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1. Machine learning validation of the AVAS classification compared to ultrasound mapping in a multicentre study

Author

Katerina Lawrie, Petr Waldauf, Peter Balaz, Radoslav Bortel, Ricardo Lacerda, Emma Aitken, Krzysztof Letachowicz, Mario D’Oria, Vittorio Di Maso, Pavel Stasko, Antonio Gomes, Joana Fontainhas, Matej Pekar, Alena Srdelic, VAVASC Study Group, and Stephen O’Neill

Subjects
Arteriovenous access, Classification system, Dialysis, Mapping, Random forest, Renal replacement therapy, Medicine, Science
Abstract

Abstract The Arteriovenous Access Stage (AVAS) classification simplifies information about suitability of vessels for vascular access (VA). It’s been previously validated in a clinical study. Here, AVAS performance was tested against multiple ultrasound mapping measurements using machine learning. A prospective multicentre international study (NCT04796558) with patient recruitment from March 2021-July 2024. Demographics, risk factors, vessels parameters, types of predicted and created VA (pVA, cVA) were collected. We modelled pVA and cVA using the Random Forest algorithm. Model performance was estimated and compared using Bayesian generalized linear models. ROC AUC with 95% credible intervals was the performance metric. 1151 patients were included. ROC AUC for pVA prediction by AVAS was 0.79 (0.77;0.82) and by mapping was 0.85 (0.83;0.88). ROC AUC for cVA prediction by AVAS was 0.71 (0.69;0.74) and by mapping was 0.8 (0.78;0.83). Using AVAS with other parameters increased the ROC AUC to 0.87 for pVA (0.84;0.89) and 0.82 (0.79;0.84) for cVA. Using mapping with other parameters increased the ROC AUC to 0.88 for pVA (0.86;0.91) and 0.85 (0.83;0.88) for cVA. Multiple mapping measurements showed higher performance at VA prediction than AVAS. However, AVAS is simpler and quicker, so may be preferable for routine clinical practice.

Published
2025
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2. Subgroup differences in public attitudes, preferences and self-reported behaviour related to deceased organ donation before and after the introduction of the ‘soft’ opt-out consent system in England: mixed-methods study

Author

Paul Boadu, Leah McLaughlin, Jane Noyes, Stephen O’Neill, Mustafa Al-Haboubi, Lorraine Williams, Jennifer Bostock, and Nicholas Mays

Subjects
Organ donation, Deemed consent, Inequalities, Latent class analysis, Mixed-methods, Public attitudes and behaviours, Public aspects of medicine, RA1-1270
Abstract

Abstract Background In the UK, over 7,000 people are on the waiting list for an organ transplant and there are inequalities in need, access and waiting time for organs, with notable differences between minority ethnic groups. In May 2020, England changed the law and introduced a ‘soft’ opt-out system of consent to organ donation with a view to increase consent rates. We aimed to learn more about the impact of the law change on attitudes and views likely to be relevant to consent to deceased organ donation between different population subgroups. Methods Mixed-methods design involving latent class analysis of data from twelve repeated cross-sectional surveys undertaken from 2015 to 2021 (n = 19,011); analysis of the law change survey dataset collected quarterly from 2018 to 2022 (n = 45,439); and interviews with purposively selected members of the public (n = 30) with a focus on minority perspectives. Results Support for the principle of deceased organ donation remained high and stable in the general population (80%) but was 20% lower among ethnic minorities. From 2018 to 2022, an average of 58% of the general population was aware of the law change; this was lower among minority ethnic groups (31%). We identified four population subgroups (supportive donors (24% of the population); unengaged donors (22%); uncommitted donors (46%); and unsupportive donors (9%)). Interview themes included the challenges of discussing organ donation decisions, balancing autonomy with respecting family relationships, targeted misinformation, frustrations at the lack of consensus between community leaders, limited understanding of what happens during the end-of-life care leading to organ donation, and how this aligns with cultural values and preferences. Conclusion Implementation of the law change has not been associated to date with any change in public attitudes and preferences likely to influence consent overall or in minority ethnic groups in England. Uncommitted donors may benefit from encouragement to express their organ donation decision, and unengaged donors from attempts to address mis/information, confusion, and uncertainty. Interventions to raise the consent rate need to take account of the significant role of the family as well as wider community influences on attitudes, preferences and decision-making, particularly among certain minority (ethnic) groups.

Published
2024
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3. Classifications of haemodialysis vascular access stenosis: a scoping review

Author

Petr Waldauf, Michael Corr, Stephen O’neill, Katerina Lawrie, Jan Malik, Libor Janousek, Stepan Maly, and Jaroslav Chlupac

Subjects
Medicine
Abstract

Objectives Vascular access (VA) stenoses play a significant role in the morbidity of the haemodialysed population. Classifications for diagnosis, assessment and proposal of treatment strategies can be useful clinical and methodological tools. This review aims to present a comprehensive summary and propose further methodological approaches.Design A systematic review of the literature, evaluating classifications for dialysis-related VA stenosis.Data sources Web of Science, Scopus, PubMed, Google Scholar and the ClinicalTrials.gov registry were searched from inception to 7 December 2024.Eligibility criteria All articles containing classifications regarding dialysis VA were eligible, with no restrictions on the study type or language of the full text.Data extraction and synthesis Two independent researchers performed the search and initial screening. Four vascular surgeons assessed the included classifications using a modified Buchbinder’s critical appraisal tool to evaluate quality.Results From 4771 screened papers, 59 full-text papers were retrieved and 24 articles contained classifications. Three classifications were dedicated to VA stenosis, all based on the anatomical location of lesions. According to the modified Buchbinder’s appraisal, the classifications were assessed as moderate-to-good quality. The literature disposes of immense inconsistency in terms of the definition of significant stenosis indicated for treatment.Conclusions VA significant stenosis and its classification is a non-uniformly understood issue with many different criteria and categorisations. This basic methodological problem leads to inconsistent results. We recommend the unification of the criteria and their validation in prospective studies.

Published
2025
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4. Farm-level greenhouse gas mitigation: Understanding the effect of interactions and heterogeneity

Author

Oyinlola Rafiat Ogunpaimo, Cathal Buckley, Stephen Hynes, and Stephen O'Neill

Subjects
Climate change, Mitigation, GHG, Farm-level, Heterogeneity, Environmental sciences, GE1-350
Abstract

Mitigation of climate change remains a central focus of the European Union (EU). Under its 2030 Climate Target Plan, the European Commission proposes to raise the EU's ambition in this area, targeting a reduction in greenhouse gas emissions (GHG) of at least 55 % below 1990 levels by 2030. In Ireland, the proportion of GHG emissions from the agricultural sector is high compared to other developed countries, contributing 38.1 % of total economy-wide GHG emissions. The extent to which mitigation measures reduce GHG emissions at the farm level has received limited attention, especially the implications of farm-level heterogeneity on the optimal policy design for emission reduction. Using EU Farm Accountancy Data Network data for the Republic of Ireland in 2020, this study uses Marginal Abatement Cost Curve (MACC) analysis to assess a suite of GHG mitigation measures and accounts for interaction and heterogeneous effects across five different farm system types. The result of the study shows that reducing crude protein in animal diets is the most cost-effective measure for all farm systems. Liming and substitution to protected urea fertilisers are also cost-effective measures for all farm systems. However, some measures fluctuate between cost-intensive and cost-saving depending on the farm system type. The findings show that no two farm-level MACC curves are the same, thus farm heterogeneity needs to be accounted for efficient policy design.

Published
2025
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5. Rate and reasons for peritoneal dialysis dropout following haemodialysis to peritoneal dialysis switch: a systematic review and meta-analysis

Author

Xingge Sun, Clare McKeaveney, Joanne Shields, Chi Peng Chan, Matthew Henderson, Fiona Fitzell, Helen Noble, and Stephen O’Neill

Subjects
Haemodialysis, Peritoneal dialysis, Dropout, Technique failure, Systematic review, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Abstract Background Patient experiences and survival outcomes can be influenced by the circumstances related to dialysis initiation and subsequent modality choices. This systematic review and meta-analysis aimed to explore the rate and reasons for peritoneal dialysis (PD) dropout following haemodialysis (HD) to PD switch. Method This systematic review conducted searches in four databases, including Medline, PubMed, Embase, and Cochrane. The protocol was registered on PROSPERO (study ID: CRD42023405718). Outcomes included factors leading to the switch from HD to PD, the rate and reasons for PD dropout and mortality difference in two groups (PD first group versus HD to PD group). The Critical Appraisal Skills Programme (CASP) checklist and the GRADE tool were used to assess quality. Results 4971 papers were detected, and 13 studies were included. On meta-analysis, there was no statistically significant difference in PD dropout in the PD first group (OR: 0.81; 95%CI: 0.61, 1.09; I2 = 83%; P = 0.16), however, there was a statistically significant reduction in the rate of mortality (OR: 0.48; 95%CI: 0.25, 0.92; I2 = 73%; P = 0.03) compared to the HD to PD group. The primary reasons for HD to PD switch, included vascular access failure, patient preference, social issues, and cardiovascular disease. Causes for PD dropout differed between the two groups, but inadequate dialysis and peritonitis were the main reasons for PD dropout in both groups. Conclusion Compared to the PD first group, a previous HD history may not impact PD dropout rates for patients, but it could impact mortality in the HD to PD group. The reasons for PD dropout differed between the two groups, with no statistical differences. Psychosocial reasons for PD dropout are valuable to further research. Additionally, establishing a consensus on the definition of PD dropout is crucial for future studies.

Published
2024
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7. Trends in organ donation in England, Scotland and Wales in the context of the COVID-19 pandemic and 'opt-out' legislation.

Author

Stephen O'Neill, Karen Thomas, Leah McLaughlin, Paul Boadu, Lorraine Williams, Mustafa Al-Haboubi, Jennifer Bostock, Jane Noyes, and Nicholas Mays

Subjects
Medicine, Science
Abstract

BackgroundIn May 2020, England implemented soft 'opt-out' or 'deemed consent' for deceased donation with the intention of raising consent rates. However, this coincided with the COVID-19 pandemic, making it difficult to assess the early impact of the law change. Wales and Scotland changed their organ donation legislation to implement soft opt-out systems in 2015 and 2021 respectively. This study provides a descriptive analysis of changes in consent and transplant rates for deceased organ donation in England, Scotland and Wales.MethodsLogistic regression and descriptive trend analysis were employed to assess the probability of a patient who died in critical care becoming a donor, and to report consent rates using data, respectively, from the Intensive Care National Audit and Research Centre (ICNARC) in England from 1 April 2014 to 30 September 2021, and from the Potential Donor Audit for England, Scotland and Wales from April 2010 to June 2023.ResultsThe number of eligible donors in April-June 2020 were 56.5%, 59.3% and 57.6% lower in England, Scotland and Wales relative to April-June 2019 (pre-pandemic). By April-June 2023, the number of eligible donors had recovered to 87.4%, 64.2% and 110.3%, respectively, of their levels in 2019. The consent rate in England, Scotland and Wales reduced from 68.3%, 63.0% and 63.6% in April-June 2019 to 63.2%, 60.5% and 56.3% in April-June 2023.ConclusionsWhile the UK organ donation system shows signs of recovery from the COVID-19 pandemic, the number of eligible potential donors and consent rates remain below their pre-pandemic levels.

Published
2024
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8. Exploring the relationship between breastfeeding and the incidence of infant illnesses in Ireland: evidence from a nationally representative prospective cohort study

Author

Sarah Murphy, Laura Carter, Tasneem Al Shizawi, Michelle Queally, Sarah Brennan, and Stephen O’Neill

Subjects
Breastfeeding, Infant illness, Weighting, Propensity score matching, Entropy balancing, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Ireland has one of the lowest BF rates in the world. This study investigates the association between breastfeeding and infant health in Ireland. Methods A cross-sectional, secondary analysis of data collected from Growing Up in Ireland (GUI): the National Longitudinal Study of Children was conducted. The average morbidity for 2212. infants exclusively breastfed for at least 90 days (EBF90days) was compared to data for 3987 infants in the non-breastfed (Non-BF) group. Data were weighted using entropy balancing to ensure the comparability of groups. Sensitivity analyses considered alternative definitions of the breastfeeding group. Results Infants who were EBF90days were significantly less likely to be admitted to hospital (CI: − 0.06 to − 0.03), spent less nights in hospital (CI: − 0.37 to − 0.11), and were less likely to develop respiratory diseases including asthma (CI: − 0.03 to − 0.01), chest infections (CI: − 0.12 to − 0.08), snuffles/common colds (CI: − 0.07 to − 0.02), ear infections (CI: − 0.08 to − 0.04), eczema (CI: − 0.08 to − 0.04), skin problems (CI: − 0.04 to − 0.00), wheezing or asthma (CI: − 0.06 to − 0.03), vomiting (CI: − 0.03 to − 0.00), and colic (CI: − 0.04 to − 0.01). Further outcomes such as current health of the infant at time of interview (CI: − 0.04 to − 0.00), feeding problems (CI: − 0.04 to − 0.02) and sleeping problems (CI: − 0.02 to − 0.00) indicated a protective effect of EBF90days versus Non-BF. However, these infants were also more likely to fail to gain weight (CI: 0.01 to 0.02) and were at a slightly higher risk of developing nappy rash (CI: 0.00 to 0.02). Conclusion Exclusive breastfeeding for 90+ days is associated with protection against childhood morbidity. Given the protective effect of breastfeeding on adverse health effects in infants, policy makers should prioritise policies that support, promote and protect exclusive breastfeeding.

Published
2023
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9. Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Author

