS focussed on the Indian region, termed RCS-IND1, is introduced. RCS-IND1 includes a regional configuration of the Unified Model (UM) atmosphere, directly coupled to the JULES land surface model, on a grid with horizontal spacing of 4.4 km, enabling convection to be explicitly simulated. These are coupled through OASIS3-MCT libraries to 2.2 km grid NEMO ocean and WAVEWATCH III wave model configurations. To examine a potential approach to reduce computation cost and simplify ocean initialization, the RCS includes an alternative approach to couple the atmosphere to a lower resolution Multi-Column K-Profile Parameterization (KPP) for the ocean. Through development of a flexible modelling framework, a variety of fully and partially coupled experiments can be defined, along with traceable uncoupled simulations and options to use external input forcing in place of missing coupled components. This offers a wide scope to researchers designing sensitivity and case study assessments. Case study results are presented and assessed to demonstrate the application of RCS-IND1 to simulate two tropical cyclone cases which developed in the Bay of Bengal, namely Titli in October 2018 and Fani in April 2019. Results show realistic cyclone simulations, and that coupling can improve the cyclone track and produces more realistic intensification than uncoupled simulations for Titli but prevents sufficient intensification for Fani. Atmosphere-only UM regional simulations omit the influence of frictional heating on the boundary layer to prevent cyclone over-intensification. However, it is shown that this term can improve coupled simulations, enabling a more rigorous treatment of the near-surface energy budget to be represented. For these cases, a 1D mixed layer scheme shows similar first-order SST cooling and feedback on the cyclones to a 3D ocean. Nevertheless, the 3D ocean generally shows stronger localized cooling than the 1D ocean. Coupling with the waves has limited feedback on the atmosphere for these cases. Priorities for future model development are discussed.

Published
2022
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17. World Autism Awareness Day

Author

Bruce J, Tonge and Avril Vaux, Brereton

Subjects
Health Knowledge, Attitudes, Practice, Asian People, Humans, India, General Medicine, Autistic Disorder, General Biochemistry, Genetics and Molecular Biology
Published
2022

18. Irish energy landscapes on film

Author

Danielle Barrios-O’Neill and Pat Brereton

Subjects
Energy (psychological), 010504 meteorology & atmospheric sciences, Irish, Natural resource economics, 020209 energy, Political science, 0202 electrical engineering, electronic engineering, information engineering, language, 02 engineering and technology, General Medicine, 01 natural sciences, language.human_language, 0105 earth and related environmental sciences
Abstract

Landscape, and its relation to place identity, is a powerful tool for visualizing and making legible the effects of environmental change. So often the operations of resource consumption and conservation occur in a way that shapes and changes particular regional landscapes. This is significant in an era where inspiring audiences and policy-makers to respond to unsustainable resource use and environmental change is difficult, but where we are still compelled to care for particular elements of place as they relate to identity. In this article we examine how resource use and landscape change are communicated through Irish films, where the interactions of place identity and landscape are central. A key through line argument is how landscape is an important vehicle for expressing anxieties and contexts for resource interdependency; another is how elements of local and regional identity compete and interact with global concerns, such as climate change or globalization, in complex ways. We analyse these interactions to demonstrate how energy resource use and environmental change are linked, highlighting ‘small nation’ tensions concerning geographic identity and resource ownership that are relevant to real-world energy transitions and apply much more broadly.

Published
2021

20. Capturing Acquired Wisdom, Enabling Healthful Aging, and Building Multinational Partnerships Through Senior Global Health Mentorship

Author

Kristen Schroeder, Surbhi Grover, Silvia C. Formenti, John Wong, Ugo Amaldi, Eugenia Wendling, David A. Pistenmaa, Lawrence Roth, James M. Metz, Onyi Onyinye Balogun, H. Brereton, Donna M O'Brien, Stephen M. Hahn, Taofeeq Abdallah Ige, C. Norman Coleman, Mary Gospodarowicz, Nelson J. Chao, Simeon Chinedu Aruah, and Manjit Dosanjh

Subjects
Health Physics and Radiation Effects, Aging, Capacity Building, International Cooperation, education, Global Health, 03 medical and health sciences, 0302 clinical medicine, Mentorship, Health care, Global health, Humans, Capstone, 030212 general & internal medicine, Productivity, 030219 obstetrics & reproductive medicine, ComputingMilieux_THECOMPUTINGPROFESSION, business.industry, Mentors, Capacity building, General Medicine, Public relations, Intervention (law), Multinational corporation, Commentary, InformationSystems_MISCELLANEOUS, business
Abstract

The undeniable benefit of mentorship by experience senior mentors can meaningfully increase the breadth of their experience and contributions to society as well as address the dire inequality in global health. This model captures wisdom lost to retirement, enables opportunities for purposeful lifespan, underpins sustainable health care systems, and has the potential for building multinational partnerships., Key Messages Capturing the acquired wisdom and experience of mentors in global health offers a capstone for their careers and provides a purposeful healthspan for these professionals to continue to be engaged in meaningful work while leveraging their expertise to solve challenging health care problems.Senior professionals can mentor early career leaders to help them balance their professional commitments, interest in global health, and development of needed skills, such as understanding the nuances of cultural competence and adapting solutions to different environments.Institutional leaders, particularly in academic medical centers, recognize the importance of global engagement vis-à-vis their educational mission and for recruiting and retaining faculty and can benefit economically and programmatically from supporting experienced senior faculty or retirees to support these efforts.Program builders should include the opportunity for altruistic human service as an integral part of a career and highlight that they can access senior mentors and retirees who provide world-class expertise and mentorship at “volunteer prices.”

Published
2020

21. Toward a Preliminary Theory of Organizational Incentives: Addressing Incentive Misalignment in Private Equity-Owned Long-Term Care Facilities

Author

Alesha Ignatius Brereton

Subjects
Motivation, Health (social science), COVID-19, Humans, General Medicine, Law, Long-Term Care, Pandemics, Reimbursement, Incentive
Abstract

The COVID-19 pandemic brought critical debates regarding private equity ownership of long-term care facilities to the forefront of political, legal, and social landscapes. Like many of the historical concerns about long-term care, these debates center around low quality patient care. While the concerns present important challenges to overcome, this note theorizes the kinds of organizational incentives that may provide opportunities to align patient quality care with the financial goals of private equity investing. After a discussion of the historical context of long term care facilities and the more recent trends towards for-profit and private equity ownership of these facilities (Parts II and III), I engage with value-based models as a starting point to consider organizational level incentive possibilities (Part IV). In Part V, I consider an organizational-level pay for performance model, a time-bound incentive structure, and investor-specific incentives as three distinct possibilities for addressing the patient care issues identified.

Published
2022

22. Pseudohypoxic HIF pathway activation dysregulates collagen structure-function in human lung fibrosis

Author

Liudi Yao, Christopher J Brereton, Elizabeth R Davies, Yilu Zhou, Milica Vukmirovic, Joseph A Bell, Siyuan Wang, Robert A Ridley, Lareb SN Dean, Orestis G Andriotis, Franco Conforti, Lennart Brewitz, Soran Mohammed, Timothy Wallis, Ali Tavassoli, Rob M Ewing, Aiman Alzetani, Benjamin G Marshall, Sophie V Fletcher, Philipp J Thurner, Aurelie Fabre, Naftali Kaminski, Luca Richeldi, Atul Bhaskar, Christopher J Schofield, Matthew Loxham, Donna E Davies, Yihua Wang, and Mark G Jones

Subjects
Cultured, General Immunology and Microbiology, Cells, Pulmonary Fibrosis, General Neuroscience, fibrosis, Settore MED/10 - MALATTIE DELL'APPARATO RESPIRATORIO, General Medicine, Fibroblasts, General Biochemistry, Genetics and Molecular Biology, Mixed Function Oxygenases, Repressor Proteins, Oxidative Stress, Gene Expression Regulation, Transforming Growth Factor beta, cell biology, Humans, human, Collagen, Hypoxia-Inducible Factor 1, Lung, Biomarkers, Cells, Cultured
Abstract

Extracellular matrix (ECM) stiffening with downstream activation of mechanosensitive pathways is strongly implicated in fibrosis. We previously reported that altered collagen nanoarchitecture is a key determinant of pathogenetic ECM structure-function in human fibrosis (Jones et al., 2018). Here, through human tissue, bioinformatic and ex vivo studies we provide evidence that hypoxia-inducible factor (HIF) pathway activation is a critical pathway for this process regardless of the oxygen status (pseudohypoxia). Whilst TGFβ increased the rate of fibrillar collagen synthesis, HIF pathway activation was required to dysregulate post-translational modification of fibrillar collagen, promoting pyridinoline cross-linking, altering collagen nanostructure, and increasing tissue stiffness. In vitro, knockdown of Factor Inhibiting HIF (FIH), which modulates HIF activity, or oxidative stress caused pseudohypoxic HIF activation in the normal fibroblasts. By contrast, endogenous FIH activity was reduced in fibroblasts from patients with lung fibrosis in association with significantly increased normoxic HIF pathway activation. In human lung fibrosis tissue, HIF-mediated signalling was increased at sites of active fibrogenesis whilst subpopulations of human lung fibrosis mesenchymal cells had increases in both HIF and oxidative stress scores. Our data demonstrate that oxidative stress can drive pseudohypoxic HIF pathway activation which is a critical regulator of pathogenetic collagen structure-function in fibrosis.

Published
2022

23. Clinical and radiographic outcomes of a transosseous suture technique for displaced lateral clavicle fractures

Author

Daniel S. Brereton, Todd C. Moen, Jerrick G. Robker, Marci Gamez, and Wayne Z. Burkhead

Subjects
Adult, Male, medicine.medical_specialty, Radiography, Elbow, Fracture Fixation, Internal, Fractures, Bone, 03 medical and health sciences, Fixation (surgical), 0302 clinical medicine, medicine, Humans, Effective treatment, Orthopedics and Sports Medicine, Muscle Strength, Range of Motion, Articular, Aged, Retrospective Studies, Transosseous suture, 030222 orthopedics, business.industry, Suture Techniques, 030229 sport sciences, General Medicine, Middle Aged, Clavicle, Nonsurgical treatment, Surgery, Treatment Outcome, medicine.anatomical_structure, Female, business, Range of motion
Abstract

Background The purpose of this study was to evaluate the clinical and radiographic outcomes of a transosseous suture fixation technique for the treatment of unstable lateral clavicle fractures. The appropriate treatment for lateral clavicle fractures is controversial. Many authors have argued for nonsurgical treatment of these injuries; however, recent literature has shown a role for the surgical treatment of unstable fractures. The paucity of lateral clavicular bone and the unique anatomy of this area of the shoulder makes surgical treatment of these injuries challenging. This article reports a single-surgeon experience with a transosseous suture fixation technique for the treatment of unstable lateral clavicle fractures. Materials and Methods A retrospective review of all patients with unstable lateral clavicle fractures treated with a transosseous suture technique from 2015-2018 was performed. The indication for surgery was significant displacement between the main medial and lateral clavicle fragments. The surgical technique used was a modification of the technique as described by Levy. Patients were followed postoperatively with active and passive range of motion (ROM) measurements, strength testing, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, visual analog scale score, and standard radiographs. Patients were followed to radiographic union. Results Twelve patients underwent surgical fixation of unstable lateral clavicle fractures from 2015-2018. All patients had excellent function, full ROM, minimal pain, and improved functional scores at final follow-up. Eleven patients achieved complete union of the fracture. One patient healed with a fibrous union; however, the fracture had maintained alignment and the patient was asymptomatic and satisfied with the result. No patient required a second surgery. Conclusion We found that the transosseous suture technique for fixation is an effective treatment for unstable lateral clavicle fracture. This technique is reproducible, cost effective, and limits the need for revision surgery often encountered with other techniques.

Published
2020

24. Assessment of Environmental Impacts on Health: Examples from the Pacific Basin

Author

Paul Jagals, Colleen Lau, Claire Brereton, and Injeong Kim

Subjects
Humans, Bayes Theorem, General Medicine, Public Health, Environment, Child, Environmental Health, Risk Assessment
Abstract

Assessing environmental impacts on health in the Pacific Basin is challenged by significantly varying data types - quantities, qualities, and paucities - because of varying geographic sizes, environments, biodiversity, ecological assets, and human population densities, with highly varied and unequal socio-economic development and capacity to respond to environmental and health challenges. We discuss three case-based methodological examples from Pacific Basin environmental health impact assessments. These methods could be used to improve environmental health evidence at all country and regional levels across a spectrum of big data availability to no data. These methods are, 1) a risk assessment of airborne particulate matter in Korea based on the chemical composition of these particulates; 2) the use of system dynamics to appraise the influences of a range of environmental health determinants on child health outcomes in remote Solomon Islands; and 3) precision environmental public health methodologies based on comprehensive data collection, analyses, and modelling (including Bayesian belief networks and spatial epidemiology) increasing precision for good environmental health decision making to prevent and control a zoonotic disease in Fiji Islands. We show that while a common theme across the three examples is the value of high quality and quantity data to support stronger policy decisions and appropriate prioritizing of investment, it is also clear that for many countries in the Pacific Basin, sufficient data will remain a challenge to inform decision makers about environmental impact on health.

Published
2021

25. A blended learning perineal suturing programme for midwifery students: An evaluative descriptive study

Author

Siobhan Brereton, Mary Curtin, Elizabeth Greene, Philip Hardie, Marcelina Szafranska, and Ciara Kirwan

Subjects
Sutures, Pregnancy, Humans, Learning, Female, Students, Nursing, Clinical Competence, General Medicine, Midwifery, General Nursing, Education
Abstract

The purpose of this study was to examine midwifery students' views and experiences of learning perineal suturing skills through a blended learning approach.Evidence suggests that not all midwifery students are gaining sufficient experience in perineal trauma and suturing to sufficiently prepare them to achieve competency in this skill at the point of registration.The blended learning approach included lectures, a bespoke 'suture at home kit', online reusable learning objects, and an optional face-to-face drop-in suture clinic. Midwifery students submitted a video demonstration of the skills acquired and then attended a clinical skills laboratory in preparation for a face-to-face competency assessment on campus.A qualitative descriptive evaluation research design study was undertaken from 22 participants. Deductive thematic analysis was selected to analyse the qualitative data. Two themes were identified. The first theme, 'learning at home', included sub-themes of 'deliberate practice' and 'the ability to make mistakes. The second theme, 'achieving competency', included sub-themes of 'equipment' and 'bringing it all together' CONCLUSIONS: The blended learning approach of the programme applied to teach perineal suturing had a positive influence on midwifery students learning of the skill. The acquisition of knowledge using the suture at home kit gave the students confidence and prepared them for laboratory practice and assessment, and ultimately prepared them for practice placement. They identified other clinical skills suited to using an 'at home' simulation pack. The validation of the perineal suturing programme by midwifery students supports the need for a blended learning approach for this and other clinical skills. All participants expressed a positive view of the programme and found it beneficial for their learning. Midwifery students recognised that the suture at home kit gave them confidence, knowledge of the skill and preparedness for the clinical skills laboratory practice and assessment. They identified other clinical skills suited to using an 'at home' simulation pack. The positive experiences of midwifery students in this study to a blended-learning programme for perineal suturing education and training further validated the recognised need to develop and include online, and face to face learning approaches for this vital aspect of intrapartum care.

