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1. Positive Digital Practices: Supporting Positive Learner Identities and Student Mental Wellbeing in Technology-Enhanced Higher Education

Author

Kate Lister, Elena Riva, Alison Hartley, Philippa Waterhouse, Naomi Moller, Leigh Downes, Tim Coughlan, Agnes Kukulska-Hulme, Elaine McPherson, Ian Macdonald, Sophie Jones-Tinsley, Cath Brown, and Ruth Tudor

Abstract

Embedding mental wellbeing in learning is a priority for the UK Higher Education sector, as increasing numbers of students disclose mental health difficulties, challenges and conditions. Technology-enhanced, distance and blended learning is uniquely positioned to make a change for good in the sector; it can provide alternatives to traditional education models, support hard-to-reach students and make positive changes to practice. However, to make positive change, it needs to address the barriers to mental health that are inherent throughout education, and embed student wellbeing throughout its practices, cultures and digital environments. The Positive Digital Practices project aims to scale up existing work on mental wellbeing in technology-enhanced learning, creating resources to support practitioners in three focus areas: "Positive Learner Identities"--supporting students' emotional awareness, reflection, resilience in adversity and wellbeing literacy; "Positive Digital Communities"--supporting students' sense of belonging and facilitating meaningful connections that do not rely on a campus environment; "Positive Digital Pedagogies"--creating and sharing pedagogical practices that support mental wellbeing. In this paper, we present baseline data from staff and students on perceptions of barriers and enablers to student mental wellbeing, and we explore examples of positive practice from the "Positive Learner Identities" work area. We present the participatory co-creation methodologies used, the resources created, and we discuss how these can be applied by practitioners. These resources are a call to action for post-secondary practitioners to work together to enhance student mental health and wellbeing, and make education a more inclusive, equitable experience.

Published
2024

2. Equitable Access to Higher Education Learning and Assessment: Perspectives from Low-Resource Contexts

Author

Saraswati Dawadi, Fereshte Goshtasbpour, and Agnes Kukulska-Hulme

Abstract

The COVID-19 pandemic forced higher education institutions to provide education online. Yet, little is known about students' and teachers' experiences of the shift in pedagogical modality in low-resource contexts. This study explored undergraduate students' and teachers' experiences of online education during the pandemic in Kenya and Nepal. Semi-structured interviews with students (n = 24) and teachers (n = 8) suggest that the pandemic further exacerbated existing inequalities. Furthermore, it affected the mental wellbeing of students; almost all reported heightened anxiety associated with their career prospects and learning. However, the findings also suggest that the pandemic created a conducive atmosphere to enhance digital literacy, and to foster peer support practices. Pedagogical implications of the study are highlighted in the context of promoting equity in future learning environments.

Published
2024

3. Reclaiming Accountability through Collaborative Curriculum Enquiry: New Directions in Teacher Evaluation

Author

Moira Hulme, Abigail Comber, Eli Jones, Julian Grant, and John Baumber

Abstract

Teacher evaluation and teachers' professional learning are too often confined to separate areas of research and professional practice. Rather than approach evaluation and enquiry as distinct or irreconcilable, this paper applies the ideas of Stenhouse to explore new possibilities for the reappropriation of mandated appraisal in ways that support teachers' professional growth. Illustrative case studies of laboratory schools in the United States and England are used to examine the interaction of local and lateral forms of professional accountability with external and hierarchical regulatory frameworks. The article reports the design and enactment of change in two schools (a US kindergarten through twelfth grade school and a UK high school) connected through the International Association of Laboratory Schools (IALS) that purposively redesigned appraisal over a three-year period to build capacity for collaborative curriculum enquiry. Attention is afforded to the space for manoeuvre between advisory and mandatory guidance, and the challenges to relational trust and collective responsibility posed by performance-based accountability systems. The findings provide new insights into how teacher-led collaborative enquiry (curricular co-design) can address the unintended consequences of test-based accountability and rubrics-based observation as principal drivers of educational improvement.

Published
2024
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4. LanguageScreen: The Development, Validation, and Standardization of an Automated Language Assessment App

Author

Charles Hulme, Joshua McGrane, Mihaela Duta, Gillian West, Denise Cripps, Abhishek Dasgupta, Sarah Hearne, Rachel Gardner, and Margaret Snowling

Abstract

Purpose: Oral language skills provide a critical foundation for formal education and especially for the development of children's literacy (reading and spelling) skills. It is therefore important for teachers to be able to assess children's language skills, especially if they are concerned about their learning. We report the development and standardization of a mobile app--LanguageScreen--that can be used by education professionals to assess children's language ability. Method: The standardization sample included data from approximately 350,000 children aged 3;06 (years;months) to 8;11 who were screened for receptive and expressive language skills using LanguageScreen. Rasch scaling was used to select items of appropriate difficulty on a single unidimensional scale. Results: LanguageScreen has excellent psychometric properties, including high reliability, good fit to the Rasch model, and minimal differential item functioning across key student groups. Girls outperformed boys, and children with English as an additional language scored less well compared to monolingual English speakers. Conclusions: LanguageScreen provides an easy-to-use, reliable, child-friendly means of identifying children with language difficulties. Its use in schools may serve to raise teachers' awareness of variations in language skills and their importance for educational practice.

Published
2024
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9. Mechanistic safety assessment via multi-omic characterisation of systemic pathway perturbations following in vivo MAT2A inhibition

Author

Fogal, Valentina, Michopoulos, Filippos, Jarnuczak, Andrew F., Hamza, Ghaith M., Harlfinger, Stephanie, Davey, Paul, Hulme, Heather, Atkinson, Stephen J., Gabrowski, Piotr, Cheung, Tony, Grondine, Michael, Hoover, Clare, Rose, Jonathan, Bray, Chandler, Foster, Alison J., Askin, Sean, Majumder, Muntasir Mamun, Fitzpatrick, Paul, Miele, Eric, Macdonald, Ruth, Keun, Hector C., and Coen, Muireann

Published
2024
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11. Curbing the major and growing threats from invasive alien species is urgent and achievable

Author

Roy, Helen E., Pauchard, Aníbal, Stoett, Peter J., Renard Truong, Tanara, Meyerson, Laura A., Bacher, Sven, Galil, Bella S., Hulme, Philip E., Ikeda, Tohru, Kavileveettil, Sankaran, McGeoch, Melodie A., Nuñez, Martin A., Ordonez, Alejandro, Rahlao, Sebataolo J., Schwindt, Evangelina, Seebens, Hanno, Sheppard, Andy W., Vandvik, Vigdis, Aleksanyan, Alla, Ansong, Michael, August, Tom, Blanchard, Ryan, Brugnoli, Ernesto, Bukombe, John K., Bwalya, Bridget, Byun, Chaeho, Camacho-Cervantes, Morelia, Cassey, Phillip, Castillo, María L., Courchamp, Franck, Dehnen-Schmutz, Katharina, Zenni, Rafael Dudeque, Egawa, Chika, Essl, Franz, Fayvush, Georgi, Fernandez, Romina D., Fernandez, Miguel, Foxcroft, Llewellyn C., Genovesi, Piero, Groom, Quentin J., González, Ana Isabel, Helm, Aveliina, Herrera, Ileana, Hiremath, Ankila J., Howard, Patricia L., Hui, Cang, Ikegami, Makihiko, Keskin, Emre, Koyama, Asuka, Ksenofontov, Stanislav, Lenzner, Bernd, Lipinskaya, Tatsiana, Lockwood, Julie L., Mangwa, Dongang C., Martinou, Angeliki F., McDermott, Shana M., Morales, Carolina L., Müllerová, Jana, Mungi, Ninad Avinash, Munishi, Linus K., Ojaveer, Henn, Pagad, Shyama N., Pallewatta, Nirmalie P. K. T. S., Peacock, Lora R., Per, Esra, Pergl, Jan, Preda, Cristina, Pyšek, Petr, Rai, Rajesh K., Ricciardi, Anthony, Richardson, David M., Riley, Sophie, Rono, Betty J., Ryan-Colton, Ellen, Saeedi, Hanieh, Shrestha, Bharat B., Simberloff, Daniel, Tawake, Alifereti, Tricarico, Elena, Vanderhoeven, Sonia, Vicente, Joana, Vilà, Montserrat, Wanzala, Wycliffe, Werenkraut, Victoria, Weyl, Olaf L. F., Wilson, John R. U., Xavier, Rafael O., and Ziller, Sílvia R.

Published
2024
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12. A compact X-ray source via fast microparticle streams

Author

Rolf Behling, Christopher Hulme, Gavin Poludniowski, Panagiotis Tolias, and Mats Danielsson

Subjects
Engineering (General). Civil engineering (General), TA1-2040
Abstract

Abstract The spatiotemporal resolution of diagnostic X-ray images is limited by the erosion and rupture of conventional stationary and rotating anodes of X-ray tubes from extreme density of input power and thermal cycling of the anode material. Conversely, detector technology has developed rapidly. Finer detector pixels demand improved output from brilliant keV-type X-ray sources with smaller X-ray focal spots than today and would be available to improve the efficacy of medical imaging. In addition, novel cancer therapy demands for greatly improved output from X-ray sources. However, since its advent in 1929, the technology of high-output compact X-ray tubes has relied upon focused electrons hitting a spinning rigid rotating anode; a technology that, despite of substantial investment in material technology, has become the primary bottleneck of further improvement. In the current study, an alternative target concept employing a stream of fast discrete metallic microparticles that intersect with the electron beam is explored by simulations that cover the most critical uncertainties. The concept is expected to have far-reaching impact in diagnostic imaging, radiation cancer therapy and non-destructive testing. We outline technical implementations that may become the basis of future X-ray source developments based on the suggested paradigm shift.

