Is the 3 mm tolerance for axillary node biopsy still adequate for indication of axillary disease? Retrospective audit (2023)

Type of publication:Conference abstract

Author(s):Deane L.; Cielecki L.; Williams S.; Metelko M.; Alkouly M.; Aksoy U.; Vaughan J.; Burley S.; Barlow E.; Cobby E.

Citation:Breast Cancer Research. Conference: Symposium Mammographicum Conference 2023. Glasgow United Kingdom. 25(Supplement 2) (no pagination), 2023. Date of Publication: October 2023.

Abstract:Background: A 3 mm tolerance for cortical thickness on axillary lymph nodes is a standard measurement used as one of the thresholds to decide if potentially suspicious for disease. Our department conducted an audit of the ultrasound outcomes for lymph node involvement in the axilla after several unexpected positive post-surgical cases with previously negative axillae on ultrasound, were obtained. This could impact the patient directly if further axillary surgery was required. Method(s): 12 months of ultrasound results were compared to the pathology results for surgical axillary biopsy, lymph node sampling and surgical axillary clearance. Result(s): Forty-seven cases out of 388 cases were false negative. Sensitivity was 41.25% and specificity was 91.56%. Analysis: Nineteen cases were excluded due to morphological data unavailable at the time of the audit. Twenty-eight cases analysed either revealed disease too small to be visualised, positive nodes not in the axilla, not biopsied by a second consultant when returning for biopsy procedure and learning difficulties. All these cases were conducted by different consultants on different ultrasound units. No identifiable trend was seen. Conclusion(s): The sensitivity is in keeping with peer review investigations and therefore the 3 mm threshold for identifying possible disease is still adequate. Any learning points from individual cases were taken forward to aid with service improvement.

Prevalence of Dyslipidemia and the Association With Levels of TSH and T4 Hormones Among Patients in South Region of Jordan (2023)

Type of publication:Journal article

Author(s):Atrooz O.M.; *Hiresh M.N.; Alghonmeen R.D.; Atrooz M.O.; Hiresh G.N.; Alasoufi A.M.; Atrooz I.O.

Citation:Journal of Medical Biochemistry. 42(4) (pp 706-713), 2023.

Abstract:Background: Glycolipid metabolism disorders (dysglycolipidemia) are characterized by elevated levels of glycolipid profile components and fasting blood glucose. Dysglycolipidemia are major threats to human health and life. Therefore, the aim of this cross-sectional study is to estimate the prevalence of dysglycolipidemia and the existence of association of TSH and T4 and glycolipid profiles. Method(s): Cross-sectional data were obtained from the medical laboratory of Ma'an Governmental Hospital. A total of 141 patients' results were collected (18-60 years). Differences in the glycolipidemic profiles according to age and sex and TSH and T4 were compared. Different statistical analyses were used to analyze the prevalence of dysglycolipidemia and the correlation with the levels of TSH and T4. Result(s): The study involved results of 141 patients (54.7% males and 45.3% females) in Ma'an Province (Jordan), who visited the internal medicine clinic at Ma'an Governmental Hospital. Patients have overweight and BMI of more than 25 kg/m<sup>2</sup>. The overall results of the prevalence of dyslipidemia indicated that patients have 42.5% of hypercholesterolemia, 48.2% of high LDL-C, 34.1% of hypertriglyceridemia, and 41.8% of low HDL-C. The prevalence of isolated lipid profiles showed that 10 patients have mixed dyslipidemia. The association of dyslipidemia with age indicated a positive significance between triglyceride and older people (>=40 years), while HDL levels have a significance with gender (p=0.025). The overall ANOVA model yielded non-statistical significant results between levels of any components of lipid profile and levels of TSH and T4 hormones. Welch test (p=0.036) showed positive significance between levels of fasting blood glucose and triglyceride levels. Conclusion(s): Our results showed and confirmed the presence of a high percentage of hyperlipidemia in Ma'an province and there was no relationship with levels of TSH and T4. A relationship exists between levels of triglycerides and blood glucose concentrations.

Link to full-text [open access - no password required]

The impact of community teaching sessions on onward referral to specialist diabetic foot services (2024)

Type of publication:Journal article

Author(s):Al-Saadi, Nina; *Beard, Nichola; Al-Hashimi, Khalid; Suttenwood, Helen; Wall, Michael; *Jones, Steven; Merriman, *Catherine

Citation:Primary care diabetes. 18(1):79-83, 2024 Feb.

Abstract:INTRODUCTION: Prompt referral of patients with diabetic foot ulceration (DFU) to specialist services can lead to more timely assessment of these patients and subsequent improved rates of limb salvage and patient outcomes. In this study we wanted to determine the impact of education in the primary care setting on onward referrals to our specialist Diabetic Foot multi-disciplinary team (MDT) clinic. METHODS: As part of a Diabetic Foot Roadshow, four teaching sessions were delivered in primary care settings across Shropshire by our specialist team from 17th March to the 25th May 2022. Attendees included podiatrists, tissue viability nurses, district nurses and wound care practitioners. Hospital records were used to identify all onward referrals to our Diabetic Foot MDT clinic in the weeks before and after delivery of the roadshow education sessions. RESULTS: 184 referrals were made to the diabetic foot clinic from January to July 2022. There were 0.3 referrals per day in the months prior to the commencement of the education sessions, compared to 1.5 referrals per day following the commencement of the teaching sessions. This increase in referrals was statistically significant (p < 0.0001). CONCLUSION: Teaching sessions delivered to community specialist healthcare professionals significantly increase onward referral of patients to specialist services, facilitating more timely assessment and management of patients with DFUs.

GWAS and meta-analysis identifies 49 genetic variants underlying critical COVID-19 (2023)

