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1. Interim report for the International Muon Collider Collaboration (IMCC)

Author: Accettura, C., Adrian, S., Agarwal, R., Ahdida, C., Aimé, C., Aksoy, A., Alberghi, G. L., Alden, S., Amapane, N., Amorim, D., Andreetto, P., Anulli, F., Appleby, R., Apresyan, A., Asadi, P., Mahmoud, M. Attia, Auchmann, B., Back, J., Badea, A., Bae, K. J., Bahng, E. J., Balconi, L., Balli, F., Bandiera, L., Barbagallo, C., Barlow, R., Bartoli, C., Bartosik, N., Barzi, E., Batsch, F., Bauce, M., Begel, M., Berg, J. S., Bersani, A., Bertarelli, A., Bertinelli, F., Bertolin, A., Bhat, P., Bianchi, C., Bianco, M., Bishop, W., Black, K., Boattini, F., Bogacz, A., Bonesini, M., Bordini, B., de Sousa, P. Borges, Bottaro, S., Bottura, L., Boyd, S., Breschi, M., Broggi, F., Brunoldi, M., Buffat, X., Buonincontri, L., Burrows, P. N., Burt, G. C., Buttazzo, D., Caiffi, B., Calatroni, S., Calviani, M., Calzaferri, S., Calzolari, D., Cantone, C., Capdevilla, R., Carli, C., Carrelli, C., Casaburo, F., Casarsa, M., Castelli, L., Catanesi, M. G., Cavallucci, L., Cavoto, G., Celiberto, F. G., Celona, L., Cemmi, A., Ceravolo, S., Cerri, A., Cerutti, F., Cesarini, G., Cesarotti, C., Chancé, A., Charitonidis, N., Chiesa, M., Chiggiato, P., Ciccarella, V. L., Puviani, P. Cioli, Colaleo, A., Colao, F., Collamati, F., Costa, M., Craig, N., Curtin, D., D'Angelo, L., Da Molin, G., Damerau, H., Dasu, S., de Blas, J., De Curtis, S., De Gersem, H., Del Moro, T., Delahaye, J. -P., Denisov, D., Denizli, H., Dermisek, R., Valdor, P. Desiré, Desponds, C., Di Luzio, L., Di Meco, E., Di Petrillo, K. F., Di Sarcina, I., Diociaiuti, E., Dorigo, T., Dreimanis, K., Pree, T. du, Edgecock, T., Fabbri, S., Fabbrichesi, M., Farinon, S., Ferrand, G., Somoza, J. A. Ferreira, Fieg, M., Filthaut, F., Fox, P., Franceschini, R., Ximenes, R. Franqueira, Gallinaro, M., Garcia-Sciveres, M., Garcia-Tabares, L., Gargiulo, R., Garion, C., Garzelli, M. V., Gast, M., Gerber, C. E., Giambastiani, L., Gianelle, A., Gianfelice-Wendt, E., Gibson, S., Gilardoni, S., Giove, D. A., Giovinco, V., Giraldin, C., Glioti, A., Gorzawski, A., Greco, M., Grojean, C., Grudiev, A., Gschwendtner, E., Gueli, E., Guilhaudin, N., Han, C., Han, T., Hauptman, J. M., Herndon, M., Hillier, A. D., Hillman, M., Holmes, T. R., Homiller, S., Jana, S., Jindariani, S., Johannesson, S., Johnson, B., Jones, O. R., Jurj, P. -B., Kahn, Y., Kamath, R., Kario, A., Karpov, I., Kelliher, D., Kilian, W., Kitano, R., Kling, F., Kolehmainen, A., Kong, K. C., Kosse, J., Krintiras, G., Krizka, K., Kumar, N., Kvikne, E., Kyle, R., Laface, E., Lane, K., Latina, A., Lechner, A., Lee, J., Lee, L., Lee, S. W., Lefevre, T., Leonardi, E., Lerner, G., Li, P., Li, Q., Li, T., Li, W., Voti, R. Li, Lindroos, M., Lipton, R., Liu, D., Liu, M., Liu, Z., Lombardi, A., Lomte, S., Long, K., Longo, L., Lorenzo, J., Losito, R., Low, I., Lu, X., Lucchesi, D., Luo, T., Lupato, A., Métral, E., Mękała, K., Ma, Y., Mańczak, J. M., Machida, S., Madlener, T., Magaletti, L., Maggi, M., Durand, H. Mainaud, Maltoni, F., Mandurrino, M., Marchand, C., Mariani, F., Marin, S., Mariotto, S., Martin-Haugh, S., Masullo, M. R., Mauro, G. S., Mazzolari, A., Mele, B., Meloni, F., Meng, X., Mentink, M., Miceli, R., Milas, N., Mohammadi, A., Moll, D., Montella, A., Morandin, M., Morrone, M., Mulder, T., Musenich, R., Nardecchia, M., Nardi, F., Neuffer, D., Newbold, D., Novelli, D., Olvegård, M., Onel, Y., Orestano, D., Osborne, J., Otten, S., Torres, Y. M. Oviedo, Paesani, D., Griso, S. Pagan, Pagani, D., Pal, K., Palmer, M., Pampaloni, A., Panci, P., Pani, P., Papaphilippou, Y., Paparella, R., Paradisi, P., Passeri, A., Pastrone, N., Pellecchia, A., Piccinini, F., Piekarz, H., Pieloni, T., Plouin, J., Portone, A., Potamianos, K., Potdevin, J., Prestemon, S., Puig, T., Qiang, J., Quettier, L., Rabemananjara, T. R., Radicioni, E., Radogna, R., Rago, I. C., Ratkus, A., Resseguie, E., Reuter, J., Ribani, P. L., Riccardi, C., Ricciardi, S., Robens, T., Robert, Y., Roger, C., Rojo, J., Romagnoni, M., Ronald, K., Rosser, B., Rossi, C., Rossi, L., Rozanov, L., Ruhdorfer, M., Ruiz, R., Queiroz, F. S., Saini, S., Sala, F., Salierno, C., Salmi, T., Salvini, P., Salvioni, E., Sammut, N., Santini, C., Saputi, A., Sarra, I., Scarantino, G., Schneider-Muntau, H., Schulte, D., Scifo, J., Sen, T., Senatore, C., Senol, A., Sertore, D., Sestini, L., Rêgo, R. C. Silva, Simone, F. M., Skoufaris, K., Sorbello, G., Sorbi, M., Sorti, S., Soubirou, L., Spataro, D., Stamerra, A., Stapnes, S., Stark, G., Statera, M., Stechauner, B. M., Su, S., Su, W., Sun, X., Sytov, A., Tang, J., Taylor, R., Kate, H. Ten, Testoni, P., Thiele, L. S., Garcia, R. Tomas, Mugglestone, M. Topp, Torims, T., Torre, R., Tortora, L. T., Trifinopoulos, S., Udongwo, S. -A., Vai, I., Valente, R. U., van Rienen, U., van Weelderen, R., Vanwelde, M., Velev, G., Venditti, R., Vendrasco, A., Verna, A., Verweij, A., Verwilligen, P., Villamzar, Y., Vittorio, L., Vitulo, P., Vojskovic, I., Wang, D., Wang, L. -T., Wang, X., Wendt, M., Widorski, M., Wozniak, M., Wu, Y., Wulzer, A., Xie, K., Yang, Y., Yap, Y. C., Yonehara, K., Yoo, H. D., You, Z., Zanetti, M., Zaza, A., Zhang, L., Zhu, R., Zlobin, A., Zuliani, D., and Zurita, J. F.
Subjects: Physics - Accelerator Physics, High Energy Physics - Experiment
Abstract: The International Muon Collider Collaboration (IMCC) [1] was established in 2020 following the recommendations of the European Strategy for Particle Physics (ESPP) and the implementation of the European Strategy for Particle Physics-Accelerator R&D Roadmap by the Laboratory Directors Group [2], hereinafter referred to as the the European LDG roadmap. The Muon Collider Study (MuC) covers the accelerator complex, detectors and physics for a future muon collider. In 2023, European Commission support was obtained for a design study of a muon collider (MuCol) [3]. This project started on 1st March 2023, with work-packages aligned with the overall muon collider studies. In preparation of and during the 2021-22 U.S. Snowmass process, the muon collider project parameters, technical studies and physics performance studies were performed and presented in great detail. Recently, the P5 panel [4] in the U.S. recommended a muon collider R&D, proposed to join the IMCC and envisages that the U.S. should prepare to host a muon collider, calling this their "muon shot". In the past, the U.S. Muon Accelerator Programme (MAP) [5] has been instrumental in studies of concepts and technologies for a muon collider., Comment: This document summarises the International Muon Collider Collaboration (IMCC) progress and status of the Muon Collider R&D programme
Published: 2024

2. Real-Time Scene Graph Generation

Author: Neau, Maëlic, Santos, Paulo E., Sammut, Karl, Bosser, Anne-Gwenn, and Buche, Cédric
Subjects: Computer Science - Computer Vision and Pattern Recognition
Abstract: Scene Graph Generation (SGG) can extract abstract semantic relations between entities in images as graph representations. This task holds strong promises for other downstream tasks such as the embodied cognition of an autonomous agent. However, to power such applications, SGG needs to solve the gap of real-time latency. In this work, we propose to investigate the bottlenecks of current approaches for real-time constraint applications. Then, we propose a simple yet effective implementation of a real-time SGG approach using YOLOV8 as an object detection backbone. Our implementation is the first to obtain more than 48 FPS for the task with no loss of accuracy, successfully outperforming any other lightweight approaches. Our code is freely available at https://github.com/Maelic/SGG-Benchmark.
Published: 2024

3. Hybrid Navigation Acceptability and Safety

Author: Clement, Benoit, Dubromel, Marie, Santos, Paulo E., Sammut, Karl, Oppert, Michelle, and Dayoub, Feras
Subjects: Electrical Engineering and Systems Science - Systems and Control, Computer Science - Robotics
Abstract: Autonomous vessels have emerged as a prominent and accepted solution, particularly in the naval defence sector. However, achieving full autonomy for marine vessels demands the development of robust and reliable control and guidance systems that can handle various encounters with manned and unmanned vessels while operating effectively under diverse weather and sea conditions. A significant challenge in this pursuit is ensuring the autonomous vessels' compliance with the International Regulations for Preventing Collisions at Sea (COLREGs). These regulations present a formidable hurdle for the human-level understanding by autonomous systems as they were originally designed from common navigation practices created since the mid-19th century. Their ambiguous language assumes experienced sailors' interpretation and execution, and therefore demands a high-level (cognitive) understanding of language and agent intentions. These capabilities surpass the current state-of-the-art in intelligent systems. This position paper highlights the critical requirements for a trustworthy control and guidance system, exploring the complexity of adapting COLREGs for safe vessel-on-vessel encounters considering autonomous maritime technology competing and/or cooperating with manned vessels.
Published: 2024
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4. Human-Centric Goal Reasoning with Ripple-Down Rules

Author: Brameld, Kenji, Castro, Germán, Sammut, Claude, Roberts, Mark, and Aha, David W.
Subjects: Computer Science - Robotics, Computer Science - Artificial Intelligence, Computer Science - Multiagent Systems
Abstract: ActorSim is a goal reasoning framework developed at the Naval Research Laboratory. Originally, all goal reasoning rules were hand-crafted. This work extends ActorSim with the capability of learning by demonstration, that is, when a human trainer disagrees with a decision made by the system, the trainer can take over and show the system the correct decision. The learning component uses Ripple-Down Rules (RDR) to build new decision rules to correctly handle similar cases in the future. The system is demonstrated using the RoboCup Rescue Agent Simulation, which simulates a city-wide disaster, requiring emergency services, including fire, ambulance and police, to be dispatched to different sites to evacuate civilians from dangerous situations. The RDRs are implemented in a scripting language, FrameScript, which is used to mediate between ActorSim and the agent simulator. Using Ripple-Down Rules, ActorSim can scale to an order of magnitude more goals than the previous version., Comment: Proceedings of the Ninth Goal Reasoning Workshop (Advances in Cognitive Systems, 2021)
Published: 2024

5. Unveiling the pandemic’s ripples: a study of COVID-19’s effects on catfish and shrimp farmers and export enterprises in Vietnam

Author: Nguyen, Thanh Tung, Huynh, Hoang Huy, Luu, Duc Dien, Tran, Cam Thi Hong, Tsai, Wen-Pei, and Sammut, Jesmond
Published: 2024
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6. Improving nutritional status after allogeneic stem cell transplantation: results of phase 2 ALLONUT clinical trial

Author: Estran, Sophie, Loschi, Michael, Benachour, Sami, Soldati, Alizée, Chiche, Edmond, Sammut, Rinzine, Robert, Guillaume, Jacquel, Arnaud, Chibois, Jacques, Schneider, Stephane, and Cluzeau, Thomas
Published: 2024
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7. Attention-aware Social Graph Transformer Networks for Stochastic Trajectory Prediction

Author: Liu, Yao, Li, Binghao, Wang, Xianzhi, Sammut, Claude, and Yao, Lina
Subjects: Computer Science - Computer Vision and Pattern Recognition
Abstract: Trajectory prediction is fundamental to various intelligent technologies, such as autonomous driving and robotics. The motion prediction of pedestrians and vehicles helps emergency braking, reduces collisions, and improves traffic safety. Current trajectory prediction research faces problems of complex social interactions, high dynamics and multi-modality. Especially, it still has limitations in long-time prediction. We propose Attention-aware Social Graph Transformer Networks for multi-modal trajectory prediction. We combine Graph Convolutional Networks and Transformer Networks by generating stable resolution pseudo-images from Spatio-temporal graphs through a designed stacking and interception method. Furthermore, we design the attention-aware module to handle social interaction information in scenarios involving mixed pedestrian-vehicle traffic. Thus, we maintain the advantages of the Graph and Transformer, i.e., the ability to aggregate information over an arbitrary number of neighbors and the ability to perform complex time-dependent data processing. We conduct experiments on datasets involving pedestrian, vehicle, and mixed trajectories, respectively. Our results demonstrate that our model minimizes displacement errors across various metrics and significantly reduces the likelihood of collisions. It is worth noting that our model effectively reduces the final displacement error, illustrating the ability of our model to predict for a long time., Comment: 14 pages, 9 figures, 6 tables
Published: 2023

8. Analysis of composition on the original scale of measurement

Author: Firth, David and Sammut, Fiona
Subjects: Statistics - Methodology
Abstract: In current applied research the most-used route to an analysis of composition is through log-ratios -- that is, contrasts among log-transformed measurements. Here we argue instead for a more direct approach, using a statistical model for the arithmetic mean on the original scale of measurement. Central to the approach is a general variance-covariance function, derived by assuming multiplicative measurement error. Quasi-likelihood analysis of logit models for composition is then a general alternative to the use of multivariate linear models for log-ratio transformed measurements, and it has important advantages. These include robustness to secondary aspects of model specification, stability when there are zero-valued or near-zero measurements in the data, and more direct interpretation. The usual efficiency property of quasi-likelihood estimation applies even when the error covariance matrix is unspecified. We also indicate how the derived variance-covariance function can be used, instead of the variance-covariance matrix of log-ratios, with more general multivariate methods for the analysis of composition. A specific feature is that the notion of `null correlation' -- for compositional measurements on their original scale -- emerges naturally., Comment: This is a preliminary version, made available prior to journal submission. Comments that could improve the paper would be very much welcomed
Published: 2023

9. Online Learning and Planning in Cognitive Hierarchies

Author: Hengst, Bernhard, Pagnucco, Maurice, Rajaratnam, David, Sammut, Claude, and Thielscher, Michael
Subjects: Computer Science - Artificial Intelligence, Computer Science - Robotics
Abstract: Complex robot behaviour typically requires the integration of multiple robotic and Artificial Intelligence (AI) techniques and components. Integrating such disparate components into a coherent system, while also ensuring global properties and behaviours, is a significant challenge for cognitive robotics. Using a formal framework to model the interactions between components can be an important step in dealing with this challenge. In this paper we extend an existing formal framework [Clark et al., 2016] to model complex integrated reasoning behaviours of robotic systems; from symbolic planning through to online learning of policies and transition systems. Furthermore the new framework allows for a more flexible modelling of the interactions between different reasoning components.
Published: 2023