Published
2022

26. Patterns of tobacco use in low and middle income countries by tobacco product and sociodemographic characteristics: nationally representative survey data from 82 countries

Author

Michaela Theilmann, Julia M Lemp, Volker Winkler, Jennifer Manne-Goehler, Maja E Marcus, Charlotte Probst, William A Lopez-Arboleda, Cara Ebert, Christian Bommer, Maya Mathur, Glennis Andall-Brereton, Silver K Bahendeka, Pascal Bovet, Farshad Farzadfar, Erfan Ghasemi, Mary T Mayige, Sahar Saeedi Moghaddam, Kibachio J Mwangi, Shohreh Naderimagham, Lela Sturua, Rifat Atun, Justine I Davies, Till Bärnighausen, Sebastian Vollmer, and Pascal Geldsetzer

Subjects
Male, Cross-Sectional Studies, Tobacco, Smokeless, Tobacco, Prevalence, Humans, Tobacco Products, General Medicine, Developing Countries
Abstract

ObjectivesTo determine the prevalence and frequency of using any tobacco product and each of a detailed set of tobacco products, how tobacco use and frequency of use vary across countries, world regions, and World Bank country income groups, and the socioeconomic and demographic gradients of tobacco use and frequency of use within countries.DesignSecondary analysis of nationally representative, cross-sectional, household survey data from 82 low and middle income countries collected between 1 January 2015 and 31 December 2020.SettingPopulation based survey data.Participants1 231 068 individuals aged 15 years and older.Main outcome measuresSelf-reported current smoking, current daily smoking, current smokeless tobacco use, current daily smokeless tobacco use, pack years, and current use and use frequencies of each tobacco product. Products were any type of cigarette, manufactured cigarette, hand rolled cigarette, water pipe, cigar, oral snuff, nasal snuff, chewing tobacco, and betel nut (with and without tobacco).ResultsThe smoking prevalence in the study sample was 16.5% (95% confidence interval 16.1% to 16.9%) and ranged from 1.1% (0.9% to 1.3%) in Ghana to 50.6% (45.2% to 56.1%) in Kiribati. The user prevalence of smokeless tobacco was 7.7% (7.5% to 8.0%) and prevalence was highest in Papua New Guinea (daily user prevalence of 65.4% (63.3% to 67.5%)). Although variation was wide between countries and by tobacco product, for many low and middle income countries, the highest prevalence and cigarette smoking frequency was reported in men, those with lower education, less household wealth, living in rural areas, and higher age.ConclusionsBoth smoked and smokeless tobacco use and frequency of use vary widely across tobacco products in low and middle income countries. This study can inform the design and targeting of efforts to reduce tobacco use in low and middle income countries and serve as a benchmark for monitoring progress towards national and international goals.

Published
2022

27. The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults

Author

Chea Stanford Wesseh, Demetre Labadarios, David Guwatudde, Dismand Houinato, Lindsay M. Jaacks, Jutta Mari Adelin Jorgensen, Brice Wilfried Bicaba, Lela Sturua, Kokou Agoudavi, Roy A Wong-McClure, Glennis Andall-Brereton, Mary T Mayige, Mohamed Msaidie, Nuno Lunet, Corine Houehanou, Till Bärnighausen, Nahla Hwalla, Sebastian Vollmer, Lindiwe Tsabedze, Gladwell Gathecha, Rifat Atun, Sarah Quesnel-Crooks, Zhaxybay Zhumadilov, Mongal Singh Gurung, Maja E Marcus, Andrew Stokes, Albertino Damasceno, Gibson B. Kagaruki, Kibachio Joseph Muiruri Mwangi, Jennifer Manne-Goehler, Bolormaa Norov, Maria Dorobantu, Silver Bahendeka, Pascal Geldsetzer, Cara Ebert, Abla M. Sibai, Justine Davies, Krishna Kumar Aryal, Adil Supiyev, Omar Mwalim, Joao S Martins, Khem Bahadur Karki, and Pascal Bovet

Subjects
education.field_of_study, business.industry, Cross-sectional study, Population, 1. No poverty, Psychological intervention, General Medicine, 030204 cardiovascular system & hematology, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Blood pressure, Meta-analysis, Global health, Per capita, Medicine, 030212 general & internal medicine, 10. No inequality, business, education, Disease burden, Demography
Abstract

Summary Background Evidence from nationally representative studies in low-income and middle-income countries (LMICs) on where in the hypertension care continuum patients are lost to care is sparse. This information, however, is essential for effective targeting of interventions by health services and monitoring progress in improving hypertension care. We aimed to determine the cascade of hypertension care in 44 LMICs—and its variation between countries and population groups—by dividing the progression in the care process, from need of care to successful treatment, into discrete stages and measuring the losses at each stage. Methods In this cross-sectional study, we pooled individual-level population-based data from 44 LMICs. We first searched for nationally representative datasets from the WHO Stepwise Approach to Surveillance (STEPS) from 2005 or later. If a STEPS dataset was not available for a LMIC (or we could not gain access to it), we conducted a systematic search for survey datasets; the inclusion criteria in these searches were that the survey was done in 2005 or later, was nationally representative for at least three 10-year age groups older than 15 years, included measured blood pressure data, and contained data on at least two hypertension care cascade steps. Hypertension was defined as a systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or reported use of medication for hypertension. Among those with hypertension, we calculated the proportion of individuals who had ever had their blood pressure measured; had been diagnosed with hypertension; had been treated for hypertension; and had achieved control of their hypertension. We weighted countries proportionally to their population size when determining this hypertension care cascade at the global and regional level. We disaggregated the hypertension care cascade by age, sex, education, household wealth quintile, body-mass index, smoking status, country, and region. We used linear regression to predict, separately for each cascade step, a country's performance based on gross domestic product (GDP) per capita, allowing us to identify countries whose performance fell outside of the 95% prediction interval. Findings Our pooled dataset included 1 100 507 participants, of whom 192 441 (17·5%) had hypertension. Among those with hypertension, 73·6% of participants (95% CI 72·9–74·3) had ever had their blood pressure measured, 39·2% of participants (38·2–40·3) had been diagnosed with hypertension, 29·9% of participants (28·6–31·3) received treatment, and 10·3% of participants (9·6–11·0) achieved control of their hypertension. Countries in Latin America and the Caribbean generally achieved the best performance relative to their predicted performance based on GDP per capita, whereas countries in sub-Saharan Africa performed worst. Bangladesh, Brazil, Costa Rica, Ecuador, Kyrgyzstan, and Peru performed significantly better on all care cascade steps than predicted based on GDP per capita. Being a woman, older, more educated, wealthier, and not being a current smoker were all positively associated with attaining each of the four steps of the care cascade. Interpretation Our study provides important evidence for the design and targeting of health policies and service interventions for hypertension in LMICs. We show at what steps and for whom there are gaps in the hypertension care process in each of the 44 countries in our study. We also identified countries in each world region that perform better than expected from their economic development, which can direct policy makers to important policy lessons. Given the high disease burden caused by hypertension in LMICs, nationally representative hypertension care cascades, as constructed in this study, are an important measure of progress towards achieving universal health coverage. Funding Harvard McLennan Family Fund, Alexander von Humboldt Foundation.

Published
2019

28. P013 A pilot study for ultrasound examination of the pterygomandibular raphe to predict efficacy of mandibular advancement splint therapy in obstructive sleep apnoea

Author

Elizabeth C. Brown, Lauriane Jugé, C Brereton, Lynne E. Bilston, and A Ferreira

Subjects
musculoskeletal diseases, Mandibular advancement splint, Orthodontics, medicine.anatomical_structure, business.industry, Ultrasound, Medicine, Pterygomandibular raphe, General Medicine, business, Sleep in non-human animals
Abstract

Background A lack of predictive indicators for mandibular advancement splint (MAS) efficacy limits their use in the treatment of obstructive sleep apnoea (OSA). The absence of a tendinous pterygomandibular raphe (PMR) in the lateral nasopharynx on MRI may predict MAS efficacy, however MRI is time and resource intensive. We aimed to assess the feasibility of ultrasound in determining PMR absence compared to MRI. Methods 10 healthy participants were recruited to undergo both MRI and ultrasound of the lateral airway. Surrounding anatomical landmarks were examined to establish the presence or absence of the PMR. These results will be compared to MRI to determine parameters on ultrasound which correlate to an absent PMR. Progress to date 8 of the 10 participants have undergone both MRI and ultrasound, of which half were women, mean age 53 years, mean BMI 28 and mean AHI 3. In all 8 participants so far parameters for assessment of the PMR were identified and described, including presence of anatomical landmarks, localisation and width of the PMR space, and presence of a hyperechoic structure within the space. Comparison of these parameters with MRI to determine predictors of PMR presence or absence is currently underway. Intended outcome and impact Validation of ultrasound in the assessment for presence or absence of a tendinous PMR will enable further study of this structure as a predictive marker for MAS efficacy in OSA. This could assist clinicians in identifying suitable patients for MAS therapy.

Published
2021

29. Assessing Violence and Injury Surveillance in the Caribbean

Author

G. M. Andall-Brereton and W. A. Mueller

Subjects
medicine.medical_specialty, business.industry, Environmental health, Epidemiology, Medicine, General Medicine, Injury surveillance, business
Abstract

Objective: To determine the status of existing violence and injury prevention (VIP) efforts and surveillance systems in the Caribbean. Methods: The Caribbean Public Health Agency (CARPHA) undertook a survey to gather evidence of VIP in 24 CARPHA member states. The survey was administered to national epidemiologists and non-communicable disease focal points in October 2015 using an online tool, ‘Survey Monkey’. Questions were asked about the availability in each country of VIP representative surveys, policies, action plans, laws, victim support services, and surveillance systems. Results: Nineteen (79%) countries completed the VIP survey. Only three (16%) countries indicated having conducted a nationally representative survey. Twelve (63%) had not developed a national policy, and 14 (74%) had not implemented an action plan on VIP. Each country reported the existence of VIP laws and offered victim support services, though average law enforcement ranged from 40% to 79%. Nine (47%) countries indicated using an injury registry, and 15 (79%) reported collecting injury data using in-patient records, mainly from public hospitals. All 19 countries confirmed that records of reported violent incidents were maintained by the police. Unique identifiers were generally lacking in registries and data collected by the police. Only four (44%) countries with registries, 10 (67%) countries with in-patient injury data, and 12 (63%) countries with police records indicated that the data were shared with other organizations. Conclusion: Each country reported some level of injury surveillance system. However, such systems should be harmonized to produce more complete baseline data. The use of unique identifiers is required to reduce duplication and effectively link surveillance systems available in countries.

Published
2018

30. A pathway to value-based care of chronic rhinosinusitis using a claims database

Author

Derek D. Cyr, James C. Denneny, Kristine Schulz, Jean Brereton, and David L. Witsell

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Chronic rhinosinusitis, medicine.medical_treatment, Population, Value based care, General Medicine, Evidence-based medicine, Septoplasty, Internal medicine, otorhinolaryngologic diseases, medicine, Acute rhinosinusitis, Claims database, Diagnostic endoscopy, education, business
Abstract

Objective To construct a comprehensive picture of the typical chronic rhinosinusitis (CRS) patient in the United States including the demographics, comorbidities, and geographic prevalence. The study will also identify the diagnostic and treatment regimens, their cost, and pattern of use for both medically and surgically managed patients. Study design Historical cohort study utilizing private and public payer databases. Methods Medical claims data from the Truven Health MarketScan Research Databases from the years 2010 to 2012 for patients with acute rhinosinusitis (ARS) and CRS 18 and older were analyzed. Results There were 54 million unique patients in the databases from 2010 to 2012. Approximately 8 million had at least one diagnosis of ARS and 298,337 had a diagnosis of CRS. Females represented 63.7% of patients with ARS and 59.4% with CRS. Medicare patients represented 6.7% of the ARS population and 10.2% of the CRS population. The mean cost of a CRS episode for those commercially insured was $1024 and $762 in Medicare. CRS patients underwent diagnostic procedures including diagnostic endoscopy (55.1%), cultures (23.6%), sinus CT scan (82.1%) and MRI (0.2%). Endoscopic sinus surgery (ESS) was performed on 14.4% of those patients with CRS. Change in frequency of medication use from the 6 months prior to ESS to the 6 months post-ESS yielded a reduction in total costs of 34.2% or $3.9 M. The most commonly operated sinuses (with or without septoplasty on same day as ESS) were the maxillary (94%/76.1%); followed by ethmoid (82.1%/66.6%); frontal (38.8%/35.1%); and sphenoid (28.5%/28.1%). In total, 16.6% had one sinus operated on, 39.1% had two, 24.6% had three, and 18.7% had four sinuses operated on. Conclusions This data paints a much clearer understanding of the current medical and surgical management. This study confirms the previously described "value proposition" for the surgical management of those CRS patients refractory to medical management. Level of evidence 4.

Published
2018

31. Understanding sociality and behavior change associated with a nesting event in a captive flock of great white pelicans

Author

James Fryer, James E. Brereton, and Paul E. Rose

Subjects
Social network, business.industry, Visitor pattern, media_common.quotation_subject, General Medicine, Biology, Social Environment, Nesting Behavior, Courtship, Fishery, Birds, Vigilance (behavioural ecology), Pelican, Animal welfare, biology.animal, Animals, Animal Science and Zoology, Animals, Zoo, Flock, Seasons, business, Social Behavior, Sociality, media_common
Abstract

Zoo-housed pelicans are commonplace, but their breeding record is poor and little research is published on the activity patterns, as potential predictors of nesting, of captive flocks. Existing literature shows that comparative research can provide useful information for husbandry and conservation planning for pelican populations. The opportunity arose to investigate the time-activity budget and social network of a breeding flock of captive great white pelicans. Three chicks were hatched in June and July 2016 and one in March 2017. Data on state behaviors, space use, and association preferences were collected around these nesting events, from October 2016 to February 2017 and July to October 2017. Results suggest that pre-nesting periods were associated with heightened flock-wide vigilance, suggesting that vigilance may be a precursor for courtship or nesting activity. Social network analysis revealed nonrandom associations between birds and a social structure across the flock, in which subadults seemed to associate more with each other than with adult birds. A limited visitor effect was noted; whilst no overall behavior change was apparent with different numbers of visitors, pelicans did widen their enclosure usage with increased visitor presence. These data are relevant to those attempting to breed this pelican, who wish to know more about the daily behavior patterns of this species across the season and physiological state, and who wish to understand pelican social structure, which is useful to the planning and implementation of bird moves or changes to the social environment of the flock. Further extending such research to include uninterrupted observation over a successful breeding event is recommended.