Type of publication:
Journal article

Author(s):
Pairo-Castineira E.; Rawlik K.; Bretherick A.D.; Qi T.; Wu Y.; Nassiri I.; McConkey G.A.; Klaric L.; Kousathanas A.; Richmond A.; Malinauskas T.; Thwaites R.; Morrice K.; Maslove D.; Semple M.G.; Knight J.; Hinds C.; Horby P.; Ling L.; McAuley D.; Montgomery H.; Openshaw P.J.M.; Begg C.; Walsh T.; Tenesa A.; Flores C.; Riancho J.A.; Rojas-Martinez A.; Clohisey S.; Millar J.; Aitkin E.; Aravindan L.; Armstrong R.; Biggs H.; Boz C.; Chikowore P.; Coutts A.; Coyle J.; Cullum L.; Das S.; Day N.; Donnelly L.; Duncan E.; Finernan P.; Fourman M.H.; Furlong A.; Furniss J.; Gallagher B.; Gilchrist T.; Golightly A.; Griffiths F.; Hafezi K.; Hamilton D.; Hendry R.; Kearns N.; Law D.; Law R.; Law S.; Lidstone-Scott R.; Lauder C.; Macgillivray L.; Maclean A.; Mal H.; McCafferty S.; McMaster E.; Meikle J.; Murphy S.; Mybaya H.; Oosthuyzen W.; Zheng C.; Chen J.; Parkinson N.; Paterson T.; Tucker P.; Schon K.; Stenhouse A.; Das M.; Swets M.; Szoor-McElhinney H.; Taneski F.; Turtle L.; Wackett T.; Ward M.; Weaver J.; Wrobel N.; Zechner M.; Pan J.; Grau N.; Jones T.O.; Lim R.; Marotti M.; Whitton C.; Bociek A.; Campos S.; Arbane G.; Shankar-Hari M.; Ostermann M.; Cha M.; DAmato F.; Kosifidou E.; Lorah S.; Morera K.; Brady L.; Hugill K.; Henning J.; Bonner S.; Headlam E.; List A.; Morley J.; Welford A.; Kamangu B.; Ratnakumar A.; Shoremekun A.; Alldis Z.; Astin-Chamberlain R.; Bibi F.; Biddle J.; Blow S.; Bolton M.; Borra C.; Bowles R.; Burton M.; Choudhury Y.; Cox A.; Ebano P.; Fotiadis S.; Gurasashvili J.; Halls R.; Hartridge P.; Kallon D.; Kassam J.; Lancoma-Malcolm I.; Matharu M.; May P.; Mitchelmore O.; Newman T.; Patel M.; Pheby J.; Pinzuti I.; Prime Z.; Prysyazhna O.; Shiel J.; Tierney C.; Zongo O.; Zak A.; Mundy M.; Thompson C.; Pritchard L.; Gellamucho M.; Cartlidge D.; Bandla N.; Bailey L.; Delaney J.; Scott L.; Abdelrazik M.; Alasdair F.; Carter D.; Elhassan M.; Ganesan A.; Lamond Z.; Purohit D.; Rohit K.; Saleem M.; Wall A.; Xavier K.; Bakthavatsalam D.; Gehad K.; Gnanapragasam P.; Jain K.; Jain S.; Malik A.; Pappachan N.; Moreno-Cuesta J.; Haldeos A.; Vincent R.; Oziegb M.; Cavazza A.; Cockrell M.; Corcoran E.; Depante M.; Finney C.; Jerome E.; Knighton A.; Nayak M.; Pappa E.; Saha S.; Dodd A.; O'Reilly K.; McPhail M.; Clarey E.; Noble H.; Coghlan P.; Brett S.; Gordon A.; Templeton M.; Antcliffe D.; Banach D.; Darnell S.; Fernandez Z.; Jepson E.; Mohammed A.; Rojo R.; Arias S.S.; Gurung A.T.; Fernandez-Roman J.; Hamilton D.O.; Johnson E.; Johnston B.; Martinez M.L.; Mulla S.; Waite A.A.C.; Williams K.; Waugh V.; Welters I.; Emblem J.; Norris M.; Shaw D.; Bashyal A.; Beer S.; Hutton P.; McKechnie S.; Davidson N.; Readion G.; Ryu J.; Wilson J.; Agrawal S.; Elston K.; Jones M.; Meaney E.; Polgarova P.; Elbehery M.; Summers C.; Daubney E.; Ng A.; Marshall J.; Pathan N.; Stroud K.; White D.; Andrew A.; Ashraf S.; Dent M.; Langley M.; Peters C.; Ryan L.; Sampson J.; Wei S.; Baddeley A.; Meredith M.; Morris L.; Gibbons A.; McLoughlin L.; Delgado C.C.; Clark V.; Dawson D.; Ding L.; Durrant G.; Ezeobu O.; Hurt W.J.; Kanu R.; Kinch A.; Leaver S.; Lisboa A.; Mathew J.; Patel K.; Saluzzio R.P.; Rawlins J.; Samakomva T.; Shah N.; Sicat C.; Texeira J.; De Queiroz J.G.; Da Gloria E.F.; Maccacari E.; Yun N.; Manna S.; Farnell-Ward S.; Maizcordoba M.; Thanasi M.; Ali H.H.; Hastings J.; Grauslyte L.; Hussain M.; Ruge B.; King S.; Pogreban T.; Rosaroso L.; Smith H.; Phull M.-K.; *Adams N.; Franke G.; George A.; Salciute E.; Wong J.; Dunne K.; Flower L.; Sharland E.; Sra S.; Andrew G.; Callaghan M.; Barclay L.; Baillie K.; Hope D.; Mcculloch C.; Allen M.; Baptista D.; Crowe R.; Fox J.; Khera J.; Loveridge A.; McKenley I.; Morino E.; Naranjo A.; O'Connor D.; Simms R.; Sollesta K.; Swain A.; Herdman-Grant R.; Joseph A.; Nown A.; Rose S.; Pogson D.; Boxall H.; Brimfield L.; Claridge H.; Daly Z.; George S.; Gribbin A.; Cheema Y.; Cutler S.; Richards O.; Roynon-Reed A.; Cherian S.; Heron A.E.; Williams G.; Szakmany T.; Waters A.; Dunhill J.; Jones F.; Morris R.; Ship L.; Cardwell A.; Ali S.; Bhatterjee R.; Bolton R.; Chukkambotla S.; Coleman D.; Dalziel J.; Dykes J.; Fine C.; Gay B.; Goddard W.; Goodchild D.; Harling R.; Hijazi M.; Keith S.; Khan M.; Matt R.; Ryan-Smith J.; Saad S.; Springle P.; Thomas J.; Truman N.; Kazi A.; Smith M.; Collier H.; Davison C.; Duberley S.; Hargreaves J.; Hartley J.; Patel T.; Kent A.; Goodwin E.; Zaki A.; Tibke C.; Hopkins S.; Gerrard H.; Jackson M.; Bennett S.; Mills R.; Bell J.; Campbell H.; Dawson A.; Dodds S.; Duffy S.; Gallagher L.; McCafferty G.; Short S.; Thomas K.; Walker C.; Reynolds J.; Yates B.; McKie H.; Panteli M.; Thompson M.; Waddell G.; De Beger S.; Abraheem A.; Dunmore C.; Girach R.; Jones R.; London E.; Nagra I.; Nasir F.; Sainsbury H.; Smedley C.; Brearey S.; Burchett C.; Faulkner M.; Jeffrey H.; Bamford P.; Shaikh F.; Slack L.; Davies A.; Brooke H.; Suarez J.C.; Charlesworth R.; Hansson K.; Norris J.; Poole A.; Sandhu R.; Smithson E.; Thirumaran M.; Wagstaff V.; Buckley S.; Sloan B.; Rose A.; Major A.; Metcalfe A.; Almaden-Boyle C.; Austin P.; Chapman S.; Eros A.; Cabrelli L.; Cole S.; Whyte C.; Casey M.; Bafitis V.; Tsinaslanidis G.; George C.; Khade R.; Black C.; Ashok S.R.; Farley S.; Brinkworth E.; Harford R.; Murphy C.; Williams M.; Newey L.; Toghill H.; Lewis S.; Rees T.; Battle C.; Baker M.; Travers J.; Chesters K.; Baxter N.; Arnott A.; McCreath G.; Rooney L.; Sim M.; Henderson S.; Dalton C.; Kennedy-Hay S.; O'Donohoe L.; O'Hare M.; Orlikowska I.; McNeela F.; Lyle A.; Hughes A.; Radhakrishnan J.; Gibson S.; Bancroft H.; Bellamy M.; Daglish J.; Kadiri S.; Moore F.; Rhodes J.; Sangombe M.; Peterkin Z.; Carmody M.; Cottle J.; Peasgood E.; de Gordoa L.O.-R.; Cinquina Z.; Howard K.; Joy R.; Roche S.; Birkinshaw I.; Carter J.; Ingham J.; Marshall N.; Pearson H.; Scott Z.; Dasgin J.; Gill J.; Nilsson A.; Hull D.; Ahmadhaider N.; Bates M.; McGhee C.; Ellis H.; Howe G.S.; Singh J.; Stroud N.; Lynch C.; Krishnamurthy V.; Lim L.; Jha R.; Egan J.; Felton T.; Glasgow S.; Padden G.; Choudhr O.; Moss S.; Lingeswaran S.; Alexander P.; Fiouni S.; Ward L.; Allen S.; Shaw J.; Smith C.; Adanini O.; Collins R.; Msiska M.; Ofori L.; Bhatia N.; Dolan H.; Brunton M.; Caterson J.; Coles H.; Keating L.; Tilney E.; Jacques N.; Frise M.; Armistead J.; Bartley S.; Bhuie P.; Rai S.; Tomkova G.; Greer S.; Shuker K.; Tridente A.; Dobson E.; Tully R.; Dearden J.; Drummond A.; Kamath P.; Mulcahy M.; Munt S.; O'Connor G.; Philbin J.; Rishton C.; Scott C.; Winnard S.; Hasni N.; Gascoyne R.; Hawes J.; Pritchard K.; Stevenson L.; Whileman A.; Beavis S.; Bishop L.; Cart C.; Dale K.; Kelly-Baxter M.; Mendelski A.; Moakes E.; Smith R.; Woodward J.; Wright S.; Allan A.; Botello A.; Liew J.; Medhora J.; Trumper E.; Savage F.; Scott T.; Place M.; Kaye C.; Benyon S.; Marriott S.; Park L.; Quinn H.; Skyes D.; Zitter L.; Baines K.; Gordon E.; Keenan S.; Pitt A.; Duffy K.; Ireland J.; Semple G.; Turner L.; Cathcart S.; Rimmer D.; Puxty A.; Puxty K.; Hurst A.; Miller J.; Speirs S.; Bradshaw Z.; Brown J.; Melling S.; Preston S.; Slawson N.; Warden S.; Beasley A.; Stoddard E.; Benham L.; Cupitt J.; Caswell M.; Elawamy L.; Wignall A.; Roberts B.; Golding H.; Leggett S.; Male M.; Marani M.; Prager K.; Williams T.; Golder K.; Jones O.; Cusack R.; Bolger C.; Burnish R.; Carter M.; Jackson S.; Salmon K.; Biss J.; Aquino M.; Croft M.; Frost V.; White I.; Govender K.; Webb N.; Stapleton L.; Wells C.; Nikitas N.; Sanchez-Rodriguez A.; Spencer K.; Stowe B.; Izzard Y.; Poole M.; Monnery S.; Trotman S.; Beech V.; Combes E.; Joefield T.; Covernton P.; Savage S.; Woodward E.; Camsooksai J.; Reschreiter H.; Barclay C.; DeAth Y.; Dube J.; Humphrey C.; Jenkins