10. Sim-to-Real Transfer of Adaptive Control Parameters for AUV Stabilization under Current Disturbance

Author: Chaffre, Thomas, Wheare, Jonathan, Lammas, Andrew, Santos, Paulo, Chenadec, Gilles Le, Sammut, Karl, and Clement, Benoit
Subjects: Computer Science - Robotics, Computer Science - Artificial Intelligence, Electrical Engineering and Systems Science - Systems and Control
Abstract: Learning-based adaptive control methods hold the premise of enabling autonomous agents to reduce the effect of process variations with minimal human intervention. However, its application to autonomous underwater vehicles (AUVs) has so far been restricted due to 1) unknown dynamics under the form of sea current disturbance that we can not model properly nor measure due to limited sensor capability and 2) the nonlinearity of AUVs tasks where the controller response at some operating points must be overly conservative in order to satisfy the specification at other operating points. Deep Reinforcement Learning (DRL) can alleviates these limitations by training general-purpose neural network policies, but applications of DRL algorithms to AUVs have been restricted to simulated environments, due to their inherent high sample complexity and distribution shift problem. This paper presents a novel approach, merging the Maximum Entropy Deep Reinforcement Learning framework with a classic model-based control architecture, to formulate an adaptive controller. Within this framework, we introduce a Sim-to-Real transfer strategy comprising the following components: a bio-inspired experience replay mechanism, an enhanced domain randomisation technique, and an evaluation protocol executed on a physical platform. Our experimental assessments demonstrate that this method effectively learns proficient policies from suboptimal simulated models of the AUV, resulting in control performance 3 times higher when transferred to a real-world vehicle, compared to its model-based nonadaptive but optimal counterpart.
Published: 2023

11. Predictability of B cell clonal persistence and immunosurveillance in breast cancer

Author: Sammut, Stephen-John, Galson, Jacob D., Minter, Ralph, Sun, Bo, Chin, Suet-Feung, De Mattos-Arruda, Leticia, Finch, Donna K., Schätzle, Sebastian, Dias, Jorge, Rueda, Oscar M., Seoane, Joan, Osbourn, Jane, Caldas, Carlos, and Bashford-Rogers, Rachael J. M.
Published: 2024
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12. Supervision und Beratung mit Praktikern, die bei Familien und Trauma eingreifen

Author: Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, Cooper, Jan, Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, and Cooper, Jan
Published: 2024
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13. Arbeiten im Territorium: Therapeutenerfahrungen mit gewalttätigem Verhalten in Paaren und Familien

Author: Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, Cooper, Jan, Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, and Cooper, Jan
Published: 2024
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14. Prävention und Frühintervention bei Gewalt und Missbrauch in Familien

Author: Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, Cooper, Jan, Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, and Cooper, Jan
Published: 2024
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15. Leben mit Gewalt in der Familie: Retrospektive Erinnerungen an die Kindheitserfahrungen von Frauen

Author: Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, Cooper, Jan, Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, and Cooper, Jan
Published: 2024
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16. Heilung und Reparatur in Beziehungen: Therapeutische Arbeit mit Paaren

Author: Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, Cooper, Jan, Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, and Cooper, Jan
Published: 2024
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17. Wenn die Gewalt aufhört: Unterschiedliche Beziehungen und verschiedene Formen von Gewalt in der Familie

Author: Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, Cooper, Jan, Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, and Cooper, Jan
Published: 2024
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18. Paaren helfen, sicher zu trennen: Arbeiten an sicheren Trennungen

Author: Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, Cooper, Jan, Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, and Cooper, Jan
Published: 2024
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19. Systemische Arbeit mit Eltern, Kindern und erwachsenen Überlebenden, wenn der Missbrauch aufhört

Author: Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, Cooper, Jan, Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, and Cooper, Jan
Published: 2024
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20. Wie man hilft, die Gewalt zu stoppen: Anwendung einer Sicherheitsmethodik über die Lebensspanne

Author: Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, Cooper, Jan, Sammut Scerri, Clarissa, Vetere, Arlene, Abela, Angela, and Cooper, Jan
Published: 2024
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21. Demonstration of full polarization control of soft X-ray pulses with Apple X undulators at SwissFEL using recoil ion momentum spectroscopy

Author: Christoph Kittel, Antoine Sarracini, Sven Augustin, Ningchen Yang, Andre Al Haddad, Eugenio Ferrari, Gregor Knopp, Jonas Knurr, Ana Sofia Morillo-Candas, Iwona Swiderska, Eduard Prat, Nicholas Sammut, Thomas Schmidt, Christoph Bostedt, Marco Calvi, and Kirsten Schnorr
Subjects: soft x-rays, fels, polarization, undulator, coltrims, apple x, reaction microscope, recoil ion momentum spectroscopy, Nuclear and particle physics. Atomic energy. Radioactivity, QC770-798, Crystallography, QD901-999
Abstract: The ability to freely control the polarization of X-rays enables measurement techniques relying on circular or linear dichroism, which have become indispensable tools for characterizing the properties of chiral molecules or magnetic structures. Therefore, the demand for polarization control in X-ray free-electron lasers is increasing to enable polarization-sensitive dynamical studies on ultrafast time scales. The soft X-ray branch Athos of SwissFEL was designed with the aim of providing freely adjustable and arbitrary polarization by building its undulator solely from modules of the novel Apple X type. In this paper, the magnetic model of the linear inclined and circular Apple X polarization schemes are studied. The polarization is characterized by measuring the angular electron emission distributions of helium for various polarizations using cold target recoil ion momentum spectroscopy. The generation of fully linear polarized light of arbitrary angle, as well as elliptical polarizations of varying degree, are demonstrated.
Published: 2024
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22. Enhanced X-ray free-electron laser performance with optical klystron and helical undulators

Author: Christoph Kittel, Marco Calvi, Sven Reiche, Nicholas Sammut, Guanglei Wang, and Eduard Prat
Subjects: free-electron lasers, synchrotron radiation, undulators, polarization of light, x-ray lasers, Nuclear and particle physics. Atomic energy. Radioactivity, QC770-798, Crystallography, QD901-999
Abstract: This article presents a demonstration of the improved performance of an X-ray free-electron laser (FEL) using the optical klystron mechanism and helical undulator configuration, in comparison with the common planar undulator configuration without optical klystron. The demonstration was carried out at Athos, the soft X-ray beamline of SwissFEL. Athos has variable-polarization undulators, and small magnetic chicanes placed between every two undulators to fully exploit the optical klystron. It was found that, for wavelengths of 1.24 nm and 3.10 nm, the required length to achieve FEL saturation is reduced by about 35% when using both the optical klystron and helical undulators, with each effect accounting for about half of the improvement. Moreover, it is shown that a helical undulator configuration provides a 20% to 50% higher pulse energy than planar undulators. This work represents an important step towards more compact and high-power FELs, rendering this key technology more efficient, affordable and accessible to the scientific community.
Published: 2024
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23. Distilled Mid-Fusion Transformer Networks for Multi-Modal Human Activity Recognition

Author: Li, Jingcheng, Yao, Lina, Li, Binghao, and Sammut, Claude
Subjects: Computer Science - Human-Computer Interaction, Computer Science - Computer Vision and Pattern Recognition
Abstract: Human Activity Recognition is an important task in many human-computer collaborative scenarios, whilst having various practical applications. Although uni-modal approaches have been extensively studied, they suffer from data quality and require modality-specific feature engineering, thus not being robust and effective enough for real-world deployment. By utilizing various sensors, Multi-modal Human Activity Recognition could utilize the complementary information to build models that can generalize well. While deep learning methods have shown promising results, their potential in extracting salient multi-modal spatial-temporal features and better fusing complementary information has not been fully explored. Also, reducing the complexity of the multi-modal approach for edge deployment is another problem yet to resolve. To resolve the issues, a knowledge distillation-based Multi-modal Mid-Fusion approach, DMFT, is proposed to conduct informative feature extraction and fusion to resolve the Multi-modal Human Activity Recognition task efficiently. DMFT first encodes the multi-modal input data into a unified representation. Then the DMFT teacher model applies an attentive multi-modal spatial-temporal transformer module that extracts the salient spatial-temporal features. A temporal mid-fusion module is also proposed to further fuse the temporal features. Then the knowledge distillation method is applied to transfer the learned representation from the teacher model to a simpler DMFT student model, which consists of a lite version of the multi-modal spatial-temporal transformer module, to produce the results. Evaluation of DMFT was conducted on two public multi-modal human activity recognition datasets with various state-of-the-art approaches. The experimental results demonstrate that the model achieves competitive performance in terms of effectiveness, scalability, and robustness., Comment: 13 pages, 6 figures
Published: 2023

24. DRL-Based Thruster Fault Recovery for Unmanned Underwater Vehicles.

Author: Katell Lagattu, Gilles Le Chenadec, Eva Artusi, Paulo E. Santos, Karl Sammut, and Benoit Clement
Published: 2024
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25. Towards Food, Nutrition and Income Security in Papua New Guinea Through Inland Fish Farming

Author: Sammut, Jesmond, Vira, Havini, Tong, Shanice, Nicholl, Matthew, Noiney, Joshua, Mazumder, Debashish, Wani, Jacob, Hiruy, Kiros, Lau, Sue Mei, Dansie, Andrew, editor, Alleway, Heidi K., editor, and Böer, Benno, editor
Published: 2024
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26. Multi-level Attention Network with Weather Suppression for All-Weather Action Detection in UAV Rescue Scenarios

Author: Liu, Yao, Li, Binghao, Sammut, Claude, Yao, Lina, Filipe, Joaquim, Editorial Board Member, Ghosh, Ashish, Editorial Board Member, Prates, Raquel Oliveira, Editorial Board Member, Zhou, Lizhu, Editorial Board Member, Luo, Biao, editor, Cheng, Long, editor, Wu, Zheng-Guang, editor, Li, Hongyi, editor, and Li, Chaojie, editor
Published: 2024
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27. Amazon Alexa and I: Exploring Factors Affecting Usage Behaviours and Patterns Over Time

Author: Sammut, Rachel, Lal, Banita, Ismagilova, Elvira, Rannenberg, Kai, Editor-in-Chief, Soares Barbosa, Luís, Editorial Board Member, Carette, Jacques, Editorial Board Member, Tatnall, Arthur, Editorial Board Member, Neuhold, Erich J., Editorial Board Member, Stiller, Burkhard, Editorial Board Member, Stettner, Lukasz, Editorial Board Member, Pries-Heje, Jan, Editorial Board Member, Kreps, David, Editorial Board Member, Rettberg, Achim, Editorial Board Member, Furnell, Steven, Editorial Board Member, Mercier-Laurent, Eunika, Editorial Board Member, Winckler, Marco, Editorial Board Member, Malaka, Rainer, Editorial Board Member, Sharma, Sujeet K., editor, Dwivedi, Yogesh K., editor, Metri, Bhimaraya, editor, Lal, Banita, editor, and Elbanna, Amany, editor
Published: 2024
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28. Remotely monitored physical activity from older people with cardiac devices associates with physical functioning

Author: Taylor, J.K., Peek, N., Greenstein, A.S., Sammut-Powell, C., Martin, G.P., and Ahmed, F.Z.
Published: 2024
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29. Remotely monitored physical activity from older people with cardiac devices associates with physical functioning

Author: J.K. Taylor, N. Peek, A.S. Greenstein, C. Sammut-Powell, G.P. Martin, and F.Z. Ahmed
Subjects: Cardiac devices, Remote monitoring, Physical activity, Frailty, Physical functioning, Geriatrics, RC952-954.6
Abstract: Abstract Introduction Accelerometer-derived physical activity (PA) from cardiac devices are available via remote monitoring platforms yet rarely reviewed in clinical practice. We aimed to investigate the association between PA and clinical measures of frailty and physical functioning. Methods The PATTErn study (A study of Physical Activity paTTerns and major health Events in older people with implantable cardiac devices) enrolled participants aged 60 + undergoing remote cardiac monitoring. Frailty was measured using the Fried criteria and gait speed (m/s), and physical functioning by NYHA class and SF-36 physical functioning score. Activity was reported as mean time active/day across 30-days prior to enrolment (30-day PA). Multivariable regression methods were utilised to estimate associations between PA and frailty/functioning (OR = odds ratio, β = beta coefficient, CI = confidence intervals). Results Data were available for 140 participants (median age 73, 70.7% male). Median 30-day PA across the analysis cohort was 134.9 min/day (IQR 60.8–195.9). PA was not significantly associated with Fried frailty status on multivariate analysis, however was associated with gait speed (β = 0.04, 95% CI 0.01–0.07, p = 0.01) and measures of physical functioning (NYHA class: OR 0.73, 95% CI 0.57–0.92, p = 0.01, SF-36 physical functioning: β = 4.60, 95% CI 1.38–7.83, p = 0.005). Conclusions PA from cardiac devices was associated with physical functioning and gait speed. This highlights the importance of reviewing remote monitoring PA data to identify patients who could benefit from existing interventions. Further research should investigate how to embed this into clinical pathways.
Published: 2024
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30. Rowing towards the shore: coping strategies in males living with lymphoedema

Author: Josianne Scerri, Sarah Cilia Vincenti, Michael Galea, Carmel Cefai, Paulann Grech, Alexei Sammut, and Christie Attard
Subjects: lymphoedema, interpretative phenomenological analysis, coping, cancer, males, Medicine (General), R5-920
Abstract: Lymphoedema is a swelling in part of the body due to an obstructed flow of lymphatic fluid. Extant literature mainly targets coping strategies in females having breast cancer related lymphoedema. This research aims to explore the coping strategies of males living with lymphoedema, secondary to cancer treatment. Semi-structured, in-depth interviews were conducted with 13 males aged between 50 to 85 years. Five themes emerged namely: adjusting attire, changing lifestyle activity, distracting the mind, leaning onto available support and immersing in spirituality. Males described wearing loose, easy-to-wear clothing over swollen body parts. Changes in lifestyle included pacing of activities, avoiding/modifying activities to avoid injury and incorporating treatment in their daily routine. Distraction was enabled though immersion in work, engaging in hobbies and humorous banter. Participants also coped by expressing gratitude, living in the present moment, accepting situations over which they lacked control, connecting with nature, and turning to their religious beliefs. There is a need for health professionals to explore the illness narratives and coping strategies of males living with lymphoedema as this impacts their overall well-being. Interventions targeting coping strategies for males with lymphoedema should address the physical, emotional, psychological and spiritual domains of well-being.
Published: 2024
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31. Access to and quality of elective care: a prospective cohort study using hernia surgery as a tracer condition in 83 countries