Published
2021

32. Cardiovascular disease risk profile and management practices in 45 low-income and middle-income countries: A cross-sectional study of nationally representative individual-level survey data

Author

Bahendeka K Silver, Pascal Geldsetzer, Krishna Kumar Aryal, Lindiwe Tsabedze, Sebastian Vollmer, Rifat Atun, Nuno Lunet, Joao S Martins, Kokou Agoudavi, Arpita Ghosh, Briar McKenzie, Corine Houehanou, Zhaxybay Zhumadilov, Glennis Andall-Brereton, Jutta M Adelin Jorgensen, Abla M. Sibai, David Peiris, Mongal Singh Gurung, Maja-Emilia Marcus, Albertino Damasceno, Michaela Theilmann, Mary T Mayige, Bolormaa Norov, Lindsay M. Jaacks, Jacqui Webster, Demetre Labadarios, David Guwatudde, Till Bärnighausen, Adil Supiyev, Jennifer Manne-Goehler, and Justine Davies

Subjects
Male, Cross-sectional study, Epidemiology, Economics, Psychological intervention, Social Sciences, Blood Pressure, Disease, 030204 cardiovascular system & hematology, Cardiovascular Medicine, Economic Geography, Global Health, Vascular Medicine, Survey methodology, 0302 clinical medicine, Medical Conditions, Interquartile range, Medicine and Health Sciences, Medicine, Public and Occupational Health, 030212 general & internal medicine, Geography, Regression analysis, General Medicine, Middle Aged, 3. Good health, Cardiovascular Diseases, Low and Middle Income Countries, Female, Research Article, Employment, Adult, Risk, Cardiology, Risk Assessment, 03 medical and health sciences, Environmental health, Humans, Developing Countries, Poverty, Antihypertensive Agents, Aged, business.industry, Cardiovascular Disease Risk, Educational attainment, Cross-Sectional Studies, Medical Risk Factors, Labor Economics, Earth Sciences, Survey data collection, Self Report, business
Abstract

Background Global cardiovascular disease (CVD) burden is high and rising, especially in low-income and middle-income countries (LMICs). Focussing on 45 LMICs, we aimed to determine (1) the adult population’s median 10-year predicted CVD risk, including its variation within countries by socio-demographic characteristics, and (2) the prevalence of self-reported blood pressure (BP) medication use among those with and without an indication for such medication as per World Health Organization (WHO) guidelines. Methods and findings We conducted a cross-sectional analysis of nationally representative household surveys from 45 LMICs carried out between 2005 and 2017, with 32 surveys being WHO Stepwise Approach to Surveillance (STEPS) surveys. Country-specific median 10-year CVD risk was calculated using the 2019 WHO CVD Risk Chart Working Group non-laboratory-based equations. BP medication indications were based on the WHO Package of Essential Noncommunicable Disease Interventions guidelines. Regression models examined associations between CVD risk, BP medication use, and socio-demographic characteristics. Our complete case analysis included 600,484 adults from 45 countries. Median 10-year CVD risk (interquartile range [IQR]) for males and females was 2.7% (2.3%–4.2%) and 1.6% (1.3%–2.1%), respectively, with estimates indicating the lowest risk in sub-Saharan Africa and highest in Europe and the Eastern Mediterranean. Higher educational attainment and current employment were associated with lower CVD risk in most countries. Of those indicated for BP medication, the median (IQR) percentage taking medication was 24.2% (15.4%–37.2%) for males and 41.6% (23.9%–53.8%) for females. Conversely, a median (IQR) 47.1% (36.1%–58.6%) of all people taking a BP medication were not indicated for such based on CVD risk status. There was no association between BP medication use and socio-demographic characteristics in most of the 45 study countries. Study limitations include variation in country survey methods, most notably the sample age range and year of data collection, insufficient data to use the laboratory-based CVD risk equations, and an inability to determine past history of a CVD diagnosis. Conclusions This study found underuse of guideline-indicated BP medication in people with elevated CVD risk and overuse by people with lower CVD risk. Country-specific targeted policies are needed to help improve the identification and management of those at highest CVD risk., Author summary Why was this study done? CVD burden in low-income and middle-income countries (LMICs) is high and rising. CVD risk estimation using validated risk prediction equations is recommended in most guidelines; however, there are few population-representative analyses of CVD risk and its association with socio-demographic characteristics. Despite guidelines recommending using CVD risk estimates as an essential first step in guiding management practices, the extent to which risk-based approaches are being implemented in LMICs is not well characterised. What did the researchers do and find? We analysed population-representative survey data from 45 LMICs to determine country-specific levels of CVD risk, associations between socio-demographic factors and levels of CVD risk, and adherence to WHO guidelines on use of blood pressure medication. We found high variation in CVD risk profiles, with higher levels of risk in the Europe and the Eastern Mediterranean region and lower levels of risk in sub-Saharan Africa, as well as an inverse association between CVD risk and higher education and employment in most countries. We found an underuse of medicines in people at elevated CVD risk across all countries (only 24.2% of males and 41.6% of females at high CVD risk are taking guideline-recommended BP medication) and an overuse of medicines in people at lower levels of CVD risk, with 47% of all BP medication being used by people at low CVD risk without a guideline indication for use. What do these findings mean? There is large variation in CVD risk across LMICs, and an inverse association between CVD risk and higher education and employment in most countries. There is an overuse of medicines in people at lower levels of CVD risk and an underuse of medicines in people at elevated CVD risk across all countries. The large heterogeneity of the findings in this study reflects varying country contexts. Country-specific targeted policies are needed to improve the identification and management of those at highest CVD risk.