Mwayi Kachapila, Mark Monahan, Adesoji O. Ademuyiwa, Yakubu Momohsani Adinoyi, Bruce M. Biccard, Christina George, Dhruva N. Ghosh, James Glasbey, Dion G. Morton, Osaheni Osayomwanbo, Rupert Pearse, Tracy E. Roberts, Atul Suroy, Saidu Yusuf Yakubu, Raymond Oppong, Aneel Bhangu, Maria Lorena Aguilera, Philip Alexander, Sara W. Al-Saqqa, Giuliano Borda-Luque, Ainhoa Costas-Chavarri, Thomas M. Drake, Faustin Ntirenganya, J. Edward Fitzgerald, Stuart J. Fergusson, J.C. Allen Ingabire, Lawani Ismaïl, Hosni Khairy Salem, Anyomih Theophilus Teddy Kojo, Marie Carmela Lapitan, Richard Lilford, Andre L. Mihaljevic, Dion Morton, Alphonse Zeta Mutabazi, Dmitri Nepogodiev, Adewale O. Adisa, Riinu Ots, Francesco Pata, Thomas Pinkney, Tomas Poškus, Ahmad Uzair Qureshi, Antonio Ramos-De la Medina, Sarah Rayne, Catherine A. Shaw, Sebastian Shu, Richard Spence, Neil Smart, Stephen Tabiri, Ewen M. Harrison, Azmina Verjee, Emmy Runigamugabo, Chetan Khatri, Midhun Mohan, Zahra Jaffry, Afnan Altamini, Andrew Kirby, Kjetil Søreide, Gustavo Recinos, Jen Cornick, Maria Marta Modolo, Dushyant Iyer, Sebastian King, Tom Arthur, Sayeda Nazmum Nahar, Ade Waterman, Michael Walsh, Arnav Agarwal, Augusto Zani, Mohammed Firdouse, Tyler Rouse, Qinyang Liu, Juan Camilo Correa, Peep Talving, Mengistu Worku, Alexis Arnaud, Vassilis Kalles, Basant Kumar, Sunil Kumar, Radhian Amandito, Roy Quek, Luca Ansaloni, Ahmed Altibi, Donatas Venskutonis, Justas Zilinskas, Tomas Poskus, John Whitaker, Vanessa Msosa, Yong Yong Tew, Alexia Farrugia, Elaine Borg, Zineb Bentounsi, Tanzeela Gala, Ibrahim Al-Slaibi, Haya Tahboub, Osaid H. Alser, Diego Romani, Sebestian Shu, Piotr Major, Aurel Mironescu, Matei Bratu, Amar Kourdouli, Aliyu Ndajiwo, Abdulaziz Altwijri, Mohammed Ubaid Alsaggaf, Ahmad Gudal, Al Faifi Jubran, Sam Seisay, Bettina Lieske, Irene Ortega, Jenifa Jeyakumar, Kithsiri J. Senanayake, Omar Abdulbagi, Yucel Cengiz, Dmitri Raptis, Yuksel Altinel, Chia Kong, Ella Teasdale, Gareth Irwin, Michael Stoddart, Rakan Kabariti, Sukrit Suresh, Katherine Gash, Ragavan Narayanan, Mayaba Maimbo, Besmir Grizhja, Shpetim Ymeri, Gezim Galiqi, Roberto Klappenbach, Diego Antezana, Alvaro Enrique Mendoza Beleño, Cecilia Costa, Belen Sanchez, Susan Aviles, Claudio Gabriel Fermani, Rubén Balmaceda, Santiago Villalobos, Juan Manuel Carmona, Daniel Hamill, Peter Deutschmann, Simone Sandler, Daniel Cox, Ram Nataraja, Claire Sharpin, Damir Ljuhar, Demi Gray, Morgan Haines, Dush Iyer, Nithya Niranjan, Scott D'Amours, Morvarid Ashtari, Helena Franco, Ashrarur Rahman Mitul, Sabbir Karim, Nowrin F. Aman, Mahnuma Mahfuz Estee, Umme Salma, Joyeta Razzaque, Tasnia Hamid Kanta, Sayeeda Aktar Tori, Shadid Alamin, Swapnil Roy, Shadid Al Amin, Rezaul Karim, Muhtarima Haque, Amreen Faruq, Farhana Iftekhar, Margaret O'Shea, Greg Padmore, Ramesh Jonnalagadda, Andrey Litvin, Aliaksandr Filatau, Dzmitry Paulouski, Maryna Shubianok, Tatsiana Shachykava, Dzianis Khokha, Vladimir Khokha, Fernande Djivoh, Francis Dossou, Djifid Morel Seto, Dansou Gaspard Gbessi, Bruno Noukpozounkou, Yacoubou Imorou Souaibou, Kpèmahouton René Keke, Fred Hodonou, Ernest Yemalin Stephane Ahounou, Thierry Alihonou, Max Dénakpo, Germain Ahlonsou, Alemayehu Ginbo Bedada, Carlos Nsengiyumva, Sandrine Kwizera, Venerand Barendegere, Philip Choi, Simon Stock, Luai Jamal, Georges Azzie, Sameer Kushwaha, Tzu-Ling Chen, Chingwan Yip, Irene Montes, Felipe Zapata, Sebastian Sierra, Maria Isabel Villegas Lanau, Maria Clara Mendoza Arango, Ivan Mendoza Restrepo, Ruben Santiago Restrepo Giraldo, Edgar Domini, Robert Karlo, Jakov Mihanovic, Mohamed Youssef, Hossam Elfeki, Waleed Thabet, Aly Sanad, Gehad Tawfik, Ahmed Zaki, Noran Abdel-Hameed, Mohamed Mostafa, Muhammad Fathi Waleed Omar, Ahmed Ghanem, Emad Abdallah, Adel Denewar, Eman Emara, Eman Rashad, Ahmad Sakr, Rehab Elashry, Sameh Emile, Toqa Khafagy, Sara Elhamouly, Arwa Elfarargy, Amna Mamdouh Mohamed, Ghada Saied Nagy, Abeer Esam, Eman Elwy, Aya Hammad, Salwa Khallaf, Eman Ibrahim, Ahmed Saidbadr, Ahmed Moustafa, Amany Eldosouky Mohammed, Mohammed Elgheriany, Eman Abdelmageed, Eman Abd Al Raouf, Esraa Samir Elbanby, Maha Elmasry, Mahitab Morsy Farahat, Eman Yahya Mansor, Eman Magdy Hegazy, Esraa Gamal, Heba Gamal, Hend Kandil, Doaa Maher Abdelrouf, Mohamed Moaty, Dina Gamal, Nada El-Sagheer, Mohamed Salah, Salma Magdy, Asmaa Salah, Ahmed Essam, Ahmed Ali, Mahmoud Badawy, Sara Ahmed, Mazed Mohamed, Abdelrahman Assal, Mohamed Sleem, Mai Ebidy, Aly Abd Elrazek, Diaaaldin Zahran, Nourhan Adam, Mohamed Nazir, Adel B. Hassanein, Ahmed Ismail, Amira Elsawy, Rana Mamdouh, Mohamed Mabrouk, Lopna Ahmed Mohamed Ahmed, Mohamed Hassab Alnaby, Eman Magdy, Manar Abd-Elmawla, Marwan Fahim, Bassant Mowafy, Moustafa Ibrahim Mahmoud, Meran Allam, Muhammad Alkelani, Noran Halim El Gendy, Mariam Saad Aboul-Naga, Reham Alaa El-Din, Alyaa Halim Elgendy, Mohamed Ismail, Mahmoud Shalaby, Aya Adel Elsharkawy, Mahmoud Elsayed Moghazy, Khaled Hesham Elbisomy, Hend Adel Gawad Shakshouk, Mohamed Fouad Hamed, Mai Mohamed Ebidy, Mostafa Abdelkader, Mohamed Karkeet, Hayam Ahmed, Israa Adel, Mohammad Elsayed Omar, Mohamed Ibrahim, Omar Ghoneim, Omar Hesham, Shimaa Gamal, Karim Hilal, Omar Arafa, Sawsan Adel Awad, Menatalla Salem, Fawzia Abdellatif Elsherif, Nourhan Elsabbagh, Moustafa R. Aboelsoud, Ahmed Hossam Eldin Fouad Rida, Amr Hossameldin, Ethar Hany, Yomna Hosny Asar, Nourhan Anwar, Mohamed Gadelkarim, Samar Abdelhady, Eman Mohamed Morshedy, Reham Saad, Nourhan Soliman, Mahmoud Salama, Eslam Ezzat, Arwa Mohamed, Arwa Ibrahim, Alaa Fergany, Sara Mohammed, Aya Reda, Yomna Allam, Hanan Adel Saad, Afnan Abdelfatah, Aya Mohamed Fathy, Ahmed El-Sehily, Esraa Abdalmageed Kasem, Ahmed Tarek Abdelbaset Hassan, Ahmed Rabeih Mohammed, Abdalla Gamal Saad, Yasmin Elfouly, Nesma Elfouly, Arij Ibrahim, Amr Hassaan, Mohammed Mustafa Mohammed, Ghada Elhoseny, Mohamed Magdy, Esraa Abd Elkhalek, Yehia Zakaria, Tarek Ezzat, Ali Abo El Dahab, Mohamed Kelany, Sara Arafa, Osama Mokhtar Mohamed Hassan, Nermin Mohamed Badwi, Ahmad Saber Sleem, Hussien Ahmed, Kholoud Abdelbadeai, Mohamed Abozed Abdullah, Muhammad Amsyar Auni Lokman, Suraya Bahar, Anan Rady Abdelazeam, Abdelrahman Adelshone, Muhammad Bin Hasnan, Athirah Zulkifli, Siti Nur Alia Kamarulzamil, Abdelaziz Elhendawy, Aliang Latif, Ahmad Bin Adnan, Shahadatul Shaharuddin, Aminah Hanum Haji Abdul Majid, Mahmoud Amreia, Dina Al-Marakby, Mahmoud Salma, Mohamad Jeffrey Bin Ismail, Elissa Rifhan Mohd Basir, Citra Dewi, Mohd Ali, Aya Yehia Ata, Maha Nasr, Asmaa Rezq, Ahmed Sheta, Sherif Tariq, Abd Elkhalek Sallam, Abdelrhman K.Z. Darwish, Sohaila Elmihy, Shady Elhadry, Ahmed Farag, Haidar Hajeh, Abdelaziz Abdelaal, Amro Aglan, Ahmed Zohair, Mahitab Essam, Omar Moussa, Esraa El-Gizawy, Mostafa Samy, Safia Ali, Esraa Elhalawany, Ahmed Ata, Mohamed El Halawany, Mohamed Nashat, Samar Soliman, Alaa Elazab, Mostada Samy, Mohamed A. Abdelaziz, Khaled Ibrahim, Ahmed mohamed Ibrahim, Ammar Gado, Usama Hantour, Esraa Alm Eldeen, Mohamed Reda loaloa, Arwa Abouzaid, Mostafa Ahmed Bahaa Eldin, Eman Hashad, Fathy Sroor, Doaa Gamil, Eman Mahmoud Abdulhakeem, Mahmoud Zakaria, Fawzy Mohamed, Marwan Abubakr, Elsayed Ali, Hesham Magdy, Menna Tallah Ramadan, Mohamed Abdelaty Mohamed, Salma Mansour, Hager Abdul Aziz Amin, Ahmed Rabie Mohamed, Mahmoud Saami, Nada Ahmed Reda Elsayed, Adham Tarek, Sabry Mohy Eldeen Mahmoud, Islam Magdy El Sayed, Amira Reda, Martina Yusuf Shawky, Mohammed Mousa Salem, Shahinaz Alaa El-Din, Noha Abdullah Soliman, Muhammed Talaat, Shahinaz Alaael-Dein, Ahmed Abd Elmoen Elhusseiny, Noha Abdullah, Mohammed Elshaar, Aya AbdelFatah Ibraheem, Hager Abdulaziz, Mohammed Kamal Ismail, Mona Hamdy Madkor, Mohamed Abdelaty, Sara Mahmoud Abdel-Kader, Osama Mohamed Salah, Mahmoud Eldafrawy, Ahmed Zaki Eldeeb, Mostafa Mahmoud Eid, Attia Attia, Khalid Salah El-Dien, Ayman Shwky, Mohamed Adel Badenjki, Abdelrahman Soliman, Samaa Mahmoud Al Attar, Farrag Sayed, Fahd Abdel Sabour, Mohammed G. Azizeldine, Muhammad Shawqi, Abdullah Hashim, Ahmed Aamer, Ahmed Mahmoud Abdelraouf, Mahmoud Abdelshakour, Amal Ibrahim, Basma Mahmoud, Mohamed Ali Mahmoud, Mostafa Qenawy, Ahmed M. Rashed, Ahmed Dahy, Marwa Sayed, Ahmed W. Shamsedine, Bakeer Mohamed, Ahmad Hasan, Mahmoud M. Saad, Khalil Abdul Bassit, Nadia Khalid Abd El-Latif, Nada Elzahed, Ahmed El Kashash, Nada Mohamed Bekhet, Sarah Hafez, Ahmed Gad, Mahmoud Elkhadragy Maher, Ahmed Abd Elsameea, Mohamed Hafez, Ahmad Sabe, Ataa Ahmed, Ahmed Shahine, Khaled Dawood, Shireen Gaafar, Reem Husseiny, Omnia Aboelmagd, Ahmed Soliman, Nourhan Mesbah, Hossam Emadeldin, Amgad Al Meligy, Amira Hassan Bekhet, Doaa Hasan, Khaled Alhady, Ahmad Khaled Sabe, Mahmoud A. Elnajjar, Majed Aboelella, Ward Hamsho, Ihab Hassan, Hala Saad, Galaleldin Abdelazim, Hend Mahmoud, Noha Wael, Ahmedali M. Kandil, Ahmed Magdy, Shimaa Said Elkholy, Badr Eldin Adel, Kareem Dabbour, Saged Elsherbiney, Omar Mattar, Abdulshafi Khaled Abdrabou, Mohammed Yahia Mohamed Aly, Abdelrahman Geuoshy, Ahmedglal Elnagar, Saraibrahim Ahmed, Ibrahem Abdelmotaleb, Amr Ahmed Saleh, Manar Saeed, Shady Mahmoud, Badreldin Adel Tawfik, Samar Adel Ismail, Esraay Zakaria, Mariam O. Gad, Mohamed Salah Elhelbawy, Monica Bassem, Noha Maraie, Nourhan Medhat Elhadary, Nourhan Semeda, Shaza Rabie Mohamed, Hesham Mohammed Bakry, A.A. Essam, Dina Tarek, Khlood Ashour, Alaa Elhadad, Abdulrahman Abdel-Aty, Ibrahim Rakha, Sara Mamdouh Matter, Rasha Abdelhamed, Omar Abdelkader, Ayat Hassaan, Yasmin Soliman, Amna Mohamed, Sara Ghanem, Sara Amr Mohamed Farouk, Eman Mohamed Ibrahim, Esraa El-Taher, Merna Mostafa, Mohamed Fawzy Mahrous Badr, Rofida Elsemelawy, Aya El-Sawy, Ahmad Bakr, Ahmad Abdel Razaq Al Rafati, Sten Saar, Arvo Reinsoo, Nebyou Seyoum, Tewodros Worku, Agazi Fitsum, Matti Tolonen, Ari Leppäniemi, Ville Sallinen, Benoît Parmentier, Matthieu Peycelon, Sabine Irtan, Sabrina Dardenne, Elsa Robert, Betty Maillot, Etienne Courboin, Alexis Pierre Arnaud, Juliette Hascoet, Olivier Abbo, Amir Ait Kaci, Thomas Prudhomme, Quentin Ballouhey, Céline Grosos, Laurent Fourcade, Tolg Cecilia, Colombani Jean-Francois, Francois-Coridon Helene, Xavier Delforge, Elodie Haraux, Bertrand Dousset, Roberto Schiavone, Sebastien Gaujoux, Jean-Baptiste Marret, Aurore Haffreingue, Julien Rod, Mariette Renaux-Petel, Jean-François Lecompte, Jean Bréaud, Pauline Gastaldi, Chouikh Taieb, Raquillet Claire, Echaieb Anis, Nasir Bustangi, Manuel Lopezv, Aurelien Scalabre, Maria Giovanna Grella, Aurora Mariani, Guillaume Podevin, Françoise Schmitt, Erik Hervieux, Aline Broch, Cecile Muller, Dickson Bandoh, Francis Abantanga, Martin Kyereh, Hamza Asumah, Eric Kofi Appiah, Paul Wondoh, Adam Gyedu, Charles Dally, Kwabena Agbedinu, Michael Amoah, Abiboye Yifieyeh, Frank Owusu, Mabel Amoako-Boateng, Makafui Dayie, Richmond Hagan, Sam Debrah, Micheal Ohene-Yeboah, Joe-Nat Clegg-Lampety, Victor Etwire, Jonathan Dakubo, Samuel Essoun, William Bonney, Hope Glover-Addy, Samuel Osei-Nketiah, Joachim Amoako, Niiarmah Adu-Aryee, William Appeadu-Mensah, Antoinette Bediako-Bowan, Florence Dedey, Mattew Ekow, Emmanuel Akatibo, Musah Yakubu, Hope Edem Kofi Kordorwu, Kwasi Asare-Bediako, Enoch Tackie, Kenneth Aaniana, Emmanuel Acquah, Richard Opoku-Agyeman, Anthony Avoka, Kwasi Kusi, Kwame Maison, Frank Enoch Gyamfi, Gandau Naa Barnabas, Saiba Abdul-Latif, Philip Taah Amoako, Anthony Davor, Victor Dassah, Enoch Dagoe, Prince Kwakyeafriyie, Elliot Akoto, Eric Ackom, Ekow Mensah, Ebenezer Takyi Atkins, Christian Lari Coompson, Nikolaos Ivros, Christoforos Ferousis, Vasileios Kalles, Christos Agalianos, Ioannis Kyriazanos, Christos Barkolias, Angelos Tselos, Georgios Tzikos, Evangelos Voulgaris, Dimitrios Lytras, Athanasia Bamicha, Kyriakos Psarianos, Anastasios Stefanopoulos, Ioannis Patoulias, Dimitrios Sfougaris, Ioannis Valioulis, Dimitrios Balalis, Dimitrios Korkolis, Dimitrios K. Manatakis, Georgios Kyrou, Georgios Karabelias, Iason-Antonios Papaskarlatos, Kolonia Konstantina, Nikolaos Zampitis, Stylianos Germanos, Aspasia Papailia, Theodosios Theodosopoulos, Georgios Gkiokas, Magdalini Mitroudi, Christina Panteli, Thomas Feidantsis, Konstantinos Farmakis, Dimitrios Kyziridis, Orestis Ioannidis, Styliani Parpoudi, Georgios Gemenetzis, Stavros Parasyris, Christos Anthoulakis, Nikolaos Nikoloudis, Michail Margaritis, Maria-Lorena Aguilera-Arevalo, Otto Coyoy-Gaitan, Javier Rosales, Luis Tale, Rafael Soley, Emmanuel Barrios, Servio Tulio Torres Rodriguez, Carlos Paz Galvez, Danilo Herrera Cruz, Guillermo Sanchez Rosenberg, Alejandro Matheu, David Monterroso Cohen, Marie Paul, Angeline Charles, Justin Chak Yiu Lam, Man Hon Andrew Yeung, Chi Ying Jacquelyn Fok, Ka Hin Gabriel Li, Anthony Chuk-Him Lai, Yuk Hong Eric Cheung, Hong Yee Wong, Ka Wai Leung, Tien Seng Bryan Lee, Wai Him Lam, Weihei Dao, Stephanie Hiu-wai Kwok, Tsz-Yan Katie Chan, Yung Kok Ng, T.W.C. Mak, Chi Chung Foo, James Yang, Ankur Bhatnagar, Vijaid Upadhyaya, Uday Muddebihal, Wasim Dar, K.C. Janardha, Neerav Aruldas, Fidelis Jacklyn Adella, Anthonius Santoso Rulie, Ferdy Iskandar, Jonny Setiawan, Cicilia Viany Evajelista, Hani Natalie, Arlindawati Suyadi, Rudy Gunawan, Herlin Karismaningtyas, Lusi Padma Sulistianingsih Mata, Ferry Fitriya Ayu Andika, Afifatun Hasanah, T. Ariani Widiastini, Nurlaila Ayu Purwaningsih, Annisa Dewi Fitriana Mukin, Dina Faizatur Rahmah, Hazmi Dwinanda Nurqistan, Hasbi Maulana Arsyad, Novia Adhitama, Wifanto Saditya Jeo, Nathania Sutandi, Audrey Clarissa, Phebe Anggita Gultom, Matthew Billy, Andreass Haloho, Nadya Johanna, Felix Lee, Radin Mohd Nurrahman Radin Dorani, Martha Glynn, Mohammad Alherz, Wennweoi Goh, Haaris A. Shiwani, Lorraine Sproule, Kevin C. Conlon, Miklosh Bala, Asaf Kedar, Luca Turati, Federica Bianco, Francesca Steccanella, Gaetano Gallo, Mario Trompetto, Giuseppe Clerico, Matteo Papandrea, Giuseppe Sammarco, Rosario Sacco, Angelo Benevento, Luisa Giavarini, Mariano Cesare Giglio, Luigi Bucci, Gianluca Pagano, Viviana Sollazzo, Roberto Peltrini, Gaetano Luglio, Arianna Birindelli, Salomone Di Saverio, Gregorio Tugnoli, Miguel Angel Paludi, Pietro Mingrone, Domenica Pata, Francesco Selvaggi, Lucio Selvaggi, Gianluca Pellino, Natale Di Martino, Gianluca Curletti, Paolo Aonzo, Raffaele Galleano, Stefano Berti, Elisa Francone, Silvia Boni, Laura Lorenzon, Annalisa lo Conte, Genoveffa Balducci, Gianmaria Confalonieri, Giovanni Pesenti, Laura Gavagna, Giorgio Vasquez, Simone Targa, Savino Occhionorelli, Dario Andreotti, Giacomo Pata, Andrea Armellini, Deborah Chiesa, Fabrizio Aquilino, Nicola Chetta, Arcangelo Picciariello, Mohamed Abdelkhalek, Andrea Belli, Silvia De Franciscis, Annamaria Bigaran, Alessandro Favero, Stefano M.M. Basso, Paola Salusso, Martina Perino, Sylvie Mochet, Diego Sasia, Francesco Riente, Marco Migliore, David Merlini, Silvia Basilicò, Carlo Corbellini, Veronica Lazzari, Yuri Macchitella, Luigi Bonavina, Daniele Angelieri, Diego Coletta, Federica Falaschi, Marco Catani, Claudia Reali, Mariastella Malavenda, Celeste Del Basso, Sergio Ribaldi, Massimo Coletti, Andrea Natili, Norma Depalma, Immacolata Iannone, Angelo Antoniozzi, Davide Rossi, Daniele Gui, Gerardo Perrotta, Matteo Ripa, Francesco Ruben Giardino, Maurizio Foco, Erika Vicario, Federico Coccolini, Gabriela Elisa Nita, Nicoletta Leone, Andrea Bondurri, Anna Maffioli, Andrea Simioni, Davide De Boni, Sandro Pasquali, Elena Goldin, Elena Vendramin, Eleonora Ciccioli, Umberto Tedeschi, Luca Bortolasi, Paola Violi, Tommaso Campagnaro, Simone Conci, Giovanni Lazzari, Calogero Iacono, Alfredo Gulielmi, Serena Manfreda, Anna Rinaldi, Maria Novella Ringressi, Beatrice Brunoni, Giuseppe Salamone, Mirko Mangiapane, Paolino De Marco, Antonella La Brocca, Roberta Tutino, Vania Silvestri, Leo Licari, Tommaso Fontana, Nicolò Falco, Gianfranco Cocorullo, Mostafa Shalaby, Pierpaolo Sileri, Claudio Arcudi, Isam Bsisu, Khaled Aljboor, Lana Abusalem, Aseel Alnusairat, Ahmad Qaissieh, Emad Al-Dakka, Ali Ababneh, Oday Halhouli, Taha Yusufali, Hussein Mohammed, Justus Lando, Robert Parker, Wairimu Ndegwa, Mantas Jokubauskas, Jolanta