Author: Dönmez, A Eylül, Goswami, Aakansha Giri, Raheja, Aashna, Bhadani, Aayush, El Kady, Abd Elrahman Safwat, Alniemi, Abdalaziz, Awad, Abdalkarim, Aladl, Abdalla, Younis, Abdalla, Alwali, Abdallah, Khalil, Abdallah, Mansour, Abdallah, Elkhouly, Abdallah Mohamed, Rashad Temerik, Abdallah, Hasan, Abdallatef, Chied, Abdelhafid, Abdraba, Abdelhamid, Hrora, Abdelmalek, Abdelshafi, Abdelrahman, Alwali, Abdelrahman, Maraqa, Abdelrahman, Ghaffar, Abdul, Chekfa, Abdul Jabar, Al Balushi, Abdul Majeed, Quddus, Abdul, Hammadieh, Abdul Rahman, Muntaka, Abdul-Jalilu Mohammed, Asekun, Abdulazeez, Alshahrani, Abdulaziz, Jowharji, Abdulaziz, Alshukre, Abdulbaset, Khair Etareig, Abdulhafid, Abubakar Abdulkarim, Abdulhafiz, Ashiru, Abdulhafiz, Alailesh, Abdulhamid, Al-Mallah, Abdullah, Baydoun, Abdullah, Chaudhry, Abdullah, Askin, Abdullah Emre, Almutairi, Abdulmjeed, Belkhair, Abdulmunem, Abdllah, Abdulrahman, Alhammali, Abdulrahman, Basalim, Abdulrahman, Abouelnagah, Abdulrahman Galal Mohamed Mostafa, Ghazal, Abdulrahman, Mohammed, Abdulrahman, Qasem, Abdulrahman, Anadani, Abdulrazak, Jimoh, Abdulrazaq, Lawal, Abdulrazzaq Oluwagbemiga, Khaity, Abdulrhman, Lawal, Abdulwahab, Elzoubi, Abdurrahim Esseid, Sheshe, Abdurrahman Abba, Cetişli, Abdurrahman Furkan, Oyedele, Abeeb, Aljahdali, Abeer, Aboelnasr, Abeer Gamal Elsyed, Demessie, Abel, Bhargava, Abhilasha, Sonkar, Abhinav Arun, Bavaharan, Abhirame, Khan, Abid, Campbell, Abigail, Oyelekan, Abimbola Adeola Akintunde, Okunlola, Abiodun Idowu, Ojewuyi, Abiodun, Ekerin, Abiola, Saleh, Abobakr, Khairy, Abouelatta, Muthunayagam, Abraham Benjamin, Botha, Abraham, Teshome Sahilemariam, Abraham, Nawawi, Abrar, Muhammad, Abubakar Bala, Dahiru, Abubakar, Yahaya, Abubakar, Abdelmalik, Abubaker, Anuar, Abul Akmal Arif, Ousseini, Adakal, Leon -Del- Angel, Adalberto, Frankel, Adam, Gyedu, Adam, Lim, Adam, Lukáč, Adam, Peckham-Cooper, Adam, Sabbah, Adam, Varga, Adam, Sanou, Adama, Issaka, Adamu, Ningi, Adamu, Yeshitila, Addis, Yingess, Addisu, Olugbami, Adebayo, Moses, Damola-Okesiji, Adebola, Lawal, Adedayo, Ojo, Adedoyin, Hashmi, Adeel, Fakoya, Adegbolahan, Ishola, Adegoke, Abiodun, Adekunle, Ajayi, Adekunle, Mouffokes, Adel, Bonelli, Adele, Adekoya, Adeleke, Akeem Aderogba, Adeleke, Özcan, Adem, Ayoade, Ademidun, Adeyeye, Ademola, Agbaje, Ademola, Talabi, Ademola, Ademuyiwa, Adesoji, Adewumiya, Adesoji, Ademuyiwa, Adesoji O, Aderounmu, Adewale, Adisa, Adewale, Oke, Adewale, Ragab, Adham, Alzadjali, Adil, Baksi, Aditya, Jayapalan, Aditya, Md Yunos, Adnan, Pisanu, Adolfo, Salazar, Adolfo, Salinas Barragan, Adrian Alberto, Fox, Adrian, Stollberg, Adrian, Franco, Adriana, Neves, Adriana, Vricheva, Adriana, Hodonou, Adrien Montcho, Aghayeva, Afag, Liaquat, Affifa, Alsultan, Afnan, Morad, Afnan, Kalidis, Afroditi Angella, Gkouniaroudi, Agathi, Karakosta, Agathi, Lovi, Agbenya, Yevide, Agossou Barthélémy, Duro, Agustin, Rodriguez Gonzalez, Agustin, Tariq, Ahbala, Abaidalla, Ahmad, Abuhammad, Ahmad, Abuhantash, Ahmad, Mansour, Ahmad Adel, Ahmad Zaidi, Ahmad Al Hafeez, Alahmad Alismael, Ahmad, Alayed, Ahmad, Alfarwan, Ahmad, Alhaj, Ahmad, Ali, Ahmad, Alroobi, Ahmad, Alsheikh, Ahmad, Alusef, Ahmad, Alzu'Bi, Ahmad, Kayali, Ahmad Amir, Bouhuwaish, Ahmad, Doghaim, Ahmad, El-Sherbiney, Ahmad, Ghazal, Ahmad, Ramly, Ahmad Nasir, Raza, Ahmad, Qureshi, Ahmad Uzair, Arnaout, Ahmad Yamen, Abdelhamid, Ahmed, Abuthaher, Ahmed, Adel, Ahmed, Ahmayda, Ahmed, Al-Mouahhed, Ahmed, Alagha, Ahmed, Albalawi, Ahmed, Albhaisi, Ahmed, Alrifaee, Ahmed, Azam, Ahmed, Barakat, Ahmed, Al-Hajjaj, Ahmed Basim Abed, Dawoud, Ahmed, El Shamarka, Ahmed, El-Bastwesy, Ahmed, Elghrieb, Ahmed, Elkhalifa, Ahmed, Elmosalamy, Ahmed, Elshazli Mahmoud, Ahmed, Montaser, Ahmed G., Gbeadese, Ahmed, Haty, Ahmed, K. 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Chisom, Jamieson-Grigg, Chloe, Ong, Chon Sum, Alphonse, Chris, Bode, Chris, Varghese, Chris, Carrillo Sarango, Christian, Esteo Verdu, Christian, Krautz, Christian, Mosca, Christian, Nimbona, Christian, Nikolaou, Christina, Wiesner, Christina, Kloppers, Christo, Kourouniotis, Christoforos, Seiler, Christoph, Knee, Christopha, Mpirimbanyi, Christophe, Aboah, Christopher, Amah, Christopher, Cheong, Christopher, Harmston, Christopher, Leung, Christopher, Seet, Christopher, Smart, Christopher, Chouliaras, Christos, Damaskos, Christos, Doudakmanis, Christos, Kaselas, Christos, Limas, Christos, Ntagkas, Christos, Papazacharias, Christos, Stefanou, Christos, Thrasyvoulou, Christos, Tsalikidis, Christos, Karagianni, Chrysanthi, Kolla, Chrysoula-Christina, Ugwunne, Chuka, Ilo, Chukwudi, Nwegbu, Chukwuemeka, Onwuzu, Chukwuka, Weadick, Ciara, De Martino, Ciro, Donohoe, Claire, Gutierrez De La Rosa, Clara Elena, Florián Villa, Clara Marcela, Petcu, Clara Teodora, Cecconi, Claudia, Banal, Claudine, Brandi, Claudio, Hossu, Claudiu, Onuoha, Clement, Osime, Clement, Shelton, Clifford, Fuentes Orozco, Clotilde, Adumah, Collins, Dina, Constantin, Nastos, Constantinos, Aguero, Coral, Markin, Coretta, Hoogerboord, Cornelis, Da Lio, Corrado, Saviello, Cosimo, Bezede, Cosmin, Distefano, Costanza, Elliot-Wilson, Courtney, Bokossa, Covalic, Lupercio Figueroa, Cristian Israel, Riboni, Cristiana, Meola, Cristiano, Costa, Cristina, Gas, Cristina, Larotonda, Cristina, Soddu, Cristina, Vacca, Cristina, Vera Mansilla, Cristina, Li, Crystal, Agbonrofo, Cynthia, Akli-Nartey, Cynthia, Molewa, Cynthia, Nelly Rosine, Cyuzuzo Ngwije, Rega, D., Koike, Daisuke, Wickramasinghe, Dakshitha, Clarke, Damian, Fry, Damian, Hannedige, Damsadie, Powell, Dan-Beck, Kasasbeh, Dana, Samardali, Dana, Sharl Ajami, Dani, Badran, Dania, Adjei, Daniel, Muhie, Daniel Ahmed, Pérez Muñoz, Daniel Alejandro, Alifoe, Daniel, Aparicio-López, Daniel, Baños Méndez, Daniel, Cristian, Daniel, Eaton, Daniel, Gero, Daniel, Makary, Daniel, Montwedi, Daniel, Muñoz, Daniel, Patterson, Daniel, Reim, Daniel, Agbley, Daniel Yao Dodzie, Patiño García, Daniela Cristina, Di Pietrantonio, Daniela, Pais, Daniela, Rosado, Daniela, Tavares, Daniela, Alberti, Daniele, Fusario, Daniele, Massaro, Daniele, Paglione, Daniele, Pironi, Daniele, Kurochka, Daniil, Centonze, Danilo Corrado, Hackner, Danilo, Herrera, Danilo, Amangaliyev, Daniyar, Silva-Cano, Danny Wladimir, Chaudhry, Daoud, Palmisano, Dario, Ribero, Dario, Vukosav, Dario, Misca, Darius, Lowen, Darren, Rattray, Darren, Walia, Darshanjit Singh, Maan, Darvesh, Muyenzi, Daryle, Verdi, Daunia, Bardsley, David, Reyes Rodríguez, David Estuardo, Fra Corral, David, Garcia López De Goicoechea, David, Gavit, David, Gómez, David, Idowu, David, Konkin, David, Labadah, David Kplorla Kekeli, Liu, David, Merlini, David, Mitchell, David, Moro-Valdezate, David, Osifo, David, Proud, David, Ridder, David, Gobatti, Davide, Muschitiello, Davide, Pertile, Davide, Zulian, Davide, Mengiste, Dawit, Mikami, Dean, Mohanty, Debajyoti, Chatterjee, Debarghya, Komolafe, Deborah Olaitan, Scotto Di Carlo, Deborah, Wright, Deborah, Rahme, Deema, Talreja, Deep Parkash, Jain, Deepak, Rajput, Deepak, Singh, Deepak, Anbu, Deepika, Ibrahim, Dena, Phom, Denchu, Hili, Denise, Osei, Dennis Broni, Daary, Dennis, Kyeremeh, Dennis, Shen, Dennis, Uymaz, Derya Salim, Cianflocca, Desiree, Ashitey, Desmond, Evripidou, Despo, Papageorgouli, Despoina, Kaushal, Devesh, Abeysirigunawardana, Dewmi, Dugar, Dharmendra, Mallik, Dhiraj, Ghosh, Dhruva, Houmran, Diaa, Abdulrahman, Diala, Pantoja Pachajoa, Diana Alejandra, Cardona Gomez, Diana Catalina, Fenner, Diana, Gonzalez, Diana Samantha, Siriwardena, Diana, Garcés Palacios, Diana Sofía, Stoian, Diana, Zuikyte, Diana, Sosa Méndez, Dianne Alitzá, Wickramarathna, Dickson, Mutter, Didier, Palma Portillo, Diego Andrés, Chavez Fernandez, Diego, Córdova García, Diego, Enjuto, Diego, Giulitti, Diego, Sasia, Diego, Visconti, Diego, Yiğit, Dilara, George, Dilip, Rabaia, Dima, Georgiev, Dimitar, Hadzhiev, Dimitar, Alexandrou, Dimitrios, Balalis, Dimitrios, Giakoustidis, Dimitrios, Manatakis, Dimitrios K., Korkolis, Dimitrios, Lytras, Dimitrios, Massaras, Dimitrios, Moris, Dimitrios, Politis, Dimitrios, Sampanis, Dimitrios, Schizas, Dimitrios, Tsiardas, Dimitrios, Vardakostas, Dimitrios, Kotsaris, Dimitris, Khattab, Dina Hesham, M. Awad, Dina, Alrokh, Dina Sami, Schippers, Dina, Waleed, Dina, Salinovic, Dinko, Gonçalves Múrias Gomes, Diogo Miguel, Silva, Diogo, Vaz Acosta, Diogo, Morton, Dion, Panagopoulos, Dionisios, Kelgiorgi, Dionysia, Dellaportas, Dionysios, Prevezanos, Dionysios, Joshi, Dipti, Ozal, Direm, Yigit, Direnc, Chimkaomasiri, Divine, Jabbar, Diya, Nepogodiev, Dmitri, Belekar, Dnyanesh, Abdalaziz, Doaa, Abunemer, Doaa, Attia, Doaa, Elkafrawy, Doaa, Dimitrov, Dobromir, Pignatelli, Domenica, Merlicco, Domenico, Soriero, Domenico, Zerbo, Domenico, Atouguia, Domingas, Fairbrass, Dominic, T. Enti, Donald, Venskutonis, Donatas, Rukavina, Dora, Caruso, Dorena, Herappe, Dorihela, Lee, Dorinda Norbetha, Ofosuhene, Doris, Hajela, Apoorva, Badwan, Basem, Kulkarni, Datta, Dhawan, Deep, Dhillon, Jeevanjit, Mehmood, Manzer, Mahmood, Namrah, Nikam, Narendra, Ramchandani, Radhakrishna, Thind, Ravinder Singh, Riazhussain, D Hafiz, Maqsood, Saliha, Alalawi, Yousef, Tyagi, Harshdeep, Kshirsagar, Shivani, Ahmed, Hisham, Juan Carlos, Luna Cydejko, Kone, Dramane, Omar, Duaa, Alves, Duarte Gil, Subasinghe, Duminda, Ommi, Durgesh, Joshiba, Durshney, Chakarov, Dzhevdet, Arkoh, Ebenezer Ameyaw, Frimpong-Manso, Ebenezer, Ada, Ece, Lincango, Eddy P., Lozada Hernandez, Edgard Efren, Hodžić, Edin, Di Marco, Edith, Baccalini, Edoardo Andrea, Baldini, Edoardo, González Marín, Eduardo, Gutierrez, Eduardo, Sepúlveda, Eduardo, Dainius, Edvinas, Zhang, Edward, Yenli, Edwin Mwintiereh Ta-Ang, Antoniou, Efstathios, Kapasakis, Efstathios, Baili, Efstratia, Poulios, Efthymios, Kubiliute, Egle, Osaze, Ehioghae, Afeikhena, Ehis, Elshennawy, Eiad, Athanasopoulou, Eirini, Synekidou, Eirini, Ekaladze, Eka, Tampaki, Ekaterini Christina, Adam, Elaf, Adel Hamdoun Aziz, Elaf, Yousuf, Elamin, Gialamas, Eleftherios, Spartalis, Eleftherios, Bedzhanyan, Elen, Toma, Elena Adelina, Daukšaitė, Elena, Desiato, Elena, Dvivedi, Elena, Hadzhieva, Elena, Martí Cuñat, Elena, Montalbán Martínez, Elena, Montanari, Elena, Signaroli, Elenasofia, Efremidou, Eleni, Gavriil, Eleni, Karakeke, Eleni, Mavrodimitraki, Eleni, Papamattheou, Eleni, Jose, Elenza, Cianci, Eleonora, Ciccioli, Eleonora, Daleva, Eleonora, Locci, Eleonora, Lori, Eleonora, Silanos, Eleonora, Ayala, Elí, Bankart, Eliana, Brolese, Eliane, Efstathiou, Elias, Salloum, Elias, Colak, Elif, Terzi, Elif Didem, Ametefe, Elikem, Cagigal Ortega, Elima Pilar, Donnarumma, Elio, Mina, Elisa, Reitano, Elisa, Wallner, Elisabeth, Moggia, Elisabetta, Betz, Elise, Kontis, Elissaios, Anestiadou, Elissavet, Gimson, Eliza, Lun, Elizabeth, Fraser, Elizabeth, Li, Elizabeth, Torres De Anda, Elizabeth Magaly, Murphy, Elizabeth Mary Ann, O'Connell, Elizabeth, Redondo, Elizabeth, Lun, Elizabeth Weng Yan, Francis, Ella, Haiden, Elmar, Hamed, Elmonzir, Alkhalifa, Elmustafa, Dexter, Eloise, Daketsey, Elorm, Setsoafia, Elorm, Mohamed, Elsagad, Mohammed, Elsamoual, Hegab, Elsayed, Ay, Elvin, Adinolfi, Elvira, Mbanzabugabo, Elvis, Chin, Elynn, Ahmed, Emad Ali, Younes, Eman, Basile, Emanuela, Gessa, Emanuela, Pontecorvi, Emanuele, Romairone, Emanuele, Hatangimana, Eméry, Ndizeye, Emile, Ciofic, Emilia, Dijan, Emilio, López-Negrete Cueto, Emilio, Baker, Emily, Reid, Emily, Schmidt, Emily, Alić, Emir, Bičakčić, Emir, Agbowada, Emma, Colton, Emma, Downing, Emma, Haege, Emma, O'Neill, Emma, Roussos, Emmanouel, Nachelleh, Emmanuel Aadereyir, Adebunmi, Emmanuel, Obiesie, Emmanuel Ahuizechukwu, Akakpo, Emmanuel Bismark, Konlan, Emmanuel Dammigu Francis, Nwangwu, Emmanuel Ifeanyi, Kafui Ayodeji, Emmanuel, Ofori, Emmanuel Owusu, Spanoudakis, Emmanuel, Abate, Emmanuele, Balik, Emre, Bozdağ, Emre, Bozkurt, Emre, Karabulut, Emre Cagri, Ozoran, Emre, Tunçcan, Emre, Tuzuner, Emre, Halilović, Emsad, Alabed, Enaam, Zidan, Enas, Hodžić, Enes, Aybar, Engin, Yildirim, Engin Okan, Wong, Enoch, Yhoshu, Enono, Bisogno, Enrica, Andolfi, Enrico, Ferri, Enrico, Potenza, Enrico, Spalice, Enrico, Volpin, Enrico, González, Enrique, Downes, Eoin, Gallo, Erdachew, Kamer, Erdinc, Naidoo, Eressa, Erginöz, Ergin, Bara, Eric, Irungu, Eric, García-Villegas, Eric Yusif, Mazzotta, Erica, Monati, Erica, Chan, Erick, Gómez Mejía, Erika, Dylja, Eris, Somuncu, Erkan, Yavuz, Erkan, Begunić, Ernes, Margelis, Ernest, Osei, Ernest Owusu, Saitoglou, Ertzan, Agastra, Ervis, Mazumdar, Eshan, Soyer Güldoğan, Esra, Abu Siam, Esra'A, Abdelbaset, Esraa, Abdu, Esraa, Adel Mahmod Sultan, Esraa, Nubi Mohamed, Esraa Gamal, Abuobaida Banaga Hag El Tayeb, Essam Eldien, Ali, Essraa, Page-Taylor, Estelle, Marra, Ester, Garcia Santos, Esther Pilar, Elsheikh, Ethar, Unal, Ethem, Tan, Eugene, De Leo, Eugenio, Borges, Eva, Gáspár, Éva, Ruiz-Daum, Eva, Apostolopoulos, Evaggelos, Samara, Evangelia, Barkolias, Evangelos, Fradelos, Evangelos, Hopping, Eve, Romo Ascencio, Evelia Veronica, Sosa Ferreira, Ever David, Shestakov, Evgenii, Tyurina, Evgenya, Hristova, Evguenia, Efthymiou, Evripidis, Tokidis, Evripidis, Harrison, Ewen, Dontoh, Ewurama Akroma, Mansour, Eyad, Yeshialem, Eyosiyas, Dabbagh, Ezeddin, Amer, Ezzeldin, Manasci, Fabiana, Gomes, Fabio, Medas, Fabio, d'Acapito, Fabrizio, Vassallo, Fabrizio, Haddad, Fadi, Elhabishi, Fadwa, Akhtar, Fahad, Tauheed, Fahad, Al Abbood, Fahd, Gareb, Fahed, Ghazali, Fairuz, Alnazawi, Faisal, Ondago, Faith, Rasoaherinomenjanahary, Fanjandrainy, Wiese, Fanny, González Ponce, Fanny Yesenia, Georgiades, Fanourios, Ali, Farah, Galley, Fareeda, Huda, Farhanul, Amir, Farhat Naaz, Ashraf, Fariha, Alfarsi, Faris, Ayasra, Faris, Ali, Farman, Mahmoud, Faten, Aliskander, Fater, Tahir Lwdie, Fathea, Buyuker, Fatih, Aguilar Del Castillo, Fátima, Mohammed Daoud, Fatima Ahmed, Alowjaly, Fatima, Oni, Fatima, Rauf, Fatima, Elkhafeefi, Fatimah, Hourri, Fatine, Monib, Fatma A., Alshreef, Fatma, Benghalbon, Fatma, Ntirenganya, Faustin, Ashraf, Fauziyah, Chahrour, Fayez, Ahmad, Fazal, Parray, Fazlul Qadir, Philips, Febi, Campus, Federica, Di Marco, Federica, Ferraina, Federica, Frongia, Federica, Maffeis, Federica, Natali, Federica, Pederiva, Federica, Scolari, Federica, Tofani, Federica, Marin, Federico Alberto Niccolò, Biolchini, Federico, Cappellacci, Federico, Corronca, Federico, Mazzola, Federico, Suldrup, Federico, Nyarko, Felicia, Casas J, Felipe, Zapata, Felipe, Aigner, Felix, Alakaloko, Felix, Amoako, Felix, Camacho, Felix, Hammett, Felix, Kuubetersob B. N, Felix, Alahmad, Feras, Alnimri, Feras, Haddad, Feras, Gool, Ferhana, Castro, Fernanda, Diaz, Fernanda, Lucero, Fernanda, Vovola, Fernanda, Mahnic, Fernando, Mercado Sanchez, Fernando, Prieto La Noire, Fernando, Soggiu, Fiammetta, Tsige, Fikreab, Brzeszczyński, Filip, Rudisch, Filip, Valente Costa Pinto, Filipa, Ramalho De Almeida, Filipe, Banchini, Filippo, Palomino Escalante, Fiorella, Fadzlullah, Fitri, Terefe, Fitsum, Sulo, Fjorenta, Ciccarone, Flavia, Tirelli, Flavio, Krämer, Florian, Grama, Florin, Spanos, Foivos, Solimene, Folco, Akinwande, Foluso, Osman, Forzia, Stefou, Foteini, Kyramargios, Fotios, Stavratis, Fotios, Alassani, Fousseni, Ascari, Francesca, Cammelli, Francesca, D'Agostino, Francesca, Tropeano, Francesca Paola, Peters, Francesca, Ré, Francesca, Brucchi, Francesco, Casti, Francesco, Coratti, Francesco, Ferrara, Francesco, Floris, Francesco, Izzo, Francesco, Maffei, Francesco, Palmieri, Francesco, Pata, Francesco, Porcelli, Francesco, Selvaggi, Francesco, Velluti, Francesco, Mulita, Francesk, Bello, Francis, Caiquo, Francis, Dossou, Francis, Eshun, Francis Junior, Opoku Twene, Francis, Tierenye, Francis, Quayson, Francis William, Romo Rosales, Francisco David, Ibañez Ortiz, Francisco, León Frutos, Francisco Javier, Redondo Calvo, Francisco Javier, Silva Rivera, Francisco Javier, Barbosa Camacho, Francisco José, Bujalance Cabrera, Francisco Manuel, Ruescas, Francisco, Irakiza, Franck Fanon, Corvatta, Franco, Pascual, Franco Raúl, Roviello, Franco, Roodt, Francois, Gyamfi, Frank Enoch, Olaniru, Frank, Owusu, Frank, Bader, Franz G., Anzinger, Franz-Xaver, Agbodo, Fred David Anku, Ris, Frederic, Agbemafoh, Frederick Mawuli, Afonso, Frederico, Nazareth, Frederico, Berrevoet, Frederik, Hounde, Fréjus, Demiral, Furkan, Hassooni, Furqan Ridha Hassooni, Kafa, Gabi, Cárdenas Rivera, Gabriel, Ntwari, Gabriel, Szydlo Shein, Gabriel, Ambriz González, Gabriela, Nita, Gabriela Elisa, Bellio, Gabriele, Moitzi, Gabriele, Urdang, Gabriella, Marom, Gad, Gallo, Gaetano, Luglio, Gaetano, Poillucci, Gaetano, Singh, Gagandeep, Saletta, Gaia, Abouelnagah, Galal, Yarovenko, Galina, Kazobinka, Gallina, Ahmed, Gamal Mutwakil Gamal, Rahman, Ganiyu Adebisi, Smith, Garett, Pillai, Gargi, Saxena, Garima, Gbessi, Gaspard, Nkunguzi, Gaston, Jalal, Gaurav, Chillarge, Gauri, Singh, Gautam, Mevognon, Gedeon, Getachew, Gedion, George, Gejoe, De La Peña González, Gema, Martínez Izquierdo, Gema, Grande, Gennaro, Birikorang, Geoffrey, Weber, Georg F., Singer, Georg, Ansong, George, Bashour, George, Brown, George Darko, Hneino, George, Kavalieratos, George, Kenchadze, George, Nagy, George, Pappas Gogos, George, Skroubis, George, Waiyaki, George, Cox, Georgia, Zeringa, Georgia, De Wee, Georgin, Hart, Georgina, Bekakos, Georgios, Fragulidis, Georgios, Kapogiannatos, Georgios, Karakaidos, Georgios, Kokkinos, Georgios, Kostoulas, Georgios, Koukoulis, Georgios, Peros, Georgios, Rados, Georgios, Tsoulfas, Georgios, Verras, Georgios-Ioannis, Berger, Geraint, Adoro, Gerard Ayuka, Chamoso Mialdea, Gerardo, Palmieri, Gerardo, Procaccini, Gerardo, Steenkamp, Gerhard, Viscido, Germán Rodrigo, Dajti, Gerti, Alemayehu, Getachew, Seyfu, Gezachew, Birqeeq, Ghada, Alsheikh, Ghadeer, Alrayyes, Ghaith, El Hunjul, Ghalib Nashaat, Zaza, Ghayath, Matroud, Ghazlah, Alhadwah, Ghena, Maltinti, Gherardo, Awais, Ghina, Shamsi, Ghina, Calini, Giacomo, Carganico, Giacomo, Zanus, Giacomo, Canu, Gian Luigi, Mendiola, Gian, Ibero Casadiego, Giana Pamela, Cocorullo, Gianfranco, Baronio, Gianluca, Pellino, Gianluca, Zanni, Gianluca, Poto, Gianmario Edoardo, Gravante, Gianpiero, Aduroja, Gideon, Almogy, Gidon, Bond-Smith, Giles, Natchagande, Gilles, Bechara, Gio, Brachini, Gioia, Riccioli, Giordana, Ercolani, Giorgio, Farris, Giorgio, Giraudo, Giorgio, Mammolo, Giovanna, Pavone, Giovanna, Sgarzini, Giovanna, Aprea, Giovanni, Fonsi, Giovanni Battista, Boroni, Giovanni, De Angeli, Giovanni, De Palma, Giovanni Domenico, Emiliani, Giovanni, Grava, Giovanni, Guercio, Giovanni, De Carlo, Giulia, Del Corpo, Giulia, Duranti, Giulia, Galatioto, Giulia, Grassi, Giulia, Graziano, Giulia, Marini, Giulia Maria Francesca, Munzi, Giulia, Tarantino, Giulia, Borda-Luque, Giuliano, Pellicano', Giuseppe Antonino, Canonico, Giuseppe, Carollo, Giuseppe, Ietto, Giuseppe, Palomba, Giuseppe, Pascarella, Giuseppe, Salamone, Giuseppe, Sica, Giuseppe, Sorrentino, Giuseppe, Orlando, Giuseppina, Pignata, Giusto, Pisarevi, Givi, Akcakoca, Gizem, Owusu, Godfred, Yohanna Abrak, Godwin, Kurtoglu, Gokalp Kagan, Kurtoglugk, Gokalp Kagan, Alıcı, Gökhan, Kurtoglu, Goktug Mert, Delgado Hernandez, Gonzalo, Augustin, Goran, Bhat, Gowhar Aziz, Sundaram Venkatesan, Gowtham, Chang, Grace, Eke, Grace, Lee, Grace, Massarra, Grace, Travaglini, Grazia, Scialandrone, Grazisa, Stavrou, Gregor A., Di Franco, Gregorio, Charalambous, Gregory, Christodoulidis, Gregory, Kouraklis, Gregory, Goodwin, Gregory Richard, Devidze, Grigol, Fialho, Guilherme, Santos, Guilherme, Cabezudo, Guillermo, García-Santos, Guillermo, Pou, Guillermo, Romero Reyna, Guillermo, Yanowsky-Reyes, Guillermo, Ozyuksel, Gul, Karadeniz Cakmak, Guldeniz, Kucuk, Gultekin Ozan, Bulbuloglu, Guney Cem, Sarp, Guray, Kaur, Gurleen, Nibogora, Guy Darcy, Hamdan, Gymar, Ogundipe, Habeeb, Yunes, Habib, Ayesh, Hadeel, Al Atassi, Hadi, Jalilehvand, Hadis, Masalma, Hafez, Jafarkhan, Hafis, Shahid, Hafiz Huzaifa, Younus, Hafsa, Al-Derume, Hail, Shames, Haitam, Mimouni, Haithem Ahmed, Aldare, Hajar, Odah Bashi, Hajar Omar, Abusnina, Hajer, Altounsi, Hajir, Qayum, Hajra, Baysal, Hakan, Bolukbasi, Hakan, Yigitbas, Hakan, Alkhatib, Hala, Afzal, Haleema, Mftah, Halima, Oyinlola, Halimah, Tümer, Haluk, Dolo, Hamadoun, Braham, Hamdi, Ozsahin, Hamdi, Abu-Arish, Hamdoon, Al-Aamri, Hamed, Fadlalmola, Hammad Ali, Abu Obead, Hamza, Al-Fahel, Hamza, Al-Zoubi, Hamza, Asaad, Hamza, Ejaz, Hamza, Jaber, Hamza, Bhatti, Hamza Waqar, Mohammadi Sardoo, Hamzeh, Farhat, Hana, Idheiraj, Hanadi, Zwaraa, Hanady, Al Sohabi, Hanan, Basharat, Hanan, Said, Hanan, Al-Abdallat, Haneen, Foad, Haneen, Daaboul, Hanen, Al Qadhi, Hani, Elhallaq, Hani, Alhusaini, Hanin, Lidbetter, Hannah, Reilly, Hannah, Moya- Ambriz, Hannia Betzabeth, Lederhuber, Hans, Fehrer, Hans-Jörg, Xiao, Haotian, Iswariah, Harish, Kaur, Harmeena, Cheema, Harnoor Kaur, Foda, Haroun, Chauhan, Harpreet, Kaur, Harpreet, Sagar, Harry, Unwin, Harry, Kaur, Harsharan, Panga, Harshavardhan, Gupta, Harshit, Prabhakar, Harshit Kumar, Anand, Harshitha, Pahwa, Harvinder Singh, Abbadi, Hasan, Amoudi, Hasan, Zaini, Hasan Hadi Zaini, Škiljo, Hasan, Miyasika, Hasangi, Altabbaa, Hashem, Haj Freej, Hasn, Abdelazim, Hassan, Habiba, Hassan, Kamal, Hassan, Sabir, Hassan, Zaigham, Hassan, Pehlivan, Hatice, Telci, Hatice, Abuobaida, Hayat, Tetley, Heather, Taher, Heba, Aguado López, Héctor, Askarpour, Hedyeh, Sherif Farouk Ahmed Hassan, Heidi, Devesa, Helena, Arbogast, Helmut, Nuñez Del Barrio, Henar, Abiyere, Henry, Delacave, Henry, Rice, Henry E., Pleass, Henry, Bradly, Hera, Islam, Heraa, Lule, Herman, Abozied, Hesham, Le Roux, Hettie, Hamdar, Hiba, Yaghmour, Hiba, Bileid Bakeer, Hibah, Al Miskry, Hilal, Ulman, Hilmican, Abdoun, Hind, Essalim, Hind, Yonekura, Hiroshi, Kato, Hiroyuki, Amin-Tai, Hizami, Kynaston, Holly, Pérez Baca, Honorio De Jesús, Irfan Khan, Hoor, Amir, Hosam, Elghadban, Hosam, Elfeki, Hossam, Wain, Howard, Adjei, Hubert, Dąbrowski, Hubert, Novák, Hubert, Alzuhd, Huda, Capote, Hugo, Gomez-Fernandez, Hugo, Stark, Hugo, Willy-Chidire, Hulda, Aouagbe Behanzin, Hulrich, Oneizah, Humam M.A., Dalati, Husam, Ebied, Husam, Mahajna, Husam, Ahmad, Husnain, Altawati, Husni, Adi, Hussam, Albalawi, Hussam, Alfakeer, Hussein, Embarek, Hussein, Ibrahim, Hussein, Malkawi, Hussein, Ekwuazi, Hyginus, Psilopatis, Iason, Wasiu, Ibitowa, Kereet, Ibraheem M., Suleiman, Ibrahem, Fortune, Ibrahim, Aburumman, Ibrahim, Adel, Ibrahim, Adham, Ibrahim, Ali, Ibrahim, Arnaout, Ibrahim, Çakır, Ibrahim, Suleiman, Ibrahim Eneye, Fagiri, Ibrahim, Hajmohammed, Ibrahim, 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Bertrand, Martin, Dum, Martin, Kajic, Martin, Karamanliev, Martin, Kyereh, Martin, Lucchini, Martin, Schön, Martin, Morna, Martin Tangnaa, Binda, Martina, Ceolin, Martina, Martorana, Martina, Zambon, Martina, Shams, Marvi, Alansary, Marwa, Alnuwayli, Marwa, Khalifa, Marwa, Bahnacy, Marwan, Iqreewi, Marway, Nnabagulanyi, Mary, Saleem, Marya, Alhimyar, Maryam, Kamal, Maryam, Masood, Maryam, Razaq, Maryam, Siddique, Maryam, Lazo Ramírez, Maryzela, Edeeb, Masaoud, Solkar, Maseera, Adetoyi, Mashood, Adeniyi, Caccetta, Massimiliano, Casati, Massimiliano, Veroux, Massimiliano, Dugo, Massimo, Bevanda, Mateo, Santillan, Mateo, Mietła, Mateusz, Pryt, Mateusz, Muir, Mathew, Bei, Matilda, McGuinness, Matt, Aulicino, Matteo, Castrovillari, Matteo, Filardo, Matteo, Palmeri, Matteo, Pisano, Matteo, Rottoli, Matteo, Gjoka, Mattheus, Binks, Matthew, Corcos, Matthew, Kwon, Matthew, Maybury, Matthew, Sammut, Matthew, Tutton, Matthew, Watson, Matthew, Biebl, Matthias, Janda, Matthias, Maak, Matthias, Wichmann, Matthias, Berselli, Mattia, Gritti, Mattia, Molteni, Mattia, Pacilli, Maurizio, Favoriti, Mauro, Garino, Mauro, Podda, Mauro, Santarelli, Mauro, Alfaid, Mawada, Albert, Mawadri Jimmy Isaac, Oyortey, Mawuenyo Attawa, Enßlin, Max, Berlet, Maximilian, Brunner, Maximilian, Kießler, Maximilian, Scheiterle, Maximilian, Sohn, Maximilian, Busch, Maximiliane, Perkins, Maya, Sabboh, Maya, Badkur, Mayank, Okudero, Mayowa, Mohamedshafee, Maysoon, Al-Juaifari, Maytham Aqeel, Elesseily, Mazen, Mohammad, Mazen, Nikberg, Maziar, Jean Claude, Mbonicura, Şermet, Medeni, Chisthi, Meer, Luthra, Meera, Sulciner, Megan, Kaple, Meghali, Bhat, Meghana, Koç, Mehmet Ali, Avci, Mehmet Alperen, Kizilkaya, Mehmet Celal, Kara, Mehmet Emin, Ozcelik, Mehmet Faik, Ozsoy, Mehmet Sait, Zaigham, Mehreen, Mesfin, Mekdelawit, Kalender, Mekselina, Mellado Tellez, Mel Paul, González De Miguel, Melania, Farrugia, Melanie, Theodoridou, Melanie, Barcelona, Melden Darrell, Aktas, Melik Kagan, Fernández Zurita, Melissa Andrea, Bautista, Melissa, Park, Melissa, Rodríguez-Ordoñez, Melissa-Zohemia, Yashar, Meltem, Worku, Mengistu, Al-Fraijat, Meran, Estaire Gómez, Mercedes, Shoshkova, Meri Danailova, Kruščica, Merima, Tanal, Mert, Çuhadar, Merve, Tokocin, Merve, Agyapong, Meshach Manu, Erkaya, Metincan, Okechukwu, Mgbako, Adinku, Michael, Bickford, Michael, Ediale, Michael, Issa, Michael, Konstantinidis, Michael K., Lie, Michael, M. Nathan, Michael, Maclean, Michael, Nortey, Michael, Pellen, Michael, Pham, Michael, Pitiakoudis, Michael, Singh, Michael Prodip, Spartalis, Michael, Van Der Colf, Michael, Wilson, Michael, Billis, Michail, Karanikas, Michail, Papamichail, Michail, Vailas, Michail, Kisielewski, Michał, Kusiński, Michał, Nycz, Michał, Święch, Michał, Fagbayimu, Micheal, Adamina, Michel, Fiogbe, Michel, Prudhomme, Michel, Angelucci, Michela, Campanelli, Michela, Cricrì, Michele, Grande, Michele, Manigrasso, Michele, Scopelliti, Michele, George, Michelle, Mozel, Michelle, Galasyuk, Mick, Chevallay, Mickael, Giuliano, Micol, Dobón Rascón, Miguel Ángel, Fernandez Romero, Miguel Angel, García Ureña, Miguel Ángel, Zaragoza Mendieta, Miguel Ángel, Bejarano Serrano, Miguel, Brito, Miguel, Calderon, Miguel, Jurado Román, Miguel, Palas, Miguel, Li Valencia, Miguel Roberto, Sebastián-Mendoza, Miguel-Julián, Muresan, Mihai-Stefan, Slavchev, Mihail, Agapov, Mikhail, Milentijević, Milica, Catterall, Millie, Stjepanovic, Milos, Doss, Mina, Natey, Mina, Aikins, Minas, Mattis, Minca, Ekanayake, Minoli Tharushika, Tora, Mir Mehrab Sharmin, Alsharayri, Mira, Shalaby, Mira, Boras, Miran, Riba Martínez, Mireia, Mogiatti, Mirella, Salibašić, Mirhan, Biancu, Miriam, Cappiello, Miriam, Koschke, Miriam Luise, Sadek, Mirna, Szura, Miroslaw, Horga, Miruna, Dason, Mishael, Tayyab, Mishal, Imirski, Mitko, Pejović, Mladen, Tabaza, Mo'Ath, Alneasan, Moaaz, Shalkamy, Moamen, Issa, Moammad Issa, Erfan, Moatasem, Ewedah, Moataz, Srour, Moayad, Beletachew, Moges, Abbas, Mohamad, Farho, Mohamad Ali, Marawy, Mohamad Kher, Klib, Mohamad, Morjan, Mohamad, Sawas, Mohamad Nabhan, Elghriani, Mohamed Abdelbaset Masoud, Abdelmaboud, Mohamed, Abdelmaksoud, Mohamed, Abdullahi, Mohamed, Abo Abdo, Mohamed, Ahmed, Mohamed, Ahmoud, Mohamed, Al Sayed, Mohamed, Suliman, Mohamed Almouafaq, Alsori, Mohamed, Altajouri, Mohamed, Assalhi, Mohamed, Berrakkouch, Mohamed, Elnour, Mohamed, Abdelsalam, Mohamed Elsayed Elaraby Abdelrahim, Elsayed Metwally, Mohamed, Hajalamin, Mohamed, Kamal Matter, Mohamed, Khaled, Mohamed, Kouta, Mohamed, Masoud, Mohamed, Almihashhish, Mohamed Miftah, Mokhtar, Mohamed, Mostafa, Mohamed, Yassin, Mohamed Musa, Bouhafs, Mohamed Nedjmeddine, Herdan, Mohamed Omar, Omer, Mohamed, Osman, Mohamed, Zaazou, Mohamed, Zahed Abdalla, Mohamed, Melouane, Mohamed-Sami, Abed, Mohammad, Sawaftah, Mohammad Ahmad Mohammad, Al-Masri, Mohammad, Al-Qannas, Mohammad, Ali-Hassanzadeh, Mohammad, Yunus, Mohammad Alif, Aloulou, Mohammad, Alrantisi, Mohammad, Araydah, Mohammad, Bani Hani, Mohammad, Barakat, Mohammad, Durrani, Mohammad, Khan, Mohammad Faisal, Dwikat, Mohammad Fuad, Hasan, Mohammad, Nabhan, Mohammad Hassan, Hijazi, Mohammad, Abu Albahrain, Mohammad Karam, Barakat, Mohammad Mounzer, Mubarak, Mohammad, Omar, Mohammad, Pourfridoni, Mohammad, Mslmani, Mohammad Rabee, Salah, Mohammad, Tanashat, Mohammad, Yahmad, Mohammad, Elmujtaba, Mohammed, Abd Al-Fattah, Mohammed, Abdelkabir, Mohammed, Abosedra, Mohammed, Sarker, Mohammed Abu Kawsar, Abudabbous, Mohammed, Abuwarda, Mohammed, Elgak, Mohammed Ahmed, Al Hinai, Mohammed, Al Zebda, Mohammed, Al-Shehari, Mohammed, Alharthi, Mohammed, Ali, Mohammed, Ismael Alamin, Mohammed Ali, Alqadasi, Mohammed, Alshanwani, Mohammed, Alshehri, Mohammed, Asaad, Mohammed, Bashir, Mohammed, Bohlala, Mohammed, Meghaizerou, Mohammed El Amine, Albanna, Mohammed Emad Hashem, Ghunaim, Mohammed, Goga, Mohammed, Hajhamad, Mohammed, Hamada Takrouney, Mohammed, Hammoda, Mohammed, Hamoud Almahly, Mohammed, Muragi, Mohammed, Mohammed, Mohammed Mustafa Hassan, Obaid, Mohammed, Omar, Mohammed, Said, Mohammed, Salah, Mohammed, Saleh Khatab, Mohammed, Aliyu, Mohammed Salele, Shakhshir, Mohammed, Sheriff, Mohammed, Tageldin, Mohammed, Abdelfattah, Mohanad, Daher, Mohanad, Lotfy, Mohanad, Alqedrh, Mohannad, Nasani, Mohannad, Mohd Shah, Mohd Shahrulsalam, Madany, Mohie El-Din Mostafa, Mobolaji-Ojibara, Mojisola, Nkogatse, Moleseng, Alazabi, Mona, Gupta, Money, Bogdan, Monica, Guerrero, Monica, Noguez Castillo, Monica, Gureh, Monika, Kacem, Montasser Jamaleddine, Tarar, Moosa Feroze, Seto, Morel, Steinruecke, Moritz, Edena, Morrison, Abdulsalam, Moruf, Abdelhadi Suliman Adam, Mosab, Saleh, Mosab, Anati, Mosaikah, Dokurugu, Moses Abdulai, Agunloye, Moses, Ibadin, Moses, Momoh, Moses, Abdelkarim, Mostafa, Kamar, Mostafa, Kotb, Mostafa, Mahran, Mostafa, Mohamad Amin, Mostafa, Shalaby, Mostafa, Waseem, Mostafa, Almaletti, Motasem, Saifi, Motaz, Tsuruta, Motohisa, Agbadebo, Mouhamed, Arnaout, Moumen, Ojo, Moyosoluwa, Sharma, Mrthyunjayani, Azzuz, Muad Mohamed Ramadan, Haj Hussein, Mudar, Ameen, Muftiat Omolola, Nkoronko, Mugisha, Fitri, Muhamad, Abdullah, Muhammad, Bashir, Muhammad Ahmad, Sadiq, Muhammad Ahmad, Ahmed, Muhammad, Ali, Muhammad, Al-Yusuf, Muhammad Ali, Haider, Muhammad Aliyan, Alshaar, Muhammad, Mirza, Muhammad Bilal, Che Yaacob, Muhammad, Daniyan, Muhammad, Elzayat, Muhammad, Butt, Muhammad Faizan, Sadiq, Muhammad Hamza, Chishti, Muhammad Haris, Ismail, Muhammad Izzat Shufphi, Kashif, Muhammad, Khalid, Muhammad, Mansoor Iqbal, Muhammad, Bin Khalid, Muhammad Moaz, Rafique, Muhammad Nouman, Raheem, Muhammad, Khalid, Muhammad Saud, Usama, Muhammad, Usman Malik, Muhammad, Saqib, Muhammad Waleed, Elhadi, Muhammed, Ateş, Muhammed Ikbal, Demirpolat, Muhammed Taha, Ergenç, Muhammer, Bello, Muideen, Kulimbet, Mukhtar, Nyirenda, Mulinda, Taeme, Mulugeta, Denini, Muna, Aziz, Munazzah, Yahaya, Mundashiru, Eugene, Muneza, Amadu, Munira, Chauhan, Munish, Acar, Murat, Teressa, Murti, Dauphin, Muryango, Arafat, Musa, Althomali, Musab, Rayzah, Musaed, Husain, Musharraf, Tolani, Musliu Adetola, Abu Jayyab, Mustafa, Al-Attraqchi, Mustafa, Kara, Mustafa Alper, Seker, Mustafa Ege, Gün, Mustafa, Hamed, Mustafa, Mehanny, Mustafa, Oncel, Mustafa, Sabri Massadi, Mustafa, Uyanik, Mustafa Safa, Uzunoglu, Mustafa Yener, Abdullahi, Mustapha, Saidani, Mustapha, Nofal, Mutaz, San, Myat, Ishak, Myrna, Keramida, Myrto D., Nik Burhanuddin, N.M. Syahrin, Talat, Nabila, Shehata, Nada, Alasbahi, Nadeen, Marcos, Nádia, Al Amri, Nadiah, Absy, Nadine, Parker, Naeelah, Lindi, Naeimah, Omer, Nafisa, Papadogianni, Nafsika, Rawal, Nagendra, Ismaiel, Nahar, Ben Hasan, Najat, Albahloul, Najla, Gokhare Viswanath, Nakul, Srinivas, Namitha, Christian, Nana Ama, Obuobi, Nana Kwame Asare, Beharry, Naomi, Yousefzadeh Kandevani, Naser, Alnamari, Nashwan, Oyelowo, Nasir, Oloko, Nasirudeen, Alzerwi, Nasser, Mosbah, Nasser, Shulman, Nastassia, Andrade, Natacha, Boumas, Natacha, Cobeño Tamayo, Natalia, Barrera Lopez, Natalia Guadalupe, Palamara, Natalia, Blencowe, Natalie, Marzouqa, Natalie, Blencowe, Natalie S, Salgadoe, Natalie, Techapongsatorn, Nathakorn, Paez, Nathaly, Ekwo, Nathan, Saini, Navdeep, Malik, Naveed Akhtar, Sharma, Naveen, Kumar, Navin, Chaudhry, Navneet Kumar, Karimbocus, Nawaaz, Rasool, Nazeerah, Lodhi, Nazia, Kavak, Nazli, Ildephonse, Ndayiragije, Diomede, Nduwimana, Bayleyegn, Nebiyou S., S.Bayleyegn, Nebiyou, Jović, Nediljko, 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Nikolaos, Memos, Nikolaos, Michalopoulos, Nikolaos, Mathioudakis, Nikolaos Nestor, Roukounakis, Nikolaos, Stamos, Nikolaos, Tasis, Nikolaos, Tsakiridis, Nikolaos, Vlachakos, Nikolaos, Zampitis, Nikolaos, Kouzakos, Nikolas, Börner, Nikolaus, Dimitriou, Nikoletta, Dafnios, Nikos, Banerjee, Niladri, Klammer, Nils, Maharjan, Nima, Rabai, Nimah, Oscar, Nimpaye, Harrison, Nina, Kheyrbek, Nina, Kansakar, Nirajan, Bhat, Nisar, Krishnappa, Nischal, Pahuja, Nisha, Paul Ambrose, Nitin, Renovat, Niyongabo, Musawa, Nizar, Nwanne, Njideka, Steve, Nkurunziza, Chidumije, Nnaemeka, Nwafulume, Nnaemeka, Celestine, Nnamani, Duru, Nnamdi, López Bernal, Noelia Esthela, Laquatra, Noemi, Pasqua, Noemi, Awwad, Noor Al-Deen, Ali, Nora, Hielscher, Nora, Trabulsi, Nora, Hüser, Norbert, Muñoz Montes, Norberto, Eshak, Norma-Sol, Rajab, Nosaiba, Lahnaoui, Nouhaila, Ouachou, Nouhaila, Ali, Nour, Dadoush, Nour, Fazili, Noureen, Theophile, Ntahompagaze, Ntanzi, Ntuthuko, Bibila, Nubia Samuel, Alwaer, Nuhay, Naabo, Nuhu, Jiagge, Nuna, Freitas Oliveira, Nuno Miguel, Pratas, Nuno, Morricone, Nunzia, Franco, Nunzio Francesco, Binti Yusri, Nur Aima, Ramli, Nur Natasya, Abd Ghani, Nur Suriyana, Umar, Nura, Aly, Nuran Khaled, Lakhanov, Nurgali, Al-Hroub, Nurhan, Kiziltoprak, Nurhilal, Chavarrias, Nuria, Maulenov, Nurlan, Akinbami, Nurudeen, Abdulraheem, Nurudeen Toyin, Karunaratne, Nuwanthika, Jeannette, Nyiransabiyera, Altobaishat, Obieda, Egwuonwu, Ochonma Amobi, Enciu, Octavian, Cohen-Arazi, Oded, Pheiffer, Odette, Okoye, Odili Aloysius, Omoike, Ofure, čančar, Ognjen, Ekwunife, Okechukwu Hyginus, Emuze, Okundayo, Eljizoly, Ola Abdallah, Al Hamdani, Ola, Emadeldeen, Ola, Morgan, Ola, Olajumoke, Oladapo, Popoola, Olakunle, Ajiboye, Olalekan, Olasehinde, Olalekan, Jolayemi, Olamide, Babatunde, Olanrewaju, Balogun, Olanrewaju, Olajide, Olawumi, Lisin, Oleg, Bellou, Olga, Jurić, Oliver, Ladlow, Oliver, Whitehurst, Oliver, Camilleri, Olivia, Montaño Angeles, Olivia, Pryer, Olivia, Ray, Olivia, Gabom, Olivier, Ndizeye, Olivier, Ojewuyi, Olufemi, Oluyemi, Olukayode, Elebute, Olumide, Ogunsua, Oluseyi, Fasiku, Olushola Kayode, Fasoro, Olusola, Fatudimu, Oluwafemi, Osunlusi, Oluwafemi, Owolanke, Oluwagbenga, Oso, Oluwarotimi, Alaba, Oluwaseun, Ojo, Oluwaseun, Oluseye, Oluwaseun, Oyinloye, Oluwaseun, Al Alyani, Omaima, Okrah, Omane, Agha, Omar, Al-Fahel, Omar, Almomani, Omar, Alruwaili, Omar, Ibarra, Omar, Ibrahim, Omar, Khalil, Omar, Kouli, Omar, Lima Azurdia, Omar, Mansour, Omar, Mohamed Mokbel, Omar, Omar, Omar, Bedak, Omer, Ozkan, Omer Faruk, Yalkın, Omer, Mohamed, Omnia, Ayandipo, Omobolaji, Faboya, Omolara, Williams, Omolara Modupe, Irowa, Omorodion, Attawodi, Onuche, Salako, Opeyemi, Ioannidis, Orestis, Agcaoglu, Orhan, Martin Sole, Oriol, Webster, Orla, Abouhiekal, Osama, Al Shaqran, Osama, Bahsas-Zaky, Osama, Nubi, Osama Gamal, Hany, Osama, Matar, Osama, Mahafdah, Osama R., Sarhan, Osama, Osagie, Osasumwen, Soublett Rivas, Óscar Alexander, Gülcicek, Osman Bilgin, Cuenca Torres, Osmar Manuel, Carpineto Samorani, Osvaldo, Arsalan, Othman, Coyoy-Gaitán, Otto, Nouhail, Oumaima, Boujidi, Oumama, Dicko, Ousmane A A, Ahmad, Owais, Christianah, Oyegbola, Küpçüoğlu, Özge, Zanbak Mutlu, Özgecan Pırıl, Chadha, P, Prabhu, P Santosh, Carmignani, Pablo, Arteaga Asensio, Pablo Cesar, Del Val Ruiz, Pablo, Royo Dachary, Pablo, Sancho Pardo, Pablo, Vásquez, Pablo, Sukhvibul, Pakkapol, Assouto, Pamphile, Evangelou, Panagiota, Dorovinis, Panagiotis, Kapsampelis, Panagiotis, Kokoropoulos, Panagiotis, Kostoglou, Panagiotis, Manikis, Panagiotis, Sakarellos, Panagiotis, Lykoudis, Panagis, Kumar, Pankaj, Patel, Panna, Paraskeva, Panoraia, Vassiliu, Panteleimon, Antonakis, Pantelis, De Nardi, Paola, Marongiu, Paola, Kamenova, Paolina, Venturelli, Paolina, Belotti, Paolo, Ubiali, Paolo, Grivas, Paraskevas, Stamopoulos, Paraskevas, Chatzikomnitsa, Paraskevi, Trakosari, Paraskevi, Tekam Wadje, Parfait Stéphane, Manjunath, Parikshith, Gupta, Pariza, Dhamija, Parth, Haque, Parvez, Haque, 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Omar, Yousef, Alhammoud, Yousef, Allaoua, Yousef, Tanas, Yousef, El Okazy, Youssef, Kerolous, Youssef, Mohamed, Youssef, Al-Junaidi, Youssuf, Lakdawala, Yousuf, Lu, Yuann, Asano, Yukio, Altinel, Yuksel, Aktimur, Yunus Emre, Fishman, Yuri, Kudryavcev, Yurii, Tandoğan, Yusuf Iskender, Razafimandimby, Yves Michaël, Adofo-Asamoah, Yvonne, Şenol, Zafer, Odeh, Zahra, Benamrouche, Zahra Rayane, Alkhaier, Zahraa, Al-Sheikh Ali, Zaid, Zaher, Zain Aldin, Alnajjar, Zaina, Al-Balushi, Zainab, Alkhuzaie, Zainab, Khraim, Zakaria, Toutounji, Zakaria, Djama, Zakarya, Farraj, Zamil, Shah, Zamir Ahmad, Khan, Zara, Khan, Zarnigar, Abo Alarous, Zayn Alabden, Asaad, Zaynab, Demetrashvili, Zaza, Lorenc, Zbigniew, Brekalo, Zdrinko, Hannouneh, Zein Alabdin, Robertson, Zelda, Bady, Zeyad, Durna, Zeynep, Wong, Zhen Yu, Fozo, Zien Alabdin, Klib, Zienab, Chin, Ziling, Tamou, Zime Farid, Johnson, Zina, Shabello, Ziyad, Orzeszko, Zofia, Aljalabi, Zohal, Al-Azher El-Hamel, Zohour, Karampotaki, Zoi Rafaila, Valera Sanchez, Zoraida, Matkovic, Zoran, Azhar, Zubair, Qureshi, Zubaria, Correa López, Zulema Margarita, Balciscueta, Zutoia, Musilová, Zuzana, Katusic, Zvonimir, Osama, Zyad, and Dauksa, Zygimantas
Published: 2024
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32. Bezafibrate as treatment in males for Barth syndrome: CARDIOMAN, a double-blind, placebo-controlled crossover RCT