Published
2021

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

Author

Eugenia Abaleke, Mustafa Abbas, Sadia Abbasi, Alfie Abbott, Ashraf Abdelaziz, Sherif Abdelbadiee, Mohamed Abdelfattah, Basir Abdul, Althaf Abdul Rasheed, Rezan Abdul-Kadir, Abdulfatahi Abdulmumeen, Niyaz Abdulshukkoor, Kula Abdusamad, Yazeed Abed El Khaleq, Mai Abedalla, Abeer UA Abeer Ul Amna, Adebanke Aboaba, Hani Abo-Leyah, Ahmed Abou-Haggar, Mahmoud Abouibrahim, Miriam Abraham, Tizzy Abraham, Abraheem Abraheem, Judith Abrams, Hyacinth-John Abu, Ahmad Abu-Arafeh, Syed M Abubacker, Akata Abung, Yaa Aceampong, Devikumar Acharya, Janet Acheson, Andres Acosta, Catherine Acton, Jacqueline Adabie-Ankrah, Fiona Adam, Matthew Adam, Huzaifa Adamali, Carol Adams, Kate Adams, Richard Adams, Tim Adams, Malgorzata Adamus, Kirsty Adcock, Aderonke Adebiyi, Ken Adegoke, Vicki Adell, Aldrin Adeni, Sherna Adenwalla, Oluwasegun A Adesemoye, Emmanuel O Adewunmi, Joyce Adeyemi, Elizabeth Adeyeye, Gabrielle Adkins, Adnan Adnan, John Aeron-Thomas, Lynn Afari, Debbie Affleck, Carmel Afnan, Deborah Afolabi, Muhammad Afridi, Rachel Agbeko, Chris Agbo, Sunil Aggarwal, Arameh Aghababaie, Judith Agwada-Akeru, Kwame A Agyapong, Shafana Ahamed Sadiq, Mohamed H Ahammed Nazeer, Jonathan Ah-Chuen, Mahin Ahmad, Ashar Ahmed, Bilal Ahmed, Forizuddin Ahmed, Iram Ahmed, Irshad Ahmed, Liban Ahmed, Maria C Ahmed, Muhammad S Ahmed, Naseer Ahmed, Nausheen Ahmed, Osama Ahmed, Rajia A Ahmed, Rizwan Ahmed, Saif Ahmed, Sammiya Ahmed, Sara Ahmed, Syed H Ahmed, Roa Ahmed Ali, Sana Ahmer, Dhiraj Ail, Adam Ainsley, Mark Ainsworth, Myriam Aissa, Lucy Aitchson, Lindianne Aitken, Bini Ajay, Abdulakeem Ajibode, Ayesha Ajmi, Muhammad N Akhtar, Nasim Akhtar, Suha Akili, Oludoyinsola Akindolie, Yinka Akinfenwa, Olugbenga Akinkugbe, Ibrahim Akinpelu, Umeh Akudo, Asma Al Balushi, Majd Al Dakhola, Narendra Aladangady, Sajid Alam, Abbas Al-Asadi, Kyriaki Alatzoglou, Lorraine Albon, Stephen Alcorn, Aggie Aldana, David Alderdice, Rayan Aldouri, Jonathan Aldridge, Nicolas Aldridge, Ana Alegria, Alison Alexander, John Alexander, Peter DG Alexander, Julyan Al-Fori, Bahij Al-Hakim, Shams Al-Hity, Ali Ali, Anyat Ali, Fawzia R Ali, Jawad Ali, Mariam Ali, Mohammad Ali, Oudai Ali, Sakina Ali, Syed Ali, Abid Alina, Katrin Alizaedeh, Maithem Al-Jibury, Moutaz Alkhusheh, Alison Allanson, Robert Allcock, Eireann Allen, Jonathan Allen, Kerry Allen, Louise Allen, Rebecca Allen, Sam Allen, Sharon Allen, Simon Allen, Kathryn Allison, Bethan Allman, Lynne Allsop, Christine Almadenboyle, Hassan Al-Moasseb, Magda Al-Obaidi, Lina Alomari, Akram Al-Rabahi, Bahar Al-Ramadhani, Zayneb Al-Saadi, Warkaq Al-Shamkhani, Bashar Al-Sheklly, Mary Alvarez, Maysaa Alzetani, Susan Amamou, Sakarai Ambalavanan, Sarah-Jayne Ambler, Robert Ambrogetti, Chris Ambrose, Amir Ameen, Maria R Amezaga, Allison Amin, Amina Amin, Kanish Amin, Amjad Amjad, Victoria Amosun, Khaled Amsha, Atul Anand, Samantha Anandappa, Julie Anderson, Laura Anderson, Michelle Anderson, Nicola Anderson, Rachel Anderson, Rory Anderson, Prematie Andreou, Angela Andrews, Jill 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Stephanie Bareford, Shahedal Bari, Amy Barker, Debbie Barker, Joseph B Barker, Leon Barker, Oliver Barker, Kerry Barker-Williams, Sinha Barkha, Juliana Barla, Gavin Barlow, Richard Barlow, James Barnacle, Alex Barnard, Debi Barnes, Nicky Barnes, Amy Barnett, Debra Barnett, Ashton Barnett-Vanes, William Barnsley, Andrew Barr, David Barr, Shaney Barratt, Manuella Barrera, Fiona Barrett, Jessica Barrett, Jazz Bartholomew, Sarah Bartholomew, Claire Bartlett, Georgina Bartlett, Greg Barton, Jill Barton, Rachael Barton, Rosaleen Baruah, Sonia Baryschpolec, Archana Bashyal, Betsy Basker, Ayten Basoglu, Amira Bassaly, G Bassett, Bengisu Bassoy, Anupam Basumatary, Adam Bataineh, Freddie Batalla, Tristan Bate, Harry John Bateman, Kathryn Bateman, Vhairi Bateman, Eleanor Bates, Hayley Bates, Michelle Bates, Rizvan Batha, Sally Batham, Ana Batista, Amit Batla, Dushyant Batra, Harry Batty, Thomas Batty, Miranda Baum, Carina Bautista, Fatima S Bawani, Simon Bax, Matt Baxter, Nicola Baxter, Hannah 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Chapman, Lucy Chappell, Amanda Charalambou, Bethan Charles, Dianne Charlton, Kevin Chatar, Calvin Chatha, Priyanka Chaturvedi, Muhammad YN Chaudhary, Iram Chaudhry, Zain Chaudhry, Nazia Chaudhuri, Muhammad Chaudhury, Anoop Chauhan, Milan Chauhan, Ruchi S Chauhan, Nicola Chavasse, James Cheaveau, Michelle Cheeseman, Fang Chen, Hui Min Chen, Terence Chen, Lok Y Cheng, Zhihang Cheng, Ashok Chengappa, Helen Chenoweth, Chun H Cheong, Shiney Cherian, Helen Cheshire, Sarah Chessell, Chee Kay Cheung, Elaine Cheung, Claire Cheyne, Swati Chhabra, Eric Chiang, Angela Chiapparino, Rosavic Chicano, Sam Chilcott, Phillipa Chimbo, KokWai Chin, Wen Jie Chin, Amol Chingale, Heather Chisem, Ben Chisnall, Sunder Chita, Nihil Chitalia, Chipo Chitsenga, Matthew Chiu, Brenda Chivima, Soha Choi, Willy Choon Kon Yune, Khayzer Choudhary, Vandana Choudhary, Gary Chow, Muhibbur Chowdhury, Alexander Christides, Alex Christie, Daniel Christmas, Thereza Christopherson, Mark Christy, Paris Chrysostomou, Yunli Chua, Dip Chudgar, Richard Chudleigh, Srikanth Chukkambotla, Izu Chukwulobelu, Favour Chukwunonyerem, Chi Y Chung, Jonathan Chung, Elaine Church, Sara R Church, David Churchill, Paola Cicconi, 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, Lucy Clark, Matthew Clark, Patricia Clark, Richard Clark, Thomas Clark, Zoe Clark, Andrea Clarke, Paul Clarke, Robert Clarke, Roseanne Clarke, Samantha Clarke, Sheron Clarke, Alleyna Claxton, Elizabeth Clayton, Olivia Clayton, Jill Clayton-Smith, Chris Cleaver, Jayne Clemens, Carlota Clemente de la Torre, Suzanne Clements, Sarah Clifford, Amelia Clive, Jonathan Clouston, Samantha Clueit, Andrea Clyne, Peter GL Coakley, Kathryn Cobain, Susan Coburn, Alexandra Cochrane, Patricia Cochrane, Samantha Cockburn, Helen Cockerill, Shirley Cocks, Rhodri Codd, Rachel Codling, Adam Coe, Samantha Coetzee, David Coey, 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Fenn, Isabelle Fenner, Ciara Fenton, Melisa Fenton, Cameron Ferguson, Jenny Ferguson, Kathryn Ferguson, Katie Ferguson, Lisa Ferguson, Susan Ferguson, Susie Ferguson, Victoria Ferguson, Denzil Fernandes, Candida Fernandez, Eduardo Fernandez, Sonia Fernandez Lopez, Ahmed Feroz, Pietro Ferranti, Thais Ferrari, Catarina Ferreira-De Almeida, Alexandra Ferrera, Emma Ferriman, Nicholas Fethers, Ben Field, Janet Field, Andra Fielding, Julie Fielding, Sarah Fielding, Asma Fikree, Sarah Ann Filson, Joanne Finch, Laurie Finch, Natalie Fineman, Adam Finn, Joanne Finn, Sofia Fiouni, Jo Fiquet, James Fisher, Neil Fisher, Daniel Fishman, Krystofer Fishwick, Marie Fisk, Jan Flaherty, Michael Flanagan, Charles Flanders, Julie Fleming, Lucy Fleming, Paul Fleming, William Flesher, Alison Fletcher, Lucy Fletcher, Sophie Fletcher, Christopher Flood, Jonathan Flor, Vincent Florence, Sharon Floyd, Adama Fofana, Georgina Fogarty, Linda Folkes, Aiwyne Foo, Andrew Foot, Jayne Foot, Jane Forbes, Kathryn Forcer, Jamie Ford, Jennifer Foreman, Caroline Fornolles, Adam Forrest, Ellie Forsey, Thomas Forshall, Elliot Forster, Julian Forton, Emily Foster, Joseph Foster, Rachel A Foster, Tracy Foster, Angela Foulds, Ian Foulds, Folakemi Fowe, Emily Fowler, Robert Fowler, Stephen Fowler, Caroline Fox, Claire Fox, Heather Fox, Jonathan Fox, Lauren Fox, Natalie Fox, Simon Fox, Sarah-Jane Foxton, Rebecca Frake, Alex Francioni, Olesya Francis, Rebecca Francis, Sarah Francis, Theodora Francis-Bacon, Victoria Francois, Sharon Frayling, Martyn Fredlund, Michael Freeborn, Carol Freeman, Elaine Freeman, Hannah Freeman, Nicola Freeman, Clare Freer, Eleanor French, Anastasia Fries, Matthew Frise, Renate Fromson, Claire Froneman, John Frost, Victoria Frost, Rachel Frowd, Arun Fryatt, Bridget Fuller, Elizabeth Fuller, Tracy Fuller, Duncan Fullerton, Sarah Funnell, John Furness, Hassina Furreed, Waqas Gaba, Elizabeth Gabbitas, Claire Gabriel, Joshua Gahir, Katarzyna Gajewska-Knapik, Christopher Gale, Hugo Gale, 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Julia Greig, Rebecca Grenfell, Teena Grenier, Susan Grevatt, Glaxy Grey, Andrew Gribbin, Ben Griffin, Denise Griffin, Mel Griffin, Sian Griffith, Andrew Griffiths, Daniel Griffiths, David Griffiths, Donna Griffiths, Isabel Griffiths, Nicola Griffiths, Oliver Griffiths, Sofia Grigoriadou, Steph Grigsby, Russell Gritton, Evelina Grobovaite, Clarissa Grondin, Rachel Groome, Liliana Grosu, Jenny Grounds, Jayne Groves, Neil Grubb, Julie Grundy, Francesca Guarino, Sharada Gudur, Shivang Gulati, Vikas Gulia, Pumali Gunasekera, Kirun Gunganah, Jessica Gunn, Emma Gunter, Alok Gupta, Atul Gupta, Rajeev Gupta, Richa Gupta, Tarun Gupta, Vineet Gupta, Ankur Gupta-Wright, Sambasivarao Gurram, Ishy Gurung, Shraddha Gurung, Hazel Guth, Ruth Habibi, Pamela Hackney, Christian Hacon, Aiman Haddad, Denise Hadfield, Michalis Hadjiandreou, Anna Haestier, Nauman Hafiz, Rana Hafiz-Ur-Rehman, Samantha Hagan, Jack W Hague, Rosemary Hague, Andrew Haigh, Kate Haigh, Christina Haines, Scott Hainey, Morton Hair, 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Charlie H Harper, Heather Harper, Peter Harper, Rosemary Harper, Sarah Harrhy, Sian Harrington, Yasmin Harrington-Davies, Claire Harris, Jade Harris, Julie Harris, Laura Harris, Marie-Clare Harris, Nichola Harris, David Harrison, Laura Harrison, Melanie Harrison, Rowan Harrison, Susie Harrison, Tom Harrison, Wendy Harrison, Elizabeth Harrod, Ciaran Hart, Dominic Hart, Rosemary Hartley, Ruth Hartley, Tom Hartley, William Hartrey, Hans Hartung, Alice Harvey, Angela Harvey, Max Harvey, Catherine Harwood, Helen Harwood, Neda Hasan, Brigitte Haselden, Mohammed Hashimm, Imranullah Hashmi, Zena Haslam, Abdulhakim Hassan, Adil Hassan, Ali Hassan, Waqar Ul Hassan, Philip Hassell, Alex Hastings, Bethany Hastings, Jonathan Hatton, Jennifer Haugh, May Havinden-Williams, Stefan Havlik, Dan Hawcutt, Liz Hawes, Nicola Hawes, Annie Hawkins, Nancy Hawkins, Daniel Hawley, Edward Haworth, Cathy Hay, Jamal Hayat, Anne Hayes, Melony Hayes, Fiona Hayes, Antara Hayman, Melanie Hayman, Matthew Haynes, Richard 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Highgate, Mondy Hikmat, Amanda Hill, Helen Hill, Joanne Hill, Phoebe Hill, Annette Hilldrith, Catherine Hillman-Cooper, Zoe Hilton, Alice Hindmarsh, Paul Hine, Kim Hinshaw, Clare Hird, Jemma Hives, Benson Ho, David Hobden, Gill Hobden, Maria Hobrok, Simon Hobson, Simon Hodge, Lesley Hodgen, Holly Hodgkins, Sally Hodgkinson, David Hodgson, Helen Hodgson, Luke Hodgson, Sheila Hodgson, Gemma Hodkinson, Kenneth Hodson, Matthew Hogben, Lucy Hogg, Lee Hoggett, Abigail Holborow, Becky Holbrook, Catherine Holbrook, Catherine Holden, Jill Holden, Melinda Holden, Thomas Holder, Hannah Holdsworth, Lisa Holland, Maureen Holland, Nicky Holland, Marie Hollands, Elizabeth Holliday, Nina Holling, Nigel Hollister, Laszlo Hollos, Evelyn Holmes, Megan Holmes, Raphael Holmes, Rebecca Holmes, Kelly Holroyd, Lyndsey Holt, Siobhan Holt, Alexandra Holyome, Marie Home, Kate Hong, Andrew Hood, Clare Hooper, Samantha Hope, Susan Hope, Bridget Hopkins, Peter W Horby, Stephanie Horler, Anil Hormis, Rachel Horn, Nicola Hornby, Sophie Horrocks, Latoya Horsford, Megan Horsford, Valana Horsham, Alex Horsley, Ashley Horsley, Elizabeth Horsley, Sarah Horton, Jane Hosea, Toby Hoskins, Ejaz Hossain, Muhammad S Hossain, Rashed Hossain, Maxine Hough, Sarah Hough, Kathryn Houghton, Rebecca Houlihan, Gordon Houston, Hamish Houston, Eleanor Hoverd, Roseanna Hovvels, Lee How, Laura Howaniec, Laura Howard, Linda Howard, Lucy Howard, Sarah Howard, Richard Howard-Griffin, Serena Howe, Mark Howells, Lyn Howie, Alex Howlett, Sophie Howlett, Josh Hrycaiczuk, Desmond Hsu, Hein Htet, Zaw Htet, Naing Z Htoon, Su Htwe, Ying Hu, Abby Huckle, Shahzya Huda, Alison Hudak, Lisa Hudig, Heather Hudson, Alison Hufton, Conor Huggins, Alistair Hughes, Emma Hughes, Gareth Hughes, Heather Hughes, Luke Hughes, Rachel Hughes, Rhian Hughes, Samantha Hughes, Stephen Hughes, Vikki Hughes, Wesley Hughes, Lukas Huhn, Ching Hui, Ruth Hulbert, Diana Hull, Robert Hull, Amanda Hulme, Peter Hulme, Wendy Hulse, George Hulston, Ryan Hum, Charlotte Humphrey, Alasdair Humphries, Joanne Humphries, David Hunt, Fiona Hunt, Jane Hunt, Kristen Hunt, Luke Hunt, Karl Hunter, Neil Hunter, Elizabeth Hurditch, Cian Hurley, Katrina Hurley, Mohammed A Husain, Syeda Y Husaini, Coralie Huson, Ibraar Hussain, Mohammad Hussain, Muhammad Hussain, Reda Hussain, Sajid Hussain, Samia Hussain, Sanniah Hussain, Yasmin Hussain, Mohammed Hussam El-Din, Rebecca Hussey, Christopher Hutchcroft, Camille Hutchinson, Dorothy Hutchinson, Elizabeth Hutchinson, John Hutchinson, Claire Hutsby, Paula Hutton, Daniella Hydes, Jamie Hyde-Wyatt, Niamh Hynes, Megan Hyslop, Ahmed Ibrahim, Asil Ibrahim, Kamal Ibrahim, Mohamed Ibrahim, Wadah Ibrahim, Muhammad Idrees, Hina Iftikhar, Chukwuemeka Igwe, Mohammad Ijaz, Amaju Ikomi, Clare Iles, Stamatina Iliodromiti, Lorna Ilves, La'ali Imam-Gutierrez, Christopher Imray, Haider Imtiaz, Jack Ingham, Julie Ingham, Rory Ingham, Tejas Ingle, Anne Ingram, Luke Ingram, Peter Inns, Ken Inweregbu, Andreea A Ionescu, Ana Ionita, Anil Ipe, Madiha Iqbal, Mohammed Iqbal, Faisal Iqbal Sait, Jane Ireland, Robert Irons, Mohannad Irshad, Muhammad S Irshad, Janice Irvine, Val Irvine, Robert Irving, Mina Ishak, Aminul Islam, Munim Islam, Abdurrahman Islim, Ali Ismail, Omar Ismail, M'hamedi Israa, Sharon Isralls, Shabana Issa, Monica Ivan, Chineze Ivenso, Ashleigh Ivy, Sophie Iwanikiw, Karen Ixer, Mia Iyer, Sriram Iyer, Alex Jackson, Amanda Jackson, Ben Jackson, Ella Jackson, Helen Jackson, Lauren Jackson, Melanie Jackson, Nicola Jackson, Shane Jackson, Patricia Jacob, Reni Jacob, Nicola Jacques, Anisa Jafar, Ali Jaffery, Vijay Jagannathan, Mandeep Jagpal, Fernandez R Jaime, Neemisha Jain, Seema Jain, Susan Jain, Sanjay Jaiswal, Danyal Jajbhay, Thomas Jaki, Bintou Jallow, Yusuf Jaly, Sabine Jamal, Yasmin Jameel, Albie James, Anneli James, Linda James, Mark James, Nicholas James, Olivia James, Ruth James, Tracy James, Jack Jameson, Eleana Jamieson, Aaron Jamison, Phoebe Jane, Azara Janmohamed, Lauren Jansen, 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Muhammad U Khalid, Amir Khalil, Asma Khalil, Sijjad Khalil, Ali Khan, Al-Imran Khan, Asad Khan, Burhan Khan, Fatimah Khan, Kausik Khan, Lubna Khan, Malik A Khan, Marria Khan, Mohammad Khan, Mohammed R Khan, Nayeem Khan, Omar Khan, Rahila Khan, Shabana Khan, Shahul Khan, Tasaduksultan Khan, Waseem Khan, Usman F Khatana, Jibran Khatri, Jyoti Khatri, Sagira Khatun, Taslima Khatun, Chuen R Khaw, Htet HE Khin, Kiran Khokhar, Najaf Khota, Chloe Khurana, Shruti Khurana, Faith Kibutu, Andrew Kidd, Michelle Kidd, Joe Kidney, Shane Kidney, Will Kieffer, Caroline Kilby, Eliz Kilich, Jee Whang Kim, Sarah Kimber, Andy King, Barbara King, Jennifer King, Kirsten King, Rachel King, Sam King, Victoria King, Emily King-Oakley, Laura Kingsmore, Fiona Kinney, Jeremy Kirk, Amy Kirkby, Emily Kirkham, Gemma Kirkman, Ursula Kirwan, Toby Kitching, Laura Kitto, Lauren Kittridge, Sarah Klaczek, Susan Kmachia, Christopher Knapp, Lucy Knibbs, Alicia Knight, Fraser Knight, Marian Knight, Sarah Knight, Steven 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Nyan M Kyi, Laura Kyle, Stuart Kyle, Karali-Tsilimpari Kyriaki, Julius Labao, Louise Lacey, Nikki Lack, Emma Ladlow, Heather Lafferty, Shondipon Laha, Sushil Lahane, Clement Lai, James Lai, Robert Laing, Inez Laing-Faiers, Emily Laity, Nicki Lakeman, David Lalloo, Fiona Lalloo, Sarah-Jane Lam, Fiona Lamb, Thomas Lamb, Pauline Lambert, Claudia Lameirinhas, Mohammed KG Lami, Michal Lamparski, Christine Lanaghan, Geraldine Landers, Martin J Landray, Matthew Lane, Nicholas Lane, Matilda Lang, Stephen Lang, Daniel Langer, Maggie Langley, Charles Langoya, Emily Langthorne, Helen Langton, Scott Latham, John Latham-Mollart, Afzal Latheef, Nang Latt, Dawn Lau, Eva Lau, Myra Laurenson, Hou Law, Jessica Law, Penny Law, Richard Law, Emma Lawrence, Ryan Lawrie, Michael Lay, Stephen Laybourne, Christine Laycock, Reina Layug, Maria Lazo, Amelia Lea, William Lea, Ian Leadbitter, Samuel Leafe, Thomas Leahy, Richard Lean, Lorna Leandro, Darren Leaning, Todd Leckie, Marie Anne Ledingham, Emma Lee, Hannah 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MacDonald, Sheila MacFadyen, James G MacFarlane, Jill Macfarlane, Laura Macfarlane, Lisa MacInnes, Jill MacIntyre, Kirsten Mack, Callum Mackay, Euan Mackay, Alexander Mackenzie, Matt Mackenzie, Robert MacKenzie Ross, Ami Mackey, Fiona Mackie, Robert Mackie, Carolyn Mackinlay, Claire Mackintosh, Katherine Mackintosh, Colin MacLeod, Mary J MacLeod, Michael Macmahon, Andrew MacNair, Catherine Macphee, Iain Macpherson, Allan MacRaild, Alannah Madden, Mary Madden, Norman Madeja, Paula Madgwick, Madhavi Madhusudhana, Alpha Madu, Lorraine Madziva, Marion Mafham, Emma Magavern, Negar Maghsoodi, Christopher Magier, Marios Magriplis, Natasha Mahabir, Subramanian Mahadevan-Bava, Anjanie Maharajh, Ajit Mahaveer, Bal Mahay, Hibo Mahdi, Thushika Mahendiran, Siva Mahendran, Sarah Maher, Shameera Maheswaran, Parisa Mahjoob-Afag, Ahmed Mahmood, Farhana Mahmood, Hager Mahmoud, Mian Mahmood, Waheed Mahmood, Ewan Mahony, Luke Mair, James Maitland, Rupert Major, Jaydip Majumdar, Mohammad KH Majumder, 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Martineau, Anthony Martinelli, Lauren Martinez, Jose Carlos Martinez Garrido, Vijay K Maruthamuthu, Roman Mary-Genetu, Sam Maryosh, Vidan Masani, Diego Maseda, Sheila Mashate, Yasaman Mashhoudi, Sanna Masih, Nick Maskell, Perry Maskell, Jon Maskill, Matthew Masoli, Richard Mason, Ruth Mason, Mohammad Masood, Mohammad T Masood, Syed Masood, Syed SME Masood, Lear Matapure, Cristina Matei, Manraj Matharu, Stephy Mathen, Nicole Mather, Jonathan Mathers, Joanna Matheson, Anna Mathew, Verghese Mathew, Jesha Mathews, Kate Mathias, Wadzanai Matimba-Mupaya, Nashaba Matin, Elina Matisa, Max Matonhodze, Elijah Matovu, Szeto Matthew, Alison Jane Matthews, Edgar Maureen, Maria-Emanuela Maxan, Adam Maxwell, Veronica Maxwell, James May, Joanne May, Peter May, Philippa May, Matthew Maycock, Shelley Mayor, Paul McAlinden, Audrey McAlpine, Graeme McAlpine, Jonathan McAndrew, Hamish McAuley, Sarah McAuliffe, James McBurney, Amanda McCairn, Jake McCammon, Conor McCann, Alexandra McCarrick, Brendan 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Southworth, Jason Sowter, Claudia Spalding, Enti Spata, Katie Spears, Mark Spears, Branwell Spencer, Gisele Spencer, Sue Spencer, Helen Spickett, Jennifer Spillane, William Spiller, Kerry Spinks, Michelle Spinks, Nick Spittle, Johanna Sporrer, Oliver Spring, Gemma Squires, Jack Squires, Rebecca Squires, Ram Sreenivasan, Ramesh Srinivasan, Asha Srirajamadhuveeti, Vino Srirathan, Sybil Stacpoole, Louise Stadon, Jennifer Stahle, Nikki Staines, Roxana Stanciu, Grazyna Stanczuk, Simon Stapley, Natalie Staplin, Michelle Starr, Rachael Stead, Conor Steele, Paula Stefanowska, Alison Stephens, David Stephensen, Courtney Stephenson, Elaine Stephenson, Monique Sterrenburg, Will Stevens, Amy Stevenson, Andrew Stevenson, Daniel Stevenson, Lesley Stevenson, Sarah Stevenson, Claire Stewart, Grant Stewart, Richard Stewart, Jo Stickley, Beverley Stidolph, Gemma Stiller, Sarah Stirrup, Sarah Stock, Alexander Stockdale, Lynne Stockham, Emma Stoddard, Chris Stokes, Ben Stone, Sarah Stone, Sophia Stone, Imogen Storey, Kim Storton, Frederick Stourton, Angela Strachan, Emma Stratton, Jane Stratton, Sam Straw, Dieter Streit, Emma Stride, Sally Stringer, Sophia Strong-Sheldrake, Siske Struik, Carmel Stuart, Anna Stubbs, Harrison Stubbs, Ann Sturdy, Sharon Sturney, Matt Stuttard, Cristina Suarez, Karuna Subba, Chris Subbe, Manjula Subramanian, Vaidyanathan Subramanian, Venkatram Subramanian, Chinari Subudhi, Rebecca Suckling, Srivatsan Sudershan, Taku Sugai, Peter Sugden, Rudresh Sukla, Ali Suliman, Fatimah Suliman, Sugrah Sultan, Alasdair Summers, Samyukta Sundar, Reka Sundhar, Nadia Sunni, Jay Suntharalingam, Amitava Sur, Dharmic Suresh, Shilpa Suresh, Michael Surtees, Danielle Suter, Helen Sutherland, Rebecca Sutherland, Dovile Sutinyte, Deborah Sutton, Sam Sutton, Amy Sutton-Cole, Mihaela Sutu, Marie-Louise Svensson, Sima Svirpliene, Andrew Swain, Thomas Swaine, Keshav Swarnkar, Tirion Swart, Ealish Swift, Pauline Swift, Rachael Swift, Rachel Swingler, Sophie Swinhoe, Katarzyna Swist-Szulik, Luke Swithenbank, Yasir Syed, Catriona Sykes, Daisy Sykes, Dominic Symon, Lesley Symon, Jen Syson, Gemma Szabo, Tamas Szakmany, Megan Szekely, Matthew Szeto, Maria Tadros, Lucy Tague, Hasan Tahir, Abigail Takyi, James Talbot-Ponsonby, Bradley Tallon, Bee TT Tan, Hock Tan, Huey Tan, WeiTeen Tan, Anand Tana, Rebecca Tangney, Christina Tanney, Tabitha Tanqueray, Emma Tanton, Hayley Tarft, Syed Tariq, David Tarpey, Antonia Tasiou, Elizabeth Tatam, Margaret Louise Tate, Paul Tate, Kate Tatham, Vera Tavoukjian, Alexander Taylor, Andrew Taylor, Beverley Taylor, Claire Taylor, David Taylor, Jennifer Taylor, Joanne Taylor, Julie Taylor, Karen Taylor, Leanne Taylor, Margaret Taylor, Matthew Taylor, Melanie Taylor, Natalie Taylor, Rachael Taylor, Rachel Taylor, Samantha Taylor, Suzanne Taylor, Tracey Taylor, Vicky Taylor, Michelle Taylor-Siddons, Thomas Taynton, Amelia Te, Jessica Teasdale, Julie Tebbutt, Caroline Tee, Adam Telfer, Vibha Teli, Jennifer Tempany, Julie Temple, Natalie Temple, Helen Tench, Yi He Teoh, Lynne Terrett, Louise Terry, Dariusz Tetla, Daniel Tewkesbury, Manish Thakker, Mini Thankachen, Dushen Tharmaratnam, Hilary Thatcher, Andrew Thayanandan, Krishna Thazhatheyil, Eaint Thein, Byron Theron, Phyu Thet, Kapeendran Thevarajah, Brinda Thillainathan, Yvette Thirlwall, Muthu Thirumaran, Alice Thomas, Amy Thomas, Andrew Thomas, Emma Thomas, Enson Thomas, Esther Thomas, Helen Thomas, James Thomas, Karen Thomas, Koshy Thomas, Lucy Thomas, Megan Thomas, Rachel Thomas, Rebecca Thomas, Rhys Thomas, Ruth Thomas, Sarah Thomas, Sherine Thomas, Tessy Thomas, Vicky Thomas, Rhian Thomas-Turner, Catherine Thompson, Christopher Thompson, Clara Thompson, Fiona Thompson, Katharine Thompson, Laura Thompson, Liz Thompson, Orla Thompson, Roger Thompson, Jason Thomson, Nicola Thomson, Natasha Thorn, Charlotte Thorne, Nicola Thorne, Jim Thornton, Richard Thornton, Sarah Thornton, Susan Thornton, Thomas Thornton, Christopher Thorpe, Sarah Thorpe, Paradeep Thozthumparambil, Laura Thrasyvoulou, Hannah Thraves, Guy Thwaites, Simon Tiberi, Serena Tieger, Carey Tierney, Caroline Tierney, Mark Tighe, Sorrell Tilbey, Amanda Tiller, Elizabeth Timlick, Hayley Timms, Anne-Marie Timoroksa, Samakomva Tinashe, Heather Tinkler, Marianne Tinkler, Jacqui Tipper, Sophie Tisi, Helen Tivenan, Suzy Tluk, Helen T-Michael, Anne Todd, Jackie Todd, Stacy Todd, Mohamed Tohfa, Melanie Tolson, Ana L Tomas, Natalia Tomasova, Sharon Tomlin, Simon Tomlins, Ivan Tonna, Kirsty Topham, Mathew Topping, Parisa Torabi, M Estee Torok, Mark Toshner, Ruhaif Tousis, Peter Tovey, Gareth Towersey, Jill Townley, Richard Tozer, Myat T Trafford, Helen Tranter, Christopher Travill, Sarah Traynor, Ascanio Tridente, Sanchia Triggs, Fiona Trim, Alex Trimmings, Tom Trinick, Maria Tripouki, Ashifa Trivedi, Dawn Trodd, Amy Trotter, Madeleine Trowsdale Stannard, Nigel Trudgill, Daniel Trushell-Pottinger, Maria Truslove, Shaun Trussell, Tariq Trussell, Kyriaki Tsakiridou, Christine Tsang, Peter Tsang, Kyriaki K Tsilimpari, Georgios Tsinaslanidis, Simon Tso, Sally Tucker, Aisha Tufail, Redmond Tully, Killian Turbitt, Rezon Turel, Tolga Turgut, Claudia Turley, Alison Turnbull, Aine Turner, Ash Turner, Charlotte Turner, Gail Turner, Kate Turner, Kelly Turner, Lucy Turner, Mark Turner, Patricia Turner, Sally Turner, Samantha Turner, Victoria Turner, Sharon Turney, Jon Turvey, Emma Twohey, Bhavya Tyagi, Vedang Tyagi, Abigail Tyer, Jayne Tyler, Jennifer Tyler, Alison Tyzack, Petros Tzavaras, Mohammad S Uddin, Ruhama Uddin, Salamat Ullah, Sanda Ullah, Athavan Umaipalan, Judith Umeadi, Akudo Umeh, Wilfred Umeojiako, Lizzie Undrell, Adam Unsworth, Veerpal SU Uppal, Gerry Upson, Alison Uriel, Sebastian Urruela, Hiromi Uru, Miranda Usher, Rebecca Usher, Andrew Ustianowski, Linda C Vaccari, Abhay Vaidya, Erika Vainieri, Bernardas Valecka, Jennifer Valentine, Balan Valeria, Luke Vamplew, Ekaterini Vamvakiti, Joannis Vamvakopoulos, Maud van de Venne, Alex van der Meer, Nora van der Stelt, Lynne Van Koutrik, Joseph Vance-Daniel, Rama Vancheeswaran, Samuel I Vandeyoon, Padma Vankayalapati, Chloe Vansomeren, William Van't Hoff, Sejal Vara, Anu Varghese, Maria Varghese, Teena Varghese, William Varney, Giulia Varnier, Valeria Vasadi, Vimal Vasu, Vasanthi Vasudevan, Ramu Vathenen, Manu Vatish, Heloyes Vayalaman, Christopher Vaz, Niki Veale, Bar Velan, Swati Velankar, Luxmi Velauthar, Neyme Veli, Nicola Vella, Anitha Velusamy, Ian Venables, Mavi Venditti, Ramya Venkataramakrishnan, Richard Venn, Robert Venn, Lyn Ventilacion, Mark Veres, Stefania Vergnano, Will Verling, Amit Verma, Britney Vernon, Nathan Vernon, Mark Vertue, Natalie Vethanayagam, Lucy Veys, Jennifer Vidler, Denise Vigni, Vinod W Vijayaraghavan Nalini, Enric Vilar, Neringa Vilimiene, Joseph Villiers, Sylvia Vinay, Latha Vinayakarao, Rachel Vincent, Rosie Vincent, Lisa Vincent Smith, Emma Virgilio, Abdullah M Virk, Elisa Visentin, Karunakaran Vithian, 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, Khalilullah Wahdati, Sawan Waidyanatha, Rachel Wake, Alice Wakefield, Emma Wakefield, Harry Wakefield, William Wakeford, Fiona Wakinshaw, Andrew Walden, Lorna Walding, Claire Walker, Ian Walker, Kevin Walker, Kim Walker, Linda Walker, Marie Walker, Rachel Walker, Susan Walker, Elaine Wall, Rebecca Wallbutton, Jessica Wallen, Karl Wallendszus, Arabella Waller, Michael Waller, Rosemary Waller, Gabriel Wallis, Louise Wallis, Donna Walsh, Elizabeth Walsh, Lani Walshaw, Daniel Walter, Holt Walters, Jocelyn Walters, Eileen Walton, Maggie Walton, Michael Walton, Olivia 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, Katie Ward, Luke Ward, Rachael Ward, Thomas Ward, Scott A Warden, Steve Wardle, Hassan Wardy, Tobias Wareham, Scott Waring, Jenny Warmington, Ben Warner, Christian Warner, Lewis Warnock, Sarah Warran, Lisa Warren, Yolanda Warren, Hannah Warren-Miell, Hazel J Watchorn, Holly Waterfall, Abby Waters, Donald Waters, Mark Waterstone, Catherine Watkins, Catrin Watkins, Eleanor Watkins, Karen Watkins, Lynn Watkins, Adam JR Watson, Ekaterina Watson, Eleanor Watson, Paul Watson, Robert Watson, Malcolm Watters, Donna Watterson, Daniel Watts, John Watts, Merlin Watts, Victoria Waugh, Emma Wayman, Akhlaq Wazir, Nick Weatherly, Hayley Webb, Kathryn Webb, Stephen Webb, Ian Webster, Tim Webster, Ling Wee, Thanuja Weerasinghe, Janaka Weeratunga, Maria Weetman, Shuying Wei, Freshtah Weidi, Hugh Welch, James Welch, Leanne Welch, Steven Welch, Samantha Weller, Claire Wells, Susan Wellstead, Berni Welsh, RIchard Welsh, Ingeborg Welters, Rachael Welton, Lauren Wentworth, Kate Wesseldine, Magdelena West, Raha West, Ruth West, Sophie West, Heather Weston, Alice Westwood, Bill Wetherall, Helen Wheeler, Matthew Whelband, Amanda Whileman, Jenny Whitbread, Benjamin White, Catherine White, Christopher White, Duncan White, James White, Jonathan White, Katie White, Marie White, Nick White, Sarah White, Sonia White, Tracey White, Catherine Whitehead, Anne Whitehouse, Claire Whitehouse, Tony Whitehouse, Sophie Whiteley, Gabriel Whitlingum, Elizabeth Whittaker, Lindsay Whittam, Ashley Whittington, Helen Whittle, Eunice Wiafe, Lou Wiblin, John Widdrington, Jason Wieboldt, Hannah Wieringa, Cornelia Wiesender, Laura Wiffen, Andrew Wight, Christopher Wignall, Danielle Wilcock, Emma Wilcock, Louise Wilcox, Karen Wild, Laura Wild, Stephen Wild, Michael Wilde, Peter Wilding, Tracey Wildsmith, Joe Wileman, Joy Wiles, Kate Wiles, Elva Wilhelmsen, Thomas Wiliams, David Wilkin, Hannah Wilkins, Joy Wilkins, Suzanne Wilkins, Iain Wilkinson, Lesley Wilkinson, Nicola Wilkinson, Sophia Wilkinson, Susan Wilkinson, Tim Wilkinson, Sylvia Willetts, Alexandra Williams, Alison Williams, Angharad Williams, Ava Williams, Carl Williams, Caroline V Williams, Claire Williams, Dewi Williams, Felicity Williams, Gail Williams, Hannah Williams, James Williams, Jennie Williams, John Williams, Joseph JR Williams, Karen Williams, Kathryn Williams, Marie Williams, Matthew Williams, Patricia Williams, Penny Williams, Samson Williams, Sarah Williams, Sophie Williams, Tamanna Williams, Annie Williamson, Cath Williamson, Catherine Williamson, Dawn Williamson, James D Williamson, Elizabeth Willis, Emily Willis, Heather Willis, Herika Willis, Joanna Willis, Louise Wills, Lucy Willsher, Francesca Willson, Alison Wilson, Andrea Wilson, Antoinette Wilson, Debbie Wilson, James Wilson, Kate Wilson, Lucinda Wilson, Mark Wilson, Toni Wilson, Tim Wilson, Marlar Win, Tin T Win, Lucinda Winckworth, Laura Winder, Piers Winder, Nicola Window, Simon Winn, Carmen Winpenny, Helen Winslow, Martin Winstanley, Helen Winter, Jonathan Winter, Barbara Winter-Goodwin, Stephen Wisdom, Martin Wiselka, Sophie Wiseman, Steven Wishart, Eric Witele, Nicholas Withers, Janet Wittes, Donna Wixted, Nicola Wolff, Kirsten Wolffsohn, Rebecca Wolf-Roberts, Elena Wolodimeroff, Chi-Hung Wong, Edwin Wong, Jessica SY Wong, Kit Y Wong, Nick Wong, Sam Wong, Caroline Wood, Dianne Wood, Fiona Wood, Hannah Wood, Jennifer Wood, Joe Wood, Lisa Wood, Louise Wood, Michelle Wood, Stephen Wood, Tracy Wood, Katharine Woodall, Rebecca Woodfield, Christopher Woodford, Jill Woodford, Louise Woodhead, Timothy Woodhead, Philip Woodland, Marc Woodman, Jane Woods, Katherine Woods, Sarah Woods, Elizabeth Woodward, Zoe Woodward, Megan Woolcock, Gemma Wooldridge, Rebecca Woolf, Chris Woollard, Louisa Woollen, Emma Woolley, Jade Woolley, Daniel Woosey, Dan Wootton, Joanne Wootton, Stephy Worton, Jonathan Wraight, Lynn Wren, Caroline Wrey Brown, Demi Wright, Francesca Wright, Imogen Wright, Lianne Wright, Rachel Wright, Caroline Wroe, Henry Wu, Peishan Wu, Pensee Wu, Johnathan Wubetu, Retno Wulandari, Kim Wyness, Frederick Wyn-Griffiths, Inez Wynter, Bindhu Xavier, Zhongyang Xia, Masseh Yakubi, May Yan, Michael Yanney, Salima Yasmin, Bryan Yates, David Yates, Edward Yates, Helen Yates, Mark Yates, Charlotte Yearwood Martin, Khin Yein, Robert Yellon, Fiona Yelnoorkar, Peter Yew, Kawai Yip, Laura Ylquimiche Melly, Inez Ynter, Cissy Yong, Jemma Yorke, Abdel Younes Ibrahim, Gail Young, Louise Young, Sajeda Youssouf, Ahmed Yousuf, Chrissie Yu, Bernard Yung, Daniel Yusef, Anna-Sophia Zafar, Silvia Zagalo, Su Zaher, Kareem Zaki, Nabhan Zakir, Kasia Zalewska, Ane Zamalloa, Mohsin Zaman, Shakir Zaman, Julie Zamikula, Louise Zammit, Marie Zammit-Mangion, Ausra Zdanaviciene, Esther Zebracki, Daniel Zehnder, Lisa Zeidan, Xiaobei Zhao, Dongling Zheng, Jane Zhixin, Doreen Zhu, Madiha Zia, Omar Zibdeh, Rabia Zill-E-Huma, Ei T Zin, Vivian Zinyemba, Christos Zipitis, Arkadiusz Zmierczak, Azam Zubir, Naz Zuhra, Rasha Zulaikha, Carol Zullo, Ana Zuriaga-Alvaro, National Institute for Health Research, UK Research and Innovation, University of St Andrews. School of Medicine, Horby, PW, Roddick, A, Spata, E, Staplin, N, Emberson, JR, Pessoa-Amorim, G, Peto, L, Day, J, Thwaites, G, Mafham, M, Haynes, R, and Landray, MJ