Gribauskaite, Justas Kuliavas, Audrius Dulskas, Narimantas E. Samalavicius, Kristijonas Jasaitis, Audrius Parseliunas, Viktorija Nevieraite, Margarita Montrimaite, Evelina Slapelyte, Edvinas Dainius, Romualdas Riauka, Zilvinas Dambrauskas, Andrejus Subocius, Linas Venclauskas, Antanas Gulbinas, Saulius Bradulskis, Simona Kasputyte, Deimante Mikuckyte, Mindaugas Kiudelis, Tomas Jankus, Steponas Petrikenas, Matas Pažuskis, Zigmantas Urniežius, Mantas Vilčinskas, Vincas Jonas Banaitis, Vytautas Gaižauskas, Edvard Grisin, Povilas Mazrimas, Rokas Rackauskas, Mantas Drungilas, Karolis Lagunavicius, Vytautas Lipnickas, Dovilè Majauskyté, Valdemaras Jotautas, Tomas Abaliksta, Laimonas Uščinas, Gintaras Simutis, Adomas Ladukas, Donatas Danys, Erikas Laugzemys, Saulius Mikalauskas, Elena Zdanyte Sruogiene, Petras Višinskas, Reda Žilinskienė, Deividas Dragatas, Andrius Burmistrovas, Zygimantas Tverskis, Arturas Vaicius, Ruta Mazelyte, Antanas Zadoroznas, Nerijus Kaselis, Greta Žiubrytė, Finaritra Casimir Fleur Prudence Rahantasoa, Luc Hervé Samison, Fanjandrainy Rasoaherinomenjanahary, Todisoa Emmanuella Christina Tolotra, Cornelius Mukuzunga, Chimwemwe Kwatiwani, Nelson Msiska, Feng Yih Chai, Siti Mohd Desa Asilah, Khuzaimah Zahid Syibrah, Pui Xin Chin, Afizah Salleh, Nur Zulaika Riswan, April Camilla Roslani, Hoong-Yin Chong, Nora Abdul Aziz, Keat-Seong Poh, Chu-Ann Chai, Sandip Kumar, Mustafa Mohammed Taher, Nik Ritza Kosai, Dayang Nita Abdul Aziz, Reynu Rajan, Rokayah Julaihi, Durvesh Lacthman Jethwani, Muhammad Taqiyuddin Yahaya, Nik Azim Nik Abdullah, Susan Wndy Mathew, Kuet Jun Chung, Milaksh Kumar Nirumal, R. Goh Ern Tze, Syed Abdul Wahhab Eusoffee Wan Ali, Yiing Yee Gan, Jesse Ron Swire Ting, Samuel S.Y. Sii, Kean Leong Koay, Yi Koon Tan, Alvin Ee Zhiun Cheah, Chui Yee Wong, Tuan Nur'Azmah Tuan Mat, Crystal Yern Nee Chow, Prisca A.L. Har, Yishan Der, Fitjerald Henry, Xinwei Low, Ya Theng Neo, Hian Ee Heng, Shu Ning Kong, Cheewei Gan, Yi Ting Mok, Yee Wen Tan, Kandasami Palayan, Mahadevan Deva Tata, Yih Jeng Cheong, Kuhaendran Gunaseelan, Wan Nurul 'Ain Wan Mohd Nasir, Pigeneswaren Yoganathan, Eu Xian Lee, Jian Er Saw, Li Jing Yeang, Pei Ying Koh, Shyang Yee Lim, Shuang Yi Teo, Nicole Grech, Daniela Magri, Kristina Cassar, Christine Mizzi, Malcolm Falzon, Nihaal Shaikh, Ruth Scicluna, Stefan Zammit, Sean Mizzi, Svetlana Doris Brincat, Thelma Tembo, Vu Thanh Hien Le, Tara Grima, Keith Sammut, Kurt Carabott, Ciskje Zarb, Andre Navarro, Thea Dimech, Georgette Marie Camilleri, Isaac Bertuello, Jeffrey Dalli, Karl Bonavia, Samantha Corro-Diaz, Marisol Manriquez-Reyes, Amina Abdelhamid, Abdelmalek Hrora, Sarah Benammi, Houda Bachri, Meryem Abbouch, Khaoula Boukhal, Redouane Mammar Bennai, Abdelkader Belkouchi, Mohamed Sobhi Jabal, Chaymae Benyaiche, Maarten Vermaas, Lucia Duinhouwer, Javier Pastora, Greta Wood, Maria Soledad Merlo, Akinlabi Ajao, Omobolaji Ayandipo, Taiwo Lawal, Abdussemiu Abdurrazzaaq, Muslimat Alada, Abdulrasheed Nasir, James Adeniran, Olufemi Habeeb, Ademola Popoola, Ademola Adeyeye, Ademola Adebanjo, Opeoluwa Adesanya, Adewale Adeniyi, Henry Mendel, Bashir Bello, Umar Muktar, Adedapo Osinowo, Thomas Olagboyega Olajide, Oyindamola Oshati, George Ihediwa, Babajide Adenekan, Victor Nwinee, Felix Alakaloko, Adesoji Ademuyiwa, Olumide Elebute, Abdulrazzaq Lawal, Chris Bode, Mojolaoluwa Olugbemi, Alaba Adesina, Olubukola Faturoti, Oluwatomi Odutola, Oluwaseyi Adebola, Clement Onuoha, Ogechukwu Taiwo, Omolara Williams, Fatai Balogun, Olalekan Ajai, Mobolaji Oludara, Iloba Njokanma, Roland Osuoji, Stephen Kache, Jonathan Ajah, Jerry Makama, Ahmed Adamu, Suleiman Baba, Mohammad Aliyu, Shamsudeen Aliyu, Yahaya Ukwenya, Halima Aliyu, Tunde Sholadoye, Muhammad Daniyan, Oluseyi Ogunsua, Lofty-John Anyanwu, Abdurrahaman Sheshe, Aminu Mohammad, Samson Olori, Philip Mshelbwala, Babatunde Odeyemi, Garba Samson, Oyediran Kehinde Timothy, Sani Ali Samuel, Anthony Ajiboye, Isaac Amole, Olajide Abiola, Akin Olaolorun, Torhild Veen, Arezo Kanani, Kristian Styles, Ragnar Herikstad, Johannes Wiik Larsen, Jon Arne Søreide, Elisabeth Jensen, Mads Gran, Eirik Kjus Aahlin, Tina Gaarder, Peter Wiel Monrad-Hansen, Pål Aksel Næss, Giedrius Lauzikas, Joachim Wiborg, Silje Holte, Knut Magne Augestad, Gurpreet Singh Banipal, Michela Monteleone, Thomas Tetens Moe, Johannes Kurt Schultz, Taher Al-Taher, Ayah Hamdan, Ayman Salman, Rana Saadeh, Aseel Musleh, Dana Jaradat, Soha Abushamleh, Sakhaa Hanoun, Amjad Abu Qumbos, Aseel Hamarshi, Ayman, Taher, Israa Qawasmi, Khalid Qurie, Marwa Altarayra, Mohammad Ghannam, Alaa Shaheen, Azher Herebat, Aram Abdelhaq, Ahmad Shalabi, Maram Abu-Toyour, Fatema Asi, Ala Shamasneh, Anwar Atiyeh, Mousa Mustafa, Rula Zaa'treh, Majd Dabboor, Enas Alaloul, Heba Baraka, Jehad Meqbil, Alaa Al-Buhaisi, Mohamedraed Elshami, Samah Afana, Sahar Jaber, Said Alyacoubi, Yousef Abuowda, Tasneem Idress, Eman Abuqwaider, Sara Al-Saqqa, Alaa Bowabsak, Alaa El Jamassi, Doaa Hasanain, Hadeel Al-Farram, Maram Salah, Aya Firwana, Marwa Hamdan, Israa Awad, Ahmad Ashour, Fayez Elian Al Barrawi, Ahmed Al-Khatib, Maha Al-Faqawi, Mohamed Fares, Amjad Elmashala, Mohammad Adawi, Ihdaa Adawi, Reem Khreishi, Rose Khreishi, Ahed Ghaben, Najwa Nadeem, Muhammad Saqlain, Jibran Abbasy, Abdul Rehman Alvi, Noman Shahzad, Kamran Faisal Bhopal, Zainab Iftikhar, Muhammad Talha Butt, Syed Asaat Ul Razi, Asdaq Ahmed, Ali Khan Niazi, Ibrahim Raza, Fatima Baluch, Ahmed Raza, Ahmad Bani-Sadar, Muhammad Adil, Awais Raza, Mahnoor Javaid, Muhammad Waqar, Maryam Ali Khan, Mohammad Mohsin Arshad, Mohammadasim Amjad, Gustavo Miguel Machain Vega, Jorge Torres Cardozo, Marcelo O´Higgins Roche, Gustavo Rodolfo Pertersen Servin, Helmut Alfredo Segovia Lohse, Larissa Ines Páez Lopez, Ramón Augusto Melo Cardozo, Fernando Espinoza, Angel David Pérez Rojas, Diana Sanchez, Camila Sanchez Samaniego, Shalon Guevara Torres, Alexander Canta Calua, Cesar Razuri, Nadia Ortiz, Xianelle Rodriguez, Nahilia Carrasco, Fridiz Saravia, Hector Shibao Miyasato, María Valcarcel-Saldaña, Ysabel Esthefany Alejos Bermúdez, Juan Carpio, Walter Ruiz Panez, Pedro Angel Toribio Orbegozo, Carolina Guzmán Dueñas, Kevin Turpo Espinoza, Ana Maria Sandoval Barrantes, Jorge Armando Chungui Bravo, Lorena Fuentes-Rivera, Carmen Fernández, Bárbara Málaga, Joselyn Ye, Ricardo Velasquez, Jannin Salcedo, Ana Lucia Contreras-Vergara, Angelica Genoveva Vergara Mejia, Maria Soledad Gonzales Montejo, Marilia Del Carmen Escalante Salas, Willy Alcca Ticona, Marvin Vargas, George Christian Manrique Sila, Robinson Mas, Arazzelly del Pilar Paucar, Armando José Román Velásquez, Alina Robledo-Rabanal, Ludwing Alexander Zeta Solis, Kenny Turpo Espinoza, José Luis Hamasaki Hamaguchi, Erick Samuel Florez Farfan, Linda Alvi Madrid Barrientos, Juan Jaime Herrera Matta, John Jemuel V. Mora, Menold Archee P. Redota, Manuel Francisco Roxas, Maria Jesusa B. Maño, Marie Dione Parreno-Sacdalan, Christel Leanne Almanon, Maciej Walędziak, Rafał Roszkowski, Michał Janik, Anna Lasek, Dorota Radkowiak, Mateusz Rubinkiewicz, Cristina Fernandes, Jose Costa-Maia, Renato Melo, Liviu Muntean, Aurel Sandu Mironescu, Lucian Corneliu Vida, Mariuca Popa, Hogea Mircea, Mihaela Vartic, Bogdan Diaconescu, Matei Razvan Bratu, Ionut Negoi, Mircea Beuran, Cezar Ciubotaru, Norbert Uzabumwana, Dieudonne Duhoranenayo, Elio Jovine, Nicola Zanini, Giovanni Landolfo, Murad Aljiffry, Faisal Idris, Mohammed Saleh A. Alghamdi, Ashraf Maghrabi, Abdulmalik Altaf, Aroub Alkaaki, Ahmad Khoja, Abrar Nawawi, Sondos Turkustani, Eyad Khalifah, Adel Albiety, Sarah Sahel, Reham Alshareef, Mohammed Najjar, Ahmed Alzahrani, Ahmed Alghamdi, Wedyan Alhazmi, Ghiath Al Saied, Mohammed Alamoudi, Muhammed Masood Riaz, Mazen Hassanain, Basmah Alhassan, Abdullah Altamimi, Reem Alyahya, Norah Al Subaie, Fatema Al Bastawis, Afnan Altamimi, Thamer Nouh, Roaa Khan, Milan Radojkovic, Ljiljana Jeremic, Milica Nestorovic, Jia Hao Law, Keith Say Kwang Tan, Ryan Choon Kiat Tan, Joel Kin Tan, Lau Wen Liang Joel, Xue Wei Chan, Faith Qi Hui Leong, Choon Seng Chong, Sharon Koh, Kai Yin Lee, Kuok Chung Lee, Kent Pluke, Britta Dedekind, Puyearashid Nashidengo, Mark Ian Hampton, Johanna Joosten, Sanju Sobnach, Liana Roodt, Anthony Sander, James Pape, Niveshni Maistry, Phumudzo Ndwambi, Kamau Kinandu, Myint Tun, Frederick Du Toit, Quinn Ellison, D.C. Grobler, Sule Burger, Lawrence Bongani Khulu, Rachel Moore, Vicky Jennings, Astrid Leusink, Nazmie Kariem, Juan Gouws, Kathryn Chu, Heather Bougard, Fazlin Noor, Angela Dell, Stephanie Van Straten, Arvin Khamajeet, Serge Kapenda Tshisola, Kalangu Kabongo, Victor Kong, Yoshan Moodley, Frank Anderson, Thandinkosi Madiba, Flip du Plooy, Leila Hartford, Gareth Chilton, Parveen Karjiker, Matlou Ernest Mabitsela, Sibongile Ruth Ndlovu, Maria Badicel, Robert Jaich, Jaime Ruiz-Tovar, Luis Garcia-Florez, Jorge L. Otero-Díez, Virginia Ramos Pérez, Nuria Aguado Suárez, Javier Minguez García, Sara Corral Moreno, Maria Vicenta Collado, Virginia Jiménez Carneros, Javier García Septiem, Mariana Gonzalez, Antonio Picardo, Enrique Esteban, Esther Ferrero, Eloy Espin-Basany, Ruth Blanco-Colino, Valeria Andriola, Lorena Solar García, Elisa Contreras, Carmen García Bernardo, Janet Pagnozzi, Sandra Sanz, Alberto Miyar de León, Asnel Dorismé, Joseluis Rodicio, Aida Suarez, Jessica Stuva, Tamara Diaz Vico, Laura Fernandez-Vega, Carla Soldevila-Verdeguer, Fatima Sena-Ruiz, Natalia Pujol-Cano, Paula Diaz-Jover, José Maria Garcia-Perez, Juan Jose Segura-Sampedro, Cristina Pineño-Flores, David Ambrona-Zafra, Andrea Craus-Miguel, Patricia Jimenez-Morillas, Angela Mazzella, A.B. Jayathilake, S.P.B. Thalgaspitiya, L.S. Wijayarathna, P.M.S.N. Wimalge, Hakeem Ayomi Sanni, Ogheneochuko Okenabirhie, Anmar Homeida, Abobaker Younis, Omer Abdelbagi Omer, Mustafa Abdulaziz, Ali Mussad, Ali Adam, Ida Björklund, Sandra Ahlqvist, Anders Thorell, Fredrik Wogensen, Arestis Sokratous, Michaela Breistrand, Hildur Thorarinsdottir, Johanna Sigurdadottir, Maziar Nikberg, Abbas Chabok, Maria Hjertberg, Peter Elbe, Deborah Saraste, Wiktor Rutkowski, Louise Forlin, Karoliina Niska, Malin Sund, Dennis Oswald, Georgios Peros, Rafael Bluelle, Katharina Reinisch, Daniel Frey, Adrian Palma, Dimitri Aristotle Raptis, Lucius Zumbühl, Markus Zuber, Roger Schmid, Gabriela Werder, Antonio Nocito, Alexandra Gerosa, Silke Mahanty, Lukas Werner Widmer, Julia Müller, Alissa Gübeli, Grzegorz Zuk, Osman Bilgin Gulcicek, Talar Vartanoglu, Emin Kose, Servet Rustu Karahan, Mehmet Can Aydin, Nuri Alper Sahbaz, Ilkay Halicioglu, Halil Alis, Ipek Sapci, Can Adıyaman, Ahmet Murat Pektaş, Turgut Bora Cengiz, Ilkan Tansoker, Vedatcan Işler, Muazzez Cevik, Deniz Mutlu, Volkan Ozben, Berk Baris Ozmen, Sefa Bayram, Sinem Yolcu, Berna Buse Kobal, Ömer Faruk Toto, Haluk Cem Çakaloğlu, Kagan Karabulut, Vahit Mutlu, Bahar Busra Ozkan, Saban Celik, Anil Semiz, Selim Bodur, Enisburak Gül, Busra Murutoglu, Reyyan Yildirim, Bahadir Emre Baki, Ekin Arslan, Mehmet Ulusahin, Ali Guner, Nathan Walker, Nikhita Shrimanker, Simon Cole, Ryan Breslin, Ravi Srinivasan, Mohamed Elshaer, Kristina Hunter, Ahmed Al-Bahrani, Ignatius Liew, Nora Grace Mairs, Alistair Rocke, Lachlan Dick, Mobeen Qureshi, Debkumar Chowdhury, Naomi Wright, Clare Skerritt, Dorothy Kufeji, Adrienne Ho, Tharindra Dissanayake, Athula Tennakoon, Wadah Ali, Shujing Jane Lim, Charlene Tan, Stephen O'Neill, Catrin Jones, Stephen Knight, Dima Nassif, Abhishek Sharma, Oliver Warren, Rebecca White, Aia Mehdi, Nathan Post, Eliana Kalakouti, Enkhbat Dashnyam, Frederick Stourton, Ioannis Mykoniatis, Chelise Currow, Francisca Wong, Ashish Gupta, Veeranna Shatkar, Joshua Luck, Suraj Kadiwar, Alexander Smedley, Rebecca Wakefield, Philip Herrod, James Blackwell, Jonathan Lund, Fraser Cohen, Ashwath Bandi, Stefano Giuliani, Giles Bond-Smith, Theodore Pezas, Neda Farhangmehr, Tomas Urbonas, Miklos Perenyei, Philip Ireland, Natalie Blencowe, Kirk Bowling, David Bunting, Lydia Longstaff, Kenneth Keogh, Hyunjin Jeon, Muhammad Rafaih Iqbal, Shivun Khosla, Anna Jeffery, James Perera, Ahmad Aboelkassem Ibrahem, Tariq Alhammali, Yahya Salama, Shaun Oram, Thomas Kidd, Fraser Cullen, Christopher Owen, Michael Wilson, Seehui Chiu, Hannah Sarafilovic, Jennifer Ploski, Elizabeth Evans, Athar Abbas, Sylvia Kamya, Norzawani Ishak, Carly Bisset, Cedar Andress, Ye Ru Chin, Priya Patel, David Evans, Aidan Haslegrave, Adam Boggon, Kirsten Laurie, Katie Connor, Thomas Mann, Anahita Mansuri, Rachel Davies, Ewen Griffiths, Aized Raza Shahbaz, Calvin Eng, Farhat Din, Ariadne L'Heveder, Esther H.G. Park, Ramanish Ravishankar, Kirsten McIntosh, Jih Dar Yau, Luke Chan, Susan McGarvie, Lingshan Tang, Hui Lim, Suhhuey Yap, Jay Park, Zhan Herr Ng, Shahrukh Mirza, Yun Lin Ang, Luke Walls, Chloe Roy, Simon Paterson-Brown, Julian Camilleri-Brennan, Kenneth Mclean, Michelle S. D'Souza, Savva Pronin, David Ewart Henshall, Eunice Zuling Ter, Dina Fouad, Ashish Minocha, William English, Catrin Morgan, Dominic Townsend, Laura Maciejec, Shareef Mahdi, Onyinye Akpenyi, Elisabeth Hall, Hanaan Caydiid, Zakaria Rob, Tom Abbott, Hew D. Torrance, Robin Johnston, Mohammed Akil Gani, Gianpiero Gravante, Shivanchan Rajmohan, Kiran Majid, Shiva Dindyal, Christopher Smith, Madanmohan Palliyil, Sanjay Patel, Luke Nicholson, Neil Harvey, Katie Baillie, Sam Shillito, Suzanne Kershaw, Rebecca Bamford, Peter Orton, Elke Reunis, Robert Tyler, Wai Cheong Soon, Guled M. Jama, Dharminder Dhillon, Khyati Patel, Shayanthan Nanthakumaran, Rachel Heard, Kar Yan Chen, Behrad Barmayehvar, Uttaran Datta, Sivesh K. Kamarajah, Sharad Karandikar, Sobhana Iftekhar Tani, Eimear Monaghan, Philippa Donnelly, Michael Walker, Jehangirshaw Parakh, Sarah Blacker, Anil Kaul, Arjun Paramasivan, Sameh Farag, Ashrafun Nessa, Salwa Awadallah, Jieqi Lim, James Chean Khun Ng, Ravi P. Kiran, Alice Murray, Eric Etchill, Mohini Dasari, Juan Puyana, Nadeem Haddad, Martin Zielinski, Asad Choudhry, Celeste Caliman, Mieshia Beamon, Therese Duane, Mamta Swaroop, Jonathan Myers, Rebecca Deal, Erik Schadde, Mark Hemmila, Lena Napolitano, Kathleen To, Alex Makupe, Joseph Musowoya, Niels Van Der Naald, Dayson Kumwenda, Alex Reece-Smith, Kars Otten, Anna Verbeek, Marloes Prins, Alibeth Andres Baquero Suarez, Ruben Balmaceda, Chelsea Deane, Emilio Dijan, Mahmoud Elfiky, Laura Koskenvuo, Aurore Thollot, Bernard Limoges, Carmen Capito, Challine Alexandre, Henri Kotobi, Julien Leroux, Kalitha Pinnagoda, Nicolas Henric, Olivier Azzis, Olivier Rosello, Poddevin Francois, Sara Etienne, Philippe Buisson, Sophian Hmila, Joe-Nat Clegg-Lamptey, Osman Imoro, Owusu Emmanuel Abem, Dimitrios Papageorgiou, Vasiliki Soulou, Sabrina Asturias, Lenin Peña, Donal B. O’Connor, Alberto Realis Luc, Alfio Alessandro Russo, Andrea Ruzzenente, Antonio Taddei, Camilla Cona, Corrado Bottini, Giovanni Pascale, Giuseppe Rotunno, Leonardo Solaini, Marco Maria Pascale, Margherita Notarnicola, Mario Corbellino, Michele Sacco, Paolo Ubiali, Roberto Cautiero, Tommaso Bocchetti, Elena Muzio, Vania Guglielmo, Eugenio Morandi, Patrizio Mao, Emilia De Luca, Farah Mahmoud Ali, Justas Žilinskas, Kestutis Strupas, Paulius Kondrotas, Robertas Baltrunas, Juozas Kutkevicius, Povilas Ignatavicius, Choy Ling Tan, Jia Yng Siaw, Sir Young Yam, Ling Wilson, Mohamed Rezal Abdul Aziz, John Bondin, Carmina Diaz Zorrilla, Anass Majbar, Danjuma Sale, Lawal Abdullahi, Olabisi Osagie, Omolara Faboya, Adedeji Fatuga, Agboola Taiwo, Emeka Nwabuoku, Marte Bliksøen, Zain Ali Khan, Jazmin Coronel, Cesar Miranda, Idelso Vasquez, Luis M. Helguero-Santin, Jennifer Rickard, Adesina Adedeji, Saleh Alqahtani, Max Rath, Michael Van Niekerk, Modise Zacharia Koto, Roel Matos-Puig, Leif Israelsson, Tobias Schuetz, Mahmut Arif Yuksek, Meric Mericliler, Mehmet Uluşahin, Bernhard Wolf, Cameron Fairfield, Guo Liang Yong, Katharine Whitehurst, Natalie Redgrave, Caroluce K. Musyoka, James Olivier, Kathryn Lee, Michael Cox, Muhamed M.H. Farhan-Alanie, Rory Callan, Chali Chibuye, Tebian Hassanein Ahmed Ali, Syrine Rekhis, Muna Rommaneh, Zi Hao Sam, Thays Brunelli Pugliesi, Gabriel Pardo, and Ruth Blanco