S.; Langridge E.; Milne R.; Wadams B.; Woolcock M.; Brett M.; Digby B.; Gemmell L.; Hornsby J.; MacGoey P.; O'Neil P.; Price R.; Sundaram R.; Abel L.; Rodden N.; Thomson N.; Rooney K.; Currie S.; Parker N.; Walker L.; Henderson P.; Ogg B.; Whiteley S.; Wilby L.; Long K.; Matthew S.; Salada S.; Trott S.; Watts S.; Friar Z.; Speight A.; Bastion V.; Chandna H.; Djeugam B.; Haseeb M.; Kent H.; Lubimbi G.; Murdoch S.; David B.; Lorusso R.; Vochin A.; Penacerrada M.; Wulandari R.; Heath C.; Jakkula S.; Morris A.; Ahmed A.; Nune A.; Buttriss C.; Whitaker E.; Davey M.; Golden D.; Acklery A.; Fernandes F.; Seaman B.; Earl V.; Collins A.; Adam R.; Treus E.; Holland S.; Alfonso J.; Bruce M.; Durrans L.J.; Eltayeb A.; Hey S.; Hruska M.; Lamb T.; Rothwell J.; Fitzgerald A.; Lindergard G.; T-Michael H.; Duncan T.; Baxter-Dore S.; Fox C.; Guerin J.; Hodgkiss T.; Connolly K.; McAlinden P.; Bridgett V.; Fearby M.; Gulati A.; Hanson H.; Kelly S.; McCormack L.; Nixon R.; Robinson P.; Slater V.; Stephenson E.; Webster A.; Webster K.; Hays C.; Hudson A.; Clement I.; Davis J.; Francis S.; Jerry D.; Abernathy C.; Foster L.; Gratrix A.; Cabral-Ortega L.; Hines M.; Martinson V.; Stones E.; Winter K.; Barrow E.; Wylie K.; Baines D.; Kolakaluri L.; Clark R.; Sukumaran A.; Brandwood C.; Barker M.; Paripoorani D.; Taylor C.; Downes C.; Hayman M.; Riches K.; Daniel P.; Subramanian D.; Holding K.; Hilton M.; McDonald C.; Richardson G.; Halladay G.; Harding P.; Reddy A.; Turner-Bone I.; Wilding L.; Parker R.; Lloyd M.; Smith L.; Kelly C.; Lazo M.; Neal A.; Walton O.; Melville J.; Naisbitt J.; Bullock E.; Joseph R.; Callam S.; Hudig L.; Keshet-Price J.; Stammers K.; Convery K.; Randell G.; Fottrell-Gould D.; Mwaura E.; Sutherland S.-B.; Stewart R.; Mew L.; Wren L.; Thrasyvoulou L.; Willis H.; Scriven J.; Hopkins B.; Lenton D.; Roberts A.; Bokhari M.; Lucas R.; McCormick W.; Ritzema J.; Linnett V.; Sanderson A.; Wild H.; Flanagan R.; Hull R.; Rhead K.; McKenna E.; Hughes G.; Anderson J.; Jones K.; Latham S.; Riley H.; Coulding M.; Mercer O.; Potla D.; Rehman H.; Savill H.; Turner V.; Jude E.; Kilroy S.; Apetri E.; Basikolo C.; Blackledge B.; Catlow L.; Collis M.; Doonan R.; Harris J.; Harvey A.; Knowles K.; Lee S.; Lomas D.; Lyons C.; McMorrow L.; Michael A.; Pendlebury J.; Perez J.; Poulaka M.; Proudfoot N.; Slevin K.; Thomas V.; Walker D.; Dark P.; Charles B.; McLaughlan D.; Slaughter M.; Horner D.; Cawley K.; Marsden T.; Andrews J.; Beech E.; Akinkugbe O.; Bamford A.; Belfield H.; Jones G.A.L.; McHugh T.; Meghari H.; Ray S.; Tomas A.L.; O'Neill L.; Peters M.; Bell M.; Benkenstein S.; Chisholm C.; Kupiec K.; Payne C.; Halls J.; Blakemore H.; Goff E.; Hayes K.; Smith K.; Stephens D.; Worner R.; Borislavova B.; Faulkner B.; Thomas M.; Cookson R.; Gendall E.; Larman G.; Pope R.; Smalira A.; Priestley V.; Cosier T.; Millen G.; Rand J.; Schumacher N.; Sandhar R.; Weston H.; Richardson N.; Cooper L.; Jones C.; Huang Y.-W.J.; Jacob R.; Denmade C.; McIntyre L.; Trodd D.; Martin J.; Watson G.; Bevan E.; Wreybrown C.; Bano S.; Bellwood R.; Bentley M.; Bromley M.; Gurr L.; Ledgard C.; McGowan J.; Pye K.; Sellick K.; Stacey A.; Warren D.; Wilkinson B.; Akeroyd L.; Shafique H.; Morgan J.; Shorter S.; Swinger R.; Waters E.; Lawton T.; Allan E.; Darlington K.; Davies F.; Davies L.; Easton J.; Kumar S.; Lean R.; Mackay C.; Pugh R.; Qiu X.; Rees S.; Scanlon J.; Lewis J.; Menzies D.; Bolger A.; Davies G.; Davies J.; Garrod E.; Jones H.; Manley R.; Williams H.; Frankham J.; Pitts S.; Branney D.; Tiller H.; Efford G.; Garland Z.; Grimmer L.; Gumbrill B.; Johnson R.; Sweet K.; Bewley J.; Coleman C.; Corcoran K.; Morano E.M.H.; Shiel R.; Webster D.; Bonnici J.; Daniel E.; Dell A.; Kent M.; Wilkinson A.; Brown E.; Kay A.; Campbell S.; Cowton A.; Greenaway V.; Potts K.; Hutton C.; Shepperson A.; Forsey M.; Vertue M.; Riches J.; Kaliappan A.; MacCallum N.; Bercades G.; Hass I.; Martir G.; Reyes A.; Smyth D.; Zapatamartinez M.; Alvaro A.; Jetha C.; Ma L.; Booker L.; Mostoles L.; Pratley A.; Altabaibeh A.; Parmar C.; Gilbert K.; Ferguson S.; Shepherd A.; Morris S.; Singleton J.; Baruah R.; Amamio M.; Birch S.; Briton K.; Clark S.; Doverman K.; Marshall L.; Simpson S.; Lloyd G.; Bell S.; Rivers V.; Purewal B.; Hammerton K.; Oleary R.; Cornell S.; Jarmain J.; Rogerson K.; Wakinshaw F.; Woods L.; Rostron A.; Elcioglu Z.; Roy A.; Bell G.; Dickson H.; Wilcox L.; Katary A.; English K.; Hutter J.; Pawley C.; Doble P.; Shovelton C.; Vaida M.; Purnell R.; Cagova L.; Fofano A.; Holcombe H.; Mitchell A.M.; Mwaura L.; Raman K.P.; Garnr L.; Mepham S.; Paques K.; Vuylsteke A.; Mackie J.; Pearn C.; Zamikula J.; Birt M.; Gude E.T.; Nyirenda M.; Capozzi L.; Reece-Anthony R.; Khaliq W.; Noor H.; Nilo A.C.; Grove M.; Daniel A.; Finn J.; White N.; Saha R.; Badal B.; Ixer K.; Duffin D.; Player B.; Hill H.; Davies M.; Davies R.; Hunt L.; Thomas E.; Oblak M.; Thankachen M.; Irisari J.; Sayan A.; Popescu M.; Finch C.; Jamieson A.; Quinn A.; Cooper J.; Liderth S.; Waddington N.; Burn I.; Manso K.; Penn R.; Tebbutt J.; Thornton D.; Winchester J.; Hambrook G.; Shanmugasundaram P.; Craig J.; Simpson K.; Sibbett L.; Paine S.; Conyngham J.-A.; Mupudzi M.D.; Thomas R.; Wright M.; Griffin D.; Partridge R.; Corral M.A.; Muchenje N.; Sitonik M.; Brown C.W.; Butler A.; Folkes L.; Fox H.; Gardner A.; Helm D.; Hobden G.; King K.; Margalef J.; Margarson M.; Martindale T.; Meadows E.; Raynard D.; Thirlwall Y.; Baird Y.; Gomez R.; Hodgson L.; Corin C.; Sidall E.; Szabo D.; Floyd S.; Davies H.; Austin K.; Kelsall O.; Wood H.; Anderson P.; Archer K.; Burtenshaw A.; Clayton S.; Cother N.; Cowley N.; Davis C.; Digby S.; Durie A.; Harrison A.; Low E.; McAlindon M.; McCurdy A.; Morgan A.; Rankin T.; Thrush J.; Tranter H.; Vigurs C.; Wild L.; Cornell T.; Ralph K.; Bean S.; Burt K.; Spivey M.; Richards C.; Tedstone R.; Carmody S.; Zhao X.; Page V.; Guanco M.L.; Hoxha E.; Zorloni C.; Dean C.; Jones E.; Carter E.; Dunn J.; Kong T.; Mahenthran M.; Marsh C.; Holland M.; Keenan N.; Mahmoud M.; Lyons M.; Bradley-Potts J.; Wassall H.; Young M.; Bradley P.; Burda D.; Donlon S.; Harden L.; Harris C.; Mayangao I.; Montaser R.; Mtuwa S.; Piercy C.; Smith E.; Stone S.; Verula J.; Blackman H.; Marriott C.; Michalak N.; Creagh-Brown B.; Salberg A.; Boyer N.; Pristopan V.; Walker R.; Hormis A.; Collier D.; Graham C.; Maynard V.; McCormick J.; Warrington J.; Cosgrove D.; McFarland D.; Ratcliffe J.; Charnock R.; Wynter I.; Gill M.; Kirk J.; Paul P.; Ratnam V.; Shelton S.; Jardine C.; Hay A.; Williams D.; Deacon B.; Durga L.; Hibbert M.; Kennard-Holden G.; Woodford C.; Pothecary C.; Tetla D.; Agravante K.; Smeaton J.; Price A.; Thomas A.; Thorpe C.; Knights E.; Ward D.; Laha S.; Verlander M.; Williams A.; Prout R.; Langton H.; Watters M.; Hunt C.; Novis C.; Arif S.; Cunningham A.; Hewitt C.; Hindale J.; Jackson-Lawrence K.; Shepardson S.; Wills M.; Butler S.; Tavares S.; Barber R.; Hilldrith A.; Hubbard K.; Egginton D.; Clark M.; Purvis S.; Sinclair S.; Collins V.; Landeg B.; Sell C.; Coetzee S.; Gales A.; Icke B.; Raj M.; Williams C.; Williams J.; Hill L.; Kayani A.; Masunda B.; Gondo P.; Atayeva N.; Cruz C.; Pattison N.; Burnett C.; Hatton J.; Heeney E.; Newton M.; Al-Moasseb H.; Behan T.; Stead R.; Mitra A.; Humphreys S.; Cockerill H.; Tampsett R.; Postovalova E.; Coventry T.; Fowler S.; Macmahon M.; Cochrane P.; Pirie S.; Hanley S.; Ali A.; Brady M.; Dale S.; Dance A.; Gledhill L.; Greig J.; Hanson K.; Holdroyd K.; Home M.; Ishaq T.; Kelly D.; Matapure L.; Melia D.; Mellor S.; Merwaha E.; Nortcliffe T.; Shaw L.; Shaw R.; Wood T.; Bayo L.