Subjects
Male, medicine.medical_treatment, 030204 cardiovascular system & hematology, Azithromycin, ResearchInstitutes_Networks_Beacons/humanitarian_conflict_response_institute, Rate ratio, chemistry.chemical_compound, 0302 clinical medicine, RA0421, Oxygen therapy, RA0421 Public health. Hygiene. Preventive Medicine, 030212 general & internal medicine, Hospital Mortality, 11 Medical and Health Sciences, azithromycin, education.field_of_study, Covid19, clinical trial, General Medicine, 3rd-DAS, Middle Aged, Hospitalization, Survival Rate, Treatment Outcome, Humanitarian and Conflict Response Institute, Female, Life Sciences & Biomedicine, medicine.medical_specialty, RM, Population, COVID-19/drug therapy, Azithromycin/therapeutic use, 03 medical and health sciences, Pharmacotherapy, Tocilizumab, Medicine, General & Internal, SDG 3 - Good Health and Well-being, Internal medicine, General & Internal Medicine, medicine, Humans, education, Survival rate, Mechanical ventilation, Science & Technology, business.industry, COVID-19, NIS, Length of Stay, R1, United Kingdom, COVID-19 Drug Treatment, RM Therapeutics. Pharmacology, RECOVERY Collaborative Group, chemistry, Relative risk, business, RA, Anaesthesia Pain and Critical Care
Abstract