Subjects
abdominal surgery, cost-effectiveness analysis, global surgery, high fraction of inspired oxygen, low-and middle-income countries, surgical site infection, Anesthesiology, RD78.3-87.3
Abstract

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

Published
2023
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10. A machine-learning approach to estimating public intentions to become a living kidney donor in England: Evidence from repeated cross-sectional survey data

Author

Paul Boadu, Leah McLaughlin, Mustafa Al-Haboubi, Jennifer Bostock, Jane Noyes, Stephen O'Neill, and Nicholas Mays

Subjects
public perceptions, public support, public intentions, living donor, cost-effectiveness, kidney donation, Public aspects of medicine, RA1-1270
Abstract

BackgroundLiving kidney organ donors offer a cost-effective alternative to deceased organ donation. They enable patients with life-threatening conditions to receive grafts that would otherwise not be available, thereby creating space for other patients waiting for organs and contributing to reducing overall waiting times for organs. There is an emerging consensus that an increase in living donation could contribute even more than deceased donation to reducing inequalities in organ donation between different population sub-groups in England. Increasing living donation is thus a priority for National Health Service Blood and Transplant (NHSBT) in the United Kingdom.MethodsUsing the random forest model, a machine learning (ML) approach, this study analyzed eight waves of repeated cross-sectional survey data collected from 2017 to 2021 (n = 14,278) as part of the organ donation attitudinal tracker survey commissioned by NHSBT in England to identify and help predict key factors that inform public intentions to become living donors.ResultsOverall, around 58.8% of the population would consider donating their kidney to a family member (50.5%), a friend (28%) or an unknown person (13.2%). The ML algorithm identified important factors that influence intentions to become a living kidney donor. They include, in reducing order of importance, support for organ donation, awareness of organ donation publicity campaigns, gender, age, occupation, religion, number of children in the household, and ethnic origin. Support for organ donation, awareness of public campaigns, and being younger were all positively associated with predicted propensity for living donation. The variable importance scores show that ethnic origin and religion were less important than the other variables in predicting living donor intention.ConclusionFactors influencing intentions to become a living donor are complex and highly individual in nature. Machine learning methods that allow for complex interactions between characteristics can be helpful in explaining these decisions. This work has identified important factors and subgroups that have higher propensity for living donation. Interventions should target both potential live donors and recipients. Research is needed to explore the extent to which these preferences are malleable to better understand what works and in which contexts to increase live organ donation.

Published
2023
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11. Clinical effectiveness and cost-effectiveness of emergency surgery for adult emergency hospital admissions with common acute gastrointestinal conditions: the ESORT study

Author

Richard Grieve, Andrew Hutchings, Silvia Moler Zapata, Stephen O’Neill, David G Lugo-Palacios, Richard Silverwood, David Cromwell, Tommaso Kircheis, Elizabeth Silver, Claire Snowdon, Paul Charlton, Geoff Bellingan, Ramani Moonesinghe, Luke Keele, Neil Smart, and Robert Hinchliffe

Subjects
surgery, emergency surgery, acute appendicitis, cholelithiasis, diverticular disease, abdominal wall hernia, intestinal obstruction, clinical effectiveness, cost-effectiveness, cohort, frailty, patient and public involvement, ppi, Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

Background: Evidence is required on the clinical effectiveness and cost-effectiveness of emergency surgery compared with non-emergency surgery strategies (including medical management, non-surgical procedures and elective surgery) for patients admitted to hospital with common acute gastrointestinal conditions. Objectives: We aimed to evaluate the relative (1) clinical effectiveness of two strategies (i.e. emergency surgery vs. non-emergency surgery strategies) for five common acute conditions presenting as emergency admissions; (2) cost-effectiveness for five common acute conditions presenting as emergency admissions; and (3) clinical effectiveness and cost-effectiveness of the alternative strategies for specific patient subgroups. Methods: The records of adults admitted as emergencies with acute appendicitis, cholelithiasis, diverticular disease, abdominal wall hernia or intestinal obstruction to 175 acute hospitals in England between 1 April 2010 and 31 December 2019 were extracted from Hospital Episode Statistics and linked to mortality data from the Office for National Statistics. Eligibility was determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis codes, which were agreed by clinical panel consensus. Patients having emergency surgery were identified from Office of Population Censuses and Surveys procedure codes. The study addressed the potential for unmeasured confounding with an instrumental variable design. The instrumental variable was each hospital’s propensity to use emergency surgery compared with non-emergency surgery strategies. The primary outcome was the ‘number of days alive and out of hospital’ at 90 days. We reported the relative effectiveness of the alternative strategies overall, and for prespecified subgroups (i.e. age, number of comorbidities and frailty level). The cost-effectiveness analyses used resource use and mortality from the linked data to derive estimates of incremental costs, quality-adjusted life-years and incremental net monetary benefits at 1 year. Results: Cohort sizes were as follows: 268,144 admissions with appendicitis, 240,977 admissions with cholelithiasis, 138,869 admissions with diverticular disease, 106,432 admissions with a hernia and 133,073 admissions with an intestinal obstruction. Overall, at 1 year, the average number of days alive and out of hospitals at 90 days, costs and quality-adjusted life-years were similar following either strategy, after adjusting for confounding. For each of the five conditions, overall, the 95% confidence intervals (CIs) around the incremental net monetary benefit estimates all included zero. For patients with severe frailty, emergency surgery led to a reduced number of days alive and out of hospital and was not cost-effective compared with non-emergency surgery, with incremental net monetary benefit estimates of –£18,727 (95% CI –£23,900 to –£13,600) for appendicitis, –£7700 (95% CI –£13,000 to –£2370) for cholelithiasis, –£9230 (95% CI –£24,300 to £5860) for diverticular disease, –£16,600 (95% CI –£21,100 to –£12,000) for hernias and –£19,300 (95% CI –£25,600 to –£13,000) for intestinal obstructions. For patients who were ‘fit’, emergency surgery was relatively cost-effective, with estimated incremental net monetary benefit estimates of £5180 (95% CI £684 to £9680) for diverticular disease, £2040 (95% CI £996 to £3090) for hernias, £7850 (95% CI £5020 to £10,700) for intestinal obstructions, £369 (95% CI –£728 to £1460) for appendicitis and £718 (95% CI £294 to £1140) for cholelithiasis. Public and patient involvement translation workshop participants emphasised that these findings should be made widely available to inform future decisions about surgery. Limitations: The instrumental variable approach did not eliminate the risk of confounding, and the acute hospital perspective excluded costs to other providers. Conclusions: Neither strategy was more cost-effective overall. For patients with severe frailty, non-emergency surgery strategies were relatively cost-effective. For patients who were fit, emergency surgery was more cost-effective. Future work: For patients with multiple long-term conditions, further research is required to assess the benefits and costs of emergency surgery. Study registration: This study is registered as reviewregistry784. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 1. See the NIHR Journals Library website for further project information.

Published
2023
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12. Identifying classification systems regarding vascular access for haemodialysis: protocol for a scoping review

Author

Petr Waldauf, Michael Corr, Stephen O’neill, Katerina Lawrie, Jan Bafrnec, and Peter Balaz

Subjects
Medicine
Abstract

Introduction Classifications are important clinical tools that enable data arrangement, patient categorisation and comparative research. The care of patients with end-stage renal disease who have vascular access requires collaboration of several specialists. In such a field, where several different specialties overlap, strong evidence and well-grounded recommendations for good practice are essential. In this protocol, we aim to search the literature to identify classification systems regarding vascular access for haemodialysis. This protocol serves as a pragmatic tool for setting a systematic approach using scoping review methodology. It also aims to make the study transparent and avoid potential duplication.Methods and analysis We will follow the Joanna Briggs Institute methodology for the conduct of scoping reviews during the course of the proposed review. Scopus, Web of Science, PubMed, Google Scholar and the ClinicalTrials.gov registry will be searched by two researchers. Titles and abstracts will be screened and articles featuring classifications regarding vascular access for haemodialysis will be eligible for full-text analysis. There will be no age, sex or race limitation for the study populations. The title and abstract (if abstract available) must be in English but there will be no language restrictions for full-text review. Databases will be searched from inception to the date of search. All patients indicated for creation or placement of vascular access will be eligible, as well as patients with already existing vascular access. Classifications regarding preprocedural assessment, vascular access insertion or creation, complications and their management will be included in the study. Classifications regarding peritoneal dialysis will not be eligible. A comprehensive summary of the available evidence will be presented.Ethics and dissemination The protocol and the review are exempt from ethical approval as there is no direct patient involvement and the review will summarise data from already published literature. The final article will be submitted to a peer-reviewed scientific journal.

Published
2022
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14. The Long-Term Impacts of an Integrated Care Programme on Hospital Utilisation among Older Adults in the South of England: A Synthetic Control Study

Author

Paul Seamer, Therese Lloyd, Stefano Conti, and Stephen O’Neill

Subjects
integrated care, hospital utilisation, synthetic control, long-term, older people, health care, england, Medicine (General), R5-920
Abstract

Introduction: Reducing hospital use is often viewed as a possible positive consequence of introducing integrated care (IC). We investigated the impact of an IC programme in North East Hampshire and Farnham (NEHF), in southern England, on hospital utilisation among older adults over a 55 months period. Method: We used a Generalised Synthetic Control design to investigate the effect of implementing IC in NEHF between 2015 and 2020. For a range of hospital use outcomes, we estimated the trajectory that each would have followed in the absence of IC and compared it with the actual trajectory to estimate the potential impact of IC. Results: Three years into the programme, emergency admission rates started reducing in NEHF relative to its synthetic control, particularly those resulting in overnight hospital stays. By year 5 of the study overall emergency admission rates were 9.8% lower (95% confidence interval: –17.2% to –0.6%). We found no sustained difference in rates of emergency department (ED) visits, and average length of hospital stay was significantly higher from year 2. Conclusion: An IC programme in NEHF led to lower than estimated emergency admission rates; however, the interpretation of the impact of IC on admissions is complicated as lower rates did not appear until three years into the programme and the reliability of the synthetic control weakens over a long time horizon. There was no sustained change in ED visit rates.

Published
2023
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15. Protocol for an observational cohort study investigating personalised medicine for intensification of treatment in people with type 2 diabetes mellitus: the PERMIT study

Author

Kamlesh Khunti, Samantha Wilkinson, Liam Smeeth, Laurie A Tomlinson, Amanda I Adler, Ian J Douglas, Andrew Briggs, Richard Grieve, Stephen O’neill, Richard J Silverwood, Paul Charlton, Patrick Bidulka, and Anirban Basu

Subjects
Medicine
Abstract

Introduction For people with type 2 diabetes mellitus (T2DM) who require an antidiabetic drug as an add-on to metformin, there is controversy about whether newer drug classes such as dipeptidyl peptidase-4 inhibitors (DPP4i) or sodium-glucose co-transporter-2 inhibitors (SGLT2i) reduce the risk of long-term complications compared with sulfonylureas (SU). There is widespread variation across National Health Service Clinical Commissioning Groups (CCGs) in drug choice for second-line treatment in part because National Institute for Health and Care Excellence guidelines do not specify a single preferred drug class, either overall or within specific patient subgroups. This study will evaluate the relative effectiveness of the three most common second-line treatments in the UK (SU, DPP4i and SGLT2i as add-ons to metformin) and help target treatments according to individual risk profiles.Methods and analysis The study includes people with T2DM prescribed one of the second-line treatments-of-interest between 2014 and 2020 within the UK Clinical Practice Research Datalink linked with Hospital Episode Statistics and Office of National Statistics. We will use an instrumental variable (IV) method to estimate short-term and long-term relative effectiveness of second-line treatments according to individuals’ risk profiles. This method minimises bias from unmeasured confounders by exploiting the natural variation in second-line prescribing across CCGs as an IV for the choice of prescribed treatment. The primary outcome to assess short-term effectiveness will be change in haemoglobin A1c (%) 12 months after treatment initiation. Outcome measures to assess longer-term effectiveness (maximum ~6 years) will include microvascular and macrovascular complications, all-cause mortality and hospital admissions during follow-up.Ethics and dissemination This study was approved by the Independent Scientific Advisory Committee (20-064) and the London School of Hygiene & Tropical Medicine Research Ethics Committee (21395). Results, codelists and other analysis code will be made available to patients, clinicians, policy-makers and researchers.

Published
2021
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16. Finding Refuge in King Lear: From Brexit to Shakespeare’s European Value

Author

Stephen O’Neill

Subjects
shakespeare, brexit, eu, maps, archipelago, presentism, refuge, English literature, PR1-9680
Abstract

This article considers how Shakespeare’s King Lear has become a Brexit play across a range of discourses and media, from theatre productions and journalism to social media. With its themes of division and disbursement, of cliff edges and tragic self-immolation, Lear is the Shakespearean play that has been turned to as metaphor and analogy for the UK’s decision following the 23 June 2016 referendum to leave the European Union. Reading this presentist application of Shakespeare, the article attends to Shakespeare as itself a discourse through which cultural ideas, both real and imaginary, about Brexit and the EU are negotiated. It asks how can we might remap Lear in this present context―what other meanings and histories are to be derived from the play, especially in Lear’s exile and search for refuge, or in Cordelia’s departure for and return from France? Moving from a consideration of a Brexit Lear to an archipelagic and even European Lear, this article argues that Shakespeare is simultaneously a site of supranational connections and of a desire for values of empathy and refuge that reverberate with debates about migration in Europe.