Author: Guido Pieles, Colin Steward, Lucy Dabner, Laura Collet, Lucy Culliford, Karen Sheehan, Lucy Ellis, Michaela Damin, Eva Sammut, Nuno Duarte, Owen Burgess, Curtis Wadey, Craig Williams, John Crosby, Sarah Groves, Aidan Searle, Borko Amulic, Chris Rice, Chiara Bucciarelli-Ducci, Andrew Ness, Julian Hamilton-Shield, Chris A Rogers, and Barnaby C Reeves
Subjects: randomised controlled trial, barth syndrome, inherited cardiomyopathy, bezafibrate, placebo-controlled, mitochondrial metabolism, metabolic, rare disease, crossover, resveratrol, Medicine
Abstract: Background Barth syndrome is a rare, life-threatening X-linked recessive mitochondrial disorder of lipid metabolism primarily affecting males. Previous research suggests that bezafibrate may ameliorate cellular lipid abnormalities and reduce cardiac dysfunction in an animal model. Objectives Estimate the effect of bezafibrate on clinical, biochemical, and quality-of-life outcomes. Investigate whether within-participant clinical changes parallel in vitro changes in cardiolipin ratio/profile and mitochondrial morphology when each participant’s cells are cultured with bezafibrate. Investigate as for objective 2, culturing each participant’s cells with resveratrol. Describe the most feasible methods and standardised outcome measures to optimise the conduct of future trials and evaluations in Barth syndrome. Describe features of the research infrastructure which optimised recruitment, retention and communication with families and people with Barth syndrome. Describe the perceptions of participants and their families about the research and any important potential barriers to participation. Design Randomised, placebo-controlled, crossover trial of bezafibrate versus placebo. Setting NHS hospital providing UK-wide Barth Syndrome Service. Participants Males aged ≥ 6 years with a confirmed diagnosis of Barth syndrome with stable cardiac status, able to swallow tablets of bezafibrate/placebo. Exclusions were: hypersensitivity or allergy to bezafibrate or any component of bezafibrate; hepatic, liver or renal dysfunction; gallbladder disease; or recent deterioration in general health. Interventions Fifteen weeks of bezafibrate in one period and placebo in a second period, or vice versa (randomly allocated), with at least a 1-month washout between periods. Main outcome measures The primary outcome was peak VO2; secondary outcomes were cardiac function rest and exercise echocardiography and magnetic resonance imaging, cardiolipin ratio, quality of life, dynamic skeletal muscle P-magnetic resonance spectroscopy, mitochondrial studies and neutrophil counts, and adverse events. Outcomes were measured at baseline and the end of each period. Results Eleven males were studied; all attended all three assessments. There was no difference in peak VO2 between periods (0.66 ml/kg/min lower with bezafibrate than placebo, 95% confidence interval 2.34 to 1.03; p = 0.43). There was a trend towards a higher left ventricular ejection fraction with bezafibrate when measured by echocardiography but not magnetic resonance imaging, and better echocardiography-derived rest longitudinal and circumferential strain with bezafibrate. There was no difference in quality of life or cardiolipin ratio between periods. Skeletal muscle 31P magnetic resonance spectroscopy was performed cross-sectionally and showed a trend to higher Tau and lower Qmax indices in the bazafibrate group. Two participants had serious, expected adverse reactions when taking bezafibrate; otherwise, bezafibrate was well tolerated. Limitations The sample size was very small; the bezafibrate dose may have been too low or 15 weeks too short to observe an effect; measurements of mitochondrial content and membrane potential were highly variable; P-magnetic resonance spectroscopy was available only at the final assessment. Conclusions This study did not show significant improvement in the primary and secondary outcomes with bezafibrate treatment. Future work Elamipretide, studied in a small crossover trial in the USA, is another potential intervention which may be worth evaluating in an international study. Trial registration This trial is registered as ISRCTN58006579. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation (EME) programme (NIHR award ref: 12/205/56) and is published in full in Efficacy and Mechanism Evaluation; Vol. 11, No. 13. See the NIHR Funding and Awards website for further award information. Plain language summary Barth syndrome is a rare genetic syndrome with mutations in the tafazzin gene causing long-term effects in several organ systems, leading to significant lifelong comorbidities and a reduced quality of life. Barth syndrome shows an X-linked inheritance, hence it is almost exclusively present in males. Tafazzin gene mutations impair overall cell energy metabolism, and affected individuals show compromise of the immune system with a high risk for life-threatening infections, as well as cardiac dysfunction and cardiomyopathy, muscle and general fatigue, and generally reduced mobility also leading to psychological challenges and dysfunction. Currently, specific medical therapies are limited to symptomatic treatment, and drug therapies targeting the causative mitochondrial energy disturbance are urgently needed. This randomised controlled trial explored the use of oral bezafibrate, a licensed drug that can improve cell energy metabolism. Eleven male patients received either bezafibrate or a placebo for 4 months. Exercise capacity by cardiopulmonary exercise testing on a cycle ergometer, as the primary outcome measurement, as well as cardiac function by echocardiography and magnetic resonance imaging, and cellular anatomy and function by in vitro assays and microscopy, were measured before and after this 4-month period. Bezafibrate did not significantly improve exercise capacity, cardiac function or the cellular metabolism, although several cardiac function parameters showed slight improvements with bezafibrate treatment. No significant adverse effects were recorded. The limitations of the trial were its low participant number and the relatively short duration of the drug treatment phase. The trial did prove that complex randomised controlled drug trials are feasible in people with rare diseases. Adherence was good, with parents reporting few difficulties with pill swallowing. The qualitative interviews also found that the study was acceptable to participants and the burden of participating not too onerous. We hope the research can provide a template for future studies. Scientific summary Introduction Barth syndrome is a very rare, life-threatening, X-linked recessive genetic disease almost exclusively affecting young males, caused by abnormal lipids in mitochondria. The tafazzin gene (TAZ) encodes tafazzin, a phospholipid acyltransferase. Tafazzin transfers unsaturated fatty acids with acyl chains from phospholipids to monolysocardiolipin (MLCL) and regulates remodelling and maturation of cardiolipin, a phospholipid located exclusively in the inner mitochondrial membrane. Mature tetralinoleoyl-cardiolipin (L4-CL) is essential in the mitochondrial membrane for maintaining mitochondrial membrane potential, structural integrity of electron transport chain complexes and mitochondrial cristae architecture. Cardiolipin is a major constituent of inner mitochondrial membranes, and the major effects of the aberrant gene are on muscular tissues. Cardiac and skeletal manifestations of Barth syndrome are thought to result from impaired formation of respiratory chain super-complexes. TAZ mutations decrease L4-CL and increase intermediate species of MLCL, resulting in a marked increase in the MLCL : L4-CL ratio, which provides a highly sensitive and specific biochemical test for Barth syndrome. Barth syndrome is characterised by many gene mutations and profound phenotypic variability between affected patients within families and those in different families. The disease carries many risks and problems for its sufferers, as well as major healthcare costs. Almost one-third (30%) of living UK patients have undergone cardiac transplantation. Several patients who have died due to cardiac rejection or post-transplant lymphoproliferative disease had previously undergone cardiac transplantation. Other patients who have died deteriorated too fast to undergo transplantation or died of complications while awaiting transplantation. Neutropenia is another life-threatening issue. Two-thirds of UK patients are treated with granulocyte colony-stimulating factor by subcutaneous injection. Managing neutropenia in this disease is challenging, since patients have highly variable neutrophil counts, which prevents administration of a consistent daily dose and requires repeated blood counts and physician oversight. Exercise intolerance, lethargy and fatigue are universal, interfering with daily life, schoolwork and play and often necessitating use of a wheelchair. Patients cannot perform strenuous or demanding jobs. Many have major feeding problems from infancy through to adult life; for example, requiring feeding via gastrostomies. There can be rapid deterioration during periods of stable health despite expert medical care. Ventricular arrhythmia (tachycardia or fibrillation) affects 10% of adolescents and can cause sudden cardiac death at any time. There are no specific treatments for Barth syndrome. There is no evidence that standard medications for cardiomyopathy ameliorate long-term poor outcomes. Treatment is multidisciplinary and currently limited to treating intercurrent bacterial infections, bone marrow support, physiotherapy, nutritional support, management of heart failure and arrhythmia, and consideration for heart transplantation. Experiments using lymphoblasts from patients with Barth syndrome show that either bezafibrate or resveratrol can partially normalise the deranged cardiolipin ratio. This may be important, since some patients with Barth syndrome who lack neutropenia and tend to have good exercise tolerance have cardiolipin ratios intermediate between those of typical patients and normal individuals. Bezafibrate also improved left ventricular function and showed other benefits at supraphysiological doses in a TAZ knockdown mouse model. This trial was motivated by the need for disease-specific therapy to prevent morbidity, mortality, psychological distress, and disruption of quality of life (QoL) in affected patients and their families. An effective therapy also has the potential to generate savings for the NHS. Bezafibrate is a lipid-lowering drug used in adults and children, with a good safety record in long-term use. These characteristics made it a candidate for investigation. Bezafibrate has been reported to significantly ameliorate a mitochondrial myopathy in adults and shown promising results in several animal/human cellular models of mitochondrial disease. Several of the laboratory assays and clinical investigations proposed in this study were also considered potentially important beyond the scope of this specific study, to assess associations between genotype and phenotype and for future evaluations of therapies in Barth syndrome. Objectives Estimate the effect on clinical, biochemical and QoL outcome measures of bezafibrate compared to placebo. Investigate whether clinical improvements parallel in vitro changes in cardiolipin ratio and mitochondrial morphology in each participant’s cells when cultured with bezafibrate. Investigate whether clinical improvements and culture findings with bezafibrate parallel in vitro changes in each participant’s cells when exposed to resveratrol in laboratory culture. Describe the most feasible methods and standardised outcome measures for future trials. Describe features of the research infrastructure which optimised recruitment, retention and communication with participants and families. Describe participants’ and their families’ perceptions of research and important potential barriers to participation. Methods Study design and participants CARDIOlipin MANipulation trial (CARDIOMAN) was a double-blind, placebo-controlled crossover randomised trial. Treatment was given in two 15-week periods with a minimum of 1 month’s washout period between these when no treatment was given. Twenty-six males and one female with the disease were alive in the UK when the trial was designed. Males aged ≥ 6 years in the UK diagnosed with Barth syndrome were eligible. Exclusion criteria were: hypersensitivity to bezafibrate or component of the investigational medicinal product (IMP), photoallergic or phototoxic reaction to fibrate, unstable cardiac condition, cardiac chamber shortening fraction < 25% or significant decrease in shortening fraction in the preceding year, atrial or ventricular arrhythmia not stabilised by treatment, inability to swallow the IMP, hepatic dysfunction, renal impairment (creatinine clearance < 90 ml/min), gallbladder disease, recent unspecified significant deterioration in general health, prisoners and adults lacking capacity to provide informed consent. Randomisation and masking Participants were randomised to receive either bezafibrate then placebo, or the reverse order. Allocations were generated in advance by the Bristol Trials Centre and provided to the trial pharmacy which dispensed the IMP. All investigators, members of the research team (apart from pharmacy) and participants remained blind to treatment allocation. Intervention and procedures The intervention IMP was bezafibrate taken orally as 100-mg tablets. Children aged 6–9 years started on 100 mg once daily for the first 4 weeks and, if well tolerated, increased to 100 mg twice daily for the remaining 11 weeks. Children aged 10–17 years started on 200 mg once daily for the first 4 weeks and, if well tolerated, increased to 200 mg twice daily for the remaining 11 weeks. Adults (≥ 18 years) took 200 mg twice daily throughout. The comparator IMP was placebo taken orally as visually identical tablets and manufactured to be as similar as possible in taste and smell to the intervention. The IMP was prescribed at the start of the first period and again at the end of the first period for the second period. Outcomes All in vivo outcomes except magnetic resonance spectroscopy (MRS) were assessed three times: at baseline and in the final week of each treatment phase. The primary outcome measure was peak oxygen consumption on bicycle ergometry [peak volume of oxygen (VO2)]. Secondary outcomes were: MLCL/L4-CL ratio and cardiolipin profile in blood cells; phosphocreatine (PCr)/adenosine 5’ triphosphate (ATP) ratio in cardiac muscle on 31P MRS; skeletal muscle oxidative function/on 31P MRS; QoL [age-appropriate Pediatric Quality of Life Inventory (PedsQLTM) questionnaires]; absolute neutrophil count; amino acid expression (serum arginine and cysteine); cardiac function [left and right ventricular function: left ventricular ejection fraction (LVEF%), right ventricular ejection fraction (RVEF%); and 2-D longitudinal and circumferential strain at rest, peak exercise and after recovery]; mitochondrial size and number in lymphocytes; mitochondrial area in lymphocytes and as a proportion of cytoplasm area; mitochondrial function and cristae organisation in lymphocytes/neutrophils; arrhythmia profile from 12-lead electrocardiogram at rest and during exercise. Qualitative research methods explored participants’ and families’ experiences of the different interventions. Adverse events Serious adverse events (SAEs) and non-serious adverse events (AEs) were collected from participants from the time of consent until 1 month after the final period. Participants’ general practitioners were asked to inform the research team of suspected AEs. Participants were asked questions about SAEs/AEs at each research clinic visit and in monthly phone calls, including during the washout period. SAEs were reviewed by the Chief Investigator, who decided whether the SAE was related to bezafibrate. Statistical analysis A total of 20 males aged ≥ 6 years were potentially eligible. The sample size was dictated by the number of eligible boys willing to take part. The primary analysis estimated the difference in mean peak VO2 between placebo and bezafibrate periods (two-tailed 5% significance level). A sample size of 12 participants allowed the trial to detect a difference of 0.90 (within subject) standard deviations with 80% power. The statistical analysis plan (SAP) prespecified that all analyses should be conducted according to the intention-to-treat (ITT) principle. The ITT population comprised all participants and periods, according to the randomised allocations. The safety population comprised all randomised participants, according to the treatment received in each period, who received at least one dose of IMP. All statistical tests were two-sided and used a 5% significance level, except for interactions that used a 10% significance level. Treatment effects were estimated with 95% confidence intervals (CIs). No formal adjustment was made for multiple testing. The treatment effect for the primary outcome was analysed using mixed linear regression models, adjusting for period (fixed effect; exploring interactions where necessary) and participants (random effects). Model assumptions were tested using standard methods, and the carry-over effect was estimated by including treatment order. Treatment effects for continuously scaled secondary outcomes (prespecified in the SAP) were estimated and tested using the same methods. Results There was no statistically significant difference between bezafibrate and placebo in peak VO2, which was 0.66 ml/kg/min lower (95% CI −2.34 to 1.03; p = 0.43) with bezafibrate. There was a borderline statistically significant increase in LVEF% using echocardiography (3.72%, 95% CI −0.26% to 7.69%; p = 0.065) but no evidence of a difference when using magnetic resonance imaging (MRI) (0.15%, 95% CI −3.21% to 3.51%; p = 0.926). There was also no difference for RVEF% between bezafibrate and placebo (0.32, 95% CI −2.32 to 2.96; p = 0.801). Longitudinal and circumferential strain at rest were better (lower) with bezafibrate than with placebo; differences were –1.67 (95% CI −3.11 to −0.22; p = 0.026) and −2.72 (95% CI −5.03 to −0.40; p = 0.024) respectively. There was no difference in diastolic ratio at rest between bezafibrate and placebo, and no differences in strain or diastolic ratio at peak exercise or after 2 minutes’ recovery. All participants had sinus rhythm at rest and during exercise for all three time points. Magnetic resonance spectroscopy was only performed after the second period for 10 participants. PCr/ATP ratio in cardiac muscle was not collected. Cross-sectionally (five vs. five participants), MRS appeared to increase Tau and reduce Qmax parameters with bezafibrate compared to placebo. Monolysocardiolipin/L4-CL ratio did not differ between bezafibrate and placebo but deteriorated in the second period (20% higher, 95% CI 3% to 40%; p = 0.024). Neutrophil count also showed no difference between bezafibrate and placebo but increased in the second period (2.26, 95% CI 0.08 to 4.45; p = 0.043). Plasma cysteine increased with bezafibrate (32% higher, 95% CI 8% to 62%; p = 0.001) but plasma arginine did not (25% higher, 95% CI −10% to 72%; p = 0.180). Mitochondrial outcomes on blood samples did not show marked differences and were not formally compared. Quality-of-life scores were transformed to a 0–100 scale (higher being better). Bezafibrate had no effect on core (−3.41, 95% CI −8.67 to 1.86; p = 0.192) or fatigue (1.71, 95% CI −6.28 to 9.71; p = 0.659) QoL scores. Emerging themes identified in qualitative interviews were classified as overarching, related to lived experience with Barth syndrome, and trial participation and conduct. Participants and families were pleased to take part in the trial, viewing participation as ‘giving back’ to the medical community. No participant withdrew, and the trial was not perceived to be too onerous for families. Participating in the research gave both individuals and families a sense of responsibility for their condition, partly driven by appreciation for the Barth Syndrome Service and staff expertise. Monolysocardiolipin/L4-CL ratio in vitro was estimated from samples of cells incubated with control, bezafibrate or resveratrol. Each drug reduced the MLCL/L4-CL ratio, largely by increasing intermediate cardiolipin species, and more so with resveratrol than with bezafibrate. Ratios were nevertheless profoundly abnormal in comparison to patients with intermediate Barth phenotypes. Discussion Main findings: study results There was no clinically important or statistically significant improvement in peak VO2 with bezafibrate compared to placebo. There were inconsistent findings for LVEF% by method of measurement; echocardiography showed a borderline improvement that cardiac MRI did not demonstrate. Longitudinal and circumferential strain measurements were better at rest with bezafibrate, but not at peak exercise. There were no clinically important or statistically significant improvements in core or fatigue QoL domains. Plasma cysteine was significantly improved with bezafibrate treatment. Plasma arginine also increased but not significantly. Neutrophil count was unaffected and there was no significant change in cardiolipin ratio in participants’ blood with bezafibrate. There were no significant period effects except for MLCL/L4-CL ratio and neutrophil count, both increased in the second period. In vitro incubation of Epstein–Barr virus-transformed patient lymphoblasts with either bezafibrate or resveratrol resulted in improved MLCL/L4-CL ratios, an effect that was more profound with resveratrol. Treatment with this drug also resulted in a more obvious increase in intermediate MLCL species. Strengths and limitations Strengths of the trial are: randomisation and placebo blinding; crossover design; excellent retention; completeness of the data, good adherence and IMP tolerance. There were several limitations. The sample size (outside our control) was very small, and interpretation of effects for many secondary outcomes was challenging. Longer treatment duration or a higher bezafibrate dose might have produced better outcomes. Bezafibrate may have induced adverse reactions in some participants, inadvertently causing unblinding. The group of participants randomised to receive bezafibrate first was older than the group randomised to the opposite order, which may explain period effects. The electron microscopic and mitochondrial assessments proved problematic and were not completed in vitro. Measurements of mitochondrial content and membrane potential were highly variable. Amino acid levels were not assayed after fasting. Echocardiography images during exercise testing were often suboptimal. Lessons for the future Magnetic resonance spectroscopy in children is still exploratory, and protocols need to be better validated, but it is considered very promising as a potential objective functional outcome. Cardiolipin profile is not a good outcome for research, although it is appropriate for diagnosis because the Barth cardiolipin profile is so extremely different from a normal profile. Electron microscopy measurements of mitochondria should not be considered as outcomes in future trials. Peak VO2 should be the preferred current primary outcome because it is resistant to bias compared to other functional outcomes. Conclusion The trial did not show a significant treatment effect for the primary outcome, peak VO2. Some secondary outcomes such as systolic function measured by echocardiography and amino acid levels provided some evidence of benefit. The trial provided insights about trial methods and conduct in the context of a very rare paediatric disease that should inform future studies. Trial registration This trial is registered as ISRCTN58006579. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation (EME) programme (NIHR award ref: 12/205/56) and is published in full in Efficacy and Mechanism Evaluation; Vol. 11, No. 13. See the NIHR Funding and Awards website for further award information.
Published: 2024
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33. Intramyocardial immunomodulation with human CD16+ monocytes to treat myocardial infarction in pig: a blind randomized preclinical trial