The RECOVERY trial is supported by a grant to the University of Oxford from UK Research and Innovation (Medical Research Council) and NIHR (MC_PC_19056) and by core funding provided by NIHR Oxford Biomedical Research Centre, Wellcome, the Bill & Melinda Gates Foundation, the Department for International Development, Health Data Research UK, the Medical Research Council Population Health Research Unit, the NIHR Health Protection Unit in Emerging and Zoonotic Infections, and NIHR Clinical Trials Unit Support Funding. TJ is supported by a grant from UK Medical Research Council (MC_UU_0002/14) and an NIHR Senior Research Fellowship (NIHR-SRF-2015-08-001). WSL is supported by core funding provided by NIHR Nottingham Biomedical Research Centre. Background: Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19. Methods: In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospital with COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once per day by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatment groups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment and were twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants and local study staff were not masked to the allocated treatment, but all others involved in the trial were masked to the outcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) were eligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was 65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomly allocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall, 561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days (rate ratio 0·97, 95% CI 0·87-1·07; p=0·50). No significant difference was seen in duration of hospital stay (median 10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days (rate ratio 1·04, 95% CI 0·98-1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, no significant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilation or death (risk ratio 0·95, 95% CI 0·87-1·03; p=0·24). Interpretation: In patients admitted to hospital with COVID-19, azithromycin did not improve survival or other prespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restricted to patients in whom there is a clear antimicrobial indication. Publisher PDF

Published
2021

34. Pleuroparenchymal fibroelastosis in idiopathic pulmonary fibrosis: Survival analysis using visual and computer-based computed tomography assessment

Author

Recep Savaş, Iain A. Stewart, Omer Unat, Marcel Veltkamp, Eyjolfur Gudmundsson, Hendrik W. van Es, Coline H.M. van Moorsel, Mark Jones, Frouke T. van Beek, An Zhao, Christopher J. Brereton, Arjun Nair, Athol U. Wells, Katarina Pontoppidan, Joseph Jacob, Daniel C. Alexander, Nesrin Mogulkoc, Bahareh Gholipour, and Sam M. Janes

Subjects
medicine.medical_specialty, Medicine (General), Idiopathic pulmonary fibrosis, FEV1/FVC ratio, R5-920, Medicine, General & Internal, Internal medicine, General & Internal Medicine, Linear regression, medicine, Derivation, Quantitative analysis, Computed tomography, Survival analysis, Science & Technology, business.industry, Hazard ratio, Interstitial lung disease, Retrospective cohort study, Pleuroparenchymal fibroelastosis, General Medicine, medicine.disease, PPFE, Idiopathic pulmonary fibrosis, IPF, business, Life Sciences & Biomedicine, Research Paper, PPFE
Abstract

Background: Idiopathic pulmonary fibrosis (IPF) and pleuroparenchymal fibroelastosis (PPFE) are known to have poor outcomes but detailed examinations of prognostic significance of an association between these morphologic processes are lacking. Methods: Retrospective observational study of independent derivation and validation cohorts of IPF populations. Upper-lobe PPFE extent was scored visually (vPPFE) as categories of absent, moderate, marked. Computerised upper-zone PPFE extent (cPPFE) was examined continuously and using a threshold of 2.5% pleural surface area. vPPFE and cPPFE were evaluated against 1-year FVC decline (estimated using mixed-effects models) and mortality. Multivariable models were adjusted for age, gender, smoking history, antifibrotic treatment and diffusion capacity for carbon monoxide. Findings: PPFE prevalence was 49% (derivation cohort, n = 142) and 72% (validation cohort, n = 145). vPPFE marginally contributed 3-14% to variance in interstitial lung disease (ILD) severity across both cohorts. In multivariable models, marked vPPFE was independently associated with 1-year FVC decline (derivation: regression coefficient 18.3, 95 CI 8.47-28.2%; validation: 7.51, 1.85-13.2%) and mortality (derivation: hazard ratio [HR] 7.70, 95% CI 3.50-16.9; validation: HR 3.01, 1.33-6.81). Similarly, continuous and dichotomised cPPFE were associated with 1-year FVC decline and mortality (cPPFE > 2.5% derivation: HR 5.26, 3.00-9.22; validation: HR 2.06, 1.28-3.31). Individuals with cPPFE > 2.5% or marked vPPFE had the lowest median survival, the cPPFE threshold demonstrated greater discrimination of poor outcomes at two and three years than marked vPPFE. Interpretation: PPFE quantification supports distinction of IPF patients with a worse outcome independent of established ILD severity measures. This has the potential to improve prognostic management and elucidate separate pathways of disease progression. Funding: This research was funded in whole or in part by the Wellcome Trust [209,553/Z/17/Z] and the NIHR UCLH Biomedical Research Centre, UK. (c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/), Wellcome Trust [209553/Z/17/Z]; NIHR UCLH Biomedical Research Centre, UK; NIHR South-ampton Biomedical Research Centre; EPSRC [EP/M020533/1], This research was funded in whole or in part by the Wellcome Trust [209553/Z/17/Z]. For the purpose of open access, the author has applied a CC-BY public copyright licence to any author accepted manuscript version arising from this submission. This project, JJ, EG and SMJ were also supported by the NIHR UCLH Biomedical Research Centre, UK. MGJ and CB acknowledge the support of the NIHR South-ampton Biomedical Research Centre. EPSRC grant EP/M020533/1 helped support this work.

Published
2021

35. A diagnostic evaluation of single screen testing for malaria in the returning traveler: A large retrospective cohort study

Author

Richard Body, Patricia van den Berg, Charles Reynard, Peter L. Chiodini, John H McDermott, M. L. Brereton, Katie Geary, and John Burthem

Subjects
medicine.medical_specialty, Plasmodium falciparum, malaria, Antigens, Protozoan, Sensitivity and Specificity, 03 medical and health sciences, 0302 clinical medicine, parasitic diseases, medicine, Humans, Malaria, Falciparum, Prospective cohort study, Retrospective Studies, Rapid diagnostic test, biology, Manchester Cancer Research Centre, business.industry, Diagnostic Tests, Routine, Public health, ResearchInstitutes_Networks_Beacons/mcrc, 030208 emergency & critical care medicine, Retrospective cohort study, General Medicine, medicine.disease, biology.organism_classification, Confidence interval, Malaria, returning traveller, Cohort, Emergency medicine, Emergency Medicine, diagnostic accuracy, business
Abstract

BackgroundScreening for malaria in the returning traveler has often required repeat testing; however, audit data suggest that patients have not been reattending. We sought to ascertain if this was safe by examining the diagnostic efficacy of a single screen consisting of a rapid diagnostic test (RDT) and a thin film.MethodsWe conducted a retrospective cohort study of patients with suspected malaria who attended in the past 5 years from two large teaching hospitals. We assessed the diagnostic accuracy of a single screen, reporting measures of sensitivity and specificity. To establish a reference standard, we cross-linked data with the national malaria registry held at Public Health England and regional centers.ResultsThe cohort consisted of 1365 patients, of whom 33 opted out of the research and one did not have a complete initial screen. Of those 1331 screens there were 74 cases of Plasmodium falciparum (prevalence of 5.6%) and 104 of any malaria species (prevalence of 7.8%). Sensitivity for the detection of P. falciparum was 100.00% (95% confidence interval [CI] = 95.1 to 100), with a specificity of 99.4% (95% CI = 98.9 to 99.8). For the detection of any species of malaria the sensitivity was slightly lower due to the presence of one false negative; sensitivity was 99.0% (95% CI = 94.8 to 100) and specificity was 99.5% (95% CI = 98.9 to 99.8).ConclusionsA single thin film and RDT is likely to be sufficient as a first screen for falciparum malaria in the returning traveler with important caveats. For those sent home from emergency departments, appropriate safety netting must be provided. Further prospective study is required to investigate this approach.

Published
2020

36. Intestinal microbiota predict HSCT outcome

Author

Joao B. Xavier, Takanori Teshima, Gunjan L. Shah, Yusuke Shono, Eric G. Pamer, John B. Slingerland, Marcel R.M. van den Brink, André Gessner, Antonio L.C. Gomes, Ying Taur, Boglarka Gyurkocza, Doris M. Ponce, Nerea Castillo Flores, Annelie Clurman, Miguel-Angel Perales, Lauren Bohannon, Ernst Holler, Richard J. Lin, Kasumi Hayasaka, Jonathan U. Peled, Lucrecia Yáñez San Segundo, Kristi Romero, Michael Scordo, Robert R. Jenq, Molly Maloy, Sean M Devlin, Gabriel K Armijo, Juliet N. Barker, Melissa D. Docampo, Ioannis Politikos, Niloufer Khan, Christoph K. Stein-Thoeringer, Roberta J. Wright, Amy Bush, Daniela Weber, Anthony D. Sung, Miriam Sanchez-Escamilla, Kate A. Markey, Nelson J. Chao, Christina Cho, Ann E. Slingerland, Luigi A Amoretti, Eric R. Littmann, Daniel G. Brereton, Emily Fontana, Yuta Hasegawa, Daigo Hashimoto, Sergio Giralt, Julia A. Messina, Marina Burgos da Silva, Ana Alarcon Tomas, and Meagan V. Lew

Subjects
Oncology, Adult, Male, medicine.medical_specialty, medicine.medical_treatment, MEDLINE, Hematopoietic stem cell transplantation, 030204 cardiovascular system & hematology, Bioinformatics, Article, 03 medical and health sciences, Feces, 0302 clinical medicine, Cell transplantation, Internal medicine, medicine, Transplantation, Homologous, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Survival analysis, Hematopoietic cell, business.industry, Microbiota, Gastrointestinal Microbiome, Hematopoietic Stem Cell Transplantation, General Medicine, Biodiversity, Middle Aged, Prognosis, Survival Analysis, Transplantation, Multicenter study, Haematological cancer, Female, business, human activities, Microbiota composition
Abstract

BACKGROUND: Relationships between microbiota composition and clinical outcomes after allogeneic hematopoietic-cell transplantation have been described in single-center studies. Geographic variations in the composition of human microbial communities and differences in clinical practices across institutions raise the question of whether these associations are generalizable. METHODS: The microbiota composition of fecal samples obtained from patients who were undergoing allogeneic hematopoietic-cell transplantation at four centers was profiled by means of 16S ribosomal RNA gene sequencing. In an observational study, we examined associations between microbiota diversity and mortality using Cox proportional-hazards analysis. For stratification of the cohorts into higher- and lower-diversity groups, the median diversity value that was observed at the study center in New York was used. In the analysis of independent cohorts, the New York center was cohort 1, and three centers in Germany, Japan, and North Carolina composed cohort 2. Cohort 1 and subgroups within it were analyzed for additional outcomes, including transplantation-related death. RESULTS: We profiled 8767 fecal samples obtained from 1362 patients undergoing allogeneic hematopoietic-cell transplantation at the four centers. We observed patterns of microbiota disruption characterized by loss of diversity and domination by single taxa. Higher diversity of intestinal microbiota was associated with a lower risk of death in independent cohorts (cohort 1: 104 deaths among 354 patients in the higher-diversity group vs. 136 deaths among 350 patients in the lower-diversity group; adjusted hazard ratio, 0.71; 95% confidence interval [CI], 0.55 to 0.92; cohort 2: 18 deaths among 87 patients in the higher-diversity group vs. 35 deaths among 92 patients in the lower-diversity group; adjusted hazard ratio, 0.49; 95% CI, 0.27 to 0.90). Subgroup analyses identified an association between lower intestinal diversity and higher risks of transplantation-related death and death attributable to graft-versus-host disease. Baseline samples obtained before transplantation already showed evidence of microbiome disruption, and lower diversity before transplantation was associated with poor survival. CONCLUSIONS: Patterns of microbiota disruption during allogeneic hematopoietic-cell transplantation were similar across transplantation centers and geographic locations; patterns were characterized by loss of diversity and domination by single taxa. Higher diversity of intestinal microbiota at the time of neutrophil engraftment was associated with lower mortality. (Funded by the National Cancer Institute and others.)

Published
2020

37. Current challenges in three-dimensional bioprinting heart tissues for cardiac surgery

Author

Christopher J. Jackson, Anthony W. Ashton, Christopher D Roche, Russell J L Brereton, and Carmine Gentile

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, Respiratory System, Review, Stem cells, 030204 cardiovascular system & hematology, Revascularization, Regenerative medicine, Cardiac regeneration, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Cardiac Surgical Procedures, 1102 Cardiorespiratory Medicine and Haematology, 030304 developmental biology, 0303 health sciences, Transplantation, Myocardial tissue, Tissue Engineering, business.industry, AcademicSubjects/MED00920, Bioprinting, Heart, General Medicine, Cardiac tissues, Cardiac surgery, Heart tissues, Printing, Three-Dimensional, Surgery, Eacts/108, Stem cell, Cardiology and Cardiovascular Medicine, business, Biomedical engineering
Abstract

Summary Previous attempts in cardiac bioengineering have failed to provide tissues for cardiac regeneration. Recent advances in 3-dimensional bioprinting technology using prevascularized myocardial microtissues as ‘bioink’ have provided a promising way forward. This review guides the reader to understand why myocardial tissue engineering is difficult to achieve and how revascularization and contractile function could be restored in 3-dimensional bioprinted heart tissue using patient-derived stem cells.

Published
2020

38. What Support do Systematic Reviews Provide for Evidence-informed Teaching about Software Engineering Practice?

Author

Pearl Brereton, Nikki Williams, David Budgen, and Sarah Drummond

Subjects
lcsh:Computer software, education, T1, business.industry, 05 social sciences, provenance, 020207 software engineering, Sample (statistics), 02 engineering and technology, General Medicine, Evidence informed, Q1, lcsh:QA76.75-76.765, Systematic review, Knowledge base, Tertiary study, 0502 economics and business, 0202 electrical engineering, electronic engineering, information engineering, Set (psychology), business, Software engineering, Psychology, 050203 business & management, Mapping study
Abstract

Background: The adoption of the evidence-based research paradigm by software engineering researchers has created a growing knowledge base provided by the outcomes from systematic reviews.\ud \ud Aim: We set out to identify and catalogue a sample of the knowledge provided by systematic reviews, to determine what support they can provide for an evidence-informed approach to teaching about software engineering practice.\ud \ud Method: We undertook a tertiary study (a mapping study of systematic reviews) covering the period to the end of 2015. We identified and catalogued those reviews that had findings or made recommendations that were considered relevant to teaching about industry practice.\ud \ud Results: We examined a sample of 276 systematic reviews, selecting 49 for which we could clearly identify practice-oriented findings and fecommendations that were supported by the data analysis provided in the review. We have classified these against established software engineering education knowledge categories and discuss the extent and forms of knowledge provided for each category.\ud \ud Conclusion: While systematic reviews can provide knowledge that can inform teaching about practice, relatively few systematic reviews present the outcomes in a form suitable for this purpose. Using a suitable format for presenting a summary of outcomes could improve this. Additionally, the increasing number of published systematic reviews suggests that there is a need for greater coordination regarding the cataloguing of their findings and recommendations.