Published
2019
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17. Publicly Financed Health Insurance Schemes and Horizontal Inequity in Inpatient Service Use in India

Author

Vanita Singh, Amit Garg, Arnab Kumar Laha, and Stephen O'Neill

Subjects
PFHI, RSBY, inequity, inpatient use, effective targeting., Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

Equity is a major policy objective of health care reforms across nations. Publicly Financed Health Insurance (PFHI) schemes are one major health care reform that have been adopted across developing countries to address inequity. Existing literature on the effect of PFHIs focuses on out-of-pocket expenditure and utilization of health services, while the effect of PFHIs on equity in health service use remains understudied, particularly in the Indian context. This study addresses this knowledge gap. In 2008 India launched a PFHI scheme with an aim to achieve horizontal equity, that is the equal treatment for equal needs, in the utilization of health services. Using data from the National Sample Survey Organization (NSSO), we analyze the extent of inequity in the utilization of inpatient services before (2004) and after (2014) the implementation of the PFHI. The annual hospitalization rate increased from 2.4 percent in 2004 to 4.4 percent in 2014 and the increase is higher for rural population. The proportion of population covered by any health insurance scheme increased from 0.5 percent to 15.3 percent post-PFHI implementation. The study finds that PFHIs were associated with reduced inequalities in inpatient service use, but the extent of reduction varied across states and across urban/rural areas. Our inter-state analysis shows that the States with a higher concentration of PFHIs among richer quintiles, a possible leakage and exclusion errors, have failed to ensure the needed access for their poor population. This failure reflects in their higher levels of income-based inequity in inpatient service use. This study has implications for the implementers of social security programs adopting targeted approach. There is a need for better strategies for the identification of beneficiaries and ensuring that they receive scheme benefits to have intended welfare effects.

Published
2021
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19. The benefits and harms of open notes in mental health: A Delphi survey of international experts.

Author

Charlotte Blease, Anna Kharko, Maria Hägglund, Stephen O'Neill, Deborah Wachenheim, Liz Salmi, Kendall Harcourt, Cosima Locher, Catherine M DesRoches, and John Torous

Subjects
Medicine, Science
Abstract

ImportanceAs of April 5, 2021, as part of the 21st Century Cures Act, new federal rules in the U.S. mandate that providers offer patients access to their online clinical records.ObjectiveTo solicit the view of an international panel of experts on the effects on mental health patients, including possible benefits and harms, of accessing their clinical notes.DesignAn online 3-round Delphi poll.SettingOnline.ParticipantsInternational experts identified as clinicians, chief medical information officers, patient advocates, and informaticians with extensive experience and/or research knowledge about patient access to mental health notes.Main outcomes, and measuresAn expert-generated consensus on the benefits and risks of sharing mental health notes with patients.ResultsA total of 70 of 92 (76%) experts from 6 countries responded to Round 1. A qualitative review of responses yielded 88 distinct items: 42 potential benefits, and 48 potential harms. A total of 56 of 70 (80%) experts responded to Round 2, and 52 of 56 (93%) responded to Round 3. Consensus was reached on 65 of 88 (74%) of survey items. There was consensus that offering online access to mental health notes could enhance patients' understanding about their diagnosis, care plan, and rationale for treatments, and that access could enhance patient recall and sense of empowerment. Experts also agreed that blocking mental health notes could lead to greater harms including increased feelings of stigmatization. However, panelists predicted there could be an increase in patients demanding changes to their clinical notes, and that mental health clinicians would be less detailed/accurate in documentation.Conclusions and relevanceThis iterative process of survey responses and ratings yielded consensus that there would be multiple benefits and few harms to patients from accessing their mental health notes. Questions remain about the impact of open notes on professional autonomy, and further empirical work into this practice innovation is warranted.

Published
2021
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20. Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort study

Author

Nebyou Seyoum, Ville Sallinen, Ari Leppäniemi, Andrea Belli, Clare Skerritt, Naomi Wright, Savva Pronin, Azmina Verjee, Oliver Warren, Michele Sacco, Arnav Agarwal, Simon Paterson-Brown, David Evans, Philip Choi, Ashish Gupta, Jonathan Myers, Victor Kong, Michael Wilson, Ewen M Harrison, Mircea Beuran, Ionut Negoi, Zahra Jaffry, Leonardo Solaini, Thomas M Drake, Sara W Al-Saqqa, Sule Burger, Kathryn Chu, Dhruv Ghosh, Hosni Khairy Salem, Marie Carmela Lapitan, Ismail Lawani, Maria Lorena Aguilera, Mayaba Maimbo, Alex Makupe, Vanessa Msosa, Alphonse Zeta Mutabazi, Riinu Ots, Ahmad Uzair Qureshi, Sarah Rayne, Marie Dione Parreno-Sacdalan, Richard Spence, Richard Lilford, Tom Abbott, Gehad Tawfik, Sebastian King, Alexia Farrugia, Jay Park, Abhishek Sharma, Augusto Zani, Christopher Smith, Jonathan Lund, Stefano Giuliani, John Whitaker, Elaine Borg, Alexis Arnaud, Esther Ferrero, Andrea Ruzzenente, Jennifer Rickard, Yousef Abuowda, Enas Alaloul, Natalie Blencowe, Sanjay Patel, Mark Ian Hampton, Ewen Griffiths, André L Mihaljevic, Elizabeth Evans, Catherine A Shaw, Jennifer Ploski, Mengistu Worku, Ashish Minocha, Shiva Dindyal, Midhun Mohan, Dina Fouad, Christopher Owen, Priya Patel, Sunil Kumar, James Yang, Kevin C Conlon, Sandro Pasquali, Mohamed Mostafa, Yoshan Moodley, Kathryn Lee, Gareth Irwin, Kjetil Søreide, Catrin Morgan, Ruth Blanco-Colino, Francesco Pata, Gianluca Pellino, Luke Nicholson, Taiwo Lawal, Omolara Williams, Andrey Litvin, Elodie Haraux, James Olivier, Michael Stoddart, Rebecca White, Luigi Bonavina, Chetan Khatri, Stephen O'Neill, Roger Schmid, Stephen Knight, Ahmed Soliman, Carly Bisset, Robert Parker, Rakan Kabariti, Joshua Luck, Guo Liang Yong, Tanzeela Gala, David Bunting, Lydia Longstaff, Ye Ru Chin, J Edward Fitzgerald, Giuliano Borda-Luque, Ainhoa Costas-Chavarri, Stuart J Fergusson, Anyomih Theophilus Teddy Kojo, Adewale O Adisa, Tomas Poškus, Antonio Ramos-De la Medina, Sebastian Shu, Afnan Altamini, Andrew Kirby, Gustavo Recinos, Jen Cornick, Maria Marta Modolo, Sayeda Nazmum Nahar, Ade Waterman, Ismail Lawini, Mohammed Firdouse, Tyler Rouse, Qinyang Liu, Juan Camilo Correa, Peep Talving, Dushyant Iyer, Tom Arthur, MariaLorena Aguilera, Basant Kumar, Radhian Amandito, Roy Quek, Luca Ansaloni, Ahmed Altibi, Donatas Venskutonis, Justas Zilinskas, YongYong Tew, Ramos-DelaMedina Antonio, Zineb Bent, Ibrahim Al-Slaibi, Haya Tahboub, Osaid H Alser, Diego Romani, Sebestian Shu, Piotr Major, Aurel Mironescu, Matei Bratu, Amar Kourdouli, Saint Kitts, Mohammed Ubaid Alsaggaf, Ahmad Gudal, Al Faifi Jubran, Sierra Leone, Sam Seisay, Bettina Lieske, Irene Ortega, Jenifa Jeyakumar, Kithsiri Senanayake, Omar Abdulbagi, Yucel Cengiz, Dmitri Raptis, Yuksel Altinel, Chia Kong, Ella Teasdale, Sukrit Suresh, Katherine Gash, Mark Scott, Ragavan Narayanan, Besmir Grizhja, Shpetim Ymeri, Gezim Galiqi, Roberto Klappenbach, Diego Antezana, Alvaro Enrique MendozaBeleño, Cecilia Costa, Belen Sanchez, Susan Aviles, Claudio Gabriel Fermani, Rubén Balmaceda, Santiago Villalobos, Juan Manuel Carmona, Daniel Hamill, Peter Deutschmann, Simone Sandler, Daniel Cox, Ram Nataraja, Claire Sharpin, Damir Ljuhar, Demi Gray, Morgan Haines, Dush Iyer, Nithya Niranjan, Scott D'Amours, Morvarid Ashtari, Helena Franco, Ashrarur Rahman Mitul, Sabbir Karim, Nowrin F Aman, Mahnuma Mahfuz Estee, Umme Salma, Joyeta Razzaque, Tasnia Hamidkanta, Sayeedaaktar Tori, Md Shadid Alamin, Swapnil Roy, Md Shadid Al Amin, Muhtarima Haque, Amreen Faruq, Farhana Iftekhar Margaret, Greg Padmore O'Shea, Ramesh Jonnalagadda, Aliaksandr Filatau, Dzmitry Paulouski, Maryna Shubianok, Tatsiana Shachykava, Dzianis Khokha, Vladimir Khokha, Fernande Djivoh, Francis Dossou, Dansou Gaspard Gbessi, Bruno Noukpozounkou, Yacoubou Imorou Souaibou, Kpèmahouton René Keke, Fred Hodonou, Ernestyemalinstephane Ahounou, Thierry Alihonou, Max Dénakpo, Germain Ahlonsou, Alemayehu Ginbo Bedada, Carlos Nsengiyumva, Sandrine Kwizera, Venerand Barendegere, Simon Stock, Luai Jamal, Georges Azzie, Sameer Kushwaha, Tzu-Ling Chen, Chingwan Yip, Irene Montes, Felipe Zapata, Sebastian Sierra, Mohamed Youssef, Hossam Elfeki, Waleed Thabet, Aly Sanad, Ahmed Zaki, Noran Abdel-Hameed, Esraa Abd Elkhalek, Yehia Zakaria, Tarek Ezzat, Ali Abo ElDahab, Mohamed Kelany, Sara Arafa, OsamaMokhtar Mohamed Hassan, Nermin Mohamed Badwi, Ahmad Saber Sleem, Hussien Ahmed, Kholoud Abdelbadeai, Mohamed Abozed Abdullah, Muhammadamsyarauni Lokman, Suraya Bahar, Anan Radyabdelazeam, Abdelrahman Adelshone, Muhammad Bin Hasnan, Athirah Zulkifli, Siti NurAlia Kamarulzamil, Abdelaziz Elhendawy, Aliang Latif, Ahmad Bin Adnan, Shahadatul Shaharuddin, Aminah HanumHaji AbdulMajid, Mahmoud Amreia, Dina Al-Marakby, Mahmoud Salma, Mohamadjeffreybin Ismail, Elissa Rifhan MohdBasir, Citra Dewi MohdAli, Aya Yehia Ata, Maha Nasr, Asmaa Rezq, Ahmed Sheta, Sherif Tariq, Abdelkhalek Sallam, Abdelrhman KZ Darwish, Sohaila Elmihy, Shady El Hadry, Ahmed Farag, Haidar Hajah, Abdelaziz Seliem, Amro Aglan, Ahmed Zohair, Mahitab Essam, Omar Moussa, Esraa El-Gizawy, Mostafa Samy, Safia Ali, Esraa Elhalawany, Ahmed Ata, Mohamed Elhalawany, Mohamed Nashat, Samar Soliman, Alaa Elazab, Mostada Samy, Mohamed A Abdelaziz, Khaled Ibrahim, Ahmed mohamed Ibrahim, Ammar Gado, Usama Hantour, Esraa Alm Eldeen, Mohamed Reda loaloa, Arwa Abouzaid, Mostafa Ahmedbahaaeldin, Eman Hashad, Fathy Sroor, Doaa Gamil, Eman Mahmoudabdulhakeem, Mahmoud Zakaria, Fawzy Mohamed, Marwan Abubakr, Elsayed Ali, Hesham Magdy, Mennatallah Ramadan, Mohamed Abdelatymohamed, Salma Mansour, Hager Abdulazizamin, Ahmed Rabiemohamed, Mahmoud Saami, Nada Ahmedredaelsayed, Adham Tarek, Sabry Mohyeldeenmahmoud, Islam MagdyEl Sayed, Amira Reda, Martina Yusufshawky, Mohammed Mousasalem, Shahinaz Alaa El-Din, Noha Abdullah Soliman, Muhammed Talaat, Shahinaz Alaael-Dein AhmedAbdelmoenelhusseiny, Noha Abdullah, Mohammed Elshaar, Aya Abdelfatahibraheem, Hager Abdulaziz, Mohammed Kamal Ismail, Mona Hamdymadkor, Mohamed Abdelaty, Sara 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Otero-Díez, Virginia Ramospérez, Nuria Aguadosuárez, Javier Minguez García, Sara Corral Moreno, Maria Vicenta Collado, Virginia Jiménez Carneros, Javier García Septiem, Mariana Gonzalez, Antonio Picardo, Enrique Esteban, Eloy Espin-Basany, Valeria Andriola, Lorena Solargarcía, Elisa Contreras, Carmen Garcíabernardo, Janet Pagnozzi, Sandra Sanz, Alberto Miyardeleón, Asnel Dorismé, Joseluis Rodicio, Aida Suarez, Jessica Stuva, Tamara Diazvico, Laura Fernandez-Vega, Carla Soldevila-Verdeguer, Fatima Sena-Ruiz, Natalia Pujol-Cano, Paula Diaz-Jover, José Maria Garcia-Perez, Juan Jose Segura-Sampedro, Cristina Pineño-Flores, David Ambrona-Zafra, Andrea Craus-Miguel, Patricia Jimenez-Morillas, Angela Mazzella, A.B Jayathilake, S.P.B Thalgaspitiya, L.S. Wijayarathna, P.M.S.N. Wimalge, Hakeem Ayomi Sanni, Aliyu Ndajiwo, Ogheneochuko Okenabirhie, Anmar Homeida, Abobaker Younis, Omer Abdelbagi Omer, Mustafa Abdulaziz, Ali Mussad, Ali M. Gilani, Ida Björklund, Sandra Ahlqvist, Anders Thorell, Fredrik Wogensen, Arestis Sokratous, Michaela Breistrand, Hildur Thorarinsdottir, Johanna Sigurdadottir, Maziar Nikberg, Maria Hjertberg, Peter Elbe, Deborah Saraste, Wiktor Rutkowski, Louise Forlin, Karoliina Niska, Malin Sund, Dennis Oswald, Georgios Peros, Rafael Bluelle, Katharina Reinisch, Daniel Frey, Adrian Palma, Dimitriaristotle Raptis, Lucius Zumbühl, Markus Zuber, Gabriela Werder, Antonio Nocito, Alexandra Gerosa, Silke Mahanty, Lukas Werner Widmer, Julia Müller, Alissa Gübeli, Grzegorz Zuk, Osman Bilgin Gulcicek, Talar Vartanoglu, Emin Kose, Servet Rustu Karahan, Mehmet Can Aydin, Nuri Alper Sahbaz, Ilkay Halicioglu, Halil Alis, Ipek Sapci, Can Adıyaman, Ahmet Murat Pektaş, Turgut Bora Cengiz, Ilkan Tansoker, Vedatcan Işler, Muazzez Cevik, Deniz Mutlu, Volkan Ozben, Berk Baris Ozmen, Sefa Bayram, Sinem Yolcu, Berna Buse Kobal, Ömer Faruk Toto, Haluk Cem Çakaloğlu, Kagan Karabulut, Vahit Mutlu, Bahar Busra Ozkan, Saban Celik, Anil Semiz, Selim Bodur, Enisburak Gül, Busra Murutoglu, Reyyan Yildirim, Bahadir Emre Baki, Ekin Arslan, Mehmet Ulusahin, Ali Guner, Nathan Walker, Nikhita Shrimanker, Simon Cole, Ryan Breslin, Ravi Srinivasan, Mohamed Elshaer, Kristina Hunter, Ahmed Al-Bahrani, Ignatius Liew, Nora Grace Mairs, Alistair Rocke, Lachlan Dick, Mobeen Qureshi, Debkumar Chowdhury, Adrienne Ho, Tharindra Dissanayake, Athula Tennakoon, Wadah Ali, Shujing Jane Lim, Charlene Tan, Catrin Jones, Dima Nassif, Aia Mehdi, Nathan Post, Eliana Kalakouti, Enkhbat Dashnyam, Frederick Stourton, Ioannis Mykoniatis, Chelise Currow, Francisca Wong, Veeranna Shatkar, Suraj Kadiwar, Alexander Smedley, Rebecca Wakefield, Philip Herrod, James Blackwell, Fraser Cohen, Ashwath Bandi, Giles Bond-Smith, Theodore Pezas, Neda Farhangmehr, Tomas Urbonas, Miklos Perenyei, Philip Ireland, Kirk Bowling, Kenneth Keogh, Hyunjin Jeon, Muhammad Rafaih Iqbal, Shivun Khosla, Anna Jeffery, James Perera, Ahmad Aboelkassem Ibrahem, Tariq Alhammali, Yahya Salama, Shaun Oram, Thomas Kidd, Fraser Cullen, Seehui Chiu, Hannah Sarafilovic, Athar Abbas, Sylvia Kamya, Norzawani Ishak, Cedar Andress, Aidan Haslegrave, Adam Boggon, Kirsten Laurie, Katie Connor, Thomas Mann, Anahita Mansuri, Rachel Davies, Aized Raza Shahbaz, Calvin Eng, Farhat Din, Ariadne L'heveder, Esther H.G. Park, Ramanish Ravishankar, Kirsten Mcintosh, Jih Dar Yau, Luke Chan, Susan Mcgarvie, Lingshan Tang, Hui Lim, Suhhuey Yap, Zhanherr Ng, Shahrukh Mirza, Yun Lin Ang, Luke Walls, Chloe Roy, Julian Camilleri-Brennan, Kenneth Mclean, Michelle D'souza, David Ewart Henshall, Eunicezuling Ter, William English, Dominic Townsend, Laura Maciejec, Shareef Mahdi, Onyinye Akpenyi, Elisabeth Hall, Hanaan Caydiid, Zakaria Rob, Hew D Torrance, Robin Johnston, Mohammedakil Gani, Gianpiero Gravante, Shivanchan Rajmohan, Kiran Majid, Madanmohan Palliyil, Neil Harvey, Katie Baillie, Sam Shillito, Suzanne Kershaw, Rebecca Bamford, Peter Orton, Elke Reunis, Robert Tyler, Waicheong Soon, Guled M. Jama, Dharminder Dhillon, Khyati Patel, Shayanthan Nanthakumaran, Rachel Heard, Kar Yan Chen, Behrad Barmayehvar, Uttaran Datta, Sobhana Iftekhartani, Eimear Monaghan, Philippa Donnelly, Michael Walker, Jehangirshaw Parakh, Sarah Blacker, Anil Kaul, Arjun Paramasivan, Sameh Farag, Ashrafun Nessa, Salwa Awadallah, Jieqi Lim, James Cheankhunng, Ravi P. Kiran, Alice Murray, Eric Etchill, Mohini Dasari, Juan Puyana, Nadeem Haddad, Martin Zielinski, Asad Choudhry, Celeste Caliman, Mieshia Beamon, Therese Duane, Mamta Swaroop, Rebecca Deal, Erik Schadde, Mark Hemmila, Lena Napolitano, Kathleen To, Joseph Musowoya, Niels Van Der Naald, Dayson Kumwenda, Alex Reece-Smith, Kars Otten, Anna Verbeek, Marloes Prins, Alibeth Andres Baquero Suarez, Chelsea Deane, Emilio Dijan, Mahmoud Elfiky, Laura Koskenvuo, Aurore Thollot, Bernard Limoges, Carmen Capito, Challine Alexandre, Henri Kotobi, Julien Leroux, Kalitha Pinnagoda, Nicolas Henric, Olivier Azzis, Olivier Rosello, Poddevin Francois, Sara Etienne, Philippe Buisson, Sophian Hmila, Joe-Nat Clegg-Lamptey, Osman Imoro, Owusu Emmanuel Abem, Dimitrios Papageorgiou, Vasiliki Soulou, Sabrina Asturias, Lenin Peña, Donal B O’Connor, Alberto Realis Luc, Alfio Alessandro Russo, Antonio Taddei, Camilla Cona, Corrado Bottini, Giovanni Pascale, Giuseppe Rotunno, Marco Maria Pascale, Margherita Notarnicola, Mario Corbellino, Paolo Ubiali, Roberto Cautiero, Tommaso Bocchetti, Elena Muzio, Vania Guglielmo, Eugenio Morandi, Patrizio Mao, Emilia De Luca, Farah Mahmoud Ali, Paulius Kondrotas, Robertas Baltrunas, Juozas Kutkevicius, Povilas Ignatavicius, Choy Ling Tan, Jia Yng Siaw, Sir Young Yam, Ling Wilson, Mohamed Rezal Abdul Aziz, John Bondin, Carmina Diaz Zorrilla, Anass Majbar, Agboola Taiwo, Emeka Nwabuoku, Marte BliksØen, Zain Ali Khan, Jazmin Coronel, Cesar Miranda, Idelso Vasquez, Luis M. Helguero-Santin, Adesina Adedeji, Saleh Alqahtani, Max Rath, Michael Van Niekerk, Modise Zacharia Koto, Roel Matos-Puig, Leif Israelsson, Tobias Schuetz, Mahmut Arif Yuksek, Meric Mericliler, Bernhard Wolf, Cameron Fairfield, Katharine Whitehurst, Natalie Redgrave, Caroluce K Musyoka, Michael Cox, Muhamed M H Farhan-Alanie, Rory Callan, Chali Chibuye, Tebian Hassanein Ahmed Ali, Syrine Rekhis, Muna Rommaneh, Zi Hao Sam, Thays Brunelli Pugliesi, Gabriel Pardo, and Ruth Blanco

