Lack of regional pathways impact on surgical delay: Analysis of the Orthopaedic Trauma Hospital Outcomes-Patient Operative Delays (ORTHOPOD) study (2023)

Type of publication:Journal article

Author(s):Ahmed H.E.; Baldock T.; Wei N.; Walshaw T.; Walker R.; Trompeter A.; Scott S.; Eardley W.G.P.; Stevenson I.; Yoong A.; Rankin I.; Dixon J.; Lim J.W.; Sattar M.; McDonald S.; Davies H.; Jones L.; Nolan M.; McGinty R.; Stevenson H.; Bowe D.; Sim F.; Vun J.; Strain R.; Giannoudis V.; Talbot C.; Gunn C.; Le H.P.D.; Bradley M.; Lloyd W.; Hanratty B.; Lim Y.; Brookes-Fazakerley S.; Varasteh A.; Francis J.; Choudhry N.; Malik S.; Vats A.; Evans A.; Garner M.; Zbaeda M.; Diamond O.; Baker G.; Napier R.; Guy S.; McCauley G.; King S.; Edwards G.; Lin B.; Davoudi K.; Haines S.; Raghuvanshi M.; Buddhdev P.; Karam E.; Nimmyel E.; Ekanem G.; Lateef R.; Jayadeep J.S.; Crowther I.; Mazur K.; Hafiz N.; Khan U.; Chettiar K.; Ibrahim A.; Gopal P.; Tse S.; Lakshmipathy R.; Towse C.; Al-Musawi H.; Walmsley M.; Aspinall W.; Metcalfe J.; Moosa A.; Crome G.; Abdelmonem M.; Lakpriya S.; Hawkins A.; Waugh D.; Kennedy M.; Elsagheir M.; Kieffer W.; Oyekan A.; Collis J.; Raad M.; Raut P.; Baker M.; Gorvett A.; Gleeson H.; Fahmy J.; Walters S.; Tinning C.; Chaturvedi A.; Russell H.; Alsawada O.; Sinnerton R.; Warwick C.; Dimascio L.; Ha T.T.; King T.; Engelke D.; Chan M.; Gopireddy R.; Deo S.; Vasarhelyi F.; Jhaj J.; Dogramatzis K.; McCartney S.; Ardolino T.; Fraig H.; Hiller-Smith R.; Haughton B.; Greenwood H.; Stephenson N.; Chong Y.; Sleat G.; Saedi F.; Gouda J.; Ravi S.M.; Henari S.; Imam S.; Howell C.; Theobald E.; Wright J.; Cormack J.; Borja K.; Wood S.; Khatri A.; Bretherton C.; Tunstall C.; Lowery K.; Holmes B.; Nichols J.; Bashabayev B.; Wildin C.; Sofat R.; Thiagarajan A.; Abdelghafour K.; Nicholl J.; Abdulhameed A.; Duke K.; Maling L.; McCann M.; Masud S.; Marshman J.; Moreau J.; Cheema K.; Rageeb P.M.; Mirza Y.; Kelly A.; Hassan A.; Christie A.; Davies A.; Tang C.; Frostick R.; Pemmaraju G.; Handford C.; Chauhan G.; Dong H.; Choudri M.J.; Loveday D.; Bawa A.; Baldwick C.; Roberton A.; Burden E.; Nagi S.; Johnson-Lynn S.; Guiot L.; Kostusiak M.; Appleyard T.; Mundy G.; Basha A.; Abdeen B.; Robertson-Smith B.; Hussainy H.A.; Reed M.; Jamalfar A.; Flintoft E.; McGovern J.; Alcock L.; Koziara M.; Ollivere B.; Zheng A.; Atia F.; Goff T.; Slade H.; Teoh K.; Shah N.; Al-Obaedi