Published
2020

39. Patterns of nocturnal activity in captive greater flamingos

Author

James E. Brereton, Paul E. Rose, Darren P. Croft, and Imogen Lloyd

Subjects
0106 biological sciences, Behavior, Animal, 05 social sciences, Art history, General Medicine, Motor Activity, Biology, 010603 evolutionary biology, 01 natural sciences, Circadian Rhythm, Birds, Animals, Animals, Zoo, 0501 psychology and cognitive sciences, Animal Science and Zoology, Statistical analysis, 050102 behavioral science & comparative psychology, Postgraduate research, Camera placement
Abstract

Wild flamingos are known to forage overnight, but little is known of their nocturnal activity patterns in captivity. Captive flamingos can show daytime inactivity, reflecting natural periods of resting and loafing documented in wild birds. Assessment of behavior outside of normal zoo opening hours can provide more detailed information on how animals use the space provided to them, and highlights how enclosure areas not commonly occupied during the day may still be important for inhabitants at other times. We examine whether captive flamingos at WWT Slimbridge Wetland Centre change their enclosure usage and behavior overnight compared to that observed during daylight. Using three night-vision remote cameras, the behavior and enclosure usage of a flock of over 270 greater flamingos was recorded from March to July 2016. Results show that these flamingos had higher rates of foraging at certain points during the night, and had a more even enclosure usage when compared to daylight hours. Change in pool use is apparent throughout the course of the day and night, suggesting that different areas of water depth are used by these flamingos at different times. Flamingos increased nocturnal foraging in their pool during the breeding season. The large enclosure size and range of different land and water areas may have enabled these flamingos to follow daily activity patterns similar to those observed in wild birds. Captive flamingos clearly show a difference between daytime and nocturnal behavior patterns and this should be considered when designing enclosures and general management routines for these birds.

Published
2018

40. Motivation and Prior Animal Experience of Newly Enrolled Veterinary Nursing Students at two Irish Third-Level Institutions

Author

Bernadette Brereton, D. P. Campion, Karen Dunne, and Vivienne Duggan

Subjects
Adult, Male, Adolescent, 020205 medical informatics, 040301 veterinary sciences, media_common.quotation_subject, education, 02 engineering and technology, Animal Technicians, Education, 0403 veterinary science, Young Adult, Irish, Nursing, Surveys and Questionnaires, Veterinary nursing, 0202 electrical engineering, electronic engineering, information engineering, Institution, Animals, Humans, Medicine, Nurse education, Animal Husbandry, media_common, Motivation, General Veterinary, business.industry, 04 agricultural and veterinary sciences, General Medicine, Focus Groups, Focus group, language.human_language, Clinical Practice, language, Hidden curriculum, Female, Education, Veterinary, business, Ireland, Veterinary Nurses
Abstract

Veterinary nurses report an intrinsic desire to work with animals. However, this motivation may be eroded by poor working conditions and low pay, resulting in the exit of experienced veterinary nurses from clinical practice. This study sought to quantify the level of animal-handling experience students possessed at the start of their training and to explore the factors motivating them to enter veterinary nurse training in two Irish third-level institutions. The authors had noted a tendency for veterinary nursing students to possess limited animal-handling skills, despite their obvious motivation to work with animals. The study explores possible reasons for this, as it mirrors previous reports in relation to students of veterinary medicine. First-year veterinary nursing students at Dundalk Institute of Technology and University College Dublin were surveyed and a focus group was held in each institution to explore student motivations for choosing this career and their prior animal-handling experience and workplace exposure. The results show that veterinary nursing students are highly intrinsically motivated to work with and care for animals. The majority had spent time in the veterinary workplace before starting their studies but they had limited animal-handling experience beyond that of family pets, primarily dogs. The study also revealed potential tensions between the veterinary nursing and veterinary medical students at University College Dublin: a hitherto unexposed aspect of the hidden curriculum in this institution. The results of this study highlight the need for ongoing investment in practical animal-handling training for veterinary nursing students.

Published
2018

41. Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries: A multicountry analysis of survey data

Author

David Guwatudde, Glennis Andall-Brereton, Rifat Atun, Dismand Houinato, Nuno Lunet, Pascal Bovet, Joao S Martins, Jutta Mari Adelin Jorgensen, Roy A Wong-McClure, Gibson B. Kagaruki, Demetre Labadarios, Garry Brian, Joseph Kibachio Mwangi, Jacqueline A. Seiglie, Lindsay M. Jaacks, Justine Davies, Till Bärnighausen, Sumithra Krishnamurthy Reddiar, Khem Bahadur Karki, Nahla Hwalla, Krishna Kumar Aryal, Adil Supiyev, Omar Mwalim Omar, Zhaxybay Zhumadilov, Cara Ebert, Andrew Stokes, Brice Wilfried Bicaba, Mohamed Msaidie, Sebastian Vollmer, Jennifer Manne-Goehler, Pascal Geldsetzer, Abla M. Sibai, Mary T Mayige, Sarah Quesnel-Crooks, Maja E Marcus, Corine Houehanou, Lisa R. Hirschhorn, Bahendeka K Silver, Mongal Singh Gurung, Bolormaa Norov, Lela Sturua, and Instituto de Saúde Pública da Universidade do Porto

Subjects
Economics, Social Sciences, Blood Pressure, 030204 cardiovascular system & hematology, Logistic regression, Global Health, Vascular Medicine, 0302 clinical medicine, Endocrinology, Medical Conditions, Risk Factors, Surveys and Questionnaires, Per capita, Global health, Medicine and Health Sciences, Public and Occupational Health, 030212 general & internal medicine, 10. No inequality, 1. No poverty, General Medicine, 3. Good health, Cardiovascular Diseases, Preparedness, Hypertension, Income, Medicine, Research Article, Endocrine Disorders, 03 medical and health sciences, Health Economics, Diagnostic Medicine, Diabetes mellitus, Environmental health, medicine, Diabetes Mellitus, Humans, Human Development Index, Noncommunicable Diseases, Developing Countries, Poverty, Quality of Health Care, Health economics, Health Care Policy, business.industry, Health Services Administration and Management, Odds ratio, medicine.disease, Health Care, Cross-Sectional Studies, Metabolic Disorders, Diabetes Diagnosis and Management, business
Abstract

Background Cardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of countries to manage cardiovascular disease risk factors (CVDRFs) are regularly collected by ministries of health and global health agencies. We aimed to assess whether these indicators are associated with patient receipt of quality clinical care. Methods and findings We did a secondary analysis of cross-sectional, nationally representative, individual-patient data from 187,552 people with hypertension (mean age 48.1 years, 53.5% female) living in 43 low- and middle-income countries (LMICs) and 40,795 people with diabetes (mean age 52.2 years, 57.7% female) living in 28 LMICs on progress through cascades of care (condition diagnosed, treated, or controlled) for diabetes or hypertension, to indicate outcomes of provision of quality clinical care. Data were extracted from national-level World Health Organization (WHO) Stepwise Approach to Surveillance (STEPS), or other similar household surveys, conducted between July 2005 and November 2016. We used mixed-effects logistic regression to estimate associations between each quality clinical care outcome and indicators of country development (gross domestic product [GDP] per capita or Human Development Index [HDI]); national capacity for the prevention and control of noncommunicable diseases (‘NCD readiness indicators’ from surveys done by WHO); health system finance (domestic government expenditure on health [as percentage of GDP], private, and out-of-pocket expenditure on health [both as percentage of current]); and health service readiness (number of physicians, nurses, or hospital beds per 1,000 people) and performance (neonatal mortality rate). All models were adjusted for individual-level predictors including age, sex, and education. In an exploratory analysis, we tested whether national-level data on facility preparedness for diabetes were positively associated with outcomes. Associations were inconsistent between indicators and quality clinical care outcomes. For hypertension, GDP and HDI were both positively associated with each outcome. Of the 33 relationships tested between NCD readiness indicators and outcomes, only two showed a significant positive association: presence of guidelines with being diagnosed (odds ratio [OR], 1.86 [95% CI 1.08–3.21], p = 0.03) and availability of funding with being controlled (OR, 2.26 [95% CI 1.09–4.69], p = 0.03). Hospital beds (OR, 1.14 [95% CI 1.02–1.27], p = 0.02), nurses/midwives (OR, 1.24 [95% CI 1.06–1.44], p = 0.006), and physicians (OR, 1.21 [95% CI 1.11–1.32], p < 0.001) per 1,000 people were positively associated with being diagnosed and, similarly, with being treated; and the number of physicians was additionally associated with being controlled (OR, 1.12 [95% CI 1.01–1.23], p = 0.03). For diabetes, no positive associations were seen between NCD readiness indicators and outcomes. There was no association between country development, health service finance, or health service performance and readiness indicators and any outcome, apart from GDP (OR, 1.70 [95% CI 1.12–2.59], p = 0.01), HDI (OR, 1.21 [95% CI 1.01–1.44], p = 0.04), and number of physicians per 1,000 people (OR, 1.28 [95% CI 1.09–1.51], p = 0.003), which were associated with being diagnosed. Six countries had data on cascades of care and nationwide-level data on facility preparedness. Of the 27 associations tested between facility preparedness indicators and outcomes, the only association that was significant was having metformin available, which was positively associated with treatment (OR, 1.35 [95% CI 1.01–1.81], p = 0.04). The main limitation was use of blood pressure measurement on a single occasion to diagnose hypertension and a single blood glucose measurement to diagnose diabetes. Conclusion In this study, we observed that indicators of country preparedness to deal with CVDRFs are poor proxies for quality clinical care received by patients for hypertension and diabetes. The major implication is that assessments of countries’ preparedness to manage CVDRFs should not rely on proxies; rather, it should involve direct assessment of quality clinical care., Author summary Why was the study done? Diseases such as high blood pressure and diabetes are becoming increasingly common in low- and middle-income countries (LMICs). Treatment for these conditions is simple and cheap. However, without treatment, sufferers are at high risk of adverse consequences, such as heart attacks and strokes. It is important therefore to be able to measure whether patients who need treatment are getting it. Currently, LMICs’ progress towards being able to treat patients with hypertension and diabetes is measured using proxies, for example, whether policies, guidelines, funding, structures, or human resources are in place. What did the researchers find? We measured whether 187,552 people with hypertension living in 43 LMICs and 40,795 people with diabetes living in 28 LMICs had their high blood pressure or diabetes treated well; i.e., they had these conditions diagnosed, treated, or controlled. We found that most proxy measures were not reflective of whether patients had their condition treated well. What do these findings mean? To judge countries’ progress towards ability to treat hypertension and diabetes requires directly assessing whether people with these diseases are getting the treatment that they need. The main limitation of the study was that a one-time measurement of blood pressure or blood glucose was used to define whether participants had high blood pressure or diabetes. To make a concrete clinical diagnosis requires more detailed investigation.

Published
2019

42. Design of Plasmodium vivax Hypoxanthine-Guanine Phosphoribosyltransferase Inhibitors as Potential Antimalarial Therapeutics

Author

Dominik Rejman, Ian M. Brereton, Lieve Naesens, Luke W. Guddat, Dana Hocková, Tristan I. Croll, Dianne T. Keough, Eva Zborníková, Gregory K. Pierens, Radek Pohl, Marina Chavchich, Michael D. Edstein, and Geoff W. Birrell

Subjects
Models, Molecular, 0301 basic medicine, Hypoxanthine Phosphoribosyltransferase, Protein Conformation, Plasmodium vivax, Chemistry Techniques, Synthetic, Pharmacology, Crystallography, X-Ray, Biochemistry, Pyrrolidine, Antimalarials, 03 medical and health sciences, chemistry.chemical_compound, Catalytic Domain, parasitic diseases, Humans, Transferase, Pentosyltransferases, chemistry.chemical_classification, Diphosphonates, biology, Drug discovery, Escherichia coli Proteins, Plasmodium falciparum, General Medicine, Xanthine, biology.organism_classification, 030104 developmental biology, Enzyme, chemistry, Hypoxanthine-guanine phosphoribosyltransferase, Drug Design, Molecular Medicine
Abstract

Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) are the foremost causative agents of malaria. Due to the development of resistance to current antimalarial medications, new drugs for this parasitic disease need to be discovered. The activity of hypoxanthine-guanine-[xanthine]-phosphoribosyltransferase, HG[X]PRT, is reported to be essential for the growth of both of these parasites, making it an excellent target for antimalarial drug discovery. Here, we have used rational structure-based methods to design an inhibitor, [3R,4R]-4-guanin-9-yl-3-((S)-2-hydroxy-2-phosphonoethyl)oxy-1-N-(phosphonopropionyl)pyrrolidine, of PvHGPRT and PfHGXPRT that has Ki values of 8 and 7 nM, respectively, for these two enzymes. The crystal structure of PvHGPRT in complex with this compound has been determined to 2.85 A resolution. The corresponding complex with human HGPRT was also obtained to allow a direct comparison of the binding modes of this compound with the two enzymes. The tetra-(ethyl l-phenylalanine) tetraamide ...