Author: Raimondo Ascione, Vito D. Bruno, Tom Johnson, Eva Sammut, Andrew Bond, Daniel Lopez-Baz, Julia Deutsch, Mick Bailey, Amedeo Chiribiri, Ashish Patel, Andrew Baker, and Bijan Modarai
Subjects: myocardial infarction, ischemic heart failure, treatment, immunomodulation, monocytes, intramyocardial delivery, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: BackgroundHuman CD16+ monocytes (hCD16+ Ms) have proangiogenic properties. We assessed the feasibility, safety and efficacy of hCD16+ Ms in a porcine model of myocardial infarction (MI).Methods and resultsA total of 27 female Large White pigs underwent MI with reperfusion and cardiac magnetic resonance (CMR). Five days later, animals received intramyocardial injections of hCD16+ Ms in saline (n = 13) or saline only (n = 14). hCD16+ Ms were selected from leucocyte cones. Feasibility/safety endpoints included injury at injected sites, malignant arrhythmias, cancer, haematoma, left ventricular (LV) dilatation, troponin release and downstream organ injury. Co-primary efficacy outcome included LV scar and ejection fraction (LVEF) at 30-day post-injections by CMR. Immunohistochemistry included neo-angiogenesis, fibrosis, markers of myofibroblast and inflammation. Four animals were excluded before injections due to untreatable malignant arrhythmias or lung injury. Median cell number and viability were 48.75 million and 87%, respectively. No feasibility/safety concerns were associated with the use of hCD16+ Ms. The LV scar dropped by 14.5gr (from 25.45 ± 8.24 to 10.8 ± 3.4 gr; −55%) and 6.4gr (from 18.83 ± 5.06 to 12.4 ± 3.9gr; −30%) in the hCD16+ Ms and control groups, respectively (p = 0.015). The 30-day LVEF did not differ between groups, but a prespecified sub-analysis within the hCD16+ Ms group showed that LVEF was 2.8% higher and LV scar 1.9gr lower in the subgroup receiving a higher cell dose. Higher tissue levels of neo-angiogenesis, myofibroblast and IL-6 and lower levels of TGF-β were observed in the hCD16+ Ms group.ConclusionsThe use of hCD16+ Ms in acute MI is feasible, safe and associated with reduced LV scar size, increased tissue levels of neo-angiogenesis, myofibroblasts and IL-6 and reduced pro-fibrotic TGF-β at 30-day post-injections. A higher cell dose might increase the LVEF effect while reducing scar size, but this warrants validation in future studies.
Published: 2024
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34. Development and translation of thiometallate sulfide donors using a porcine model of coronary occlusion and reperfusion