-A.; Usher M.; Wilson A.; Kitson R.; Pinnell J.; Robinson M.; Boltwood K.; Birch J.; Bough L.; Tutton R.; Winter-Goodwin B.; Goodsell J.; Taylor K.; Williams P.; Williams S.; Cave A.; Rees J.; Imeson-Wood J.; Amin V.; Karthik K.; Kausar R.; Anastasescu E.; Reid K.; Anumakonda V.; Stoddart E.; Demetriou C.; Eckbad C.; Howie L.; Mitchard S.; Ramos L.; White K.; Hierons S.; Kelly F.; Serrano-Ruiz A.; Evans G.; Nicol L.; Wilkins J.; Hulacka K.; Debreceni G.; Crickmore V.; Hill K.; Kannan T.; Dagutao Z.; Beesley K.; Lewis A.; Perry J.; Antony S.; Board S.; Buckley C.; Pippard L.; Tanate A.; Wood D.; Kubisz-Pudelko A.; Gouda A.; Auld F.; Donnachie J.; Murdoch E.; Prentice L.; Runciman N.; Senaratne D.; Short A.; Sweeney L.; Symon L.; Todd A.; Turner P.; McCann E.; Salutous D.; Edmond I.; Whitelaw L.; Venkatesh H.; Bland Y.; Kajtor I.; Kavanagh L.; Singler K.; Linfield-Brown G.; Moore L.S.P.; Vizcaychipi M.; Martins L.; Moore L.; Bull R.; Carungcong J.; Allen L.; Beranova E.; Knight A.; Price C.; Tilbey S.; Turney S.; Hazelton T.; Tutt G.; Arora M.; Turki S.; Sinfield E.; Deery J.; Ramos H.; Cristiano D.; Dormand N.; Farzad Z.; Gummadi M.; Salmi S.; Sloane G.; Varghese M.; Patel B.; Kamal L.; Zborowski A.C.; Coe R.; Anderson M.; Beadle J.; Coates C.; Collins K.; Crowley M.; Johnson L.; King L.; Paramsothy R.; Sargeant J.; Silva P.; Stuart C.; Taylor J.; Tyl D.; Wakefield P.; Kamundi C.; Olufuwa O.; Belagodu Z.; Gherman A.; Oakley N.; Allan J.; Geary T.; Meikle A.; O'Brien P.; Wood S.; Clark A.; Houston G.; Black K.; Clarkson M.; D'Sylva S.; Morrison A.; Norman K.; Taylor M.; Clements S.; Cohrane C.; Gonzalez N.; Strachan D.; Moar K.; Smythe M.; Nichol A.; Brickell K.; Ali I.A.M.; Beaumont K.; Elsaadany M.; Fernandes K.; Ally S.M.; Rangarajan H.; Sarathy V.; Selvanayagam S.; Vedage D.; White M.; Coton Z.; Joshy A.; Blunt M.; Curgenven H.; Botfield L.; Dexter C.; Kuravi A.; Butler J.; Chadwick R.; Ranga P.; Richardson L.; Virgilio E.; Anwer M.; Garg A.; Botfield D.; Marriott X.; Stewart K.; Phillips C.; Nowak J.; Skinner D.; Jones S.; Crawley R.; Crew A.; Cunningham M.; Daniels A.; Harrison L.; Hope S.; Lancaster N.; Matthews J.; Wray G.; Nicholson A.; Inweregbu K.; Cutts S.; Miller K.; Brady A.; Chan R.; McIvor S.; Prady H.; Mathew B.; Little J.; Furniss T.; Wright C.; King B.; Wasson C.; O'Neill A.; Turley C.; McGuigan P.; Collins E.; Finn S.; Green J.; McAuley J.; Nair A.; Quinn C.; Tauro S.; Ward K.; McGinlay M.; Reddy K.; Ahmad N.; Anderson S.; Barker J.; Bauchmuller K.; Birchall K.; Bird S.; Cawthron K.; Chetam L.; Cole J.; Donne B.; Foote D.; Ford A.; Hanratty H.; Harrington K.; Hesseldon L.; Housley K.; Jackson Y.; Jarman C.; Kibutu F.; Lenagh B.; Macharia I.; Masuko S.; Milner L.; Newell H.; Nwafor L.; Oxspring S.; Phillips P.; Raithatha A.; Rowland-Jones S.; Smith J.; Thompson R.; Trower H.; Walker S.; Watson J.; Wiles M.; Lye A.; Willson J.; Mills G.; Harris S.; Hartill E.; Barron A.; Collins C.; Kaul S.; Nolan C.; Polgar O.; Prendergast C.; Rogers P.; Shokkar R.; Woodruff M.; Mahay K.; Thwaites V.; Reed A.; Meyrick H.; Passmore H.; Farwell J.; Brown A.; Gregory J.; Armstrong D.; Bowey A.; Cowley A.; Corner A.; Highgate J.; Rutherfurd C.; Taylor J.-A.; Goodwin S.; Rutherford C.; Eapen B.; Trim F.; Donnison P.; Armstrong L.; Bates H.; Dooks E.; Farquhar F.; Kitching A.; McParland C.; Packham S.; Hairsine B.; Andreou P.; Hales D.; Mathews M.; Patel R.; Barry P.; Flint N.; Hailstone J.; Ghuman N.; Leonard B.; Lees R.; Butcher D.; Leng K.; Butterworth-Cowin N.; O'Sullivan S.; Ghosh A.; Adams C.; *Agasou A.; *Arden T.; *Beekes M.; *Bowes A.; *Boyle P.; *Button H.; *Carnahan M.; *Carter A.; *Childs D.; *Gaylard J.; *Hurford F.; *Hussain Y.; *Javaid A.; *Jones J.; *Leigh M.; *Martin T.; *Millward H.; *Motherwell N.; *Mullan D.; *Newman J.; *Rikunenko R.; *Stickley J.; *Summers J.; *Ting L.; *Tivenan H.; *Donaldson D.; *Capps N.; *Cale E.; *Osbourne W.; *Pajak S.; *Rankin J.; *Tonks L.; Baird T.; Harkins M.; Ruddy J.; West J.; Duffield J.; Mallon L.; Smith O.; Smuts S.; Campbell A.; Davies C.; Davies S.; Jobes L.; Whitehead V.; Watkins C.; Bowman F.; Milligan B.; McPherson L.; Metherell S.; Harris N.; Lake V.; Radford E.; Smallwood A.; Gopal S.; Vassell K.; Bell D.; Boyle R.; Douglas K.; Glass L.; Lennon L.; Rattray A.; Beith C.; Lee E.; Parsons P.; Attwood B.; Jefferson P.; Ranganathan M.; Atwal I.; Campbell B.; Day A.; Stagg C.; Haynes E.; Ahmed C.; Clamp S.; Colley J.; Haq R.; Hayes A.; Joseph S.; Maqsood Z.; Hussain S.; Hulme J.; Domingos P.; Kumar R.; Purewal M.; Taylor B.; Bunni L.; Latif M.; Jennings C.; Jose S.; Marshall R.; Metryka A.; Subramanian G.; Burgoyne A.; O'Connell S.; Tyler A.; Waldron J.; Hilltout P.; Evitts J.; Ward G.; Bremmer P.; Hawkins C.; Jackman S.; Ogorek M.; Ashby K.; Thornton L.; Mercer P.; Halkes M.; Revill A.; Saint B.; Fletcher J.; Netherton K.; Chablani M.; Kirkby A.; Roper A.; Szymiczek K.; Sutherland I.; O'Brien L.; Connell J.; Davies K.; Lewis T.; Omar Z.; Perkins E.; Roche L.; Sathe S.; Davies E.; Lyon A.; Mapfunde I.; Willis C.; Hitchcock R.; Hall K.; King C.; Fagan A.; Nazari R.; Worsley L.; Allibone S.; Kasipandian V.; Patel A.; Cutting P.; Genetu R.; Mac A.; Murphy A.; Ward S.; Butt F.; Ayers A.; Harrison W.; Mackintosh K.; North J.; Ashton L.; Bi R.; Owen S.; Winmill H.; Scholefield B.; Blowing H.; Williams E.; Duskova M.; Edwards M.; Rees A.; Thomas H.; Hughes R.; Brooks J.; Phipps J.; Brooks S.; Dennis C.; Srikaran S.; Sukha A.; Tiongson G.; Adams K.; Andrew B.; Brayne A.; Carter S.; Findlay L.; Fisher E.; Jackson P.; Kaye D.; Parkin J.; Tuckey V.; Hunt J.; Love N.; van Koutrick L.; Hanson A.; Dent K.; Horsley E.; Pearson S.; Spencer S.; Hutchinson D.; Player J.; Potoczna D.; Akhtar M.N.; Cottam L.-J.; Nauyokas K.; Sanders J.; Garcia S.M.; Pakou G.; Diaba C.; Filipe H.; John L.; Maharajh A.; de Neef M.; Martin D.; Eastgate C.; Teoh P.C.; Barrett F.; Bradley C.; Donaldson A.; Mascarenhas M.; O'Hara M.; Okeefe L.; Clarke N.; Whiteside J.; Campbell R.; Matheson J.; McDonald D.; Patience D.; Rice P.; Smith T.; Clapham M.; Mutch R.; Barberis L.; Harper R.; Craig H.; Poultney U.; Burns K.; Higham A.; Twiss S.; Barton J.; George L.; Harrop C.; Mathew S.; Wright D.J.; Harrison R.; Toohie J.; Chandler B.; Turnbull A.; Mallinson J.; Elliott K.; Wolf-Roberts R.; Tench H.; Otahal I.; Hobrok M.; Loosley R.; McGuinness H.; Sims T.; Afolabi D.; Allison K.S.; Anderson T.; Dore R.; Jones D.; Rogers N.; Saunderson P.; Whitbread J.; O'Malley L.; Rad L.; Hawcutt D.; Aldridge J.; Tolson M.; Garrioch S.; Tomlinson J.; Grosdenier M.; Loader D.; Kapoor R.; Hector G.; Scherewode J.; Sri-Chandana C.; Stephenson L.; Marsh S.; Dela Rosa A.; Jhanji S.; Bemand T.; Howle R.; Baikady R.R.; Thomas B.; Black E.; Tatham K.; Gurram S.; Watson E.; Parris V.; Quaid S.; McGregor A.; Saunderson A.; O'Brien R.; Moultrie S.; Service J.; Cheyne C.; Odam M.; Wiliams A.; Barnes N.; Csabi P.; Da Rocha J.; Glynou L.; Huffenberger A.; Bryant J.; Pickard A.; Roe N.; Bellini A.; Mayer A.; Burrow A.; Colley N.; Evans J.; Howlett A.; Khalifeh Z.; Pryce J.; Gorman C.; Easthope A.; Brady R.; Timlick E.; Antoine P.; Gupta A.; Hardy J.; Houlden H.; Moncur E.; Tucci A.; Raith E.; Tariq A.; Brealey D.; Tagliavini E.; Ramsay B.; Fidler K.; Donnelly K.; Hollis R.; Barr J.; Boyd E.; Irvine V.; Shelley B.; Buckley J.; Hamilton C.; Valdeavella K.; Abellan J.; Acosta-Isaac R.; Aguado J.M.; Aguilar C.; Aguilera-Albesa S.; Sabbagh A.A.; Alba J.; Albu S.; Alcala-Gallardo K.A.M.; Alcoba-Florez J.; Batres S.A.; Algarin-Lara H.R.; Almadana V.; Almeida J.; Almoguera B.; Alonso M.R.; Alvarez N.; Alvarez-Benitez Y.; Alvarez-Navia F.; Walther R.A.-S.; Andreu-Bernabeu A.; Antonijoan M.R.; Arana-Arri E.; Aranda C.; Arango C.; Araque C.; Araujo N.K.; Araujo I.M.T.; Arcanjo A.C.; Arnaiz A.; Fernandez F.A.; Arranz M.J.; Lopez J.R.A.; Artiga M.