Subjects
Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Abstract

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings.Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI).Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI.Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.

Published
2020
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22. Developing composite indices of geographical access and need for nursing home care in Ireland using multiple criteria decision analysis [version 1; peer review: 2 approved]

Author

Brian P. Reddy, Stephen O'Neill, and Ciaran O'Neill

Subjects
nursing homes, older adults, multiple criteria decision analysis, composite index, eng, Medicine
Abstract

Background: Spatial accessibility has consistently been shown to influence utilisation of care and health outcomes, compared against local population needs. We sought to identify how appropriately nursing homes (NHs) are distributed in Ireland, as its NH market lacks central planning. Methods: We used multiple criteria decision analysis (MCDA) approaches to develop composite indices of both access (incorporating measures of availability, choice, quality and affordability) and local NH need for over 65s (relating to the proportion living alone, with cognitive disabilities or with low self-rated health, estimated scores for activities of daily living and instrumental activities of daily living, the average number of disabilities per person and the average age of this group). Data for need were derived from census data. Results were mapped to better understand underlying geographical patterns. Results: By comparing local accessibility and need, underserved areas could be identified, which were clustered particularly in the country’s northwest. Suburbs, particularly around Dublin, were by this measure relatively overserved. Conclusions: We have developed multi-dimensional indices of both accessibility to, and need for, nursing home care. This was carried out by combining granular, open data sources and elicited expert/stakeholder opinion from practitioners. Mapping these data helped to highlight clear evidence of inequitable variation in nursing home distribution.

Published
2020
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23. Generating national projections of dementia cases for Ireland using a calibrated macro-simulation model

Author

Tom Pierse, Fiona Keogh, and Stephen O'Neill

Subjects
Medicine
Abstract

Introduction Epidemiological data on dementia is not available in many European countries and regions due to the high cost and complexity of conducting large scale dementia screening studies. The available epidemiological studies identify potentially substantial variation in the prevalence of dementia over time and across Europe.Methods In this paper we generate simulations of the number of dementia cases in Ireland from 1991 to 2036 using a three-state Markov illness-death model. Parameters values are selected for each simulation from a range using a random parameter search pattern. We employ a novel calibration method which exploits the strong relationship between dementia, ageing and mortality. Simulation weights are generated based on differences between observed and modelled cohorts of older people and the reported number of deaths from dementia. Irish Census data from 1991 to 2016 and the number of recorded deaths due to dementia in 2018 are used as calibration points. A weighted average projection of the number of dementia cases is generated.Results We estimate a weighted average number of cases of dementia in 2016 of 54 877 increasing to 98 946 in 2036; this estimate is substantially lower than the estimates generated using extrapolation methods. We show the wide range of possible outcomes given the range in the available parameter estimates and show that irrespective of whether the incidence rate of dementia is declining the number of cases of dementia is rapidly increasing due to population ageing.Conclusion Previous studies have used parameter estimates from meta-analyses of the literature or from individual studies. In this paper we supplement these with a calibration approach using observed cause of death and population age structure data. These additional sources of data can be used to generate estimates of dementia prevalence in any country or region which has census data and data on deaths due to dementia.

Published
2020
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24. Evidence of Psychological Targeting but not Psychological Tailoring in Political Persuasion Around Brexit

Author

Christopher Walker, Stephen O’Neill, Lee de-Wit, and Eve Isham

Subjects
Technology, Medicine, Science
Abstract

There are numerous associations between psychological characteristics and political values, but it is unclear whether messages tailored to these psychological characteristics can influence political decisions. Two studies (N = 398, N = 395) tested whether psychological-based argument tailoring could influence participants’ decision-making. We constructed arguments based on the 2016 Brexit referendum; Remain supporters were presented with four arguments supporting the Leave campaign, tailored to reflect the participant’s strongest (/weakest) moral foundation (Loyalty or Fairness) or personality trait (Conscientiousness or Openness). We tested whether individuals scoring high on a trait would find the tailored arguments more persuasive than individuals scoring low on the same trait. We found clear evidence for targeting, particularly for Loyalty, but either no evidence or weak evidence, in the case of Conscientiousness, for tailoring. Overall, the results suggest that targeting political messages could be effective, but provide either no, or weak evidence that tailoring these messages influences political decision-making.

Published
2020
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25. FKBP12 activates the cardiac ryanodine receptor Ca2+-release channel and is antagonised by FKBP12.6.

Author

Elena Galfré, Samantha J Pitt, Elisa Venturi, Mano Sitsapesan, Nathan R Zaccai, Krasimira Tsaneva-Atanasova, Stephen O'Neill, and Rebecca Sitsapesan

Subjects
Medicine, Science
Abstract

Changes in FKBP12.6 binding to cardiac ryanodine receptors (RyR2) are implicated in mediating disturbances in Ca(2+)-homeostasis in heart failure but there is controversy over the functional effects of FKBP12.6 on RyR2 channel gating. We have therefore investigated the effects of FKBP12.6 and another structurally similar molecule, FKBP12, which is far more abundant in heart, on the gating of single sheep RyR2 channels incorporated into planar phospholipid bilayers and on spontaneous waves of Ca(2+)-induced Ca(2+)-release in rat isolated permeabilised cardiac cells. We demonstrate that FKBP12 is a high affinity activator of RyR2, sensitising the channel to cytosolic Ca(2+), whereas FKBP12.6 has very low efficacy, but can antagonise the effects of FKBP12. Mathematical modelling of the data shows the importance of the relative concentrations of FKBP12 and FKBP12.6 in determining RyR2 activity. Consistent with the single-channel results, physiological concentrations of FKBP12 (3 µM) increased Ca(2+)-wave frequency and decreased the SR Ca(2+)-content in cardiac cells. FKBP12.6, itself, had no effect on wave frequency but antagonised the effects of FKBP12.We provide a biophysical analysis of the mechanisms by which FK-binding proteins can regulate RyR2 single-channel gating. Our data indicate that FKBP12, in addition to FKBP12.6, may be important in regulating RyR2 function in the heart. In heart failure, it is possible that an alteration in the dual regulation of RyR2 by FKBP12 and FKBP12.6 may occur. This could contribute towards a higher RyR2 open probability, 'leaky' RyR2 channels and Ca(2+)-dependent arrhythmias.

Published
2012
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28. A comparison of synthetic control approaches for the evaluation of policy interventions using observational data: Evaluating the impact of redesigning urgent and emergency care in Northumberland

Author

Geraldine M. Clarke, Adam Steventon, and Stephen O'Neill

Subjects
Health Policy
Abstract

To compare the original synthetic control (OSC) method with alternative approaches (Generalised (GSC), Micro (MSC), and Bayesian (BSC) synthetic control methods) and re-evaluate the impact of a significant restructuring of urgent and emergency care in North-East England, which included the opening of the UK's first purpose-built specialist emergency care hospital.Simulations and data from Secondary Uses Service data, a single comprehensive repository for patient-level health care data in England.Hospital use of individuals exposed and unexposed to the restructuring is compared. We estimate the impact using OSC, MSC, BSC and GSC applied at the general practice level. We contrast the estimation methods' performance in a Monte Carlo simulation study.Hospital activity data from Secondary Uses Service for patients aged over 18 years registered at a general practice in England from April 2011 to March 2019.None of the methods dominated across all simulation scenarios. GSC was generally preferred. In contrast to an earlier evaluation which used OSC, GSC reported a smaller impact of the opening of the hospital on Accident and Emergency (AE) department (also known as emergency department or casualty) visits and no evidence for any impact on the proportion of AE patients seen within 4 hours.The simulation study highlights cases where the considered methods may lead to biased estimates in health policy evaluations. GSC was found to be the most reliable method of those considered. Considering more disaggregated data over a longer time span and applying GSC indicates that the specialist emergency care hospitals in Northumbria had less impact on AE visits and waiting times than suggested by the original evaluation which applied OSC to more aggregated data. This article is protected by copyright. All rights reserved.

Published
2023
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29. Ethnic and socioeconomic disparities in initiation of second‐line antidiabetic treatment for people with type 2 diabetes in England: A cross‐sectional study

Author

Patrick Bidulka, Rohini Mathur, David G. Lugo‐Palacios, Stephen O'Neill, Anirban Basu, Richard J. Silverwood, Paul Charlton, Andrew Briggs, Liam Smeeth, Amanda I. Adler, Ian J. Douglas, Kamlesh Khunti, and Richard Grieve

Subjects
Endocrinology, Endocrinology, Diabetes and Metabolism, Internal Medicine
Abstract

To assess any disparities in the initiation of second-line antidiabetic treatments prescribed among people with type 2 diabetes mellitus (T2DM) in England according to ethnicity and social deprivation level.This cross-sectional study used linked primary (Clinical Practice Research Datalink) and secondary care data (Hospital Episode Statistics), and the Index of Multiple Deprivation (IMD). We included people aged 18 years or older with T2DM who intensified to second-line oral antidiabetic medication between 2014 and 2020 to investigate disparities in second-line antidiabetic treatment prescribing (one of sulphonylureas [SUs], dipeptidyl peptidase-4 [DPP-4] inhibitors, or sodium-glucose cotransporter-2 [SGLT2] inhibitors, in combination with metformin) by ethnicity (White, South Asian, Black, mixed/other) and deprivation level (IMD quintiles). We report prescriptions of the alternative treatments by ethnicity and deprivation level according to predicted percentages derived from multivariable, multinomial logistic regression.Among 36 023 people, 85% were White, 10% South Asian, 4% Black and 1% mixed/other. After adjustment, the predicted percentages for SGLT2 inhibitor prescribing by ethnicity were 21% (95% confidence interval [CI] 19-23%), 20% (95% CI 18-22%), 19% (95% CI 16-22%) and 17% (95% CI 14-21%) among people with White, South Asian, Black, and mixed/other ethnicity, respectively. After adjustment, the predicted percentages for SGLT2 inhibitor prescribing by deprivation were 22% (95% CI 20-25%) and 19% (95% CI 17-21%) for the least deprived and the most deprived quintile, respectively. When stratifying by prevalent cardiovascular disease (CVD) status, we found lower predicted percentages of people with prevalent CVD prescribed SGLT2 inhibitors compared with people without prevalent CVD across all ethnicity groups and all levels of social deprivation.Among people with T2DM, there were no substantial differences by ethnicity or deprivation level in the percentage prescribed either SGLT2 inhibitors, DPP-4 inhibitors or SUs as second-line antidiabetic treatment.

Published
2022
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36. A comparison of quasi-experimental methods with data before and after an intervention: an introduction for epidemiologists and a simulation study

Author

Roch A Nianogo, Tarik Benmarhnia, and Stephen O’Neill

Subjects
Epidemiology, General Medicine
Abstract

Background As the interest in and use of quasi-experimental methods to evaluate impacts of health policies have dramatically increased in the epidemiological literature, we set out this study to (i) systematically compare several quasi-experimental methods that use data before and after an intervention and contrast their performance within a simulation framework while providing a brief overview of the methods; and (ii) discuss challenges that could arise from using these methods as well as directions for future research in the context of epidemiological applications. Methods We considered single-group designs [pre-post and interrupted time series (ITS)] and multiple-group designs [controlled interrupted time series/difference-in-differences, synthetic control methods (SCMs): traditional SCMs and generalized SCMs]. We assessed performance based on bias and root mean squared error. Results We identified settings in which each method failed to provide unbiased estimates. We found that, among the methods investigated, when data for multiple time points and for multiple control groups are available (multiple-group designs), data-adaptive methods such as the generalized SCM were generally less biased than other methods evaluated in our study. In addition, when all of the included units have been exposed to treatment (single-group designs) and data for a sufficiently long pre-intervention period are available, then the ITS performs very well, provided the underlying model is correctly specified. Conclusions When using a quasi-experimental method using data before and after an intervention, epidemiologists should strive to use, whenever feasible, data-adaptive methods that nest alternative identifying assumptions including relaxing the parallel trend assumption (e.g. generalized SCMs).

Published
2023
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38. Use of Telemedicine for Post-discharge Assessment of the Surgical Wound. International Cohort Study, and Systematic Review with Meta-analysis