O.; Jamal B.; Bell S.; Macey A.; Brown C.; Simpson C.; Alho R.; Wilson V.; Lewis C.; Blyth D.; Chapman L.; Woods L.; Katmeh R.; Pasapula C.; Youssef H.; Tan J.; Famure S.; Grazette A.; Lloyd A.; Beaven A.; Jackowski A.; Piper D.; Lotfi N.; Chakravarthy J.; Elzawahry A.; Trew C.; Neo C.; Elamin-Ahmed H.; Ashwood N.; Wembridge K.; Eyre-Brook A.; Greaves A.; Watts A.; Stedman T.; Ker A.; Wong L.S.; Fullarton M.; Phelan S.; Choudry Q.; Qureshi A.; Moulton L.; Cadwallader C.; Jenvey C.; Aqeel A.; Francis D.; Simpson R.; Phillips J.; Matthews E.; Thomas E.; Williams M.; Jones R.; White T.; Ketchen D.; Bell K.; Swain K.; Chitre A.; Lum J.; Syam K.; Dupley L.; O'Brien S.; *Ford D.; *Chapman T.; *Zahra W.; Guryel E.; McLean E.; Dhaliwal K.; Regan N.; Berstock J.; Deano K.; Donovan R.; Blythe A.; Salmon J.; Craig J.; Hickland P.; Matthews S.; Brown W.; Borland S.; Aminat A.; Stamp G.; Zaheen H.; Jaibaji M.; Egglestone A.; Sampalli S.R.; Goodier H.; Gibb J.; Islam S.; Ranaboldo T.; Theivendran K.; Bond G.; Richards J.; Sanghera R.; Robinson K.; Fong A.; Tsang B.; Dalgleish J.; McGregor-Riley J.; Barkley S.; Eardley W.; Elhassan A.; Tyas B.; Chandler H.; McVie J.; Negus O.; Ravi K.; Qazzaz L.; Mohamed M.; Sivayoganthan S.; Poole W.; Slade G.; Beaumont H.; Beaumont O.; Taha R.; Lever C.; Sood A.; Moss M.; Khatir M.; Jeffers A.; Brookes C.; Dadabhoy M.; Bhattacharya R.; Singh A.; Beer A.; Hodgson H.; Rahman K.; Barter R.; Mackinnon T.; Frasquet-Garcia A.; Aldarragi A.; Warner C.; Pantelides C.; Attwood J.; Al-Uzri M.; Qaoud Q.A.; Green S.; Osborne A.; Griffiths A.; Emmerson B.; Slater D.; Altahoo H.; Scott H.; Rowland D.; O'Donnell J.; Edwards T.; Hafez A.; Khan B.; Crane E.; Axenciuc R.; Al-Habsi R.; McAlinden G.; Sterne J.; Wong M.L.; Patil S.; Ridha A.; Rasidovic D.; Searle H.; Choudhry J.; Farhan-Alanie M.M.; Tanagho A.; Sharma S.; Thomas S.; Smith B.; McMullan M.; Winstanley R.; Mirza S.; Hamlin K.; Elgayar L.; Larsen M.P.; Eissa M.; Stevens S.; Hopper G.P.; Fang Soh T.C.; Doorgakant A.; Yogeswaran A.; Myatt D.; Mahon J.; Ward N.; Reid S.; Deierl K.; Brogan D.; Little M.; Deakin S.; Baines E.; Jones G.; Boulton H.; Douglas T.; Jeyaseelan L.; Abdale A.; Islam A.; Atkinson K.V.; Mohamedfaris K.; Mmerem K.; Jamal S.; Wharton D.; Rana A.; McAllister R.; Sasi S.; Thomas T.; Pillai A.; Flaherty D.; Khan M.; Akkena S.; Shandala Y.; Lankester B.; Hainsworth L.