-J.; Avello-Malaver Y.; Ayuso C.; Baldion A.M.; Martin B.B.; Baptista-Rosas R.C.; Barranco-Diaz A.; Barreda-Sanchez M.; Barrera-Penagos V.; Belhassen-Garcia M.; Bernal E.; Bernal-Bello D.; Bezerra J.F.; Bezerra M.A.C.; Blanca-Lopez N.; Blancas R.; Boix-Palop L.; Borobia A.; Bravo E.; Brion M.; Brochado-Kith O.; Brugada R.; Bustos M.; Cabello A.; Caceres-Agra J.J.; Calbo E.; Calderon E.J.; Camacho S.; Campos M.C.; Canadas Y.; Carbonell C.; Cardona-Huerta S.; Carioca A.A.F.; Carpintero M.S.; Segura C.C.; Carratto T.M.T.; Carrillo-Avila J.A.; Carvalho M.C.C.; Casasnovas C.; Castano L.; Castano C.F.; Castelao J.E.; Candalija A.C.; Castillo M.A.; Ceballos F.C.; Chaux J.G.; Chaves-Santiago W.G.; Chiquillo-Gomez S.; Cid-Lopez M.A.; Cienfuegos-Jimenez O.; Conde-Vicente R.; Cordero-Lorenzana M.L.; Corella D.; Corrales A.; Cortes-Sanchez J.L.; Corton M.; Costa T.X.; Cruz M.S.; Cuesta L.; Cunha G.C.R.; da Silva G.V.; Dalmau D.; Dantas-Komatsu R.C.S.; Darnaude M.T.; de Andres R.; de Araujo J.N.G.; de Juan C.; De la Cruz Troca J.; de la Horra C.; de la Hoz A.B.; De Martino-Rodriguez A.; de Sousa Alves Neri J.L.; del Campo-Perez V.; Delgado-Cuesta J.; Diaz-Caneja C.M.; Diaz-Perez A.; de Bustamante A.D.; Dietl B.; Diz-de Almeida S.; Alves M.M.; Dominguez-Garrido E.; dos Santos K.A.; Duarte A.M.; Echave-Sustaeta J.; Eiros R.; Enciso-Olivera C.O.; Escudero G.; Espana P.P.; Sanabria G.M.E.; Farinas M.C.; Fernandes M.R.; Fernandez R.; Fernandez-Caballero L.; Fernandez-Cruz A.; Fernandez-Nestosa M.J.; Fernandez-Robelo U.; Fernandez-Rodriguez A.; Fernandez-Sampedro M.; Fernandez-Sanchez R.; Fernandez-Villa T.; Ferrero S.F.; Martinez Y.F.; Capitan C.F.; Flores-Perez P.; Friaza V.; Fuenmayor-Hernandez L.; Nunez M.F.; Fumado V.; Gadea I.; Gagliardi L.; Gago-Dominguez M.; Gallego N.; Galoppo C.; Garcia I.; Garcia M.; Garcia L.; Garcia-Cerrada C.; Garcia-de-Vicuna A.; Garcia-Garcia J.; Garcia-Garcia I.; Garcia-Ibarbia C.; Garcia-Montero A.C.; Garcia-Soidan A.; Garcia-Vazquez E.; Torrejon M.C.G.; Garza-Frias E.; Gentile A.; Gil-Fournier B.; Gomez-Arrue J.; Gomez-Duque M.; Carrera L.G.; Garcia M.G.; Sacristan A.G.; Gonzalez-Neira A.; Gonzalez-Penas J.; Gonzalez-Sagrado M.; Alvarez B.G.; de Quiros F.G.B.; Benito H.G.; Gorgojo-Galindo O.; Gorgolas M.; Guaragna F.; Guegel G.P.; Guillen-Guio B.; Guillen-Navarro E.; Guisado-Vasco P.; Gutierrez-Bautista J.F.; Gutierrez-Castaneda L.D.; Heili-Frades S.; Hernandez E.; Hernandez-Ortega L.D.; Hernandez-Perez G.; Hernandez-Vaquero R.; Moro C.H.; Herraez B.; Herranz M.T.; Herrera M.; Herrero M.J.; Herrero-Gonzalez A.; Horcajada J.P.; Imaz-Ayo N.; Intxausti-Urrutibeaskoa M.; Iniguez M.; Jacomo R.H.; Jara R.; Jazmin P.M.; Jimenez A.; Jimenez P.; Jimenez-Alfaro I.; Jimenez-Sousa M.A.; Jordan I.; Laguna-Goya R.; Laorden D.; Lasa-Lazaro M.; Lattig M.C.; Lauriente A.; Borja A.L.; Llanos L.; Lopez-Bernus A.; Lopez-Garcia E.; Lopez-Rodriguez R.; Lopez-Ruz M.A.; Granados E.L.; Lorente L.; Lozano J.E.; Lozano-Espinosa M.; Mahillo I.; Mancebo E.; Mar C.; Calvo C.M.; Marcos M.; Marcos-Delgado A.; Candon A.M.; Aguilar P.M.; Martin M.M.; Martin M.D.; Martin V.; Martin-Fernandez M.; Martin-Lopez C.; Martin-Oterino J.-A.; Martin-Pedraza L.; Martin-Vicente M.; Martinez A.; Martinez R.; Martinez J.J.; Martinez S.; Martinez-Aquino E.; Martinez-Gonzalez O.; Martinez-Lopez I.; Martinez-Nieto O.; Martinez-Paz P.; Martinez-Perez A.; Martinez-Ramas A.; Martinez-Resendez M.F.; Robles V.M.; Marzal L.; Mazzeu J.F.; Medeiros J.F.P.; Medeiros K.A.; Medrano F.J.; Meijome X.M.; Mejuto-Montero N.; Mendez-Echevarria A.; Charris H.M.; Macias E.M.; Mercadillo F.; Mercado-Sesma A.R.; Minguez P.; Molina A.J.J.; Molina-Roldan E.; Montoya J.J.; Moraes V.M.S.; Moreira-Escriche P.; Morelos-Arnedo X.; Moreno-Docon A.; Moreno-Escalante J.; Cuerda V.M.; Fernandez A.M.; Morilla R.; Garcia P.M.; Neira P.; Nevado J.; Nieto-Ganan I.; Nunes J.F.R.; Nunez-Torres R.; Obrador-Hevia A.; Ocejo-Vinyals J.G.; Olivar V.; Oliveira S.F.; Ondo L.; Orfao A.; Ortega L.; Ortega-Paino E.; Ortiz-Flores F.; Ortiz-Lopez R.; Oteo J.A.; Pachajoa H.; Pacheco M.; Pacheco-Miranda F.J.; Conejo I.P.; Panadero-Fajardo S.; Parellada M.; Pariente-Rodriguez R.; Paz-Artal E.; Peces-Barba G.; Pedromingo Kus M.S.; Perales C.; Perez P.; Perez C.; Perez-de-Nanclares G.; Perez-Garcia F.; Perez-Matute P.; Perez-Serra A.; Perez-Tomas M.E.; Perucho T.; Pichardo L.A.; Pinho S.M.T.; Pinsach-Abuin M.; Pinzon L.A.; Pita G.; Pla-Junca F.; Planas-Serra L.; Pompa-Mera E.N.; Porras-Hurtado G.L.; Pujol A.; Chavez M.E.Q.; Quijada M.A.; Quintela I.; Ramirez-Montano D.; Leon S.R.; Sedes P.R.; Recalde D.; Recio-Fernandez E.; Resino S.; Ribeiro A.P.; Rivadeneira-Chamorro C.S.; Roa-Agudelo D.; Pardo M.R.; Rodriguez M.J.; Rodriguez-Artalejo F.; Rodriguez-Ferrer M.; Rodriguez-Gallego C.; Rodriguez-Garcia J.A.; Rodriguez-Hernandez M.A.; Rodriguez-Nicolas A.; Rodriguez-Palmero A.; Rodriguez-Ruiz E.; Rodriguez-Urrego P.A.; Maya B.R.; Novoa G.E.R.; Rojo F.; Romero-Coronado A.; Garcia F.R.; Rosa L.S.; Rosales-Castillo A.; Rubio C.; Olivera M.R.; Ruiz M.; Ruiz-Cabello F.; Ruiz-Casares E.; Ruiz-Cubillan J.J.; Ruiz-Hornillos J.; Ryan P.; Salamanca H.D.; Salazar-Garcia L.; Origlia G.G.S.; Sanchez P.-L.; Sanchez-Pablo C.; Sanchez-Pernaute O.; Sanchez Lopez A.J.; Prados M.C.S.; Real J.S.; Redondo J.S.; Sancho-Sainz C.; Sangil A.; Santos A.; Santos N.P.C.; Schluter A.; Segovia S.; Serra-Llovich A.; Puras F.S.; Porras M.S.; Sicolo M.A.; Silbiger V.N.; Silva N.S.; Silva F.T.C.; Fuentes C.S.; Sole-Violan J.; Soria J.M.; Sorli J.V.; Sousa R.R.; Souto J.C.; Souza K.S.C.; Souza V.S.; Sprockel J.J.; Suarez-Rama J.J.; Suarez-Zamora D.A.; Taboada-Fraga X.; Tamayo E.; Tamayo-Velasco A.; Taracido-Fernandez J.C.; Tavares N.A.C.; Telleria C.; Castano J.A.T.; Teper A.; Torres-Macho J.; Torres-Tobar L.; Torres Gutierrez R.P.; Troya J.; Urioste M.; Valencia-Ramos J.; Valido A.; Gallo J.P.V.; Varon B.; Vasconcelos R.H.T.; Vega T.; Velasco-Quirce S.; Velez-Santamaria V.; Victor V.; Estevez J.V.; Vieitez-Santiago M.; Vilches C.; Villalobos L.; Villar F.; Villar-Garcia J.; Villaverde C.; Villoslada-Blanco P.; Virseda-Berdices A.; Yanez Z.; Zapatero-Gaviria A.; Zarate R.; Zazo S.; de Heredia M.L.; Mendes I.; Moreno R.; Sande E.; Lapunzina P.; Alex B.; Andrikopoulos P.; Bach B.; Barclay W.S.; Bogaert D.; Chand M.; Chechi K.; Cooke G.S.; da Silva Filipe A.; de Silva T.; Docherty A.B.; dos Santos Correia G.; Dumas M.-E.; Dunning J.; Fletcher T.; Green C.A.; Greenhalf W.; Griffin J.; Gupta R.K.; Harrison E.M.; Ho A.Y.W.; Holden K.; Horby P.W.; Ijaz S.; Khoo S.; Klenerman P.; Lewis M.; Liggi S.; Lim W.S.; Maslen L.; Mentzer A.J.; Merson L.; Meynert A.M.; Moore S.C.; Noursadeghi M.; Olanipekun M.; Osagie A.; Palmarini M.; Palmieri C.; Paxton W.A.; Pollakis G.; Price N.; Rambaut A.; Robertson D.L.; Russell C.D.; Sancho-Shimizu V.; Sands C.; Scott J.T.; Sigfrid L.; Solomon T.; Sriskandan S.; Stuart D.; Swann O.V.; Takats Z.; Takis P.; Tedder R.S.; Thompson A.A.R.; Thomson E.C.; Thwaites R.S.; Turtle L.C.W.; Zambon M.; Carson G.; Drake T.M.; Fairfield C.J.; Knight S.R.; Mclean K.A.; Murphy D.; Norman L.; Pius R.; Shaw C.A.; Connor M.; Dalton J.; Gamble C.; Girvan M.; Halpin S.; Harrison J.; Jackson C.; Marsh L.; Roberts S.; Saviciute E.; Knight S.; Lahnsteiner E.; Leeming G.; Norris L.; Scott-Brown J.; Tait S.; Wham M.; Lee J.; Plotkin D.; Keating S.; Donegan C.; Spencer R.G.; Donohue C.; Hardwick H.; Shelton J.F.; Shastri A.J.; Ye C.; Weldon C.H.; Filshtein-Sonmez T.; Coker D.; Symons A.; Esparza-Gordillo J.; Aslibekyan S.; Auton A.; Yang J.; Ponting C.P.; Wilson J.F.; Vitart V.; Abedalthagafi M.; Luchessi A.D.; Parra E.J.; Cruz R.; Carracedo A.; Fawkes A.; Murphy L.; Rowan K.; Pereira A.C.; Law A.; Fairfax B.; Hendry S.C.; Baillie J.K.