Author

James, Glasbey, Issi, Trout, Victoria, Adeyeye, Adesoji, Ademuyiwa, Adewale, Adisa, Alisha, Bhatt, Bruce, Biccard, Peter, Brocklehurst, Jean De La Croix Allen Ingabire, Francis Moïse Dossou, Irani, Durán, Rohini, Dutta, Dhruva, Ghosh, Frank, Gyamfi, Pollyanna, Hardy, Gabriella, Hyman, Ritu, Jain, Bryar, Kadir, Stephen, Knight, Oluwaseun, Ladipo-Ajayi, Ismail, Lawani, Souliath, Lawani, Rachel, Lillywhite, Rhiannon, Macefield, Laura, Magill, Janet, Martin, Jonathan, Mathers, Kenneth, Mclean, Punam, Mistry, Rohin, Mittal, Rachel, Moore, Dion, Morton, Faustin, Ntirenganya, Emmanuel, Ofori, Rupert, Pearse, Alberto, Peón, Thomas, Pinkney, Antonio Ramos de la Medina, Tubasiime, Ronald, David, Roman, Joana, Simoes, Anita, Slade, Stephen, Tabiri, Donna, Smith, Ewen, Harrison, Aneel, Bhangu, Azmina, Verjee, Emmy, Runigamugabo, Adesoji, O Ademuyiwa, Adewale, O Adisa, Maria Lorena Aguilera, Afnan, Altamini, Philip, Alexander, Sara, W Al-Saqqa, Giuliano, Borda-Luque, Jen, Cornick, Ainhoa, Costas-Chavarri, Thomas, M Drake, Stuart, J Fergusson, J Edward Fitzgerald, C Allen Ingabire, J, Lawani, Ismaïl, Zahra, Jaffry, Hosni Khairy Salem, Chetan, Khatri, Andrew, Kirby, Anyomih Theophilus Teddy Kojo, Marie Carmela Lapitan, Richard, Lilford, Andre, L Mihaljevic, Midhun, Mohan, Alphonse Zeta Mutabazi, Dmitri, Nepogodiev, Riinu, Ots, Pata, Francesco, Tomas, Poškus, Ahmad Uzair Qureshi, Antonio Ramos-De la Medina, Sarah, Rayne, Gustavo, Recinos, Kjetil, Søreide, Catherine, A Shaw, Sebastian, Shu, Richard, Spence, Neil, Smart, Ewen, M Harrison, Maria Marta Modolo, Dushyant, Iyer, Sebastian, King, Tom, Arthur, Sayeda Nazmum Nahar, Ade, Waterman, Michael, Walsh, Arnav, Agarwal, Zani, Augusto, Mohammed, Firdouse, Tyler, Rouse, Qinyang, Liu, Juan Camilo Correa, Peep, Talving, Mengistu, Worku, Alexis, Arnaud, Vassilis, Kalles, Basant, Kumar, Sunil, Kumar, Radhian, Amandito, Roy, Quek, Luca, Ansaloni, Ahmed, Altibi, Donatas, Venskutonis, Justas, Zilinskas, Tomas, Poskus, John, Whitaker, Vanessa, Msosa, Yong Yong Tew, Alexia, Farrugia, Elaine, Borg, Zineb, Bentounsi, Tanzeela, Gala, Ibrahim, Al-Slaibi, Haya, Tahboub, Osaid, H Alser, Diego, Romani, Sebestian, Shu, Piotr, Major, Aurel, Mironescu, Matei, Bratu, Amar, Kourdouli, Aliyu, Ndajiwo, Abdulaziz, Altwijri, Mohammed Ubaid Alsaggaf, Ahmad, Gudal, Al Faifi Jubran, Sam, Seisay, Bettina, Lieske, Irene, Ortega, Jenifa, Jeyakumar, Kithsiri, J Senanayake, Omar, Abdulbagi, Yucel Cengiz Dmitri Raptis, Yuksel, Altinel, Chia, Kong, Ella, Teasdale, Gareth, Irwin, Michael, Stoddart, Rakan, Kabariti, Sukrit, Suresh, Katherine, Gash, Ragavan, Narayanan, Mayaba, Maimbo, Besmir, Grizhja, Shpetim, Ymeri, Gezim, Galiqi, Roberto, Klappenbach, Diego, Antezana, Alvaro Enrique Mendoza Beleño, Cecilia, Costa, Belen, Sanchez, Susan, Aviles, Claudio Gabriel Fermani, Rubén, Balmaceda, Santiago, Villalobos, Juan Manuel Carmona, Daniel, Hamill, Peter, Deutschmann, Simone, Sandler, Daniel, Cox, Ram, Nataraja, Claire, Sharpin, Damir, Ljuhar, Demi, Gray, Morgan, Haines, Morvarid, Ashtari, Helena, Franco, Ashrarur Rahman Mitul, Sabbir, Karim, Nowrin, F Aman, Mahnuma Mahfuz Estee, Salma, UMM-E, Joyeta, Razzaque, Tasnia Hamid Kanta, Sayeeda Aktar Tori, Shadid, Alamin, Swapnil, Roy, Shadid Al Amin, Rezaul, Karim, Muhtarima, Haque, Amreen, Faruq, Farhana, Iftekhar, Margaret, O'Shea, Greg, Padmore, Ramesh, Jonnalagadda, Andrey, Litvin, Aliaksandr, Filatau, Dzmitry, Paulouski, Maryna, Shubianok, Tatsiana, Shachykava, Dzianis, Khokha, Vladimir, Khokha, Fernande, Djivoh, Francis, Dossou, Djifid Morel Seto, Dansou Gaspard Gbessi, Bruno, Noukpozounkou, Yacoubou Imorou Souaibou, Kpèmahouton René Keke, Fred, Hodonou, Ernest Yemalin Stephane Ahounou, Thierry, Alihonou, Max, Dénakpo, Germain, Ahlonsou, Alemayehu Ginbo Bedada, Carlos, Nsengiyumva, Sandrine, Kwizera, Venerand, Barendegere, Philip, Choi, Simon, Stock, Luai, Jamal, Georges, Azzie, Sameer, Kushwaha, Tzu-Ling, Chen, Chingwan, Yip, Irene, Montes, Felipe, Zapata, Sebastian, Sierra, Maria Isabel Villegas Lanau, Maria Clara Mendoza Arango, Ivan Mendoza Restrepo, Ruben Santiago Restrepo Giraldo, Edgar, Domini, Robert, Karlo, Jakov, Mihanovic, Mohamed, Youssef, Hossam, Elfeki, Waleed, Thabet, Aly, Sanad, Gehad, Tawfik, Ahmed, Zaki, Noran, Abdel-Hameed, Mohamed, Mostafa, Muhammad Fathi Waleed Omar, Ahmed, Ghanem, Emad, Abdallah, Adel, Denewar, Eman, Emara, Eman, Rashad, Ahmad, Sakr, Rehab, Elashry, Sameh, Emile, Toqa, Khafagy, Sara, Elhamouly, Arwa, Elfarargy, Amna Mamdouh Mohamed, Ghada Saied Nagy, Abeer, Esam, Eman, Elwy, Aya, Hammad, Salwa, Khallaf, Eman, Ibrahim, Ahmed, Saidbadr, Ahmed, Moustafa, Amany Eldosouky Mohammed, Mohammed, Elgheriany, Eman, Abdelmageed, Eman Abd Al Raouf, Esraa Samir Elbanby, Maha, Elmasry, Mahitab Morsy Farahat, Eman Yahya Mansor, Eman Magdy Hegazy, Esraa, Gamal, Heba, Gamal, Hend, Kandil, Doaa Maher Abdelrouf, Mohamed, Moaty, Dina, Gamal, Nada, El-Sagheer, Mohamed, Salah, Salma, Magdy, Asmaa, Salah, Ahmed, Essam, Ahmed, Ali, Mahmoud, Badawy, Sara, Ahmed, Mazed, Mohamed, Abdelrahman, Assal, Mohamed, Sleem, Mai, Ebidy, Aly Abd Elrazek, Diaaaldin, Zahran, Nourhan, Adam, Mohamed, Nazir, Adel, B Hassanein, Ahmed, Ismail, Amira, Elsawy, Rana, Mamdouh, Mohamed, Mabrouk, Lopna Ahmed Mohamed Ahmed, Mohamed Hassab Alnaby, Eman, Magdy, Manar, Abd-Elmawla, Marwan, Fahim, Bassant, Mowafy, Moustafa Ibrahim Mahmoud, Meran, Allam, Muhammad, Alkelani, Noran Halim El Gendy, Mariam Saad Aboul-Naga, Reham Alaa El-Din, Alyaa Halim Elgendy, Ismail, MOHAMED BADRELDIN MOHAMED, Mahmoud, Shalaby, Aya Adel Elsharkawy, Mahmoud Elsayed Moghazy, Khaled Hesham Elbisomy, Hend Adel Gawad Shakshouk, Mohamed Fouad Hamed, Mai Mohamed Ebidy, Mostafa, Abdelkader, Mohamed, Karkeet, Hayam, Ahmed, Israa, Adel, Mohammad Elsayed Omar, Mohamed, Ibrahim, Omar, Ghoneim, Omar, Hesham, Shimaa, Gamal, Karim, Hilal, Omar, Arafa, Sawsan Adel Awad, Menatalla, Salem, Fawzia Abdellatif Elsherif, Nourhan, Elsabbagh, Moustafa, R Aboelsoud, Ahmed Hossam Eldin 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Basma, Ali Mahmoud, Mohamed, Qenawy, Mostafa, M Rashed, Ahmed, Dahy, Ahmed, Sayed, Marwa, W Shamsedine, Ahmed, Mohamed, Bakeer, Hasan, Ahmad, M Saad, Mahmoud, Abdul Bassit, Khalil, Khalid Abd El-Latif, Nadia, Elzahed, Nada, El Kashash, Ahmed, Mohamed Bekhet, Nada, Hafez, Sarah, Gad, Ahmed, Elkhadragy Maher, Mahmoud, Abd Elsameea, Ahmed, Hafez, Mohamed, Sabe, Ahmad, Ahmed, Ataa, Shahine, Ahmed, Dawood, Khaled, Gaafar, Shireen, Husseiny, Reem, Aboelmagd, Omnia, Soliman, Ahmed, Mesbah, Nourhan, Emadeldin, Hossam, Al Meligy, Amgad, Hassan Bekhet, Amira, Hasan, Doaa, Alhady, Khaled, Khaled Sabe, Ahmad, A Elnajjar, Mahmoud, Aboelella, Majed, Hamsho, Ward, Hassan, Ihab, Saad, Hala, Abdelazim, Galaleldin, Mahmoud, Hend, Wael, Noha, M Kandil, Ahmedali, Magdy, Ahmed, Said Elkholy, Shimaa, Eldin Adel, Badr, Dabbour, Kareem, Elsherbiney, Saged, Mattar, Omar, Khaled Abdrabou, Abdulshafi, Yahia Mohamed Aly, Mohammed, Geuoshy, Abdelrahman, Elnagar, Ahmedglal, Ahmed, Saraibrahim, Abdelmotaleb, 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Ana, Genoveva Vergara Mejia, Angelica, Soledad Gonzales Montejo, Maria, Del Carmen Escalante Salas, Marilia, Alcca Ticona, Willy, Vargas, Marvin, Christian Manrique Sila, George, Mas, Robinson, Del Pilar Paucar, Arazzelly, José Román Velásquez, Armando, Robledo-Rabanal, Alina, Alexander Zeta Solis, Ludwing, Turpo Espinoza, Kenny, Luis Hamasaki Hamaguchi, José, Samuel Florez Farfan, Erick, Alvi Madrid Barrientos, Linda, Jaime Herrera Matta, Juan, V Mora, John Jemuel, P Redota, Menold Archee, Francisco Roxas, Manuel, B Maño, Maria Jesusa, Dione Parreno-Sacdalan, Marie, Leanne Almanon, Christel, Walędziak, Maciej, Roszkowski, Rafa, Janik, Micha, Lasek, Anna, Radkowiak, Dorota, Rubinkiewicz, Mateusz, Fernandes, Cristina, Costa-Maia, Jose, Melo, Renato, Muntean, Liviu, Sandu Mironescu, Aurel, Corneliu Vida, Lucian, Popa, Mariuca, Mircea, Hogea, Vartic, Mihaela, Diaconescu, Bogdan, Razvan Bratu, Matei, Negoi, Ionut, Beuran, Mircea, Ciubotaru, Cezar, Uzabumwana, Norbert, Duhoranenayo, Dieudonne, Jovine, Elio, Zanini, Nicola, Landolfo, Giovanni, Aljiffry, Murad, Idris, Faisal, A Alghamdi, Mohammed Saleh, Maghrabi, Ashraf, Altaf, Abdulmalik, Alkaaki, Aroub, Khoja, Ahmad, Nawawi, Abrar, Turkustani, Sondo, Khalifah, Eyad, Albiety, Adel, Sahel, Sarah, Alshareef, Reham, Najjar, Mohammed, Alzahrani, Ahmed, Alghamdi, Ahmed, Alhazmi, Wedyan, Al Saied, Ghiath, Alamoudi, Mohammed, Masood Ria, Muhammed, Hassanain, Mazen, Alhassan, Basmah, Altamimi, Abdullah, Alyahya, Reem, Al Subaie, Norah, Al Bastawis, Fatema, Altamimi, Afnan, Nouh, Thamer, Khan, Roaa, Radojkovic, Milan, Jeremic, Ljiljana, Nestorovic, Milica, Hao Law, Jia, Say Kwang Tan, Keith, Choon Kiat Tan, Ryan, Kin Tan, Joel, Wen Liang Joel, Lau, Wei Chan, Xue, Qi Hui Leong, Faith, Seng Chong, Choon, Koh, Sharon, Yin Lee, Kai, Chung Lee, Kuok, Pluke, Kent, Dedekind, Britta, Nashidengo, Puyearashid, Ian Hampton, Mark, Joosten, Johanna, Sobnach, Sanju, Roodt, Liana, Sander, Anthony, Pape, Jame, Maistry, Niveshni, Ndwambi, Phumudzo, Kinandu, Kamau, Tun, Myint, Du Toit, Frederick, Ellison, Quinn, Burger, Sule, C Grobler, D, Bongani Khulu, Lawrence, Jennings, Vicky, Leusink, Astrid, Kariem, Nazmie, Gouws, Juan, Chu, Kathryn, Bougard, Heather, Noor, Fazlin, Dell, Angela, Van Straten, Stephanie, Khamajeet, Arvin, Kapenda Tshisola, Serge, Kabongo, Kalangu, Kong, Victor, Moodley, Yoshan, Anderson, Frank, Madiba, Thandinkosi, du Plooy, Flip, Hartford, Leila, Chilton, Gareth, Karjiker, Parveen, Ernest Mabitsela, Matlou, Ruth Ndlovu, Sibongile, Badicel, Maria, Jaich, Robert, Ruiz-Tovar, Jaime, Garcia-Florez, Lui, L Otero-Díez, Jorge, Ramos Pérez, Virginia, Aguado Suárez, Nuria, Minguez García, Javier, Corral Moreno, Sara, Vicenta Collado, Maria, Jiménez Carneros, Virginia, García Septiem, Javier, Gonzalez, Mariana, Picardo, Antonio, Esteban, Enrique, Ferrero, Esther, Espin-Basany, Eloy, Blanco-Colino, Ruth, Andriola, Valeria, Solar García, Lorena, Contreras, Elisa, García Bernardo, Carmen, Pagnozzi, Janet, Sanz, Sandra, Miyar de León, Alberto, Dorismé, Asnel, Rodicio, Joselui, Suarez, Aida, Stuva, Jessica, Diaz Vico, Tamara, Fernandez-Vega, Laura, Soldevila-Verdeguer, Carla, Sena-Ruiz, Fatima, Pujol-Cano, Natalia, Diaz-Jover, Paula, Maria Garcia-Perez, José, Jose Segura-Sampedro, Juan, Pineño-Flores, Cristina, Ambrona-Zafra, David, Craus-Miguel, Andrea, Jimenez-Morillas, Patricia, Mazzella, Angela, B Jayathilake, A, B Thalgaspitiya, S P, S Wijayarathna, L, N Wimalge, P M S, Ayomi Sanni, Hakeem, Okenabirhie, Ogheneochuko, Homeida, Anmar, Younis, Abobaker, Abdelbagi Omer, Omer, Abdulaziz, Mustafa, Mussad, Ali, Adam, Ali, Cengiz, Yucel, Björklund, Ida, Ahlqvist, Sandra, Thorell, Ander, Wogensen, Fredrik, Sokratous, Aresti, Breistrand, Michaela, Thorarinsdottir, Hildur, Sigurdadottir, Johanna, Nikberg, Maziar, Chabok, Abba, Hjertberg, Maria, Elbe, Peter, Saraste, Deborah, Rutkowski, Wiktor, Forlin, Louise, Niska, Karoliina, Sund, Malin, Oswald, Denni, Peros, Georgio, Bluelle, Rafael, Reinisch, Katharina, Frey, Daniel, Palma, Adrian, Aristotle Raptis, Dimitri, Zumbühl, Luciu, Zuber, Marku, Schmid, Roger, Werder, Gabriela, Nocito, Antonio, Gerosa, Alexandra, Mahanty, Silke, Werner Widmer, Luka, Müller, Julia, Gübeli, Alissa, Zuk, Grzegorz, Bilgin Gulcicek, Osman, Vartanoglu, Talar, Kose, Emin, Rustu Karahan, Servet, Can Aydin, Mehmet, Alper Sahbaz, Nuri, Halicioglu, Ilkay, Alis, Halil, Sapci, Ipek, Adıyaman, Can, Murat Pektaş, Ahmet, Bora Cengiz, Turgut, Tansoker, Ilkan, Işler, Vedatcan, Cevik, Muazzez, Mutlu, Deniz, Ozben, Volkan, Baris Ozmen, Berk, Bayram, Sefa, Yolcu, Sinem, Buse Kobal, Berna, Faruk Toto, Ömer, Cem Çakaloğlu, Haluk, Karabulut, Kagan, Mutlu, Vahit, Busra Ozkan, Bahar, Celik, Saban, Semiz, Anil, Bodur, Selim, Gül, Enisburak, Murutoglu, Busra, Yildirim, Reyyan, Emre Baki, Bahadir, Arslan, Ekin, Ulusahin, Mehmet, Guner, Ali, Walker, Nathan, Shrimanker, Nikhita, Cole, Simon, Breslin, Ryan, Srinivasan, Ravi, Elshaer, Mohamed, Hunter, Kristina, Al-Bahrani, Ahmed, Liew, Ignatiu, Grace Mairs, Nora, Rocke, Alistair, Dick, Lachlan, Qureshi, Mobeen, Chowdhury, Debkumar, Wright, Naomi, Skerritt, Clare, Kufeji, Dorothy, Ho, Adrienne, Dissanayake, Tharindra, Tennakoon, Athula, Ali, Wadah, Jane Lim, Shujing, Tan, Charlene, O'Neill, Stephen, Jones, Catrin, Nassif, Dima, Sharma, Abhishek, Warren, Oliver, White, Rebecca, Mehdi, Aia, Post, Nathan, Kalakouti, Eliana, Dashnyam, Enkhbat, Stourton, Frederick, Mykoniatis, Ioanni, Currow, Chelise, Wong, Francisca, Gupta, Ashish, Shatkar, Veeranna, Luck, Joshua, Kadiwar, Suraj, Smedley, Alexander, Wakefield, Rebecca, Herrod, Philip, Blackwell, Jame, Lund, Jonathan, Cohen, Fraser, Bandi, Ashwath, Giuliani, Stefano, Bond-Smith, Gile, Pezas, Theodore, Farhangmehr, Neda, Urbonas, Toma, Perenyei, Miklo, Ireland, Philip, Blencowe, Natalie, Bowling, Kirk, Bunting, David, Longstaff, Lydia, Keogh, Kenneth, Jeon, Hyunjin, Rafaih Iqbal, Muhammad, Khosla, Shivun, Jeffery, Anna, Perera, Jame, Aboelkassem Ibrahem, Ahmad, Alhammali, Tariq, Salama, Yahya, Oram, Shaun, Kidd, Thoma, Cullen, Fraser, Owen, Christopher, Wilson, Michael, Chiu, Seehui, Sarafilovi, Hannah, Ploski, Jennifer, Evans, Elizabeth, Abbas, Athar, Kamya, Sylvia, Ishak, Norzawani, Bisset, Carly, Andress, Cedar, Ru Chin, Ye, Patel, Priya, Evans, David, Haslegrave, Aidan, Boggon, Adam, Laurie, Kirsten, Connor, Katie, Mann, Thoma, Mansuri, Anahita, Davies, Rachel, Griffiths, Ewen, Raza Shahbaz, Aized, Eng, Calvin, Din, Farhat, L'Heveder, Ariadne, G Park, Esther H, Ravishankar, Ramanish, Mcintosh, Kirsten, Dar Yau, Jih, Chan, Luke, Mcgarvie, Susan, Tang, Lingshan, Lim, Hui, Yap, Suhhuey, Park, Jay, Herr Ng, Zhan, Mirza, Shahrukh, Lin Ang, Yun, Walls, Luke, Roy, Chloe, Paterson-Brown, Simon, Camilleri-Brennan, Julian, S D'Souza, Michelle, Pronin, Savva, Ewart Henshall, David, Zuling Ter, Eunice, Fouad, Dina, Minocha, Ashish, English, William, Morgan, Catrin, Townsend, Dominic, Maciejec, Laura, Mahdi, Shareef, Akpenyi, Onyinye, Hall, Elisabeth, Caydiid, Hanaan, Rob, Zakaria, Abbott, Tom, D Torrance, Hew, Johnston, Robin, Akil Gani, Mohammed, Gravante, Gianpiero, Rajmohan, Shivanchan, Majid, Kiran, Dindyal, Shiva, Smith, Christopher, Palliyil, Madanmohan, Patel, Sanjay, Nicholson, Luke, Harvey, Neil, Baillie, Katie, Shillito, Sam, Kershaw, Suzanne, Bamford, Rebecca, Orton, Peter, Reunis, Elke, Tyler, Robert, Cheong Soon, Wai, M Jama, Guled, Dhillon, Dharminder, Pate, Khyati, Nanthakumaran, Shayanthan, Heard, Rachel, Yan Chen, Kar, Barmayehvar, Behrad, Datta, Uttaran, K Kamarajah, Sivesh, Karandikar, Sharad, Iftekhar Tani, Sobhana, Monaghan, Eimear, Donnelly, Philippa, Walker, Michael, Parakh, Jehangirshaw, Blacker, Sarah, Kaul, Anil, Paramasivan, Arjun, Farag, Sameh, Nessa, Ashrafun, Awadallah, Salwa, Lim, Jieqi, Chean Khun Ng, Jame, P Kiran, Ravi, Murray, Alice, Etchill, Eric, Dasari, Mohini, Puyana, Juan, Haddad, Nadeem, Zielinski, Martin, Choudhry, Asad, Caliman, Celeste, Beamon, Mieshia, Duane, Therese, Swaroop, Mamta, Myers, Jonathan, Deal, Rebecca, Schadde, Erik, Hemmila, Mark, Napolitano, Lena, To, Kathleen, Makupe, Alex, Musowoya, Joseph, Van Der Naald, Niel, Kumwenda, Dayson, Reece-Smith, Alex, Otten, Kar, Verbeek, Anna, Prins, Marloe, Andres Baquero Suarez, Alibeth, Balmaceda, Ruben, Deane, Chelsea, Dijan, Emilio, Elfiky, Mahmoud, Koskenvuo, Laura, Thollot, Aurore, Limoges, Bernard, Capito, Carmen, Alexandre, Challine, Kotobi, Henri, Leroux, Julien, Pinnagoda, Kalitha, Henric, Nicola, Azzis, Olivier, Rosello, Olivier, Francois, Poddevin, Etienne, Sara, Buisson, Philippe, Hmila, Sophian, Clegg-Lamptey, Joe-Nat, Imoro, Osman, Emmanuel Abem, Owusu, Papageorgiou, Dimitrio, Soulou, Vasiliki, Asturias, Sabrina, Peña, Lenin, B O'Connor, Donal, Realis Luc, Alberto, Alessandro Russo, Alfio, Ruzzenente, Andrea, Taddei, Antonio, Cona, Camilla, Bottini, Corrado, Pascale, Giovanni, Rotunno, Giuseppe, Solaini, Leonardo, Maria Pascale, Marco, Notarnicola, Margherita, Corbellino, Mario, Sacco, Michele, Ubiali, Paolo, Cautiero, Roberto, Bocchetti, Tommaso, Muzio, Elena, Guglielmo, Vania, Morandi, Eugenio, Mao, Patrizio, De Luca, Emilia, Mahmoud Ali, Farah, Žilinskas, Justa, Strupas, Kestuti, Kondrotas, Pauliu, Baltrunas, Roberta, Kutkevicius, Juoza, Ignatavicius, Povila, Ling Tan, Choy, Yng Siaw, Jia, Young Yam, Sir, Wilson, Ling, Rezal Abdul Aziz, Mohamed, Bondin, John, Diaz Zorrilla, Carmina, Majbar, Ana, Sale, Danjuma, Abdullahi, Lawal, Osagie, Olabisi, Faboya, Omolara, Fatuga, Adedeji, Taiwo, Agboola, Nwabuoku, Emeka, Bliksøen, Marte, Ali Khan, Zain, Coronel, Jazmin, Miranda, Cesar, Vasquez, Idelso, M Helguero-Santin, Lui, Rickard, Jennifer, Adedeji, Adesina, Alqahtani, Saleh, Rath, Max, Van Niekerk, Michael, Zacharia Koto, Modise, Matos-Puig, Roel, Israelsson, Leif, Schuetz, Tobia, Arif Yuksek, Mahmut, Mericliler, Meric, Uluşahi, Mehmet, Wolf, Bernhard, Fairfield, Cameron, Liang Yong, Guo, Whitehurst, Katharine, Redgrave, Natalie, K Musyoka, Caroluce, Olivier, Jame, Lee, Kathryn, Cox, Michael, H Farhan-Alanie, Muhamed M, Callan, Rory, Chibuye, Chali, Hassanein Ahmed Ali, Tebian, Rekhis, Syrine, Rommaneh, Muna, Hao Sam, Zi, Hong Chieh Chen, Jacky, Roi, Dylan, Brunelli Pugliesi, Thay, Pardo, Gabriel, Blanco, Ruth, and Grasset Escobar, Eugenio