Published
2017

43. Health system performance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally representative surveys

Author

Bolormaa Norov, Lindiwe Tsabedze, Gladwell Gathecha, Mary T Mayige, Till Bärnighausen, Garry Brian, Rifat Atun, Gibson B. Kagaruki, Maria Dorobantu, Cara Ebert, Andrew Stokes, Chea Stanford Wesseh, Lindsay M. Jaacks, Bahendeka K Silver, Pascal Bovet, Lela Sturua, Jennifer Manne-Goehler, Pascal Geldsetzer, Glennis Andall-Brereton, Corine Houehanou, David Guwatudde, Demetre Labadarios, Jutta Mari Adelin Jorgensen, Kokou Agoudavi, Roy Wong McClure, Dismand Houinato, Justine Davies, Sarah Quesnel-Crooks, Krishna Kumar Aryal, Maja E Marcus, Brice Wilfried Bicaba, Mohamed Msaidie, Sebastian Vollmer, Joseph Kibachio Mwangi, Joao S Martins, Khem Bahadur Karki, Omar Mwalim, Mongal Singh Gurung, Institute of Social and Preventive Medicine, Lausanne university hospital, Laboratory of Chronic and Neurological Diseases Epidemiology (LEMACEN), University of Abomey Calavi (UAC), Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), and Université de Limoges (UNILIM)-Université de Limoges (UNILIM)

Subjects
Male, Cross-sectional study, Social Sciences, 030204 cardiovascular system & hematology, Surveys, Diabetes treatment, Biochemistry, Health Surveys/economics, 0302 clinical medicine, Endocrinology, Sociology, Delivery of Health Care/economics, Medicine and Health Sciences, Public and Occupational Health, 030212 general & internal medicine, Young adult, Health Services Needs and Demand/economics, Pharmaceutics, 1. No poverty, General Medicine, Diabetes mellitus therapy, Middle Aged, Socioeconomic Aspects of Health, 3. Good health, Poverty/economics, Income/trends, Research Design, Adolescent, Adult, Cross-Sectional Studies, Delivery of Health Care/trends, Diabetes Mellitus/economics, Diabetes Mellitus/epidemiology, Diabetes Mellitus/therapy, Female, Health Services Needs and Demand/trends, Health Surveys/trends, Humans, Poverty/trends, Young Adult, Income, Medicine, Research Article, Endocrine Disorders, MEDLINE, Research and Analysis Methods, Education, 03 medical and health sciences, Drug Therapy, Diagnostic Medicine, Diabetes mellitus, Environmental health, medicine, Diabetes Mellitus, Drug therapy, Educational attainment, Diabetes diagnosis and management, Biomarkers, Health services administration and management, Socioeconomic aspects of health, Poverty, Educational Attainment, Health Services Needs and Demand, Survey Research, business.industry, Health Services Administration and Management, Biology and Life Sciences, medicine.disease, Health Surveys, Health Care, Low and middle income countries, Metabolic Disorders, Diabetes Diagnosis and Management, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Delivery of Health Care
Abstract

Background The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach. Methods and findings We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given (“treated”), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%–9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%–5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%–78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys. Conclusions The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured., Using individual participant data from a large cohort study, Jennifer Manne-Goehler and colleagues reveal poor healthcare provision for diabetes patients in 28 LMICs., Author summary Why was this study done? Diabetes is a growing problem in low-income and middle-income countries, which already carry about 75% of the global diabetes burden, but there is limited evidence to guide policymaking in these settings. Prior studies have analyzed the cascade of care for diabetes in single-country or subnational contexts, but to our knowledge there have been no prior multi-country analyses on this subject. This study analyzes nationally representative data regarding health system performance for people who have diabetes, as defined by biological criteria, across a spectrum of levels of economic development. What did the researchers do and find? We harmonized nationally representative population-based survey data from 28 low-income and middle-income countries in 4 geographic regions, and used these data to construct the diabetes care cascade stratified by individual factors and national income. In this sample of over 800,000 adults, the overall prevalence of diabetes was 8.8% (95% CI: 8.2%–9.5%), of which 4.8% (95% CI: 4.5%–5.2%) was undiagnosed. In this study, we found that health system performance for diabetes showed large losses to care at the stage of detection (63.4% [95% CI: 56.7%–69.6%]) and low rates of diabetes control (22.8% [95% CI: 20.9%–24.9%]). Total unmet need for diabetes care (defined as the sum of undetected, detected but undiagnosed, diagnosed but untreated, and treated but not controlled diabetes) was 77.0% (95% CI: 74.9%–78.9%). Performance along the care cascade was better in upper-middle-income countries, but across all World Bank income groups, only 16%–25% of those with diabetes achieved diabetes control. Increasing age, educational attainment, and overweight or obesity were associated with higher odds of being tested, treated, and achieving control. What do these findings mean? There is a large unmet need for diabetes care that reflects the need for a greater investment of health resources to strengthen systems of care for this disease. Given that diabetes is considered a tracer condition for examining health systems, these findings also indicate that many countries face challenges in achieving universal health coverage.

Published
2019

44. Can atorvastatin with metformin change the natural history of prostate cancer as characterized by molecular, metabolomic, imaging and pathological variables? A randomized controlled trial protocol

Author

Troy Gianduzzo, Suzanne K. Chambers, Renee S. Richards, Hema Samaratunga, Suhail A.R. Doi, Robyn J Medcraft, Robert A. Gardiner, Joanna Perry-Keene, Rachel Esler, Nicholas Kienzle, Matthew J. Roberts, Macy Lu, Martin F. Lavin, Diane Payton, Nigel Dunglison, G. Coughlin, Horst Joachim Schirra, Ian M. Brereton, Clement W. K. Chow, John Yaxley, and Chikara Oyama

Subjects
Male, 0301 basic medicine, Oncology, Atorvastatin, law.invention, Prostate cancer, 0302 clinical medicine, Randomized controlled trial, law, Clinical endpoint, Pharmacology (medical), Prospective Studies, General Clinical Medicine, 11 Medical and Health Sciences, clinical trial, General Medicine, prostate cancer, metabolomics, Metformin, Clinical trial, Research Design, 030220 oncology & carcinogenesis, Drug Therapy, Combination, Public Health, medicine.drug, PCA3, medicine.medical_specialty, Citric Acid, 03 medical and health sciences, Double-Blind Method, Antigens, Neoplasm, Internal medicine, Biomarkers, Tumor, medicine, Metabolomics, Humans, business.industry, biomarkers, Prostatic Neoplasms, Prostate-Specific Antigen, Biochemical evolution, medicine.disease, 030104 developmental biology, Endocrinology, business, Biomarkers
Abstract

Background Atorvastatin and metformin are known energy restricting mimetic agents that act synergistically to produce molecular and metabolic changes in advanced prostate cancer (PCa). This trial seeks to determine whether these drugs favourably alter selected parameters in men with clinically-localized, aggressive PCa. Methods/design This prospective phase II randomized, controlled window trial is recruiting men with clinically significant PCa, confirmed by biopsy following multiparametric MRI and intending to undergo radical prostatectomy. Ethical approval was granted by the Royal Brisbane and Women's Hospital Human and The University of Queensland Medical Research Ethics Committees. Participants are being randomized into four groups: metformin with placebo; atorvastatin with placebo; metformin with atorvastatin; or placebo alone. Capsules are consumed for 8 weeks, a duration selected as the most appropriate period in which histological and biochemical changes may be observed while allowing prompt treatment with curative intent of clinically significant PCa. At recruitment and prior to RP, participants provide blood, urine and seminal fluid. A subset of participants will undergo 7Tesla magnetic resonance spectroscopy to compare metabolites in-vivo with those in seminal fluid and biopsied tissue. The primary end point is biochemical evolution, defined using biomarkers (serum prostate specific antigen; PCA3 and citrate in seminal fluid and prostatic tissue). Standard pathological assessment will be undertaken. Discussion This study is designed to assess the potential synergistic action of metformin and atorvastatin on PCa tumour biology. The results may determine simple methods of tumour modulation to reduce disease progression.

Published
2016

45. Recommendation for standardization of haematology reporting units used in the extended blood count

Author

M, Brereton, R, McCafferty, K, Marsden, Y, Kawai, J, Etzell, A, Ermens, and Gunnar, Nordin

Subjects
medicine.medical_specialty, Pediatrics, Medical Records Systems, Computerized, Standardization, Clinical Biochemistry, MEDLINE, Blood count, 030204 cardiovascular system & hematology, 03 medical and health sciences, Patient safety, 0302 clinical medicine, Internal medicine, medicine, Humans, Intensive care medicine, Hematology, business.industry, Biochemistry (medical), Wbc differential, General Medicine, Laboratories, Hospital, Laboratory results, Nucleated rbcs, business, 030215 immunology
Abstract

SummaryIntroduction It is desirable in the interest of patient safety that the reporting of laboratory results should be standardized where no valid reason for diversity exists. This study considers the reporting units used for the extended blood cell count and makes a new ICSH recommendation to encourage standardization worldwide. Methods This work is based on a literature review that included the original ICSH recommendations and on data gathered from an international survey of current practice completed by 18 countries worldwide. Results The survey results show that significant diversity in the use of reporting units for the blood count exists worldwide. The use of either non-SI or other units not recommended by the ICSH in the early 1980s has persisted despite the guidance from that time. Conclusion The diversity in use of reporting units occurs in three areas: the persistence in use of non-SI units for RBC, WBC and platelet counts, the use of three different units for haemoglobin concentration and the manual reporting of WBC differential, reticulocytes and nucleated RBCs when the latter are available from automated analysis or can be expressed as absolute numbers by calculation. A new recommendation with a rationale for each parameter is made for standardization of the reporting units used for the extended blood count.

Published
2016

46. Spondylodiscitis in a 54-year-old female scuba diver

Author

Alexandra Brelis, Neil Alan Tuttle, Rachel Brereton, and Kerrie Evans

Subjects
0301 basic medicine, Spondylodiscitis, medicine.medical_specialty, Discitis, Diving, 030106 microbiology, Unusual Association of Diseases/Symptoms, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Salmonella, Back pain, Medicine, Mechanical low back pain, Humans, Medical history, 030212 general & internal medicine, Intervertebral Disc, Physical Therapy Modalities, business.industry, Congenital spondylolisthesis, General surgery, General Medicine, Middle Aged, medicine.disease, Low back pain, Scuba diving, Anti-Bacterial Agents, Salmonella Infections, Female, Presentation (obstetrics), medicine.symptom, business, Tomography, X-Ray Computed, human activities
Abstract

A 54-year-old woman presented to a Sports Physician with a 4-year history of haemochromatosis, and she had a medical history that included a congenital spondylolisthesis resulting in a fusion of L4-S1 at age 16 years, episodic mechanical low back pain and an absence of other significant musculoskeletal symptoms. On presentation, she reported 18 months of severe low back pain that started after a scuba diving trip. After the onset of this low back pain, she developed gastrointestinal symptoms from Salmonella. The gastrointestinal symptoms improved with a course of antibiotics, but the back pain persisted in spite of analgesics, non-steroidal anti-inflammatories and several attempts at different conservative management. CT imaging ordered by the Sports Physician demonstrated an erosive spondylodiscitis of L2/3 that was not present on initial investigations. However, even in the presence of significant bony changes, the patient was successfully treated with targeted conservative therapy.

Published
2018

47. AMM15: a new high-resolution NEMO configuration for operational simulation of the European north-west shelf

Author

J. A. Graham, E. O'Dea, J. Holt, J. Polton, H. T. Hewitt, R. Furner, K. Guihou, A. Brereton, A. Arnold, S. Wakelin, J. M. Castillo Sanchez, and C. G. Mayorga Adame

Subjects
010504 meteorology & atmospheric sciences, Meteorology, 010505 oceanography, Advection, lcsh:QE1-996.5, High resolution, Stratification (water), General Medicine, Grid, 01 natural sciences, Ciencias de la Tierra y relacionadas con el Medio Ambiente, purl.org/becyt/ford/1 [https], Operational system, lcsh:Geology, purl.org/becyt/ford/1.5 [https], MODELING, North west, Climatology, Environmental science, Atlantic margin, North sea, Meteorología y Ciencias Atmosféricas, CIENCIAS NATURALES Y EXACTAS, 0105 earth and related environmental sciences
Abstract

This paper describes the next-generation ocean forecast model for the European north-west shelf, which will become the basis of operational forecasts in 2018. This new system will provide a step change in resolution and therefore our ability to represent small-scale processes. The new model has a resolution of 1.5 km compared with a grid spacing of 7 km in the current operational system. AMM15 (Atlantic Margin Model, 1.5 km) is introduced as a new regional configuration of NEMO v3.6. Here we describe the technical details behind this configuration, with modifications appropriate for the new high-resolution domain. Results from a 30-year non-assimilative run using the AMM15 domain demonstrate the ability of this model to represent the mean state and variability of the region. Overall, there is an improvement in the representation of the mean state across the region, suggesting similar improvements may be seen in the future operational system. However, the reduction in seasonal bias is greater off-shelf than on-shelf. In the North Sea, biases are largely unchanged. Since there has been no change to the vertical resolution or parameterization schemes, performance improvements are not expected in regions where stratification is dominated by vertical processes rather than advection. This highlights the fact that increased horizontal resolution will not lead to domain-wide improvements. Further work is needed to target bias reduction across the north-west shelf region. Fil: Graham, Jennifer A.. Met Office; Reino Unido Fil: O'Dea, Enda. Met Office; Reino Unido Fil: Holt, Jason. National Oceanography Centre; Reino Unido Fil: Polton, Jeff. National Oceanography Centre; Reino Unido Fil: Hewitt, Helene T.. Met Office; Reino Unido Fil: Furner, Rachel. Met Office; Reino Unido Fil: Guihou, Karen. National Oceanography Centre; Reino Unido. Ministerio de Defensa. Armada Argentina. Servicio de Hidrografía Naval. Departamento Oceanografía; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Brereton, Ashley. National Oceanography Centre; Reino Unido Fil: Arnold, Alex. Met Office; Reino Unido Fil: Wakelin, Sarah. National Oceanography Centre; Reino Unido Fil: Castillo Sanchez, Juan Manuel. Met Office; Reino Unido Fil: Mayorga Adame, C. Gabriela. National Oceanography Centre; Reino Unido

Published
2018

48. Is the Acute Internal Medicine (AIM) curriculum, for higher specialty training (HST), fit for purpose?

Author

Andrew Stewart Brereton

Subjects
Medical education, business.industry, Specialty, MEDLINE, General Medicine, Critical Care and Intensive Care Medicine, Learning opportunities, ComputingMilieux_COMPUTERSANDEDUCATION, Emergency Medicine, Internal Medicine, Curriculum development, Medicine, business, Curriculum
Abstract

This review will critically appraise the AIM curriculum from a trainee’s perspective. The author will focus on the curriculum’s aims and objectives, availability of learning opportunities, adopted assessment and evaluation strategies and finally make recommendations to aid curriculum development.

Published
2018

49. 10 years of UK NEQAS digital morphology in haematology

Author

B. De La Salle, J. Sims, M. Brereton, and J. Burthem

Subjects
Pathology, medicine.medical_specialty, business.industry, Biochemistry (medical), Clinical Biochemistry, medicine, Morphology (biology), General Medicine, business, Biochemistry
Published
2019

50. Is gentamicin safe and effective for severe community-acquired pneumonia? An 8-year retrospective cohort study

Author

Emily Dunn, Joshua S. Davis, Christopher J. Brereton, John Ferguson, Daniel Lennon, and Sarah Browning

Subjects
Microbiology (medical), Male, medicine.medical_specialty, 030231 tropical medicine, Azithromycin, law.invention, 03 medical and health sciences, 0302 clinical medicine, Community-acquired pneumonia, law, Internal medicine, Gram-Negative Bacteria, medicine, Pneumonia, Bacterial, Humans, Pharmacology (medical), 030212 general & internal medicine, Hospital Mortality, Aged, Retrospective Studies, business.industry, Aminoglycoside, Ceftriaxone, Bacterial pneumonia, Retrospective cohort study, General Medicine, Acute Kidney Injury, Length of Stay, Middle Aged, medicine.disease, Intensive care unit, Anti-Bacterial Agents, Community-Acquired Infections, Pneumonia, Infectious Diseases, Gentamicin, Female, Gentamicins, business, Gram-Negative Bacterial Infections, medicine.drug
Abstract

Gram-negative bacilli are the causative organisms in a significant proportion of patients with severe community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU). Clinical guidelines recommend broad-spectrum antimicrobials for empirical treatment despite alarming global trends in antimicrobial resistance. In this study, we aimed to assess the safety and efficacy of gentamicin, an aminoglycoside with potent bactericidal activity, for empirical Gram-negative coverage of severe CAP in patients admitted to the ICU. A retrospective cohort study was performed at a university teaching hospital where the severe CAP guideline recommends penicillin, azithromycin and gentamicin as empirical cover. Ceftriaxone plus azithromycin is used as an alternative. Adults with radiologically-confirmed severe CAP were included, comparing those who received gentamicin in the first 72 h of admission with those who did not. Participants were identified using ICD-10 codes for bacterial pneumonia and data manually extracted from electronic medical records. Of 148 patients admitted with severe pneumonia, 117 were given at least one dose of gentamicin whereas the remaining 31 were not. The two groups were well matched in terms of demographics, co-morbidities and disease severity. There were no significant differences between the gentamicin and no-gentamicin groups in the incidence of acute kidney injury [60/117 (51%) vs. 16/31 (52%), respectively], hospital mortality [20/117 (17%) vs. 7/31 (23%)] and secondary outcomes including relapse and length of hospital stay. In conclusion, gentamicin is safe and has similar outcomes to alternative Gram-negative antimicrobial regimens for empirical coverage in severe CAP patients admitted to the ICU.

Published
2017

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