Citation:Injury. 54(12) (no pagination), 2023. Article Number: 111007. Date of Publication: December 2023. [epub ahead of print]

Abstract:Introduction: Current practice following injury within the United Kingdom is to receive surgery, at the institution of first contact regardless of ability to provide timely intervention and inconsiderate of neighbouring hospital resource and capacity. This can lead to a mismatch of demand and capacity, delayed surgery and stress within hospital systems, particularly with regards to elective services. We demonstrate through a multicentre, multinational study, the impact of this at scale. Methodology: ORTHOPOD data collection period was between 22/08/2022 and 16/10/2022 and consisted of two arms. Arm 1 captured orthopaedic trauma caseload and capacity in terms of sessions available per centre and patients awaiting surgery per centre per given week. Arm 2 recorded patient and injury demographics, time of decision making, outpatient and inpatient timeframes as well as time to surgery. Hand and spine cases were excluded. For this regional comparison, regional trauma networks with a minimum of four centres enroled onto the ORTHOPOD study were exclusively analysed. Result(s): Following analysis of 11,202 patient episodes across 30 hospitals we found no movement of any patient between hospitals to enable prompt surgery. There is no current system to move patients, between regional centres despite clear discrepancies in workload per capacity across the United Kingdom. Many patients wait for days for surgery when simple transfer to a neighbouring hospital (within 10 miles in many instances) would result in prompt care within national guidelines. Conclusion(s): Most trauma patients in the United Kingdom are managed exclusively at the place of first presentation, with no consideration of alternative pathways to local hospitals that may, at that time, offer increased operative capacity and a shorter waiting time. There is no oversight of trauma workload per capacity at neighbouring hospitals within a regional trauma network. This leads to a marked disparity in waiting time to surgery, and subsequently it can be inferred but not proven, poorer patient experience and outcomes. This inevitably leads to a strain on the overall trauma system and across several centres can impact on elective surgery recovery. We propose the consideration of inter-regional network collaboration, aligned with the Major Trauma System.

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Healthcare professionals' views to inform revision of the BAPM newborn early warning trigger and track system (2023)

Type of publication:Journal article

Author(s):Ojha S.; MacAllister K.; Abdula S.; Madar J.; Rackham O.; *Tyler W.

Citation:Archives of Disease in Childhood: Fetal and Neonatal Edition. 108(1) (pp F92-F93), 2023. Date of Publication: January 2023.

Link to full-text [NHS OpenAthens account required]

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Mitral valve prolapse presenting as a missed myocardial infarction (2023)

Type of publication:Conference abstract

Author(s):*Champaneri K.; *Miller A.

Citation:Journal of the Intensive Care Society. Conference: Intensive Care Society State of the Art Congress, SOA 2023. Birmingham United Kingdom. 24(2 Supplement) (pp 194), 2023. Date of Publication: August 2023.

Abstract:Introduction: An elderly but very active gentleman presented overnight with progressive shortness of breath and leg swelling, two weeks after experiencing chest pain while lifting heavy objects in the garden. The presumed diagnosis was a missed myocardial infarction leading to heart failure exacerbated by a new diagnosis of atrial fibrillation. Despite diuresis and rate control, he became progressively more hypoxic and was taken to ICU for non-invasive ventilation. An initial POCUS scan of heart and lungs by an ultrasound fellow undertaking FUSIC accreditation showed a hyperdynamic heart, pulmonary oedema, and bilateral pleural effusions. The echocardiogram was reviewed and repeated by an advanced level operator which dramatically altered the patient's diagnosis and management. Main body: A gentleman in his early 80s presented to the Emergency Department in type one respiratory failure with a high work of breathing. Examination and investigations demonstrated raised inflammatory markers, new atrial fibrillation with a rate of 140, large bilateral plural effusions, and pitting oedema to the groin. Troponin was normal, and the BNP was 4500. ECG showed no ischaemic changes and CXR was consistent with fluid overload and/or pneumonia. Initial management consisted of supplemental oxygen, diuretics, heart rate control, and antibiotics. Despite this his oxygenation deteriorated and he was admitted to the ICU for CPAP, and metaraminol for his hypotension. An initial FUSIC heart scan did not show any signs of ventricular failure. In fact, the heart was hyperdynamic which was more consistent with sepsis. A lung ultrasound did however demonstrate large bilateral plural effusions and the significant pitting oedema of the lower limbs found on clinical examination still suggested a cardiac cause and so help was asked of an advanced level operator. A review of the images and a repeat scan revealed a severe prolapse of the posterior mitral valve leaflet with free, eccentric mitral regurgitation. The leaflet prolapse was not visible on the 1st set of images and was only discovered by more comprehensive scanning. The patient was reviewed by a cardiologist within 30 minutes and transfer to a tertiary centre for emergency mitral valve repair was arranged. <br/>Conclusion(s): Standard history, examination, and investigations of this patient led to a presumed diagnosis of ischaemic ventricular failure. While a basic heart ultrasound did not reveal the pathology, it did demonstrate signs not consistent with the suspected diagnosis prompting a request for a more comprehensive ultrasound assessment. This revealed the underlying pathology, significantly altering the patient's management. This was all done by intensive care clinicians at the bedside, significantly shortening the time to diagnosis and correct management. This case is a good example of why Intensive Care clinicians should be trained in point of care ultrasound at both basic and advanced levels.

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Experience as an international mammographer working in the UK comparing practice between Nigeria and UK (2023)

Type of publication:Conference abstract

Author(s):*Okeke C.R.; *Njoku G.

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

Abstract:Breast cancer affects women of all races without exception even though severity and survival rate are often diverse. In Nigeria about two thirds of women with breast cancer are diagnosed at an advanced stage, with the possibility of metastatic spread (Akaro- Anthony et al., 2010). A mammographer performs breast imaging techniques that produce mammographic radiographs for diagnosis (American Society of Radiologic Technologist, 2017). In Nigeria, the breast screening programme is performed by radiographers with the additional mammogram-specific training which is comparable to what is found in the United Kingdom; however, the UK screening programme also makes use of trained assistant practitioners which is not obtainable in Nigeria (Lawal et al., 2015). The breast screening programme in Nigeria invites women between the ages of 40 to 70 years, and this is justified by the fear that in Nigeria, a higher percentage of breast cancer cases are seen in younger age groups than in developed world ((Jedy-Agba et al., 2012). The mode of invitation is through public awareness campaigns, but majority of the women in the population do not frequently participate in mammography screening due to high cost and religious belief. The screening programme in Nigeria encourages women to get screened every two years (Lawal et al., 2012). However, the UK breast screening programme advice women to have breast screening mammogram, once every 3 years and is currently inviting women between the ages of 50 and 70 years for breast screening.

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Increased detection of pericardial effusion during the COVID-19 pandemic (2023)

Type of publication:Conference abstract

Author(s):*Wilson A.; *Ellis C.; *Lee E.

Citation:Echo Research and Practice. Conference: British Society of Echocardiography Annual Meeting, BSEcho 2022. London United Kingdom. 10(Supplement 1) (no pagination), 2023. Date of Publication: September 2023.

Abstract:Background: Pericardial effusions (PE) occur when there is an excess of fluid accumulating within the pericardial space. We have observed an increase in the number of PE's detected amongst all transthoracic echocardiography (TTE) scans performed since the start of the COVID- 19 pandemic irrespective of cause for referral. This is interesting given that the most common cause of PE's in the Western World is considered to be post-viral infection. Aim(s): Validate a significant increase in the rate of PE detection via TTE from January 2020-December 2021 compared to the previous 3 years and compare PE detection with national COVID-19 infection data. Method(s): All TTE scans performed between January 2017 and December 2021 were utilised to generate rates of PE detection. A t-test was performed to assess for a significant difference in PE detection pre-COVID-19 (January 2017-December 2019) and during the pandemic (January 2020-December 2021). Data on the incidence of COVID-19 cases in the UK was gathered from the Gov.uk website. Result(s): A total of 37,069 TTE's were performed pre-COVID-19 and 24,125 scans post-COVID-19. Majority of the 2020-2021 TTE's were performed in low risk COVID-19 patients. There were significantly more PE's detected post-COVID-19 compared with pre-COVID-19 with rates of detection of 0.14 and 0.05 respectively (p < 0.001). Detection of PE's increased from 2017-2021 despite a decrease in total scans performed post-COVID-19 (Figure 1). Comparison with national COVID-19 infection data shows a peak in PE incidence following a peak in infections (Figure 2). Conclusion(s): We have noticed a significant increase in PE detection since the start of the COVID-19 pandemic. This appeared to track the incidence of national COVID-19 infections.

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.

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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.; 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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).

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