Published
2024
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13. Thematic mapping of biosecurity highlights divergent conceptual foundations in human, animal, plant and ecosystem health

Author

Philip E. Hulme

Subjects
Biology (General), QH301-705.5
Abstract

Effective biosecurity policies are essential to address several major sociological and environmental challenges facing humankind including existential pandemic risks, threats to food security, loss of ecosystem services and public resistance to pesticides and vaccines. Yet biosecurity is subject to multiple interpretations that include dealing with the threats from bioterrorism, managing laboratory biosafety to prevent the escape of pathogenic organisms, handling food and agricultural production systems to prevent disease introduction and addressing the threat of introduced organisms to flora, fauna and humans. The absence of a shared vision of what biosecurity encompasses means that decision-makers are often challenged to design appropriate biosecurity policies at national and global scales. The design of effective policy strategies requires an understanding of the methodological and conceptual barriers that constrain attempts to build an interdisciplinary approach to biosecurity. Here, the first thematic map of the biosecurity research landscape is undertaken to assess just how diverse the interpretation of biosecurity is amongst the global research community and the extent to which the articles published since 2000 represent a common conceptual foundation or are largely clustered within sectors. Co-citation, bibliographic coupling and co-word analyses highlighted that the field of biosecurity encompasses a wide range of domains from biochemistry through to political science, but the research supporting different sectors largely draws from a distinct literature base. While ecosystem and plant health were clustered together within the broad grouping of biological invasions, there was a clear separation from both human and animal health. Yet, there is considerable scope for the management of biological invasions to benefit from insights derived from social perspectives in human and animal health. Biosecurity remains divided by conceptual differences and specialised vocabularies that limit the effectiveness of biosecurity policies addressing biodiversity conservation, public health and food security. To overcome these constraints requires the building of a global biosecurity community that accepts a broader definition of biosecurity, avoids sectorial jargon and establishes mechanisms to cultivate interdisciplinarity through specialised collaborative centres, cross-sectorial research programmes and conceptually rich training programmes.

Published
2024
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14. Phenotypic diversity in early Australian dingoes revealed by traditional and 3D geometric morphometric analysis

Author

Loukas G. Koungoulos, Ardern Hulme-Beaman, Melanie Fillios, and Willandra Lakes Region World Heritage Aboriginal Advisory Group

Subjects
Medicine, Science
Abstract

Abstract The dingo is a wild dog endemic to Australia with enigmatic origins. Dingoes are one of two remaining unadmixed populations of an early East Asian dog lineage, the other being wild dogs from the New Guinea highlands, but morphological connections between these canid groups have long proved elusive. Here, we investigate this issue through a morphometric study of ancient dingo remains found at Lake Mungo and Lake Milkengay, in western New South Wales. Direct accelerated mass spectrometry (AMS) radiocarbon dates from an ancient Lake Mungo dingo demonstrate that dingoes with a considerably smaller build than the predominant modern morphotype were present in semi-arid southeastern Australia c.3000–3300 calBP. 3D geometric morphometric analysis of a near-complete Mungo cranium finds closest links to East Asian and New Guinean dogs, providing the first morphological evidence of links between early dingoes and their northern relatives. This ancient type is no longer extant within the range of modern dingo variability, but populations from nearby southeastern Australia show a closer resemblance than those to the north and west. Our results reaffirm prior characterisations of regional variability in dingo phenotype as not exclusively derived from recent domestic dog hybridisation but as having an earlier precedent, and suggest further that the dingo’s phenotype has changed over time.

Published
2024
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15. Deuterated reagents in multicomponent reactions to afford deuterium-labeled products

Author

Kevin Schofield, Shayna Maddern, Yueteng Zhang, Grace E. Mastin, Rachel Knight, Wei Wang, James Galligan, and Christopher Hulme

Subjects
deuterated aldehydes, deuterated formamides, deuterated isocyanides, dhps, kinetic isotope effect, leuckart–wallach, microsomal stability, multicomponent reactions, Science, Organic chemistry, QD241-441
Abstract

The utility of bio-isosteres is broad in drug discovery and methodology herein enables the preparation of deuterium-labeled products is the most fundamental of known bio-isosteric replacements. As such we report the use of both [D1]-aldehydes and [D2]-isonitriles across 8 multicomponent reactions (MCRs) to give diverse arrays of deuterated products. A highlight is the synthesis of several FDA-approved calcium channel blockers, selectively deuterated at a t1/2 limiting metabolic soft-spot via use of [D1]-aldehydes. Surrogate pharmacokinetic analyses of microsomal stability confirm prolongation of t1/2 of the new deuterated analogs. We also report the first preparation of [D2]-isonitriles from [D3]-formamides via a modified Leuckart–Wallach reaction and their use in an MCR to afford products with [D2]-benzylic positions and likely significantly enhanced metabolic stability, a key parameter for property-based design efforts.

Published
2024
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16. What Helps Young People at Risk of Exclusion to Remain in High School? Using Q Methodology to Hear Student Voices

Author

Moira Hulme, Carrie Adamson, and Dominic Griffiths

Abstract

This study explores the views of young people attending within-school 'alternative' provision to support their return to mainstream classes. Q-methodology was used to explore pupil views about what helps and inhibits successful on-site 'reintegration'. Eighteen pupils aged 13-16 years with experience of attending school inclusion centres in three high schools participated. Protective factors supporting reintegration and mitigating the risk of further exclusion from school included the need to be seen and heard, and to have somewhere or someone to go to for support. The study highlights the importance of pupil voice and a need for greater clarity in terminology used to describe the shifting terrain of inclusion. Further research is needed on the context and factors driving the rise in in-school alternative provision in England, including blind spots in official data on the extent of pupil moves and subsequent opportunities within mainstream settings.

Published
2024
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17. Geographies of Exclusion: Rebuilding Collective Responsibility in a Fragmented School System

Author

Moira Hulme, Carrie Adamson, and Dominic Griffiths

Abstract

The goal of equity in education in England is damaged by regional disparities in outcomes and a marked social gradient in school exclusion. The most vulnerable groups are disproportionately represented in in-year transfers. Drawing on 24 interviews with school leaders and education decision-makers in a socioeconomically deprived area, this study examined institutional strategies to promote inclusion by reducing pupil mobility in an area-based initiative. The analysis highlights the interaction of administrative, professional and market logics, and the significance of the "middle tier" in mediating inter-local tensions. Further research is needed on "hidden" pupil moves and diverse forms of within-school segregation-reintegration.

Published
2024
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21. Evaluation of FluSight influenza forecasting in the 2021–22 and 2022–23 seasons with a new target laboratory-confirmed influenza hospitalizations

Author

Mathis, Sarabeth M., Webber, Alexander E., León, Tomás M., Murray, Erin L., Sun, Monica, White, Lauren A., Brooks, Logan C., Green, Alden, Hu, Addison J., Rosenfeld, Roni, Shemetov, Dmitry, Tibshirani, Ryan J., McDonald, Daniel J., Kandula, Sasikiran, Pei, Sen, Yaari, Rami, Yamana, Teresa K., Shaman, Jeffrey, Agarwal, Pulak, Balusu, Srikar, Gururajan, Gautham, Kamarthi, Harshavardhan, Prakash, B. Aditya, Raman, Rishi, Zhao, Zhiyuan, Rodríguez, Alexander, Meiyappan, Akilan, Omar, Shalina, Baccam, Prasith, Gurung, Heidi L., Suchoski, Brad T., Stage, Steve A., Ajelli, Marco, Kummer, Allisandra G., Litvinova, Maria, Ventura, Paulo C., Wadsworth, Spencer, Niemi, Jarad, Carcelen, Erica, Hill, Alison L., Loo, Sara L., McKee, Clifton D., Sato, Koji, Smith, Claire, Truelove, Shaun, Jung, Sung-mok, Lemaitre, Joseph C., Lessler, Justin, McAndrew, Thomas, Ye, Wenxuan, Bosse, Nikos, Hlavacek, William S., Lin, Yen Ting, Mallela, Abhishek, Gibson, Graham C., Chen, Ye, Lamm, Shelby M., Lee, Jaechoul, Posner, Richard G., Perofsky, Amanda C., Viboud, Cécile, Clemente, Leonardo, Lu, Fred, Meyer, Austin G., Santillana, Mauricio, Chinazzi, Matteo, Davis, Jessica T., Mu, Kunpeng, Pastore y Piontti, Ana, Vespignani, Alessandro, Xiong, Xinyue, Ben-Nun, Michal, Riley, Pete, Turtle, James, Hulme-Lowe, Chis, Jessa, Shakeel, Nagraj, V. P., Turner, Stephen D., Williams, Desiree, Basu, Avranil, Drake, John M., Fox, Spencer J., Suez, Ehsan, Cojocaru, Monica G., Thommes, Edward W., Cramer, Estee Y., Gerding, Aaron, Stark, Ariane, Ray, Evan L., Reich, Nicholas G., Shandross, Li, Wattanachit, Nutcha, Wang, Yijin, Zorn, Martha W., Aawar, Majd Al, Srivastava, Ajitesh, Meyers, Lauren A., Adiga, Aniruddha, Hurt, Benjamin, Kaur, Gursharn, Lewis, Bryan L., Marathe, Madhav, Venkatramanan, Srinivasan, Butler, Patrick, Farabow, Andrew, Ramakrishnan, Naren, Muralidhar, Nikhil, Reed, Carrie, Biggerstaff, Matthew, and Borchering, Rebecca K.

