This is a repository copy of Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. The Lancet. ISSN 0140-6736 https://doi.org/10.1016/S0140-6736(18)32521-2 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ ReuseThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) licence. This licence only allows you to download this work and share it with others as long as you credit the authors, but you can't change the article in any way or use it commercially. More information and the full terms of the licence here: https://creativecommons.org/licenses/ Implications of all the available evidenceDespite the success of some smaller projects, there was no survival benefit from a national quality improvement programme to implement a care pathway for patients undergoing emergency abdominal surgery. To succeed, large national quality improvement programmes need to allow for differences between hospitals and ensure teams have both the time and resources needed to improve patient care.

Critical illness in COVID-19 is an extreme and clinically homogeneous disease phenotype that we have previously shown1 to be highly efficient for discovery of genetic associations2. 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 group3. 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).

This article argues that the centrality of rugby as a key formulator of Pakeha ethnicity and agent of interracial integration has been contested in recent scholarly research. It further argues that although sport and ethnicity has been examined in some case‐studies and some general histories, to date we have no systematic scholarly assessment of the connections between sport and ethnicity in New Zealand. Our presently fragmented understanding of this issue reflects a wider problem within sports studies in New Zealand, namely the lack of any comprehensive study of the role of sport in New Zealand history.

Examines the utilisation of e‐mail scanning and surveillance technology by the management consulting business in the UK. Uses a questionnaire of UK management consulting firms to determine the uptake and substance of e‐mail policies, and the extent and nature of e‐mail monitoring implementation. Investigates the attitudes of management consulting employees towards e‐mail surveillance in a survey of work colleagues. Also considers e‐mail monitoring issues. Concludes that forms of workplace e‐mail monitoring are becoming more widespread. Awareness of the ramifications for worker privacy is growing, due partly to recent Government legislation. Finds that e‐mail policy adoption rates among management consultancies are comparatively low, as are levels of e‐mail scanning/surveillance software installation. Predicts that maintaining a fair balance between conflicting business and employee interests will be the key to determining the future direction of workplace e‐mail monitoring.

No abstract