The prevailing hypotheses for the persistent symptoms of Long COVID have been narrowed down to immune dysregulation and autoantibodies, widespread organ damage, viral persistence, and fibrinaloid microclots (entrapping numerous inflammatory molecules) together with platelet hyperactivation. Here we demonstrate significantly increased concentrations of Von Willebrand Factor, platelet factor 4, serum amyloid A, alpha-2-antiplasmin E-selectin, and platelet endothelial cell adhesion molecule-1, in the soluble part of the blood. It was noteworthy that the mean level of alpha-2-antiplasmin exceeded the upper limit of the laboratory reference range in Long COVID patients, and the other 5 were significantly elevated in Long COVID patients as compared to the controls. This is alarming if we take into consideration that a significant amount of the total burden of these inflammatory molecules has previously been shown to be entrapped inside fibrinolysis-resistant microclots (thus decreasing the apparent level of the soluble molecules). We also determined that by individually adding E-selectin and PECAM-1 to healthy blood, these molecules may indeed be involved in protein-protein interactions with plasma proteins (contributing to microclot formation) and platelet hyperactivation. This investigation was performed as a laboratory model investigation and the final exposure concentration of these molecules was chosen to mimic concentrations found in Long COVID. We conclude that presence of microclotting, together with relatively high levels of six inflammatory molecules known to be key drivers of endothelial and clotting pathology, points to thrombotic endotheliitis as a key pathological process in Long COVID. This has implications for the choice of appropriate therapeutic options in Long COVID.
1.1 Motivation for the research 1.2 Research objectives 1.3 Three stages of Going into HE research 1.4 How to use this report 2 METHODOLOGY 2.1 Research design considerations 2.2 How the overall design and methods fit together 2.3 Establishing the cohort 3 ANALYSIS AND DISCUSSION OF FINDINGS 3.1 Timing of information, influences and decisions 3.2 Knowledge and understanding of current arrangements 3.3 Financial and non-financial factors in HE choices 4 OBSERVATIONS AND RECOMMENDATIONS 4.1 Timing of information, influences and decisions 4.2 Knowledge and understanding of current arrangements 4.3 Financial and non-financial factors in HE choices 4.4 Summary of recommendations APPENDIX 1: HEI CASE STUDIES APPENDIX 2: BASELINE INTERVIEWS Timelines Repertory grid exercise with university choices Budgeting exercises Multiple-choice questions Scenarios Teachers and advisers Parents and guardians Use of computer aided qualitative data analysis software (Atlas.ti) Case studies of individual applicants This report summarises findings from the Going into HE research project. From the outset, the aim has been to develop a clear understanding of: ■ the role and importance of finance in the decision-making process of English-domiciled people from different groups who are considering entering full-time Higher Education (HE) in the UK; and ■ the impact of the support arrangements on their decisions. When taken alongside quantitative studies on HE participation and student finances, also published by DIUS/BIS, the qualitative research presented here contributes to an overall assessment of current student finance arrangements and should help to inform future developments. Key findings ■ Financial factors tend not to dent HE aspirations among those planning to apply. Indeed, they tend to be outweighed by a range of non-financial factors, especially for younger people. Insofar as finance is important in decision-making, it is in determining where to apply and study rather than what to study or whether to study at all. ■ Applicants tend to underestimate the amount of student financial support for which they will be eligible. Some of them arrive at key HE decisions having accessed very little information and having cursorily discounted certain options. ■ Insofar as fees are seen as an inevitability, there is broad support among students for financing these through loans for tuition. Preferences regarding loans for maintenance, however, are more divided: some students are receptive to bigger loans as a means of financing study while many mature and non-traditional students would be prepared to contemplate a lower total support package within which non-repayable support such as grants and bursaries would make up a higher proportion, leading to lower indebtedness. Methodology The Going into HE study ran from autumn 2007 to winter 2008 and was conducted by the Institute for Employment Studies (IES) on behalf of the Department for Innovation, Universities and Skills (DIUS). This research encompasses the views and experiences of 156 or more...
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