Citation:
Nature. 617(7962) (pp 764-768), 2023. Date of Publication: 25 May 2023.

Abstract:
Critical illness in COVID-19 is an extreme and clinically homogeneous disease phenotype that we have previously shown<sup>1</sup> to be highly efficient for discovery of genetic associations<sup>2</sup>. Despite the advanced stage of illness at presentation, we have shown that host genetics in patients who are critically ill with COVID-19 can identify immunomodulatory therapies with strong beneficial effects in this group<sup>3</sup>. Here we analyse 24,202 cases of COVID-19 with critical illness comprising a combination of microarray genotype and whole-genome sequencing data from cases of critical illness in the international GenOMICC (11,440 cases) study, combined with other studies recruiting hospitalized patients with a strong focus on severe and critical disease: ISARIC4C (676 cases) and the SCOURGE consortium (5,934 cases). To put these results in the context of existing work, we conduct a meta-analysis of the new GenOMICC genome-wide association study (GWAS) results with previously published data. We find 49 genome-wide significant associations, of which 16 have not been reported previously. To investigate the therapeutic implications of these findings, we infer the structural consequences of protein-coding variants, and combine our GWAS results with gene expression data using a monocyte transcriptome-wide association study (TWAS) model, as well as gene and protein expression using Mendelian randomization. We identify potentially druggable targets in multiple systems, including inflammatory signalling (JAK1), monocyte-macrophage activation and endothelial permeability (PDE4A), immunometabolism (SLC2A5 and AK5), and host factors required for viral entry and replication (TMPRSS2 and RAB2A).