Published
2024
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22. Consistency, completeness and external validity of ethnicity recording in NHS primary care records: a cohort study in 25 million patients’ records at source using OpenSAFELY

Author

Andrews, Colm D., Mathur, Rohini, Massey, Jon, Park, Robin, Curtis, Helen J., Hopcroft, Lisa, Mehrkar, Amir, Bacon, Seb, Hickman, George, Smith, Rebecca, Evans, David, Ward, Tom, Davy, Simon, Inglesby, Peter, Dillingham, Iain, Maude, Steven, O’Dwyer, Thomas, Butler-Cole, Ben F. C., Bridges, Lucy, Bates, Chris, Parry, John, Hester, Frank, Harper, Sam, Cockburn, Jonathan, Goldacre, Ben, MacKenna, Brian, Tomlinson, Laurie A., Walker, Alex J., and Hulme, William J.

Published
2024
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29. Determinants of epidemic size and the impacts of lulls in seasonal influenza virus circulation

Author

de Jong, Simon P. J., Felix Garza, Zandra C., Gibson, Joseph C., van Leeuwen, Sarah, de Vries, Robert P., Boons, Geert-Jan, van Hoesel, Marliek, de Haan, Karen, van Groeningen, Laura E., Hulme, Katina D., van Willigen, Hugo D. G., Wynberg, Elke, de Bree, Godelieve J., Matser, Amy, Bakker, Margreet, van der Hoek, Lia, Prins, Maria, Kootstra, Neeltje A., Eggink, Dirk, Nichols, Brooke E., Han, Alvin X., de Jong, Menno D., and Russell, Colin A.

Published
2024
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34. Recommendations for Emerging Good Practice and Future Research in Relation to Family and Caregiver Health Spillovers in Health Economic Evaluations: A Report of the SHEER Task Force

Author

Henry, Edward, Al-Janabi, Hareth, Brouwer, Werner, Cullinan, John, Engel, Lidia, Griffin, Susan, Hulme, Claire, Kingkaew, Pritaporn, Lloyd, Andrew, Payakachat, Nalin, Pennington, Becky, Peña-Longobardo, Luz María, Prosser, Lisa A., Shah, Koonal, Ungar, Wendy J., Wilkinson, Thomas, and Wittenberg, Eve

Published
2024
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35. Evaluation of FluSight influenza forecasting in the 2021–22 and 2022–23 seasons with a new target laboratory-confirmed influenza hospitalizations

Author

Sarabeth M. Mathis, Alexander E. Webber, Tomás M. León, Erin L. Murray, Monica Sun, Lauren A. White, Logan C. Brooks, Alden Green, Addison J. Hu, Roni Rosenfeld, Dmitry Shemetov, Ryan J. Tibshirani, Daniel J. McDonald, Sasikiran Kandula, Sen Pei, Rami Yaari, Teresa K. Yamana, Jeffrey Shaman, Pulak Agarwal, Srikar Balusu, Gautham Gururajan, Harshavardhan Kamarthi, B. Aditya Prakash, Rishi Raman, Zhiyuan Zhao, Alexander Rodríguez, Akilan Meiyappan, Shalina Omar, Prasith Baccam, Heidi L. Gurung, Brad T. Suchoski, Steve A. Stage, Marco Ajelli, Allisandra G. Kummer, Maria Litvinova, Paulo C. Ventura, Spencer Wadsworth, Jarad Niemi, Erica Carcelen, Alison L. Hill, Sara L. Loo, Clifton D. McKee, Koji Sato, Claire Smith, Shaun Truelove, Sung-mok Jung, Joseph C. Lemaitre, Justin Lessler, Thomas McAndrew, Wenxuan Ye, Nikos Bosse, William S. Hlavacek, Yen Ting Lin, Abhishek Mallela, Graham C. Gibson, Ye Chen, Shelby M. Lamm, Jaechoul Lee, Richard G. Posner, Amanda C. Perofsky, Cécile Viboud, Leonardo Clemente, Fred Lu, Austin G. Meyer, Mauricio Santillana, Matteo Chinazzi, Jessica T. Davis, Kunpeng Mu, Ana Pastore y Piontti, Alessandro Vespignani, Xinyue Xiong, Michal Ben-Nun, Pete Riley, James Turtle, Chis Hulme-Lowe, Shakeel Jessa, V. P. Nagraj, Stephen D. Turner, Desiree Williams, Avranil Basu, John M. Drake, Spencer J. Fox, Ehsan Suez, Monica G. Cojocaru, Edward W. Thommes, Estee Y. Cramer, Aaron Gerding, Ariane Stark, Evan L. Ray, Nicholas G. Reich, Li Shandross, Nutcha Wattanachit, Yijin Wang, Martha W. Zorn, Majd Al Aawar, Ajitesh Srivastava, Lauren A. Meyers, Aniruddha Adiga, Benjamin Hurt, Gursharn Kaur, Bryan L. Lewis, Madhav Marathe, Srinivasan Venkatramanan, Patrick Butler, Andrew Farabow, Naren Ramakrishnan, Nikhil Muralidhar, Carrie Reed, Matthew Biggerstaff, and Rebecca K. Borchering

Subjects
Science
Abstract

Abstract Accurate forecasts can enable more effective public health responses during seasonal influenza epidemics. For the 2021–22 and 2022–23 influenza seasons, 26 forecasting teams provided national and jurisdiction-specific probabilistic predictions of weekly confirmed influenza hospital admissions for one-to-four weeks ahead. Forecast skill is evaluated using the Weighted Interval Score (WIS), relative WIS, and coverage. Six out of 23 models outperform the baseline model across forecast weeks and locations in 2021–22 and 12 out of 18 models in 2022–23. Averaging across all forecast targets, the FluSight ensemble is the 2nd most accurate model measured by WIS in 2021–22 and the 5th most accurate in the 2022–23 season. Forecast skill and 95% coverage for the FluSight ensemble and most component models degrade over longer forecast horizons. In this work we demonstrate that while the FluSight ensemble was a robust predictor, even ensembles face challenges during periods of rapid change.

Published
2024
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36. Consistency, completeness and external validity of ethnicity recording in NHS primary care records: a cohort study in 25 million patients’ records at source using OpenSAFELY

Author

The OpenSAFELY Collaborative, Colm D. Andrews, Rohini Mathur, Jon Massey, Robin Park, Helen J. Curtis, Lisa Hopcroft, Amir Mehrkar, Seb Bacon, George Hickman, Rebecca Smith, David Evans, Tom Ward, Simon Davy, Peter Inglesby, Iain Dillingham, Steven Maude, Thomas O’Dwyer, Ben F. C. Butler-Cole, Lucy Bridges, Chris Bates, John Parry, Frank Hester, Sam Harper, Jonathan Cockburn, Ben Goldacre, Brian MacKenna, Laurie A. Tomlinson, Alex J. Walker, and William J. Hulme

Subjects
Primary care health sciences, Electronic health records, Ethnicity, Data curation, Medicine
Abstract

Abstract Background Ethnicity is known to be an important correlate of health outcomes, particularly during the COVID-19 pandemic, where some ethnic groups were shown to be at higher risk of infection and adverse outcomes. The recording of patients’ ethnic groups in primary care can support research and efforts to achieve equity in service provision and outcomes; however, the coding of ethnicity is known to present complex challenges. We therefore set out to describe ethnicity coding in detail with a view to supporting the use of this data in a wide range of settings, as part of wider efforts to robustly describe and define methods of using administrative data. Methods We describe the completeness and consistency of primary care ethnicity recording in the OpenSAFELY-TPP database, containing linked primary care and hospital records in > 25 million patients in England. We also compared the ethnic breakdown in OpenSAFELY-TPP with that of the 2021 UK census. Results 78.2% of patients registered in OpenSAFELY-TPP on 1 January 2022 had their ethnicity recorded in primary care records, rising to 92.5% when supplemented with hospital data. The completeness of ethnicity recording was higher for women than for men. The rate of primary care ethnicity recording ranged from 77% in the South East of England to 82.2% in the West Midlands. Ethnicity recording rates were higher in patients with chronic or other serious health conditions. For each of the five broad ethnicity groups, primary care recorded ethnicity was within 2.9 percentage points of the population rate as recorded in the 2021 Census for England as a whole. For patients with multiple ethnicity records, 98.7% of the latest recorded ethnicities matched the most frequently coded ethnicity. Patients whose latest recorded ethnicity was categorised as Other were most likely to have a discordant ethnicity recording (32.2%). Conclusions Primary care ethnicity data in OpenSAFELY is present for over three quarters of all patients, and combined with data from other sources can achieve a high level of completeness. The overall distribution of ethnicities across all English OpenSAFELY-TPP practices was similar to the 2021 Census, with some regional variation. This report identifies the best available codelist for use in OpenSAFELY and similar electronic health record data.

