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Hampton T, Allan J, Pearson D, Emerson H, Jones GH, Junaid M, Kanzara T, Lau AS, Siau R, Williams SP, Wilkie MD. A multi-centre analysis of a decade of endoscopic pharyngeal pouch surgery in Cheshire and Merseyside. J Laryngol Otol 2020; 134:1-6. [PMID: 33138870 DOI: 10.1017/s0022215120002224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There are sparse data on the outcomes of endoscopic stapling of pharyngeal pouches. The Mersey ENT Trainee Collaborative compared regional practice against published benchmarks. METHODS A 10-year retrospective analysis of endoscopic pharyngeal pouch surgery was conducted and practice was assessed against eight standards. Comparisons were made between results from the tertiary centre and other sites. RESULTS A total of 225 procedures were performed (range of 1.2-9.2 cases per centre per year). All centres achieved 90 per cent resumption of oral intake within 2 days. All centres achieved less than 2-day hospital stays. Primary success (84 per cent (i.e. abandonment of endoscopic stapling in 16 per cent)), symptom resolution (83 per cent) and recurrence rates (13 per cent) failed to meet the standard across the non-tertiary centres. CONCLUSION Endoscopic pharyngeal pouch stapling is a procedure with a low mortality and brief in-patient stay. There was significant variance in outcomes across the region. This raises the question of whether this service should become centralised and the preserve of either tertiary centres or sub-specialist practitioners.
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Affiliation(s)
- T Hampton
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
| | - J Allan
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - D Pearson
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - H Emerson
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - G H Jones
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
| | - M Junaid
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - T Kanzara
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Mid Cheshire Hospitals NHS Trust, Crewe, UK
| | - A S Lau
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - R Siau
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
| | - S P Williams
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - M D Wilkie
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
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Lau AS, Mamais C, McChesney E, Upile NS, Vaughan C, Veitch J, Abbas JR, Markey A, Brown NG, Evans M, Thomas J, Gaines M, Shehata Z, Wilkie MD, Leong SC. The BeSMART (Best Supportive Management for Adults Referred with Tonsillopharyngitis) multicentre observational study. Ann R Coll Surg Engl 2017; 99:573-578. [PMID: 28853603 DOI: 10.1308/rcsann.2017.0106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Tonsillopharyngitis is the most common ear, nose and throat emergency admission, with 80,000 episodes recorded in England in 2015-2016. Despite this, there is a paucity of evidence addressing the supportive management of tonsillopharyngitis in inpatients. The aim of this retrospective multicentre observational study was to consider the Best Supportive Management for Adults Referred with Tonsillopharyngitis (BeSMART) in the inpatient setting, and to establish any associations between practice and outcomes. Methods Seven hospitals in North West England and North East Scotland participated in the study. Overall, 236 adult patients admitted with tonsillopharyngitis were included. The main outcome measures were interval to return to soft diet, length of stay (LOS), pain scores and readmissions. Results Women were more likely to seek professional help before presenting to secondary care (p=0.04). Patients admitted at the weekend were more likely to have a shorter LOS (p=0.03). There was no relationship between day of admission and seniority or specialty of the doctor initially seen. Prescription of corticosteroid, analgesia and a higher initial intravenous fluid infusion rate were not related to a shorter LOS. Conclusions This study is the first to yield valuable insights into the inpatient management of tonsillopharyngitis. This work represents part of an ongoing project to establish the evidence for common medical interventions for sore throat. Patient and professional surveys as well as a prospective interventional study are planned for the future.