Link to full-text [open access - no password required]

Altmetrics:

Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA) (2022)

Type of publication:Journal article

Author(s):Sardanelli F, Trimboli RM, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, Cozzi A, de Andrade DA, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, *Ozcan Umit A, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Sacchetto D, Scaperrotta GP, Schiaffino S, Schlooz M, Szabó BK, Taylor DB, Ulus ÖS, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Di Leo G.

Citation:European Radiology. 2022 Mar;32(3):1611-1623.

Abstract:Objectives: Preoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue. Methods: This observational study enrolled women aged 18-80 years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers. Exclusion criteria included planned neoadjuvant therapy, pregnancy, personal history of any cancer, and distant metastases. Results: Of 5896 analyzed patients, 2763 (46.9%) had conventional imaging only (noMRI group), and 3133 (53.1%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1%), with preoperative intent in 2441/3133 women (77.9%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancers ≥ 20 mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (p < 0.001 for all comparisons). Mastectomy was planned based on conventional imaging in 22.4% (MRI group) versus 14.4% (noMRI group) (p < 0.001). The additional planned mastectomy rate in the MRI group was 11.3%. The overall performed first- plus second-line mastectomy rate was 36.3% (MRI group) versus 18.0% (noMRI group) (p < 0.001). In women receiving conserving surgery, MRI group had a significantly lower reoperation rate (8.5% versus 11.7%, p < 0.001). Conclusions: Clinicians requested breast MRI for women with a higher a priori probability of receiving mastectomy. MRI was associated with 11.3% more mastectomies, and with 3.2% fewer reoperations in the breast conservation subgroup. Key points: • In 19% of patients of the MIPA study, breast MRI was performed for screening or diagnostic purposes. • The current patient selection to preoperative breast MRI implies an 11% increase in mastectomies, counterbalanced by a 3% reduction of the reoperation rate. • Data from the MIPA study can support discussion in tumor boards when preoperative MRI is under consideration and should be shared with patients to achieve informed decision-making.

Link to full-text [open access - no password required]

Altmetrics:

Solving the preoperative breast MRI conundrum: design and protocol of the MIPA study (2020)

Type of publication:Journal article

Author(s):Sardanelli F, Trimboli RM, Houssami N, Gilbert FJ, Helbich TH, Alvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Andrade DA, de Lima Docema MF, Depretto C, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, *Ozcan, Umit A., Pediconi F, Preibsch H, Raya-Povedano JL, Sacchetto D, Scaperrotta GP, Schlooz M, Szabo BK, Ulus OS, Taylor DB, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Di Leo G.