Published
2024
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37. Gut microbiota and immune profiling of microbiota-humanised versus wildtype mouse models of hepatointestinal schistosomiasis

Author

K. A. Stark, G. Rinaldi, A. Costain, S. Clare, C. Tolley, A. Almeida, C. McCarthy, K. Harcourt, C. Brandt, T. D. Lawley, M. Berriman, A. S. MacDonald, J. E. Forde-Thomas, B. J. Hulme, K. F. Hoffmann, C. Cantacessi, and A. Cortés

Subjects
Host-parasite interactions, Baseline gut microbiota, Schistosoma mansoni, Human-microbiota associated mouse model, Bacterial 16S rRNA gene sequencing, Gut microbial diversity, Veterinary medicine, SF600-1100, Microbiology, QR1-502
Abstract

Abstract Mounting evidence of the occurrence of direct and indirect interactions between the human blood fluke, Schistosoma mansoni, and the gut microbiota of rodent models raises questions on the potential role(s) of the latter in the pathophysiology of hepatointestinal schistosomiasis. However, substantial differences in both the composition and function between the gut microbiota of laboratory rodents and that of humans hinders an in-depth understanding of the significance of such interactions for human schistosomiasis. Taking advantage of the availability of a human microbiota-associated mouse model (HMA), we have previously highlighted differences in infection-associated changes in gut microbiota composition between HMA and wildtype (WT) mice. To further explore the dynamics of schistosome-microbiota relationships in HMA mice, in this study we (i) characterize qualitative and quantitative changes in gut microbiota composition of a distinct line of HMA mice (D2 HMA) infected with S. mansoni prior to and following the onset of parasite egg production; (ii) profile local and systemic immune responses against the parasite in HMA as well as WT mice and (iii) assess levels of faecal inflammatory markers and occult blood as indirect measures of gut tissue damage. We show that patent S. mansoni infection is associated with reduced bacterial alpha diversity in the gut of D2 HMA mice, alongside expansion of hydrogen sulphide-producing bacteria. Similar systemic humoral responses against S. mansoni in WT and D2 HMA mice, as well as levels of faecal lipocalin and markers of alternatively activated macrophages, suggest that these are independent of baseline gut microbiota composition. Qualitative comparative analyses between faecal microbial profiles of S. mansoni-infected WT and distinct lines of HMA mice reveal that, while infection-induced alterations of the gut microbiota composition are highly dependent on the baseline flora, bile acid composition and metabolism may represent key elements of schistosome-microbiota interactions through the gut-liver axis.

Published
2024
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39. Patient and clinician perspectives of an eHealth intervention for supporting cancer treatment in the UK: mixed methods evaluation of the eRAPID randomised controlled trial

Author

Galina Velikova, Lorraine Warrington, Kate Absolom, Patricia Holch, Andrea Gibson, Jenny Hewison, Claire Hulme, Julia Brown, Bryony Dawkins, Marie Holmes, Rosemary Peacock, Zoe Rogers, Sarah Dickinson, Barbara Woroncow, Virginia Cucchi, and Eleanor Mae Hudson

Subjects
Medicine
Abstract

Objectives During 2015–2018, a randomised controlled trial (RCT) evaluated eRAPID, an eHealth intervention designed to capture patient-reported symptoms online during cancer treatment. eRAPID provides patients with advice on when to self-manage or seek medical support. Clinicians accessed symptom reports within electronic patient records. 508 participants starting systemic cancer treatment were recruited and followed for 18 weeks. The intervention group (n=256) was asked to access eRAPID and complete weekly online symptom reports. Clinicians received training on accessing and interpreting symptom reports. Overall, eRAPID had a positive impact on patients’ symptoms, quality of life and self-efficacy, particularly early in treatment and for patients with early-stage disease. Using mixed methods, we aimed to gather insight from patients and clinicians on how eRAPID worked to facilitate the interpretation of RCT findings.Methods Following a concurrent triangulation design, patient experiences of eRAPID were gathered via end-of-study interviews (n=45) and questionnaires (n=186). Clinician experiences were obtained by end-of-study interviews (n=18) and completion, throughout the trial, of feedback questionnaires (n=787 from n=55 clinicians). Framework analysis was applied to examine qualitative data and close-ended questions were descriptively summarised. Findings were mapped against results from the RCT.Setting Medical oncology services, UK cancer centre.Results Patient feedback indicated eRAPID was easy to use. Adherence to weekly reporting was influenced by health status, reminders, perceived value and clinical use. Patient-reported benefits of eRAPID included an enhanced connection with the hospital, provision of practical advice and personal monitoring, which provided reassurance and empowerment. Clinicians were positive about the potential for online symptom monitoring but had mixed levels of direct experience with using eRAPID during the trial. Patients echoed this and recommended more explicit clinician use of symptom data.Conclusions The mixed-method approach to capturing patient and clinician opinions provided valuable insight into the eRAPID intervention and complementary information on how the intervention was received and functioned.

Published
2024
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40. High glycemic variability is associated with a reduced T cell cytokine response to influenza A virus

Author

Marcus Z.W. Tong, Katina D. Hulme, Soi Cheng Law, Ellesandra Noye, Emily S. Dorey, Keng Yih Chew, Louise C. Rowntree, Carolien E. van de Sandt, Katherine Kedzierska, Marco Goeijenbier, Katharina Ronacher, Fawaz Alzaid, Jean-Baptiste Julla, Jean-Pierre Riveline, Katie E. Lineburg, Corey Smith, Emma J. Grant, Stephanie Gras, Linda A. Gallo, Helen L. Barrett, and Kirsty R. Short

Subjects
Endocrinology, Human metabolism, Science
Abstract

Summary: Diabetes mellitus significantly increases the risk of severe respiratory virus disease like influenza and COVID-19. Early evidence suggests that this susceptibility to respiratory viral disease is driven by glycemic variability, rather than average blood glucose levels. Here, we use blood samples and constant glucose monitoring (CGM) data obtained from people living with type 1 diabetes (T1D) to determine the effects of glycemic variability on the ex vivo T cell response to influenza virus. We show that high glycemic variability in participants living with T1D is associated with a reduced proportion of CD8+CD107a−IFNγ−MIP1β−TNF+ T cells in response to stimulation with influenza virus and an influenza virus peptide pool. Thus, this study provides evidence that glycemic variability affects the ex vivo T cell response to respiratory viruses. These data suggest that monitoring glycemic variability may have important implications in understanding the antiviral immune response in people with diabetes.

Published
2024
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41. Alzheimer’s disease induced neurons bearing PSEN1 mutations exhibit reduced excitability

Author

Simon Maksour, Rocio K. Finol-Urdaneta, Amy J. Hulme, Mauricio e Castro Cabral-da-Silva, Helena Targa Dias Anastacio, Rachelle Balez, Tracey Berg, Calista Turner, Sonia Sanz Muñoz, Martin Engel, Predrag Kalajdzic, Leszek Lisowski, Kuldip Sidhu, Perminder S. Sachdev, Mirella Dottori, and Lezanne Ooi

Subjects
Alzheimer’s disease, PSEN1, neuronal excitability, iNs, iPSCs, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract

Alzheimer’s disease (AD) is a devastating neurodegenerative condition that affects memory and cognition, characterized by neuronal loss and currently lacking a cure. Mutations in PSEN1 (Presenilin 1) are among the most common causes of early-onset familial AD (fAD). While changes in neuronal excitability are believed to be early indicators of AD progression, the link between PSEN1 mutations and neuronal excitability remains to be fully elucidated. This study examined iPSC-derived neurons (iNs) from fAD patients with PSEN1 mutations S290C or A246E, alongside CRISPR-corrected isogenic cell lines, to investigate early changes in excitability. Electrophysiological profiling revealed reduced excitability in both PSEN1 mutant iNs compared to their isogenic controls. Neurons bearing S290C and A246E mutations exhibited divergent passive membrane properties compared to isogenic controls, suggesting distinct effects of PSEN1 mutations on neuronal excitability. Additionally, both PSEN1 backgrounds exhibited higher current density of voltage-gated potassium (Kv) channels relative to their isogenic iNs, while displaying comparable voltage-gated sodium (Nav) channel current density. This suggests that the Nav/Kv imbalance contributes to impaired neuronal firing in fAD iNs. Deciphering these early cellular and molecular changes in AD is crucial for understanding disease pathogenesis.

Published
2024
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42. Stratified analyses refine association between TLR7 rare variants and severe COVID-19

Author

Jannik Boos, Caspar I. van der Made, Gayatri Ramakrishnan, Eamon Coughlan, Rosanna Asselta, Britt-Sabina Löscher, Luca V.C. Valenti, Rafael de Cid, Luis Bujanda, Antonio Julià, Erola Pairo-Castineira, J. Kenneth Baillie, Sandra May, Berina Zametica, Julia Heggemann, Agustín Albillos, Jesus M. Banales, Jordi Barretina, Natalia Blay, Paolo Bonfanti, Maria Buti, Javier Fernandez, Sara Marsal, Daniele Prati, Luisa Ronzoni, Nicoletta Sacchi, Joachim L. Schultze, Olaf Riess, Andre Franke, Konrad Rawlik, David Ellinghaus, Alexander Hoischen, Axel Schmidt, Kerstin U. Ludwig, Valeria Rimoldi, Elvezia M. Paraboschi, Alessandra Bandera, Flora Peyvandi, Giacomo Grasselli, Francesco Blasi, Francesco Malvestiti, Serena Pelusi, Cristiana Bianco, Lorenzo Miano, Angela Lombardi, Pietro Invernizzi, Alessio Gerussi, Giuseppe Citerio, Andrea Biondi, Maria Grazia Valsecchi, Marina Elena Cazzaniga, Giuseppe Foti, Ilaria Beretta, Mariella D'Angiò, Laura Rachele Bettini, Xavier Farré, Susana Iraola-Guzmán, Manolis Kogevinas, Gemma Castaño-Vinyals, Koldo Garcia-Etxebarria, Beatriz Nafria, Mauro D'Amato, Adriana Palom, Colin Begg, Sara Clohisey, Charles Hinds, Peter Horby, Julian Knight, Lowell Ling, David Maslove, Danny McAuley, Johnny Millar, Hugh Montgomery, Alistair Nichol, Peter J.M. Openshaw, Alexandre C. Pereira, Chris P. Ponting, Kathy Rowan, Malcolm G. Semple, Manu Shankar-Hari, Charlotte Summers, Timothy Walsh, Latha Aravindan, Ruth Armstrong, Heather Biggs, Ceilia Boz, Adam Brown, Richard Clark, Audrey Coutts, Judy Coyle, Louise Cullum, Sukamal Das, Nicky Day, Lorna Donnelly, Esther Duncan, Angie Fawkes, Paul Fineran, Max Head Fourman, Anita Furlong, James Furniss, Bernadette Gallagher, Tammy Gilchrist, Ailsa Golightly, Fiona Griffiths, Katarzyna Hafezi, Debbie Hamilton, Ross Hendry, Andy Law, Dawn Law, Rachel Law, Sarah Law, Rebecca Lidstone-Scott, Louise Macgillivray, Alan Maclean, Hanning Mal, Sarah McCafferty, Ellie Mcmaster, Jen Meikle, Shona C. Moore, Kirstie Morrice, Lee Murphy, Sheena Murphy, Mybaya Hellen, Wilna Oosthuyzen, Chenqing Zheng, Jiantao Chen, Nick Parkinson, Trevor Paterson, Katherine Schon, Andrew Stenhouse, Mihaela Das, Maaike Swets, Helen Szoor-McElhinney, Filip Taneski, Lance Turtle, Tony Wackett, Mairi Ward, Jane Weaver, Nicola Wrobel, Marie Zechner, Gill Arbane, Aneta Bociek, Sara Campos, Neus Grau, Tim Owen Jones, Rosario Lim, Martina Marotti, Marlies Ostermann, Christopher Whitton, Zoe Alldis, Raine Astin-Chamberlain, Fatima Bibi, Jack Biddle, Sarah Blow, Matthew Bolton, Catherine Borra, Ruth Bowles, Maudrian Burton, Yasmin Choudhury, David Collier, Amber Cox, Amy Easthope, Patrizia Ebano, Stavros Fotiadis, Jana Gurasashvili, Rosslyn Halls, Pippa Hartridge, Delordson Kallon, Jamila Kassam, Ivone Lancoma-Malcolm, Maninderpal Matharu, Peter May, Oliver Mitchelmore, Tabitha Newman, Mital Patel, Jane Pheby, Irene Pinzuti, Zoe Prime, Oleksandra Prysyazhna, Julian Shiel, Melanie Taylor, Carey Tierney, Suzanne Wood, Anne Zak, Olivier Zongo, Stephen Bonner, Keith Hugill, Jessica Jones, Steven Liggett, Evie Headlam, Nageswar Bandla, Minnie Gellamucho, Michelle Davies, Christopher Thompson, Marwa Abdelrazik, Dhanalakshmi Bakthavatsalam, Munzir Elhassan, Arunkumar Ganesan, Anne Haldeos, Jeronimo Moreno-Cuesta, Dharam Purohit, Rachel Vincent, Kugan Xavier, Kumar Rohit, Frater Alasdair, Malik Saleem, Carter David, Jenkins Samuel, Zoe Lamond, Wall Alanna, Jaime Fernandez-Roman, David O. Hamilton, Emily Johnson, Brian Johnston, Maria Lopez Martinez, Suleman Mulla, David Shaw, Alicia A.C. Waite, Victoria Waugh, Ingeborg D. Welters, Karen Williams, Anna Cavazza, Maeve Cockrell, Eleanor Corcoran, Maria Depante, Clare Finney, Ellen Jerome, Mark McPhail, Monalisa Nayak, Harriet Noble, Kevin O'Reilly, Evita Pappa, Rohit Saha, Sian Saha, John Smith, Abigail Knighton, David Antcliffe, Dorota Banach, Stephen Brett, Phoebe Coghlan, Ziortza Fernandez, Anthony Gordon, Roceld Rojo, Sonia Sousa Arias, Maie Templeton, Megan Meredith, Lucy Morris, Lucy Ryan, Amy Clark, Julia Sampson, Cecilia Peters, Martin Dent, Margaret Langley, Saima Ashraf, Shuying Wei, Angela Andrew, Archana Bashyal, Neil Davidson, Paula Hutton, Stuart McKechnie, Jean Wilson, David Baptista, Rebecca Crowe, Rita Fernandes, Rosaleen Herdman-Grant, Anna Joseph, Denise O'Connor, Meryem Allen, Adam Loveridge, India McKenley, Eriko Morino, Andres Naranjo, Richard Simms, Kathryn Sollesta, Andrew Swain, Harish Venkatesh, Jacyntha Khera, Jonathan Fox, Gillian Andrew, Lucy Barclay, Marie Callaghan, Rachael Campbell, Sarah Clark, Dave Hope, Lucy Marshall, Corrienne McCulloch, Kate Briton, Jo Singleton, Sohphie Birch, Lutece Brimfield, Zoe Daly, David Pogson, Steve Rose, Ceri Battle, Elaine Brinkworth, Rachel Harford, Carl Murphy, Luke Newey, Tabitha Rees, Marie Williams, Sophie Arnold, Petra Polgarova, Katerina Stroud, Eoghan Meaney, Megan Jones, Anthony Ng, Shruti Agrawal, Nazima Pathan, Deborah White, Esther Daubney, Kay Elston, Lina Grauslyte, Musarat Hussain, Mandeep Phull, Tatiana Pogreban, Lace Rosaroso, Erika Salciute, George Franke, Joanna Wong, Aparna George, Laura Ortiz-Ruiz de Gordoa, Emily Peasgood, Claire Phillips, Michelle Bates, Jo Dasgin, Jaspret Gill, Annette Nilsson, James Scriven, Carlos Castro Delgado, Deborah Dawson, Lijun Ding, Georgia Durrant, Obiageri Ezeobu, Sarah Farnell-Ward, Abiola Harrison, Rebecca Kanu, Susannah Leaver, Elena Maccacari, Soumendu Manna, Romina Pepermans Saluzzio, Joana Queiroz, Tinashe Samakomva, Christine Sicat, Joana Texeira, Edna Fernandes Da Gloria, Ana Lisboa, John Rawlins, Jisha Mathew, Ashley Kinch, William James Hurt, Nirav Shah, Victoria Clark, Maria Thanasi, Nikki Yun, Kamal Patel, Sara Bennett, Emma Goodwin, Matthew Jackson, Alissa Kent, Clare Tibke, Wiesia Woodyatt, Ahmed Zaki, Azmerelda Abraheem, Peter Bamford, Kathryn Cawley, Charlie Dunmore, Maria Faulkner, Rumanah Girach, Helen Jeffrey, Rhianna Jones, Emily London, Imrun Nagra, Farah Nasir, Hannah Sainsbury, Clare Smedley, Tahera Patel, Matthew Smith, Srikanth Chukkambotla, Aayesha Kazi, Janice Hartley, Joseph Dykes, Muhammad Hijazi, Sarah Keith, Meherunnisa Khan, Janet Ryan-Smith, Philippa Springle, Jacqueline Thomas, Nick Truman, Samuel Saad, Dabheoc Coleman, Christopher Fine, Roseanna Matt, Bethan Gay, Jack Dalziel, Syamlan Ali, Drew Goodchild, Rhiannan Harling, Ravi Bhatterjee, Wendy Goddard, Chloe Davison, Stephen Duberly, Jeanette Hargreaves, Rachel Bolton, Miriam Davey, David Golden, Rebecca Seaman, Shiney Cherian, Sean Cutler, Anne Emma Heron, Anna Roynon-Reed, Tamas Szakmany, Gemma Williams, Owen Richards, Yusuf Cheema, Hollie Brooke, Sarah Buckley, Jose Cebrian Suarez, Ruth Charlesworth, Karen Hansson, John Norris, Alice Poole, Alastair Rose, Rajdeep Sandhu, Brendan Sloan, Elizabeth Smithson, Muthu Thirumaran, Veronica Wagstaff, Alexandra Metcalfe, Mark Brunton, Jess Caterson, Holly Coles, Matthew Frise, Sabi Gurung Rai, Nicola Jacques, Liza Keating, Emma Tilney, Shauna Bartley, Parminder Bhuie, Sian Gibson, Amanda Lyle, Fiona McNeela, Jayachandran Radhakrishnan, Alistair Hughes, Bryan Yates, Jessica Reynolds, Helen Campbell, Maria Thompsom, Steve Dodds, Stacey Duffy, Sandra Greer, Karen Shuker, Ascanio Tridente, Reena Khade, Ashok Sundar, George Tsinaslanidis, Isobel Birkinshaw, Joseph Carter, Kate Howard, Joanne Ingham, Rosie Joy, Harriet Pearson, Samantha Roche, Zoe Scott, Hollie Bancroft, Mary Bellamy, Margaret Carmody, Jacqueline Daglish, Faye Moore, Joanne Rhodes, Mirriam Sangombe, Salma Kadiri, Maria Croft, Ian White, Victoria Frost, Maia Aquino, Rajeev Jha, Vinodh Krishnamurthy, Lai Lim, Li Lim, Edward Combes, Teishel Joefield, Sonja Monnery, Valerie Beech, Sallyanne Trotman, Christine Almaden-Boyle, Pauline Austin, Louise Cabrelli, Stephen Cole, Matt Casey, Susan Chapman, Clare Whyte, Yolanda Baird, Aaron Butler, Indra Chadbourn, Linda Folkes, Heather Fox, Amy Gardner, Raquel Gomez, Gillian Hobden, Luke Hodgson, Kirsten King, Michael Margarson, Tim Martindale, Emma Meadows, Dana Raynard, Yvette Thirlwall, David Helm, Jordi Margalef, Kristine Criste, Rebecca Cusack, Kim Golder, Hannah Golding, Oliver Jones, Samantha Leggett, Michelle Male, Martyna Marani, Kirsty Prager, Toran Williams, Belinda Roberts, Karen Salmon, Peter Anderson, Katie Archer, Karen Austin, Caroline Davis, Alison Durie, Olivia Kelsall, Jessica Thrush, Charlie Vigurs, Laura Wild, Hannah-Louise Wood, Helen Tranter, Alison Harrison, Nicholas Cowley, Michael McAlindon, Andrew Burtenshaw, Stephen Digby, Emma Low, Aled Morgan, Naiara Cother, Tobias Rankin, Sarah Clayton, Alex McCurdy, Cecilia Ahmed, Balvinder Baines, Sarah Clamp, Julie Colley, Risna Haq, Anne Hayes, Jonathan Hulme, Samia Hussain, Sibet Joseph, Rita Kumar, Zahira Maqsood, Manjit Purewal, Leonie Benham, Zena Bradshaw, Joanna Brown, Melanie Caswell, Jason Cupitt, Sarah Melling, Stephen Preston, Nicola Slawson, Emma Stoddard, Scott Warden, Bethan Deacon, Ceri Lynch, Carla Pothecary, Lisa Roche, Gwenllian Sera Howe, Jayaprakash Singh, Keri Turner, Hannah Ellis, Natalie Stroud, Jodie Hunt, Joy Dearden, Emma Dobson, Andy Drummond, Michelle Mulcahy, Sheila Munt, Grainne O'Connor, Jennifer Philbin, Chloe Rishton, Redmond Tully, Sarah Winnard, Susanne Cathcart, Katharine Duffy, Alex Puxty, Kathryn Puxty, Lynne Turner, Jane Ireland, Gary Semple, Kate Long, Simon Whiteley, Elizabeth Wilby, Bethan Ogg, Amanda Cowton, Andrea Kay, Melanie Kent, Kathryn Potts, Ami Wilkinson, Suzanne Campbell, Ellen Brown, Julie Melville, Jay Naisbitt, Rosane Joseph, Maria Lazo, Olivia Walton, Alan Neal, Peter Alexander, Schvearn Allen, Joanne Bradley-Potts, Craig Brantwood, Jasmine Egan, Timothy Felton, Grace Padden, Luke Ward, Stuart Moss, Susannah Glasgow, Lynn Abel, Michael Brett, Brian Digby, Lisa Gemmell, James Hornsby, Patrick MacGoey, Pauline O'Neil, Richard Price, Natalie Rodden, Kevin Rooney, Radha Sundaram, Nicola Thomson, Bridget Hopkins, Laura Thrasyvoulou, Heather Willis, Martyn Clark, Martina Coulding, Edward Jude, Jacqueline McCormick, Oliver Mercer, Darsh Potla, Hafiz Rehman, Heather Savill, Victoria Turner, Charlotte Downes, Kathleen Holding, Katie Riches, Mary Hilton, Mel Hayman, Deepak Subramanian, Priya Daniel, Oluronke Adanini, Nikhil Bhatia, Maines Msiska, Rebecca Collins, Ian Clement, Bijal Patel, A. Gulati, Carole Hays, K. Webster, Anne Hudson, Andrea Webster, Elaine Stephenson, Louise McCormack, Victoria Slater, Rachel Nixon, Helen Hanson, Maggie Fearby, Sinead Kelly, Victoria Bridgett, Philip Robinson, Julie Camsooksai, Charlotte Humphrey, Sarah Jenkins, Henrik Reschreiter, Beverley Wadams, Yasmin Death, Victoria Bastion, Daphene Clarke, Beena David, Harriet Kent, Rachel Lorusso, Gamu Lubimbi, Sophie Murdoch, Melchizedek Penacerrada, Alastair Thomas, Jennifer Valentine, Ana Vochin, Retno Wulandari, Brice Djeugam, Gillian Bell, Katy English, Amro Katary, Louise Wilcox, Michelle Bruce, Karen Connolly, Tracy Duncan, Helen T-Michael, Gabriella Lindergard, Samuel Hey, Claire Fox, Jordan Alfonso, Laura Jayne Durrans, Jacinta Guerin, Bethan Blackledge, Jade Harris, Martin Hruska, Ayaa Eltayeb, Thomas Lamb, Tracey Hodgkiss, Lisa Cooper, Joanne Rothwell, Angela Allan, Felicity Anderson, Callum Kaye, Jade Liew, Jasmine Medhora, Teresa Scott, Erin Trumper, Adriana Botello, Liana Lankester, Nikitas Nikitas, Colin Wells, Bethan Stowe, Kayleigh Spencer, Craig Brandwood, Lara Smith, Katie Birchall, Laurel Kolakaluri, Deborah Baines, Anila Sukumaran, Elena Apetri, Cathrine Basikolo, Laura Catlow, Bethan Charles, Paul Dark, Reece Doonan, Alice Harvey, Daniel Horner, Karen Knowles, Stephanie Lee, Diane Lomas, Chloe Lyons, Tracy Marsden, Danielle McLaughlan, Liam McMorrow, Jessica Pendlebury, Jane Perez, Maria Poulaka, Nicola Proudfoot, Melanie Slaughter, Kathryn Slevin, Vicky Thomas, Danielle Walker, Angiy Michael, Matthew Collis, Tracey Cosier, Gemma Millen, Neil Richardson, Natasha Schumacher, Heather Weston, James Rand, Nicola Baxter, Steven Henderson, Sophie Kennedy-Hay, Christopher McParland, Laura Rooney, Malcolm Sim, Gordan McCreath, Louise Akeroyd, Shereen Bano, Matt Bromley, Lucy Gurr, Tom Lawton, James Morgan, Kirsten Sellick, Deborah Warren, Brian Wilkinson, Janet McGowan, Camilla Ledgard, Amelia Stacey, Kate Pye, Ruth Bellwood, Michael Bentley, Jeremy Bewley, Zoe Garland, Lisa Grimmer, Bethany Gumbrill, Rebekah Johnson, Katie Sweet, Denise Webster, Georgia Efford, Karen Convery, Deirdre Fottrell-Gould, Lisa Hudig, Jocelyn Keshet-Price, Georgina Randell, Katie Stammers, Maria Bokhari, Vanessa Linnett, Rachael Lucas, Wendy McCormick, Jenny Ritzema, Amanda Sanderson, Helen Wild, Anthony Rostron, Alistair Roy, Lindsey Woods, Sarah Cornell, Fiona Wakinshaw, Kimberley Rogerson, Jordan Jarmain, Robert Parker, Amie Reddy, Ian Turner-Bone, Laura Wilding, Peter Harding, Caroline Abernathy, Louise Foster, Andrew Gratrix, Vicky Martinson, Priyai Parkinson, Elizabeth Stones, Llucia Carbral-Ortega, Georgia Bercades, David Brealey, Ingrid Hass, Niall MacCallum, Gladys Martir, Eamon Raith, Anna Reyes, Deborah Smyth, Letizia Zitter, Sarah Benyon, Suzie Marriott, Linda Park, Samantha Keenan, Elizabeth Gordon, Helen Quinn, Kizzy Baines, Lenka Cagova, Adama Fofano, Lucie Garner, Helen Holcombe, Sue Mepham, Alice Michael Mitchell, Lucy Mwaura, Krithivasan Praman, Alain Vuylsteke, Julie Zamikula, Bally Purewal, Vanessa Rivers, Stephanie Bell, Hayley Blakemore, Borislava Borislavova, Beverley Faulkner, Emma Gendall, Elizabeth Goff, Kati Hayes, Matt Thomas, Ruth Worner, Kerry Smith, Deanna Stephens, Louise Mew, Esther Mwaura, Richard Stewart, Felicity Williams, Lynn Wren, Sara-Beth Sutherland, Emily Bevan, Jane Martin, Dawn Trodd, Geoff Watson, Caroline Wrey Brown, Amy Collins, Waqas Khaliq, Estefania Treus Gude, Olugbenga Akinkugbe, Alasdair Bamford, Emily Beech, Holly Belfield, Michael Bell, Charlene Davies, Gareth A.L. Jones, Tara McHugh, Hamza Meghari, Lauran O'Neill, Mark J. Peters, Samiran Ray, Ana Luisa Tomas, Iona Burn, Geraldine Hambrook, Katarina Manso, Ruth Penn, Pradeep Shanmugasundaram, Julie Tebbutt, Danielle Thornton, Jade Cole, Rhys Davies, Donna Duffin, Helen Hill, Ben Player, Emma Thomas, Angharad Williams, Denise Griffin, Nycola Muchenje, Mcdonald Mupudzi, Richard Partridge, Jo-Anna Conyngham, Rachel Thomas, Mary Wright, Maria Alvarez Corral, Reni Jacob, Cathy Jones, Craig Denmade, Sarah Beavis, Katie Dale, Rachel Gascoyne, Joanne Hawes, Kelly Pritchard, Lesley Stevenson, Amanda Whileman, Patricia Doble, Joanne Hutter, Corinne Pawley, Charmaine Shovelton, Marius Vaida, Deborah Butcher, Susie O'Sullivan, Nicola Butterworth-Cowin, Norfaizan Ahmad, Joann Barker, Kris Bauchmuller, Sarah Bird, Kay Cawthron, Kate Harrington, Yvonne Jackson, Faith Kibutu, Becky Lenagh, Shamiso Masuko, Gary H. Mills, Ajay Raithatha, Matthew Wiles, Jayne Willson, Helen Newell, Alison Lye, Lorenza Nwafor, Claire Jarman, Sarah Rowland-Jones, David Foote, Joby Cole, Roger Thompson, James Watson, Lisa Hesseldon, Irene Macharia, Luke Chetam, Jacqui Smith, Amber Ford, Samantha Anderson, Kathryn Birchall, Kay Housley, Sara Walker, Leanne Milner, Helena Hanratty, Helen Trower, Patrick Phillips, Simon Oxspring, Ben Donne, Catherine Jardine, Dewi Williams, Alasdair Hay, Rebecca Flanagan, Gareth Hughes, Scott Latham, Emma McKenna, Jennifer Anderson, Robert Hull, Kat Rhead, Carina Cruz, Natalie Pattison, Rob Charnock, Denise McFarland, Denise Cosgrove, Ashar Ahmed, Anna Morris, Srinivas Jakkula, Asifa Ali, Megan Brady, Sam Dale, Annalisa Dance, Lisa Gledhill, Jill Greig, Kathryn Hanson, Kelly Holdroyd, Marie Home, Diane Kelly, Ross Kitson, Lear Matapure, Deborah Melia, Samantha Mellor, Tonicha Nortcliffe, Jez Pinnell, Matthew Robinson, Lisa Shaw, Ryan Shaw, Lesley Thomis, Alison Wilson, Tracy Wood, Lee-Ann Bayo, Ekta Merwaha, Tahira Ishaq, Sarah Hanley, Meg Hibbert, Dariusz Tetla, Chrsitopher Woodford, Latha Durga, Gareth Kennard-Holden, Debbie Branney, Jordan Frankham, Sally Pitts, Nigel White, Shondipon Laha, Mark Verlander, Alexandra Williams, Abdelhakim Altabaibeh, Ana Alvaro, Kayleigh Gilbert, Louise Ma, Loreta Mostoles, Chetan Parmar, Kathryn Simpson, Champa Jetha, Lauren Booker, Anezka Pratley, Colene Adams, Anita Agasou, Tracie Arden, Amy Bowes, Pauline Boyle, Mandy Beekes, Heather Button, Nigel Capps, Mandy Carnahan, Anne Carter, Danielle Childs, Denise Donaldson, Kelly Hard, Fran Hurford, Yasmin Hussain, Ayesha Javaid, James Jones, Sanal Jose, Michael Leigh, Terry Martin, Helen Millward, Nichola Motherwell, Rachel Rikunenko, Jo Stickley, Julie Summers, Louise Ting, Helen Tivenan, Louise Tonks, Rebecca Wilcox, Maureen Holland, Natalie Keenan, Marc Lyons, Helen Wassall, Chris Marsh, Mervin Mahenthran, Emma Carter, Thomas Kong, Helen Blackman, Ben Creagh-Brown, Sinead Donlon, Natalia Michalak-Glinska, Sheila Mtuwa, Veronika Pristopan, Armorel Salberg, Eleanor Smith, Sarah Stone, Charles Piercy, Jerik Verula, Dorota Burda, Rugia Montaser, Lesley Harden, Irving Mayangao, Cheryl Marriott, Paul Bradley, Celia Harris, Susan Anderson, Eleanor Andrews, Janine Birch, Emma Collins, Kate Hammerton, Ryan O'Leary, Michele Clark, Sarah Purvis, Russell Barber, Claire Hewitt, Annette Hilldrith, Karen Jackson-Lawrence, Sarah Shepardson, Maryanne Wills, Susan Butler, Silvia Tavares, Amy Cunningham, Julia Hindale, Sarwat Arif, Sarah Bean, Karen Burt, Michael Spivey, Carrie Demetriou, Charlotte Eckbad, Sarah Hierons, Lucy Howie, Sarah Mitchard, Lidia Ramos, Alfredo Serrano-Ruiz, Katie White, Fiona Kelly, Daniele Cristiano, Natalie Dormand, Zohreh Farzad, Mahitha Gummadi, Kamal Liyanage, Brijesh Patel, Sara Salmi, Geraldine Sloane, Vicky Thwaites, Mathew Varghese, Anelise C. Zborowski, John Allan, Tim Geary, Gordon Houston, Alistair Meikle, Peter O'Brien, Miranda Forsey, Agilan Kaliappan, Anne Nicholson, Joanne Riches, Mark Vertue, Elizabeth Allan, Kate Darlington, Ffyon Davies, Jack Easton, Sumit Kumar, Richard Lean, Daniel Menzies, Richard Pugh, Xinyi Qiu, Llinos Davies, Hannah Williams, Jeremy Scanlon, Gwyneth Davies, Callum Mackay, Joannne Lewis, Stephanie Rees, Metod Oblak, Monica Popescu, Mini Thankachen, Andrew Higham, Kerry Simpson, Jayne Craig, Rosie Baruah, Sheila Morris, Susie Ferguson, Amy Shepherd, Luke Stephen Prockter Moore, Marcela Paola Vizcaychipi, Laura Gomes de Almeida Martins, Jaime Carungcong, Inthakab Ali Mohamed Ali, Karen Beaumont, Mark Blunt, Zoe Coton, Hollie Curgenven, Mohamed Elsaadany, Kay Fernandes, Sameena Mohamed Ally, Harini Rangarajan, Varun Sarathy, Sivarupan Selvanayagam, Dave Vedage, Matthew White, Mandy Gill, Paul Paul, Valli Ratnam, Sarah Shelton, Inez Wynter, Siobhain Carmody, Valerie Joan Page, Claire Marie Beith, Karen Black, Suzanne Clements, Alan Morrison, Dominic Strachan, Margaret Taylor, Michelle Clarkson, Stuart D'Sylva, Kathryn Norman, Fiona Auld, Joanne Donnachie, Ian Edmond, Lynn Prentice, Nikole Runciman, Dario Salutous, Lesley Symon, Anne Todd, Patricia Turner, Abigail Short, Laura Sweeney, Euan Murdoch, Dhaneesha Senaratne, Michaela Hill, Thogulava Kannan, Wild Laura, Rikki Crawley, Abigail Crew, Mishell Cunningham, Allison Daniels, Laura Harrison, Susan Hope, Ken Inweregbu, Sian Jones, Nicola Lancaster, Jamie Matthews, Alice Nicholson, Gemma Wray, Helen Langton, Rachel Prout, Malcolm Watters, Catherine Novis, Anthony Barron, Ciara Collins, Sundeep Kaul, Heather Passmore, Claire Prendergast, Anna Reed, Paula Rogers, Rajvinder Shokkar, Meriel Woodruff, Hayley Middleton, Oliver Polgar, Claire Nolan, Kanta Mahay, Dawn Collier, Anil Hormis, Victoria Maynard, Cheryl Graham, Rachel Walker, Ellen Knights, Alicia Price, Alice Thomas, Chris Thorpe, Teresa Behan, Caroline Burnett, Jonathan Hatton, Elaine Heeney, Atideb Mitra, Maria Newton, Rachel Pollard, Rachael Stead, Vishal Amin, Elena Anastasescu, Vikram Anumakonda, Komala Karthik, Rizwana Kausar, Karen Reid, Jacqueline Smith, Janet Imeson-Wood, Denise Skinner, Jane Gaylard, Dee Mullan, Julie Newman, Alison Brown, Vikki Crickmore, Gabor Debreceni, Joy Wilkins, Liz Nicol, Rosie Reece-Anthony, Mark Birt, Alison Ghosh, Emma Williams, Louise Allen, Eva Beranova, Nikki Crisp, Joanne Deery, Tracy Hazelton, Alicia Knight, Carly Price, Sorrell Tilbey, Salah Turki, Sharon Turney, Joshua Cooper, Cheryl Finch, Sarah Liderth, Alison Quinn, Natalia Waddington, Tina Coventry, Susan Fowler, Michael MacMahon, Amanda McGregor, Anne Cowley, Judith Highgate, Jane Gregory, Susan O'Connell, Tim Smith, Luigi Barberis, Shameer Gopal, Nichola Harris, Victoria Lake, Stella Metherell, Elizabeth Radford, Amelia Daniel, Joanne Finn, Rajnish Saha, Nikki White, Phil Donnison, Fiona Trim, Beena Eapen, Jenny Birch, Laura Bough, Josie Goodsell, Rebecca Tutton, Patricia Williams, Sarah Williams, Barbara Winter-Goodwin, Ailstair Nichol, Kathy Brickell, Michelle Smyth, Lorna Murphy, Samantha Coetzee, Alistair Gales, Igor Otahal, Meena Raj, Craig Sell, Paula Hilltout, Jayne Evitts, Amanda Tyler, Joanne Waldron, Kate Beesley, Sarah Board, Agnieszka Kubisz-Pudelko, Alison Lewis, Jess Perry, Lucy Pippard, Di Wood, Clare Buckley, Peter Barry, Neil Flint, Patel Rekha, Dawn Hales, Lara Bunni, Claire Jennings, Monica Latif, Rebecca Marshall, Gayathri Subramanian, Peter J. McGuigan, Christopher Wasson, Stephanie Finn, Jackie Green, Erin Collins, Bernadette King, Andy Campbell, Sara Smuts, Joseph Duffield, Oliver Smith, Lewis Mallon, Watkins Claire, Liam Botfield, Joanna Butler, Catherine Dexter, Jo Fletcher, Atul Garg, Aditya Kuravi, Poonam Ranga, Emma Virgilio, Zakaula Belagodu, Bridget Fuller, Anca Gherman, Olumide Olufuwa, Remi Paramsothy, Carmel Stuart, Naomi Oakley, Charlotte Kamundi, David Tyl, Katy Collins, Pedro Silva, June Taylor, Laura King, Charlotte Coates, Maria Crowley, Phillipa Wakefield, Jane Beadle, Laura Johnson, Janet Sargeant, Madeleine Anderson, Ailbhe Brady, Rebekah Chan, Jeff Little, Shane McIvor, Helena Prady, Helen Whittle, Bijoy Mathew, Ben Attwood, Penny Parsons, Geraldine Ward, Pamela Bremmer, West Joe, Baird Tracy, Ruddy Jim, Ellie Davies, Sonia Sathe, Catherine Dennis, Alastair McGregor, Victoria Parris, Sinduya Srikaran, Anisha Sukha, Noreen Clarke, Jonathan Whiteside, Mairi Mascarenhas, Avril Donaldson, Joanna Matheson, Fiona Barrett, Marianne O'Hara, Laura Okeefe, Clare Bradley, Christine Eastgate-Jackson, Helder Filipe, Daniel Martin, Amitaa Maharajh, Sara Mingo Garcia, Glykeria Pakou, Mark De Neef, Kathy Dent, Elizabeth Horsley, Muhmmad Nauman Akhtar, Sandra Pearson, Dorota Potoczna, Sue Spencer, Melanie Clapham, Rosemary Harper, Una Poultney, Polly Rice, Rachel Mutch, Lisa Armstrong, Hayley Bates, Emma Dooks, Fiona Farquhar, Brigid Hairsine, Chantal McParland, Sophie Packham, Rehana Bi, Barney Scholefield, Lydia Ashton, Linsha George, Sophie Twiss, David Wright, Manish Chablani, Amy Kirkby, Kimberley Netherton, Kim Davies, Linda O'Brien, Zohra Omar, Emma Perkins, Tracy Lewis, Isobel Sutherland, Karen Burns, Dr Ben Chandler, Kerry Elliott, Janine Mallinson, Alison Turnbull, Prisca Gondo, Bernard Hadebe, Abdul Kayani, Bridgett Masunda, Taya Anderson, Dan Hawcutt, Laura O'Malley, Laura Rad, Naomi Rogers, Paula Saunderson, Kathryn Sian Allison, Deborah Afolabi, Jennifer Whitbread, Dawn Jones, Rachael Dore, Matthew Halkes, Pauline Mercer, Lorraine Thornton, Joy Dawson, Sweyn Garrioch, Melanie Tolson, Jonathan Aldridge, Ritoo Kapoor, David Loader, Karen Castle, Sally Humphreys, Ruth Tampsett, Katherine Mackintosh, Amanda Ayers, Wendy Harrison, Julie North, Suzanne Allibone, Roman Genetu, Vidya Kasipandian, Amit Patel, Ainhi Mac, Anthony Murphy, Parisa Mahjoob, Roonak Nazari, Lucy Worsley, Andrew Fagan, Thomas Bemand, Ethel Black, Arnold Dela Rosa, Ryan Howle, Shaman Jhanji, Ravishankar Rao Baikady, Kate Colette Tatham, Benjamin Thomas, Dina Bell, Rosalind Boyle, Katie Douglas, Lynn Glass, Emma Lee, Liz Lennon, Austin Rattray, Abigail Taylor, Rachel Anne Hughes, Helen Thomas, Alun Rees, Michaela Duskova, Janet Phipps, Suzanne Brooks, Michelle Edwards, Sheena Quaid, Ekaterina Watson, Adam Brayne, Emma Fisher, Jane Hunt, Peter Jackson, Duncan Kaye, Nicholas Love, Juliet Parkin, Victoria Tuckey, Lynne Van Koutrik, Sasha Carter, Benedict Andrew, Louise Findlay, Katie Adams, Jen Service, Alison Williams, Claire Cheyne, Anne Saunderson, Sam Moultrie, Miranda Odam, Kathryn Hall, Isheunesu Mapfunde, Charlotte Willis, Alex Lyon, Chunda Sri-Chandana, Joslan Scherewode, Lorraine Stephenson, Sarah Marsh, John Hardy, Henry Houlden, Eleanor Moncur, Ambreen Tariq, Arianna Tucci, Maria Hobrok, Ronda Loosley, Heather McGuinness, Helen Tench, Rebecca Wolf-Roberts, Val Irvine, Benjamin Shelley, Claire Gorman, Abhinav Gupta, Elizabeth Timlick, Rebecca Brady, Barry Milligan, Arianna Bellini, Jade Bryant, Anton Mayer, Amy Pickard, Nicholas Roe, Jason Sowter, Alex Howlett, Katy Fidler, Emma Tagliavini, and Kevin Donnelly