Author: Thomas W. Johnson, James Holt, Anna Kleyman, Shengyu Zhou, Eva Sammut, Vito Domenico Bruno, Charlotte Gaupp, Giacomo Stanzani, John Martin, Pietro Arina, Julia Deutsch, Raimondo Ascione, Mervyn Singer, and Alex Dyson
Subjects: Mitochondria, Ischaemia, Reperfusion injury, Reactive oxygen species, Selenoprotein, Tetrathiomolybdate, Medicine (General), R5-920, Biology (General), QH301-705.5
Abstract: Sulfide-releasing compounds reduce reperfusion injury by decreasing mitochondria-derived reactive oxygen species production. We previously characterised ammonium tetrathiomolybdate (ATTM), a clinically used copper chelator, as a sulfide donor in rodents. Here we assessed translation to large mammals prior to clinical testing. In healthy pigs an intravenous ATTM dose escalation revealed a reproducible pharmacokinetic/pharmacodynamic (PK/PD) relationship with minimal adverse clinical or biochemical events. In a myocardial infarction (1-h occlusion of the left anterior descending coronary artery)-reperfusion model, intravenous ATTM or saline was commenced just prior to reperfusion. ATTM protected the heart (24-h histological examination) in a drug-exposure-dependent manner (r2 = 0.58, p
Published: 2024
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35. Unveiling the invisible : a narrative inquiry about the life of adults in Malta who grew up with a sibling diagnosed with a depressive or anxiety disorder