Citation:European Radiology. 2020 Oct;30(10):5427-5436.

Abstract:Despite its high diagnostic performance, the use of breast MRI in the preoperative setting is controversial. It has the potential for personalized surgical management in breast cancer patients, but two of three randomized controlled trials did not show results in favor of its introduction for assessing the disease extent before surgery. Meta-analyses showed a higher mastectomy rate in women undergoing preoperative MRI compared to those who do not. Nevertheless, preoperative breast MRI is increasingly used and a survey from the American Society of Breast Surgeons showed that 41% of respondents ask for it in daily practice. In this context, a large-scale observational multicenter international prospective analysis (MIPA study) was proposed under the guidance of the European Network for the Assessment of Imaging in Medicine (EuroAIM). The aims were (1) to prospectively and systematically collect data on consecutive women with a newly diagnosed breast cancer, not candidates for neoadjuvant therapy, who are offered or not offered breast MRI before surgery according to local practice; (2) to compare these two groups in terms of surgical and clinical endpoints, adjusting for covariates. The underlying hypotheses are that MRI does not cause additional mastectomies compared to conventional imaging, while reducing the reoperation rate in all or in subgroups of patients. Ninety-six centers applied to a web-based call; 36 were initially selected based on volume and quality standards; 27 were active for enrollment. On November 2018, the target of 7000 enrolled patients was reached. The MIPA study is presently at the analytic phase. Key Points • Breast MRI has a high diagnostic performance but its utility in the preoperative setting is controversial. • A large-scale observational multicenter prospective study was launched to compare women receiving with those not receiving preoperative MRI. • Twenty-seven centers enrolled more than 7000 patients. The study is presently at the analytic phase.

Altmetrics:

The Impact of Artificial Intelligence on Optimizing Diagnosis and Treatment Plans for Rare Genetic Disorders (2023)

Type of publication:Journal article

Author(s):Abdallah, Shenouda; Sharifa, Mouhammad; I Kh Almadhoun, Mohammed Khaleel; Khawar, Muhammad Muneeb Sr; Shaikh, Unzla; Balabel, Khaled M; Saleh, Inam; Manzoor, Amima; Mandal, Arun Kumar; *Ekomwereren, Osatohanmwen; Khine, Wai Mon; Oyelaja, Oluwaseyi T.

Citation:Cureus. 15(10):e46860, 2023 Oct.

Abstract:Rare genetic disorders (RDs), characterized by their low prevalence and diagnostic complexities, present significant challenges to healthcare systems. This article explores the transformative impact of artificial intelligence (AI) and machine learning (ML) in addressing these challenges. It emphasizes the need for accurate and early diagnosis of RDs, often hindered by genetic and clinical heterogeneity. This article discusses how AI and ML are reshaping healthcare, providing examples of their effectiveness in disease diagnosis, prognosis, image analysis, and drug repurposing. It highlights AI's ability to efficiently analyze extensive datasets and expedite diagnosis, showcasing case studies like Face2Gene. Furthermore, the article explores how AI tailors treatment plans for RDs, leveraging ML and deep learning (DL) to create personalized therapeutic regimens. It emphasizes AI's role in drug discovery, including the identification of potential candidates for rare disease treatments. Challenges and limitations related to AI in healthcare, including ethical, legal, technical, and human aspects, are addressed. This article underscores the importance of data ethics, privacy, and algorithmic fairness, as well as the need for standardized evaluation techniques and transparency in AI research. It highlights second-generation AI systems that prioritize patient-centric care, efficient patient recruitment for clinical trials, and the significance of high-quality data. The integration of AI with telemedicine, the growth of health databases, and the potential for personalized therapeutic recommendations are identified as promising directions for the field. In summary, this article provides a comprehensive exploration of how AI and ML are revolutionizing the diagnosis and treatment of RDs, addressing challenges while considering ethical implications in this rapidly evolving healthcare landscape.

Link to full-text [open access - no password required]

Altmetrics:

Improving the Outcome of Patients With Heart Failure: Assessment of Iron Deficiency and Intravenous Iron Replacement (2023)

Type of publication:Journal article

Author(s):*Yera, Hassan O; Khan, Ahsan; Akinlade, Olawale M; Champsi, Asgher; Glouzon, Van Nam J; Spencer, Charles.

Citation:Cureus. 15(10):e47027, 2023 Oct.

Abstract:Background Iron deficiency (ID) has been shown to be a significant co-morbidity in patients with heart failure (HF), independent of their anaemia status. Correction of ID has been shown to improve quality of life, recurrent heart failure hospitalizations and morbidity. A quality improvement project was designed to improve the assessment and treatment of iron deficiency in HFatients in our tertiary care centre. Methods and results An initial baseline dataset was collected, followed by two cycles of interventions to help improve the care of HF patients admitted to our hospital over a two-month period. The Plan-Do-Study-Act (PDSA) cycle approach was applied, with the first intervention involving raising awareness of the importance and need to assess the iron status of HF patients through education provided to doctors, nurses and patients. Furthermore, information leaflets were produced and disseminated across the medical wards and through social media forums. The post-intervention datasets were collected and compared to the baseline outcomes. Baseline data showed that only four (20%) of heart failure patients had their iron status checked. Following the interventions, screening for ID increased to 80% (16), of which 85% (11) of those who identified as iron deficient received intravenous iron replacement. Conclusion The project was successful in improving the practice of screening for iron deficiency and intravenous replacement of iron in patients with HF.

Link to full-text [open access - no password required]

Altmetrics:

The development and acceptability of an educational and training intervention for recruiters to neonatal trials: the TRAIN project (2023)

Type of publication:Journal article

Author(s):Smith, V; Delaney, H; Hunter, A; Torgerson, D; Treweek, S; Gamble, C; Mills, N; Stanbury, K; Dempsey, E; Daly, M; O'Shea, J; Weatherup, K; *Deshpande, S; Ryan, M A; Lowe, J; Black, G; Devane, D.

Citation:BMC Medical Research Methodology. 23(1):265, 2023 Nov 11.

Abstract:BACKGROUND: Suboptimal or slow recruitment affects 30-50% of trials. Education and training of trial recruiters has been identified as one strategy for potentially boosting recruitment to randomised controlled trials (hereafter referred to as trials). The Training tRial recruiters, An educational INtervention (TRAIN) project was established to develop and assess the acceptability of an education and training intervention for recruiters to neonatal trials. In this paper, we report the development and acceptability of TRAIN. METHODS: TRAIN involved three sequential phases, with each phase contributing information to the subsequent phase(s). These phases were 1) evidence synthesis (systematic review of the effectiveness of training interventions and a content analysis of the format, content, and delivery of identified interventions), 2) intervention development using a Partnership (co-design/co-creation) approach, and 3) intervention acceptability assessments with recruiters to neonatal trials. RESULTS: TRAIN, accompanied by a comprehensive intervention manual, has been designed for online or in-person delivery. TRAIN can be offered to recruiters before trial recruitment begins or as refresher sessions during a trial. The intervention consists of five core learning outcomes which are addressed across three core training units. These units are the trial protocol (Unit 1, 50 min, trial-specific), understanding randomisation (Unit 2, 5 min, trial-generic) and approaching and engaging with parents (Unit 3, 70 min, trial-generic). Eleven recruiters to neonatal trials registered to attend the acceptability assessment training workshops, although only four took part. All four positively valued the training Units and resources for increasing recruiter preparedness, knowledge, and confidence. More flexibility in how the training is facilitated, however, was noted (e.g., training divided across two workshops of shorter duration). Units 2 and 3 were considered beneficial to incorporate into Good Clinical Practice Training or as part of induction training for new staff joining neonatal units. CONCLUSION: TRAIN offers a comprehensive co-produced training and education intervention for recruiters to neonatal trials. TRAIN was deemed acceptable, with minor modification, to neonatal trial recruiters. The small number of recruiters taking part in the acceptability assessment is a limitation. Scale-up of TRAIN with formal piloting and testing foreffectiveness in a large cluster randomised trial is required.

Link to full-text [open access - no password required]

Altmetrics: