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Background In most countries, healthcare workers (HCWs) represent a priority group for vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) due to their elevated risk of COVID-19 and potential contribution to nosocomial SARS-CoV-2 transmission. Concerns have been raised that HCWs from ethnic minority groups are more likely to be vaccine hesitant (defined by the World Health Organisation as refusing or delaying a vaccination) than those of White ethnicity, but there are limited data on SARS-CoV-2 vaccine hesitancy and its predictors in UK HCWs. Methods Nationwide prospective cohort study and qualitative study in a multi-ethnic cohort of clinical and non-clinical UK HCWs. We analysed ethnic differences in SARS-CoV-2 vaccine hesitancy adjusting for demographics, vaccine trust, and perceived risk of COVID-19. We explored reasons for hesitancy in qualitative data using a framework analysis. Findings 11,584 HCWs were included in the cohort analysis. 23% (2704) reported vaccine hesitancy. Compared to White British HCWs (21.3% hesitant), HCWs from Black Caribbean (54.2%), Mixed White and Black Caribbean (38.1%), Black African (34.4%), Chinese (33.1%), Pakistani (30.4%), and White Other (28.7%) ethnic groups were significantly more likely to be hesitant. In adjusted analysis, Black Caribbean (aOR 3.37, 95% CI 2.11 - 5.37), Black African (aOR 2.05, 95% CI 1.49 - 2.82), White Other ethnic groups (aOR 1.48, 95% CI 1.19 - 1.84) were significantly more likely to be hesitant. Other independent predictors of hesitancy were younger age, female sex, higher score on a COVID-19 conspiracy beliefs scale, lower trust in employer, lack of influenza vaccine uptake in the previous season, previous COVID-19, and pregnancy. Qualitative data from 99 participants identified the following contributors to hesitancy: lack of trust in government and employers, safety concerns due to the speed of vaccine development, lack of ethnic diversity in vaccine studies, and confusing and conflicting information. Participants felt uptake in ethnic minority communities might be improved through inclusive communication, involving HCWs in the vaccine rollout, and promoting vaccination through trusted networks. Interpretation Despite increased risk of COVID-19, HCWs from some ethnic minority groups are more likely to be vaccine hesitant than their White British colleagues. Strategies to build trust and dispel myths surrounding the COVID-19 vaccine in these communities are urgently required. Emphasis should be placed on the safety and benefit of SARS-CoV-2 vaccination in pregnancy and in those with previous COVID-19. Public health communications should be inclusive, non-stigmatising and utilise trusted networks. Funding UKRI-MRC and NIHR.

Despite being associated with poor initial graft function, the long-term allograft survival of NHBD kidneys does not differ significantly from the results of HBD and LD transplants.

We and others have previously described signatures of tolerance in kidney transplantation showing the differential expression of B cell–related genes and the relative expansions of B cell subsets. However, in all of these studies, the index group—namely, the tolerant recipients—were not receiving immunosuppression (IS) treatment, unlike the rest of the comparator groups. We aimed to assess the confounding effect of these regimens and develop a novel IS‐independent signature of tolerance. Analyzing gene expression in three independent kidney transplant patient cohorts (232 recipients and 14 tolerant patients), we have established that the expression of the previously reported signature was biased by IS regimens, which also influenced transitional B cells. We have defined and validated a new gene expression signature that is independent of drug effects and also differentiates tolerant patients from healthy controls (cross‐validated area under the receiver operating characteristic curve [AUC] = 0.81). In a prospective cohort, we have demonstrated that the new signature remained stable before and after steroid withdrawal. In addition, we report on a validated and highly accurate gene expression signature that can be reliably used to identify patients suitable for IS reduction (approximately 12% of stable patients), irrespective of the IS drugs they are receiving. Only a similar approach will make the conduct of pilot clinical trials for IS minimization safe and hence allow critical improvements in kidney posttransplant management.

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Cardiovascular morbidity and mortality is common in chronic renal failure patients, and may be explained in part by abnormalities in cardiovascular autonomic regulation. This review discusses the results of cardiovascular autonomic function studies in chronic renal failure patients. While covering most methods of assessing autonomic function, we focus particularly on power spectral analysis methods. These newer techniques are non-invasive, reproducible, and allow the rapid assessment of the integrity of cardiovascular autonomic reflexes at the bedside. The abnormalities of parasympathetic, sympathetic and cardiac baroreceptor function seen in dialysis-dependent patients are highlighted, and their significance in intra-dialytic hypotension and cardiovascular mortality as well as the effects of dialysis and transplantation on these parameters examined. Importantly, studies of cardiovascular autonomic dysfunction in pre-dialysis chronic renal failure patients, when abnormalities may be amenable to intervention to prevent progression and premature cardiovascular morbidity and mortality, are reviewed.

The recent change in working patterns of doctors in training has meant that the traditional systems of education are under increasing pressure and that there is the need to maximise new opportunities for learning. One new opportunity may arise after the introduction of the mandatory assessment systems (Mini-CEX, DOPPS, Multi-source feedback, and Case based discussion) in the Foundation Programmes. In this review the new assessment procedures for the Foundation Programmes are outlined and the potential of these assessments (using Mini-CEX as main example) as an opportunity to give feedback to trainees discussed. The importance of feedback in professional development and some of the techniques available for giving feedback are described. The Foundation Programme assessments will occupy a significant amount of trainees’ and trainers’ time and it is important that opportunity for feedback and learning is maximised.

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