Subjects
SARS-CoV-2, host genetics, toll-like receptor 7, targeted sequencing, rare variants, variant collapsing analysis, Genetics, QH426-470
Abstract

Summary: Despite extensive global research into genetic predisposition for severe COVID-19, knowledge on the role of rare host genetic variants and their relation to other risk factors remains limited. Here, 52 genes with prior etiological evidence were sequenced in 1,772 severe COVID-19 cases and 5,347 population-based controls from Spain/Italy. Rare deleterious TLR7 variants were present in 2.4% of young (

Published
2024
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43. The Use of Online Consultation Systems or Remote Consulting in England Characterized Through the Primary Care Health Records of 53 Million People in the OpenSAFELY Platform: Retrospective Cohort Study

Author

Martina Fonseca, Brian MacKenna, Amir Mehrkar, Caroline E Walters, George Hickman, Jonathan Pearson, Louis Fisher, Peter Inglesby, Seb Bacon, Simon Davy, William Hulme, Ben Goldacre, Ofra Koffman, and Minal Bakhai

Subjects
Public aspects of medicine, RA1-1270
Abstract

BackgroundThe National Health Service (NHS) Long Term Plan, published in 2019, committed to ensuring that every patient in England has the right to digital-first primary care by 2023-2024. The COVID-19 pandemic and infection prevention and control measures accelerated work by the NHS to enable and stimulate the use of online consultation (OC) systems across all practices for improved access to primary care. ObjectiveWe aimed to explore general practice coding activity associated with the use of OC systems in terms of trends, COVID-19 effect, variation, and quality. MethodsWith the approval of NHS England, the OpenSAFELY platform was used to query and analyze the in situ electronic health records of suppliers The Phoenix Partnership (TPP) and Egton Medical Information Systems, covering >53 million patients in >6400 practices, mainly in 2019-2020. Systematized Medical Nomenclature for Medicine–Clinical Terminology (SNOMED-CT) codes relevant to OC systems and written OCs were identified including eConsultation. Events were described by volumes and population rates, practice coverage, and trends before and after the COVID-19 pandemic. Variation was characterized among practices, by sociodemographics, and by clinical history of long-term conditions. ResultsOverall, 3,550,762 relevant coding events were found in practices using TPP, with the code eConsultation detected in 84.56% (2157/2551) of practices. Activity related to digital forms of interaction increased rapidly from March 2020, the onset of the pandemic; namely, in the second half of 2020, >9 monthly eConsultation coding events per 1000 registered population were registered compared to

Published
2024
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46. Ecological filtering shapes the impacts of agricultural deforestation on biodiversity

Author

Hua, Fangyuan, Wang, Weiyi, Nakagawa, Shinichi, Liu, Shuangqi, Miao, Xinran, Yu, Le, Du, Zhenrong, Abrahamczyk, Stefan, Arias-Sosa, Luis Alejandro, Buda, Kinga, Budka, Michał, Carrière, Stéphanie M., Chandler, Richard B., Chiatante, Gianpasquale, Chiawo, David O., Cresswell, Will, Echeverri, Alejandra, Goodale, Eben, Huang, Guohualing, Hulme, Mark F., Hutto, Richard L., Imboma, Titus S., Jarrett, Crinan, Jiang, Zhigang, Kati, Vassiliki I., King, David I., Kmecl, Primož, Li, Na, Lövei, Gábor L., Macchi, Leandro, MacGregor-Fors, Ian, Martin, Emily A., Mira, António, Morelli, Federico, Ortega-Álvarez, Rubén, Quan, Rui-Chang, Salgueiro, Pedro A., Santos, Sara M., Shahabuddin, Ghazala, Socolar, Jacob B., Soh, Malcolm C. K., Sreekar, Rachakonda, Srinivasan, Umesh, Wilcove, David S., Yamaura, Yuichi, Zhou, Liping, and Elsen, Paul R.

Published
2024
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50. Adapting the EQ-5D-3L for adults with mild to moderate learning disabilities

Author

John L. O’Dwyer, Louise D. Bryant, Claire Hulme, Paul Kind, and David M. Meads

Subjects
EQ-5D, Learning disability, Intellectual disability, Health-related quality of life, Patient-reported outcome measures., Computer applications to medicine. Medical informatics, R858-859.7
Abstract

Abstract Background Approximately 1.5 million adults in the UK have a learning disability. The difference between age at death for this group and the general population is 26 years for females and 22 years for males. The NHS Long Term Plan (January 2019) recognises learning disabilities as a clinical priority area. People with a learning disability are often excluded from research by design or lack of reasonable adjustments, and self-reported health status/health-related quality of life questionnaires such as the EQ-5D are often not appropriate for this population. Here, we systematically examine the EQ-5D-3L (its wording, content, and format) using qualitative methods to inform the adaption of the measure for use with adults with mild to moderate learning disabilities. Methods Think-aloud interviews with carers/advocates of learning-disabled adults were undertaken to explore the difficulties with completing the EQ-5D-3L. Alternative wording, language, structure, and images were developed using focus groups, stakeholder reference groups, and an expert panel. Data analysis followed a framework method. Results The dimensions and levels within the EQ-5D-3L were deemed appropriate for adults with mild to moderate learning disabilities. Consensus on wording, structure, and images was reached through an iterative process, and an adapted version of the EQ-5D-3L was finalised. Conclusion The EQ-5D-3L adapted for adults with mild to moderate intellectual/learning disabilities can facilitate measurement of self-reported health status. Research is underway to assess the potential use of the adaptation for economic evaluation.

Published
2024
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