Author: Sammut Muscat, Alessandra
Abstract: Mental health not only affects the individual, but also other members of the family. Literature focuses mostly on the parents and/or the individual being affected by the mental illness, while putting aside the siblings and how they are affected when issues related to mental illness emerge during their adolescence. As siblings grow up, the tendency is that they spend a lot of time together, and when mental health emerges, a lot of changes are incurred. This study aims to give a voice to the people who are normally silenced. Therefore, through their narratives, the study aims to understand better the trajectories of the silenced sibling, from adolescence to adulthood and how this journey shaped one's meaning of life. Furthermore, through understanding one's story, the helping professionals can work in a holistic manner within the family system. A narrative approach was adopted and thus, seven semi- structured interviews were conducted with participants who experienced having a sibling with depression and other mental health issues emerging during their adolescence. Elliot's first and second order narrative analysis was used to elicit four main themes. The findings revealed that due to the emergence of symptoms of mental illness within the family, the participants had to adopt new roles to be of help to the family. Moreover, how the participants felt and dealt with mental health within the family was explored. In addition, the theme of loss and how this journey has left an effect on their adulthood was highlighted. The participants explored how their siblings' mental illness have left them struggling in some aspects in their adulthood, but also how they have grown from this experience, making the purpose of living more meaningful to them. It seems that therapy has helped most of participants to heal and grow form this experience. Since the sample was small and based in Malta, results cannot be generalized as the participants spoke from a Maltese cultural background related to mental health, yet the meaning can be transferable. Recommendation for helping professionals to work more with all the family members, from an early start, would be beneficial in the long run.
Published: 2023

36. Healthcare Students’ and Educators’ Views on the Integration of Gender-Based Violence Education into the Curriculum: a Qualitative Inquiry in Three Countries

Author: Sammut, Dana, Ferrer, Lilian, Gorham, Emily, Hegarty, Kelsey, Kuruppu, Jacqueline, Salvo, Francisca Lopez, and Bradbury-Jones, Caroline
Published: 2023
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37. Immunomodulatory therapy in children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS, MIS-C; RECOVERY): a randomised, controlled, open-label, platform trial

Author: Faust, Saul N, Haynes, Richard, Jones, Christine E, Staplin, Natalie, Whittaker, Elizabeth, Jaki, Thomas, Juszczak, Ed, Spata, Enti, Wan, Mandy, Bamford, Alasdair, Dimitri, Paul, Finn, Adam, Furness, John, Ramanan, Athimalaipet V, Gale, Christopher, Cathie, Katrina, Drysdale, Simon, Bernatoniene, Jolanta, Murray, Clare, Roehr, Charles C, Fleming, Paul, Riordan, Andrew, Bandi, Srini, Jyothish, Deepthi, Evans, Jennifer, Emonts, Marieke, Kelly, Dominic, Pathan, Nazima, Davies, Patrick, Hague, Rosie, Pollock, Louisa, Semple, Malcolm G, Peto, Leon, Baillie, J Kenneth, Buch, Maya, Jeffery, Katie, Knight, Marian, Lim, Wei Shen, Montgomery, Alan, Mukherjee, Aparna, Mumford, Andrew, Rowan, Kathryn, Thwaites, Guy, Mafham, Marion, Emberson, Jonathan, Landray, Martin J, Horby, Peter W, Chappell, Lucy, Day, Jeremy, Dung, DV, Quang, NN, Binh, Prof, Burhan, E, Alisjahbana, B, Koirala, J, Basnet, S, Kestelyn, E, Basnyat, B, Gyanwali, P, Hamers, RL, Sandercock, P, Darbyshire, J, DeMets, D, Fowler, R, Lalloo, D, Munavvar, M, Roberts, I, Warris, A, Wittes, J, Craddock-Bamford, A, Barton, J, Basoglu, A, Brown, R, Brudlo, W, Denis, E, Fletcher, L, Howard, S, Musini, S, Taylor, K, Cui, G, Goodenough, B, King, A, Lay, M, Murray, D, Stevens, W, Wallendszus, K, Welsh, R, Crichton, C, Davies, J, Goldacre, R, Harper, C, Knight, F, Nunn, M, Salih, H, Welch, J, Campbell, M, Pessoa-Amorim, G, Zayed, M, Wiles, J, Bagley, G, Cameron, S, Chamberlain, S, Farrell, B, Freeman, H, Kennedy, A, Whitehouse, A, Wilkinson, S, Wood, C, Reith, C, Davies, K, Halls, H, Holland, L, Truell, R, Wilson, K, Lingwood, Emma, Howie, L, Lunn, M, Rodgers, Penelope, Amuasi, J, Baird, K, Bao, T, Bittaye, M, Bonney, J, D'Alessandro, U, Dhimal, M, Huyen, T, Jagne, A, Karkey, A, Maiga, O, Matey, E, Nadjm, B, Nel, J, Pant, S, Puspatriani, K, Rahardjani, M, Raijal, S, Rees, H, Rimainar, A, Roberts, C, Rocca, A, Shrestha, S, Usuf, E, Vidaillic, C, Wulandari, F, Alexander, A, Amezaga, M, Armah, C, Asghar, A, Aubrey, P, Barker-Williams, K, Barnard, A, Bartholomew, J, Beaumont-Jewell, D, Beddows, S, Beety, J, Birch, C, Boyle, P, Brend, M, Brookes, M, Callens, C, Campbell, D, Campbell, H, Cate, H, Chambers, E, Chapman, K, Coe, A, Collins, J, Crawshaw, S, Das, S, De Soyza, A, Denton, E, Dicks, P, Dolman, M, Donaldson, K, Dowden, L, Dowling, S, Drake, C, Duckles-Leech, H, Duffy, H, Gerdes, L, Gibbons, K, Gill, L, Gilmour, K, Goodwin, J, Graham, J, Green, C, Hall, C, Hall, A, Hampshire, K, Hanson, J, Harman, T, Harper, H, Harrison, S, Hicks, J, Hodgson, H, Hough, M, Jackson, S, Johnson, G, Kirk, J, Lemoine, N, Levett, C, Lock, S, Lockett, T, Logan, M, Lomme, K, Luo, J, McMillan, N, Membrey, H, Mguni, N, Minton, J, Monaghan, H, Murphy, S, Muzengi, N, Naz, M, Nickson, I, Odam, M, Ohia, U, Okell, E, Oliver, A, Pearson, K, Pine, K, Pleass, R, Porter, D, Porter, L, Potter, A, Poustie, V, Pratt, S, Price, A, Priest, A, Rodgers, A, Rook, C, Ryan, P, Sam, S, Sharratt, P, Sheffield, J, Shenton, J, Shirley, K, 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A, Watson, E, Watson, F, Watson, J, Watson, K, Watson, L, Watson, P, Watson, R, Watters, M, Watterson, D, Watts, D, Watts, J, Watts, M, Waugh, V, Wayman, M, Wazir, A, Weatherhead, M, Weatherly, N, Webb, C, Webb, H, Webb, K, Webb, S, Websdale, C, Webster, D, Webster, I, Webster, J, Webster, T, Wedlin, J, Wee, L, Weerakoon, R, Weerasinghe, T, Weeratunga, J, Weetman, M, Wei, S, Weichert, I, Welch, E, Welch, H, Welch, L, Welch, S, Welham, B, Weller, S, Wellings, L, Wells, B, Wellstead, S, Welsh, B, Welters, I, Welton, R, Wenn, V, Wentworth, L, Wesonga, J, Wesseldine, K, West, J, West, M, West, R, West, S, Western, L, Westhead, R, Weston, H, Westwood, A, Westwood, K, Westwood, S, Wetherill, B, Wheaver, S, Wheeler, H, Whelan, B, Whelband, M, Whileman, A, Whitcher, A, White, A, White, B, White, C, White, D, White, J, White, K, White, M, White, N, White, S, White, T, Whitehead, C, Whitehorn, K, Whitehouse, C, Whitehouse, T, Whiteley, J, Whiteley, L, Whiteley, S, Whitham, R, Whitlingum, G, 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P, Wubetu, J, Wulandari, R, Wurie, S, Wyatt, C, Wyn-Griffiths, F, Wynter, I, Xavier, B, Xhikola, A, Xia, B, Xia, Z, Y Ellis, T, Yacoba, E, Yakubi, M, Yan, M, Yanagisawa, Y, Yang, F, Yang, Y, Yanney, M, Yap, W, Yaqoob, N, Yasmin, S, Yates, B, Yates, D, Yates, E, Yates, H, Yates, M, Yates, T, Ye, J, Yearwood Martin, C, Yein, K, Yeoh, A, Yeung, C, Yew, P, Yewatkar, D, Ylquimiche Melly, L, Ynter, I, Yong, H, Yorke, J, Youens, J, Younes Ibrahim, A, Young, E, Young, G, Young, L, Yousafzar, A, Youssouf, S, Yousuf, A, Yu, C, Yuan, J, Yung, B, Yusef, D, Yusef, S, Yusuf, I, Zafar, A-M, Zagalo, S, Zaher, S, Zahoor, A, Zainab, M, Zak, T, Zaki, K, Zakir, N, Zalewska, K, Zamalloa, A, Zaman, M, Zaman, S, Zamikula, J, Zammit, L, Zammit-Mangion, M, Zawadzka, M, Zebracki, E, Zehnder, D, Zeidan, L, Zeinali, D, Zhang, J, Zhao, X, Zheng, D, Zia, M, Zibdeh, O, Zill-E-Huma, R, Zin, E, Zincone, E, Zindoga, G, Zinkin, E, Zinyemba, V, Zipitis, C, Zitter, L, Zmierczak, A, Zubikarai, G, Zubir, A, Zuhra, N, Zulaikha, R, Zulfikar, S, Zullo, C, and Zuriaga-Alvaro, A
Published: 2024
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38. Response Component Analysis for Sea State Estimation Using Artificial Neural Networks and Vessel Response Spectral Data