Subjects
surgical site infection , surgical complications , global surgery , global health , research methodology , outcome assessment, surgical wound, Surgery, telemedicine, postdischarge
Abstract

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P

Published
2023

39. Senolytic treatment preserves biliary regenerative capacity lost through cellular senescence during cold storage

Author

Sofia Ferreira-Gonzalez, Tak Yung Man, Hannah Esser, Rhona Aird, Alastair M. Kilpatrick, Daniel Rodrigo-Torres, Nicholas Younger, Lara Campana, Victoria L. Gadd, Benjamin Dwyer, Niya Aleksieva, Luke Boulter, Mark T. Macmillan, Yinmiao Wang, Katie J. Mylonas, David A. Ferenbach, Timothy J. Kendall, Wei-Yu Lu, Juan Carlos Acosta, Dominic Kurian, Stephen O’Neill, Gabriel C. Oniscu, Jesus M. Banales, Paul J. Krimpenfort, Stuart J. Forbes, Medical Research Council (UK), Wellcome Trust, Instituto de Salud Carlos III, and Eusko Jaurlaritza

Subjects
Mice, Humans, Animals, Constriction, Pathologic, General Medicine, Biliary Tract, Cellular Senescence
Abstract

Liver transplantation is the only curative option for patients with end-stage liver disease. Despite improvements in surgical techniques, nonanastomotic strictures (characterized by the progressive loss of biliary tract architecture) continue to occur after liver transplantation, negatively affecting liver function and frequently leading to graft loss and retransplantation. To study the biological effects of organ preservation before liver transplantation, we generated murine models that recapitulate liver procurement and static cold storage. In these models, we explored the response of cholangiocytes and hepatocytes to cold storage, focusing on responses that affect liver regeneration, including DNA damage, apoptosis, and cellular senescence. We show that biliary senescence was induced during organ retrieval and exacerbated during static cold storage, resulting in impaired biliary regeneration. We identified decoy receptor 2 (DCR2)–dependent responses in cholangiocytes and hepatocytes, which differentially affected the outcome of those populations during cold storage. Moreover, CRISPR-mediated DCR2 knockdown in vitro increased cholangiocyte proliferation and decreased cellular senescence but had the opposite effect in hepatocytes. Using the p21KO model to inhibit senescence onset, we showed that biliary tract architecture was better preserved during cold storage. Similar results were achieved by administering senolytic ABT737 to mice before procurement. Last, we perfused senolytics into discarded human donor livers and showed that biliary architecture and regenerative capacities were better preserved. Our results indicate that cholangiocytes are susceptible to senescence and identify the use of senolytics and the combination of senotherapies and machine-perfusion preservation to prevent this phenotype and reduce the incidence of biliary injury after transplantation., This work was supported by the UK Medical Research MRC (MR/K017047/1) (to S.J.F.), the Computational and Chemical Biology of Stem Cell Niche (MR/L012766/1) (to S.J.F.), the UK Regenerative Medicine Platform (MR/K026666/1) (to S.J.F.), and the Wellcome Trust Institutional Translational Partnership Award (WT iTPA) (to S.F.-G.). J.M.B. was supported by the Spanish Carlos III Health Institute (ISCIII) (PI15/01132, PI18/01075, and Miguel Servet Program CON14/00129 and CPII19/00008) cofinanced by “Fondo Europeo de Desarrollo Regional” (FEDER); “Instituto de Salud Carlos III” (CIBERehd), Spain; “Euskadi RIS3” (2019222054 and 2020333010); and the Department of Industry of the Basque Country (Elkartek: KK-2020/00008). This research was funded in whole or in part by The Wellcome Trust (grant number 209710/Z/17/Z), a cOAlition S organization.

Published
2022
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40. Author response for 'Ethnic and socioeconomic disparities in initiation of second‐line antidiabetic treatment in people with type 2 diabetes in England: a cross‐sectional study'

Author

null Patrick Bidulka, null Rohini Mathur, null David G. Lugo‐Palacios, null Stephen O'Neill, null Anirban Basu, null Richard J Silverwood, null Paul Charlton, null Andrew Briggs, null Liam Smeeth, null Amanda I Adler, null Ian J Douglas, null Kamlesh Khunti, and null Richard Grieve

Published
2022
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41. Local Instrumental Variable Methods to Address Confounding and Heterogeneity when Using Electronic Health Records: An Application to Emergency Surgery

Author

Silvia Moler-Zapata, Richard Grieve, David Lugo-Palacios, A. Hutchings, R. Silverwood, Luke Keele, Tommaso Kircheis, David Cromwell, Neil Smart, Robert Hinchliffe, and Stephen O’Neill

Subjects
Diverticular Diseases, Health Policy, Cost-Benefit Analysis, Acute Disease, Humans, Electronic Health Records, Appendicitis, Hernia, Abdominal
Abstract

Background Electronic health records (EHRs) offer opportunities for comparative effectiveness research to inform decision making. However, to provide useful evidence, these studies must address confounding and treatment effect heterogeneity according to unmeasured prognostic factors. Local instrumental variable (LIV) methods can help studies address these challenges, but have yet to be applied to EHR data. This article critically examines a LIV approach to evaluate the cost-effectiveness of emergency surgery (ES) for common acute conditions from EHRs. Methods This article uses hospital episodes statistics (HES) data for emergency hospital admissions with acute appendicitis, diverticular disease, and abdominal wall hernia to 175 acute hospitals in England from 2010 to 2019. For each emergency admission, the instrumental variable for ES receipt was each hospital’s ES rate in the year preceding the emergency admission. The LIV approach provided individual-level estimates of the incremental quality-adjusted life-years, costs and net monetary benefit of ES, which were aggregated to the overall population and subpopulations of interest, and contrasted with those from traditional IV and risk-adjustment approaches. Results The study included 268,144 (appendicitis), 138,869 (diverticular disease), and 106,432 (hernia) patients. The instrument was found to be strong and to minimize covariate imbalance. For diverticular disease, the results differed by method; although the traditional approaches reported that, overall, ES was not cost-effective, the LIV approach reported that ES was cost-effective but with wide statistical uncertainty. For all 3 conditions, the LIV approach found heterogeneity in the cost-effectiveness estimates across population subgroups: in particular, ES was not cost-effective for patients with severe levels of frailty. Conclusions EHRs can be combined with LIV methods to provide evidence on the cost-effectiveness of routinely provided interventions, while fully recognizing heterogeneity. Highlights This article addresses the confounding and heterogeneity that arise when assessing the comparative effectiveness from electronic health records (EHR) data, by applying a local instrumental variable (LIV) approach to evaluate the cost-effectiveness of emergency surgery (ES) versus alternative strategies, for patients with common acute conditions (appendicitis, diverticular disease, and abdominal wall hernia). The instrumental variable, the hospital’s tendency to operate, was found to be strongly associated with ES receipt and to minimize imbalances in baseline characteristics between the comparison groups. The LIV approach found that, for each condition, there was heterogeneity in the estimates of cost-effectiveness according to baseline characteristics. The study illustrates how an LIV approach can be applied to EHR data to provide cost-effectiveness estimates that recognize heterogeneity and can be used to inform decision making as well as to generate hypotheses for further research.

Published
2022
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44. Composite Measures for Assessing Multidimensional Social Exclusion in Later Life: Conceptual and Methodological Challenges

Author

Stephen O'Neill, Sinead Keogh, and Kieran Walsh

Subjects
Composite measure, Longitudinal study, Measure (data warehouse), Social exclusion, Sociology and Political Science, Computer science, 05 social sciences, Decision tree, General Social Sciences, Multidimensionality, 050109 social psychology, Secondary data, Data science, Weighting, Random forest, Arts and Humanities (miscellaneous), Conceptual framework, Older adults, Machine learning, 0502 economics and business, Developmental and Educational Psychology, 0501 psychology and cognitive sciences, 050207 economics
Abstract

Although there are a number of approaches to constructing a measure of multidimensional social exclusion in later life, theoretical and methodological challenges exist around the aggregation and weighting of constituent indicators. This is in addition to a reliance on secondary data sources that were not designed to collect information on social exclusion. In this paper, we address these challenges by comparing a range of existing and novel approaches to constructing a composite measure and assess their performance in explaining social exclusion in later life. We focus on three widely used approaches (sum-of-scores with an applied threshold; principal component analysis; normalisation with linear aggregation), and three novel supervised machine-learning based approaches (least absolute shrinkage and selection operator; classification and regression tree; random forest). Using an older age social exclusion conceptual framework, these approaches are applied empirically with data from Wave 1 of The Irish Longitudinal Study on Ageing (TILDA). The performances of the approaches are assessed using variables that are causally related to social exclusion. peer-reviewed 2022-01-25

Published
2021
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45. The arteriovenous access stage (AVAS) classification

Author

Hannah Magowan, Stephen O'Neill, Peter Baláž, Agnes Masengu, Jennifer B. Hanko, and Katarina Lawrie

Subjects
medicine.medical_specialty, Fistula, 030232 urology & nephrology, Arteriovenous fistula, 030204 cardiovascular system & hematology, arteriovenous graft, 03 medical and health sciences, 0302 clinical medicine, Cohen's kappa, medicine, Stage (cooking), AcademicSubjects/MED00340, arteriovenous fistula, Transplantation, business.industry, vascular access, Original Articles, medicine.disease, Confidence interval, haemodialysis, Inter-rater reliability, medicine.anatomical_structure, classification, Nephrology, Sample size determination, Upper limb, Radiology, business
Abstract

Background Key anatomical factors mean that individuals needing arteriovenous access are unique and have different possibilities for fistula creation. The aim of this article is to describe a new classification system for all patients needing haemodialysis vascular access in the upper extremity with the purpose to simplify sharing the information about suitability for surgical access creation depending on vascular anatomy. Methods According to the patient’s vascular anatomy in right and left superior extremities, patients were separated into three arteriovenous access stages (AVAS). The AVAS was validated by three blinded observers using a sample of 70 upper limb arteriovenous maps that were performed using ultrasound on patients referred for vascular access assessment. A sample size calculation was performed and calculated that for three observers, a minimum of 67 maps were required to confirm significant agreement at a Kappa value of 0.9 (95% confidence interval 0.75–0.99). Results The Kappa value for inter-rater reliability using Fleiss’ Kappa coefficient was 0.94 and all patients fitted into the AVAS classification system. Conclusion The AVAS classification system is a simplified way to share information about vascular access options based on a patient’s vascular anatomy with high inter-rater reliability.

Published
2020
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46. Portal hypertension and ascites

Author

Gabriel C. Oniscu and Stephen O'Neill

Subjects
medicine.medical_specialty, Cirrhosis, business.industry, Portal venous pressure, medicine.medical_treatment, Liver transplantation, medicine.disease, Gastroenterology, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Internal medicine, Ascites, medicine, Portal hypertension, 030211 gastroenterology & hepatology, Surgery, 030212 general & internal medicine, Portosystemic shunt, medicine.symptom, Terlipressin, business, medicine.drug
Abstract

Portal hypertension is secondary to increased resistance to blood flow and increased blood flow through the portal system. The commonest cause is liver cirrhosis. The most severe and life-threatening presentation of portal hypertension is acute variceal bleeding. Pharmacotherapy with vasoactive agents (terlipressin or somatostatin), endoscopic band ligation and radiological treatment with transjugular intra-hepatic portosystemic shunt (TIPSS) are the commonest treatment options for variceal bleeding. However, where surgical expertise exists, portosystemic shunts can be considered for refractory bleeding in patients without significant liver failure, especially when TIPSS is unavailable or contraindicated. Diuretic therapy with spironolactone and furosemide are the basis for the management of ascites. If ascites becomes refractory, repeat large volume paracentesis and TIPSS are potential treatment options. Liver transplantation offers the definitive treatment for portal hypertension secondary to cirrhosis as it cures the underlying liver disease.

Published
2020
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47. Sharing Psychotherapy Notes with Patients: Therapists’ Attitudes and Experiences

Author

Suzanne G. Leveille, Hannah Chimowitz, Katrina Welch, Stephen O’Neill, and Jan Walker

Subjects
Adult, Male, Psychotherapist, Sociology and Political Science, Attitude of Health Personnel, Social Workers, 03 medical and health sciences, 0302 clinical medicine, Documentation, Patient Portals, Humans, 030212 general & internal medicine, Clinical social work, Qualitative Research, Patient Access to Records, Social work, Medical record, Patient portal, Workload, Focus Groups, Middle Aged, Focus group, Mental health, 030227 psychiatry, Psychotherapy, Female, Psychology
Abstract

Evidence suggests that the practice of sharing clinicians’ notes with patients via online patient portals may increase patient engagement and improve patient–clinician relationships while requiring little change in providers’ workflow. Authors examined clinical social workers’ experiences and attitudes related to open psychotherapy notes using focus groups and telephone interviews. Twenty-four of 29 eligible therapists agreed to open their notes to patients, and nine participated in this study. Participants were generally positive about their experiences and reported few disruptions to their workload or practice. However, they were hesitant to bring up notes to patients during sessions, and they discussed the benefits of open therapy notes mostly hypothetically. The five therapists who did not share notes worried that open notes would be detrimental to therapeutic relationships, patient well-being, and workflow. However, the concern they discussed most often related to the electronic health record rather than to open notes, because therapy notes are visible to all authorized clinicians as part of the general medical record. Future research is needed to deepen our understanding of the risks and benefits of open psychotherapy notes and to inform development of training programs to support therapists in opening notes.

Published
2020
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49. Seven leadership and followership lessons from kidney transplantation during lockdown

Author

Megan Joffe, Stephen O'Neill, Zachery Ahmed, Aisling Courtney, and Tim Brown

Subjects
Leadership and Management, Strategy and Management, Health Policy
Abstract

BackgroundThe renal transplant team in Northern Ireland performed 70 transplants in 61 days during the first wave of COVID-19, an 8-fold increase in their typical activity. Mobilising diverse professional skills to achieve this number, especially under COVID-19 conditions, required extraordinary effort on the part of everyone involved along the transplant patient pathway, management and staff from other patient groups.MethodsFifteen transplant team members were interviewed to explore their experiences during this time.ResultsSeven key leadership and followership lessons, contextualised within The Healthcare Leadership model, were learnt from these experiences.ConclusionsWhile circumstances were untypical, the achievement and motivation of staff were no less commendable. We contend that this was not only because of the unusual circumstances but as a result of extraordinary leadership and followership, teamworking and individual agility.Recommendations for those leading services which require a quick response and collaborative effort are made.

Published
2023
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