Author: Long, Nathan K., Sgarioto, Daniel, Garratt, Matthew, and Sammut, Karl
Subjects: Computer Science - Machine Learning, Computer Science - Artificial Intelligence, Electrical Engineering and Systems Science - Signal Processing, [2010] 00-01 99-00 37N10
Abstract: The use of the `ship as a wave buoy analogy' (SAWB) provides a novel means to estimate sea states, where relationships are established between causal wave properties and vessel motion response information. This study focuses on a model-free machine learning approach to SAWB-based sea state estimation (SSE), using neural networks (NNs) to map vessel response spectral data to statistical wave properties for a small uninhabited surface vessel. Results showed a strong correlation between heave responses and significant wave height estimates, whilst the accuracy of mean wave period and wave heading predictions were observed to improve considerably when data from multiple vessel degrees of freedom (DOFs) was utilized. Overall, 3-DOF (heave, pitch and roll) NNs for SSE were shown to perform well when compared to existing SSE approaches that use similar simulation setups. One advantage of using small vessels for SAWB was shown as SSE accuracy was reasonable even when motion responses were low (in high-frequency, low wave height sea states). Given the information-dense statistical representation of vessel motion responses in spectral form, as well as the ability of NNs to effectively model complex relationships between variables, the designed SSE method shows promise for future adaptation to mobile SSE systems using the SAWB approach., Comment: Preprint revised
Published: 2022

39. Marvellous medicine: A century of insulin extract

Author: Sammut, Dave and Craig, Chantelle
Published: 2021

40. A Qualitative Exploration of the Mental Wellbeing of Maltese LGBTQ+ University Students and Acceptance within Family, Peers, and Social Circles

Author: Sammut, Enya, Fondacaro, Daniel Vella, and Camilleri, Nigel
Abstract: Mental health issues have been shown to be more common in LGBTQ+ youths when compared to heterosexual cisgender youths. This study aimed to understand the process of disclosure of sexuality and gender identity in Maltese LGBTQ+ university students and explored dynamics within the individual's family and social circles during this process. Furthermore, it aimed to elucidate insight into the views of the LGBTQ+ community on the social perception of sexualities and gender identities. 17 individuals from a University of Malta LGBTQ+ association were interviewed. The key finding from this study showed that the period of disclosure was frequently associated with anxiety or depression and that family acceptance may act as a protective factor which reduces anxiety and depression. Furthermore, transgender individuals appear to face more discrimination than gay people. This study concluded that more public awareness is needed to decrease LGBTQ+ stigma. Members within the LGBTQ+ community require more specialised support and counselling services. Further studies need to be carried out to analyse the importance of healthy family dynamics from an earlier age.
Published: 2021

41. Assessing the feasibility and acceptability of a diabetes-specific nurse-led multicomponent smoking cessation intervention in diabetes education: study protocol for an open-label pragmatic randomised controlled trial

Author: Ian Norman, Joseph Grech, Catherine Azzopardi, Moira Grixti, and Roberta Sammut
Subjects: Medicine
Abstract: Introduction Smoking cessation is an essential, but often overlooked aspect of diabetes management. Despite the need for tailored smoking cessation support for individuals with diabetes, evidence of effective interventions for this cohort is limited. Additionally, individuals with diabetes do not easily adopt such interventions, resulting in low uptake and abstinence rates. This protocol describes a study that aims to assess the feasibility and acceptability of a unique smoking cessation intervention, based on the best evidence, theory and the needs of individuals with diabetes, among patients and service providers, the diabetes nurse educators.Methods and analysis This is an open-label pragmatic randomised controlled trial. Between 80 and 100 individuals with type 1 or type 2 diabetes who smoke will be recruited from the diabetes outpatients at the main acute public hospital in Malta, starting in August 2023. Participants will be randomly assigned (1:1 ratio) to the intervention or control arm for 12 weeks. The experimental intervention will consist of three to four smoking cessation behavioural support sessions based on the 5As (Ask, Advise, Assess, Assist and Arrange) algorithm, and a 6-week supply of nicotine replacement therapy. The control intervention will consist of an active referral to the Maltese National Health Service’s one-to-one smoking cessation support service, which is based on motivational interviewing. The primary feasibility and acceptability outcomes include the recruitment and participation rates, resources used, problems identified by the nurses, the nurses’ perceived challenges and facilitators to implementation and the nurses’ and patients’ acceptability of the study intervention. Data analyses will be descriptive, with quantitative feasibility and acceptability outcomes reported with 95% confidence intervals.Ethics and dissemination Ethical clearance was obtained from the Faculty of Health Sciences Research Ethics Committee, University of Malta. The study results will be disseminated through conference presentations and a publication in a peer-reviewed journal.Trial registration number NCT05920096.
Published: 2024
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42. A web-based scoping review assessing the influence of smoking and smoking cessation on antidiabetic drug meabolism: implications for medication efficacy

Author: Carlo Maria Bellanca, Egle Augello, Giulia Di Benedetto, Chiara Burgaletto, Anna Flavia Cantone, Giuseppina Cantarella, Renato Bernardini, Riccardo Polosa, the DiaSmokeFree Working Group, Agostino Di Ciaula, Tabinda Dugal, Andre Kengne, Phuong Le Dinh, Anoop Misra, Syed Abbas Raza, Cristina Russo, Noel Somasundaram, Roberta Sammut, and Magda Walicka
Subjects: adverse drug reactions, cytochrome P450, diabetes mellitus, drug-drug interactions, drug metabolism, smoking cessation, Therapeutics. Pharmacology, RM1-950
Abstract: Currently 1.3 billion individuals globally engage in smoking, leading to significant morbidity and mortality, particularly among diabetic patients. There is urgent need for a better understanding of how smoking influences antidiabetic treatment efficacy. The review underscores the role of cigarette smoke, particularly polycyclic aromatic hydrocarbons (PAHs), in modulating the metabolic pathways of antidiabetic drugs, primarily through the induction of cytochrome P450 (CYP450) enzymes and uridine diphosphate (UDP)-glucuronosyltransferases (UGTs), thus impacting drug pharmacokinetics and therapeutic outcomes. Furthermore, the review addresses the relatively uncharted territory of how smoking cessation influences diabetes treatment, noting that cessation can lead to significant changes in drug metabolism, necessitating dosage adjustments. Special attention is given to the interaction between smoking cessation aids and antidiabetic medications, a critical area for patient safety and effective diabetes management. This scoping review aims to provide healthcare professionals with the knowledge to better support diabetic patients who smoke or are attempting to quit, ensuring tailored and effective treatment strategies. It also identifies gaps in current research, advocating for more studies to fill these voids, thereby enhancing patient care and treatment outcomes for this at-risk population.
Published: 2024
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43. Acceptability measures for evaluating smoking cessation interventions among individuals with diabetes

Author: Joseph Grech, Ian James Norman, and Roberta Sammut
Subjects: Diabetes mellitus, Tobacco cessation, Patient satisfaction, Program evaluation, Feasibility studies, Public aspects of medicine, RA1-1270
Abstract: Background: The literature indicates that individuals with diabetes do not easily adopt smoking cessation interventions. Given that the success of such interventions depends on patient involvement and attitudes, assessing intervention acceptability, including patient satisfaction and perceived usefulness, is crucial before implementing a smoking cessation intervention. This paper reports the preliminary validation of the satisfaction and perceived usefulness questionnaires for evaluating smoking cessation interventions among individuals with diabetes. Study design: Validity study. Methods: The satisfaction questionnaire contained eight statements while the perceived usefulness questionnaire had fourteen; both rated on a 5-point Likert scale. Content validation involved five tobacco cessation facilitators rating item relevance using a 4-point ordinal rating scale, suggesting improvements. The questionnaires were also translated into Maltese for local use and assessed for translation validity using a similar scale. Unanimous agreement among experts was required for item relevance and equivalence. Thirty-four individuals with type 1 or type 2 diabetes, attending a diabetes-specific smoking cessation intervention, received either the Maltese or English versions of the questionnaires. Internal consistency was measured using Cronbach's alpha. Results: After two rounds of content validation, the experts unanimously agreed on item relevance and conceptual equivalence. Fifteen and sixteen participants completed the Maltese and English versions of the questionnaires, respectively. Both questionnaires’ versions were found to have a high internal consistency (>0.8). Conclusions: These findings provide the initial validation of these instruments for assessing the acceptability of smoking cessation interventions among individuals with diabetes. Further validation in different settings using a larger sample is suggested.
Published: 2024
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44. Diagnosis codes underestimate chronic kidney disease incidence compared with eGFR-based evidence: a retrospective observational study of patients with type 2 diabetes in UK primary care

Author: Rose Sisk, Rory Cameron, Waqas Tahir, and Camilla Sammut-Powell
Subjects: diagnosis, diabetes, renal medicine, renal insufficiency, chronic, primary health care, Medicine (General), R5-920
Abstract: Background: Type two diabetes (T2D) is a leading cause of both chronic kidney disease (CKD) and onward progression to end-stage renal disease. Timely diagnosis coding of CKD in patients with T2D could lead to improvements in quality of care and patient outcomes. Aim: To assess the consistency between estimated glomerular filtration rate (eGFR)-based evidence of CKD and CKD diagnosis coding in UK primary care. Design & setting: A retrospective analysis of electronic health record data in a cohort of people with T2D from 60 primary care centres within England between 2012 and 2022. Method: We estimated the incidence rate of CKD per 100 person–years using eGFR-based CKD and diagnosis codes. Logistic regression was applied to establish which attributes were associated with diagnosis coding. Time from eGFR-based CKD to entry of a diagnosis code was summarised using the median and interquartile range. Results: The overall incidence of CKD was 2.32 (95% confidence interval [CI] = 2.24 to 2.41) and significantly higher for eGFR-based criteria than diagnosis codes: 1.98 (95% CI = 1.90 to 2.05) versus 1.06 (95% CI = 1.00 to 1.11), respectively; P
Published: 2024
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45. Behavioral Therapy for People With Diabetes Who Smoke: A Scoping Review

Author: Roberta Sammut, Joseph Grech, Riccardo Polosa, Davide Campagna, Agostino Di Ciaula, Tabinda Dugal, Andre Kenge, Anoop Misra, Syed Abbas Raza, Cristina Russo, Noel Somasundaram, Magdalena Walicka, Le Dinh Phoung, Graziella Chiara Prezzavento, Mirko Casu, Giusy Rita Maria La Rosa, and Pasquale Caponnetto
Subjects: Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract: Background: Tobacco smoking exacerbates diabetes-related complications; its prevalence is notwithstanding substantial. Persons with diabetes face a number of barriers and challenges to quitting such as multiple lifestyle restrictions; tailored interventions are required for smoking cessation. Objective: To identify research on behavioral interventions for smoking cessation in diabetes. Methods: Studies had to be randomized controlled trials, quasiexperimental or systematic reviews. The behavioral interventions included were: the 5As, Cognitive-Behavioral Therapy, Motivational Interviewing, Contingency Management, Health Coaching and Counselling, as compared to standard care. The outcomes were self-reported and/or biochemically verified smoking cessation. CINAHL Complete, MEDLINE Complete, the Cochrane databases of systematic reviews and randomized controlled trials, PsychInfo and PubMed Central were searched until July, 2023. Keywords used included diabetes, smoking cessation and each of the behavioral interventions included. Results: 1615 papers were identified. Three studies on the 5As/brief advice, 4 on Motivational Intervention and 1 on counseling were retained. The results on the 5As and Motivational Interviewing were conflicting. More intensive interventions appear to be more successful in achieving smoking cessation in smokers with diabetes. Conclusions: Future research should focus on the continued development and evaluation of structured smoking cessation interventions based on the 5As, Motivational interviewing and Cognitive Behavioral Therapy.
Published: 2024
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46. Amazon Alexa and I: Exploring Factors Affecting Usage Behaviours and Patterns Over Time

Author: Sammut, Rachel, primary, Lal, Banita, additional, and Ismagilova, Elvira, additional
Published: 2023
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47. Multi-level Attention Network with Weather Suppression for All-Weather Action Detection in UAV Rescue Scenarios

Author: Liu, Yao, primary, Li, Binghao, additional, Sammut, Claude, additional, and Yao, Lina, additional
Published: 2023
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48. From incubator’s knowledge transfer to sustainability start-ups’ impact: a case study in a French support program

Author: Lamperti, Sofia, Sammut, Sylvie, and Courrent, Jean-Marie
Published: 2023
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49. BEAT-IT: A de-novo cardiac screening programme in Maltese adolescents

Author: Abela, Mark, Yamagata, Kentaro, Bonello, John, Xuereb, Sara, Borg, Lisa, Xuereb, Rachel, Soler, Jeremy Fleri, Camilleri, William, Abela, Estelle, Callus, Adrian, Farrugia, Maria, Sapiano, Karl, Felice, Tiziana, Burg, Melanie, Sammut, Mark A., Grech, Victor, and Papadakis, Michael
Published: 2024
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50. Authenticating genuine Kakadu plum (Terminalia ferdinandiana) powders from fakes using stable isotope analysis and elemental profiling

Author: Keaney, Mariel, Mazumder, Debashish, Tadros, Carol V., Crawford, Jagoda, Gadd, Patricia S., Saeki, Paul, Sammut, Jesmond, and Saintilan, Neil
Published: 2024
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