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Affiliation(s)
- A S Lau
- Aintree University Hospital NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - C Mamais
- NHS Grampian , UK.,Mersey ENT Research Collaborative , UK
| | - E McChesney
- Aintree University Hospital NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - N S Upile
- Wirral University Teaching Hospital NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - C Vaughan
- Mid Cheshire Hospitals NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - J Veitch
- Royal Liverpool and Broadgreen University Hospitals NHS Trust , UK.,Mersey ENT Research Collaborative , UK
| | - J R Abbas
- Salford Royal NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - A Markey
- Warrington and Halton Hospitals NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - N G Brown
- NHS Grampian , UK.,Mersey ENT Research Collaborative , UK
| | - M Evans
- Aintree University Hospital NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - J Thomas
- Aintree University Hospital NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - M Gaines
- Aintree University Hospital NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - Z Shehata
- Wirral University Teaching Hospital NHS Foundation Trust , UK
| | | | - S C Leong
- Aintree University Hospital NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
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Leong SC, Tsang HK, Wilkie MD, Banhegyi G. Characterisation of patients with endoscopy-negative, computer tomography-negative midfacial segment pain using the sino-nasal outcome test. Rhinology 2017; 52:78-83. [PMID: 24618633 DOI: 10.4193/rhino13.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to qualitatively characterise patients with midfacial segment pain (MSP) using the Sino-Nasal Outcome Test (SNOT). The data will provide a detailed overview of the physical and psychological impact on patients'well-being, and how it compares with the normal, healthy population. METHODS Suitable patients were prospectively identified from the Multi-disciplinary Facial Pain Clinic at the Royal Liverpool University Hospital, based on the diagnostic criteria for MSP. The pre-treatment SNOT-22 of these patients were also compared to patients with chronic rhinosinusitis and normal healthy volunteers. RESULTS Twenty-nine consecutive patients with a diagnosis of MSP were identified, and compared with 30 CRS patients and 34 healthy volunteers. The average SNOT-22 scores of MSP and CRS patients were higher than normal healthy volunteers. Patients with CRS had the highest rhinological subscale SNOT scores compared to normal healthy volunteers and MSP. Conversely, the reported ear and facial symptoms of MSP patients were most unfavourable. A similar trend was observed in reported sleep function where MSP patients recorded higher subscale scores than the other two cohorts. The subscale mean score for psychological function of MSP patients was not significant when compared to the mean score of patients diagnosed with CRS. CONCLUSION MSP has an adverse impact on both physical and psychological well-being. The subtle differences in the SNOT subscores between MSP and CRS have provided greater insight into the character and disease impact of MSP. We propose that the SNOT may be suitably utilised in MSP to document disease severity and measure response to treatment.
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Haughey BH, Sinha P, Kallogjeri D, Goldberg RL, Lewis JS, Piccirillo JF, Jackson RS, Moore EJ, Brandwein-Gensler M, Magnuson SJ, Carroll WR, Jones TM, Wilkie MD, Lau A, Upile NS, Sheard J, Lancaster J, Tandon S, Robinson M, Husband D, Ganly I, Shah JP, Brizel DM, O'Sullivan B, Ridge JA, Lydiatt WM. Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx. Oral Oncol 2016; 62:11-19. [PMID: 27865363 PMCID: PMC5523818 DOI: 10.1016/j.oraloncology.2016.09.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/06/2016] [Accepted: 09/14/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The rapid worldwide rise in incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has generated studies confirming this disease as an entity distinct from traditional OPSCC. Based on pathology, surgical studies have revealed prognosticators specific to HPV-positive OPSCC. The current AJCC/UICC staging and pathologic nodal (pN)-classification do not differentiate for survival, demonstrating the need for new, HPV-specific OPSCC staging. The objective of this study was to define a pathologic staging system specific to HPV-positive OPSCC. METHODS Data were assembled from a surgically-managed, p16-positive OPSCC cohort (any T, any N, M0) of 704 patients from five cancer centers. Analysis was performed for (a) the AJCC/UICC pathologic staging, (b) newly published clinical staging for non-surgically managed HPV-positive OPSCC, and (c) a novel, pathology-based, "HPVpath" staging system that combines features of the primary tumor and nodal metastases. RESULTS A combination of AJCC/UICC pT-classification and pathology-confirmed metastatic node count (⩽4 versus ⩾5) yielded three groups: stages I (pT1-T2, ⩽4 nodes), II (pT1-T2, ⩾5 nodes; pT3-T4, ⩽4 nodes), and III (pT3-T4, ⩾5 nodes), with incrementally worse prognosis (Kaplan-Meier overall survival of 90%, 84% and 48% respectively). Existing AJCC/UICC pathologic staging lacked prognostic definition. Newly published HPV-specific clinical stagings from non-surgically managed patients, although prognostic, showed lower precision for this surgically managed cohort. CONCLUSIONS Three loco-regional "HPVpath" stages are identifiable for HPV-positive OPSCC, based on a combination of AJCC/UICC primary tumor pT-classification and metastatic node count. A workable, pathologic staging system is feasible to establish prognosis and guide adjuvant therapy decisions in surgically-managed HPV-positive OPSCC.
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Affiliation(s)
- B H Haughey
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA; Department of Surgery, University of Auckland Faculty of Medicine and Health Sciences, Auckland, New Zealand.
| | - P Sinha
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - D Kallogjeri
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R L Goldberg
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - J S Lewis
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J F Piccirillo
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R S Jackson
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - E J Moore
- Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - M Brandwein-Gensler
- Pathology and Anatomical Sciences, SUNY at the University at Buffalo, Buffalo, NY, USA
| | - S J Magnuson
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA
| | - W R Carroll
- Otolaryngology-Head and Neck Surgery, University of Alabama, Birmingham, AL, USA
| | - T M Jones
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M D Wilkie
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - A Lau
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - N S Upile
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jon Sheard
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK; Pathology, University of Liverpool, UK
| | - J Lancaster
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S Tandon
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M Robinson
- Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle-upon-Tyne, UK
| | - D Husband
- Clatterbridge Cancer Centre, Wirral, UK
| | - I Ganly
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J P Shah
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D M Brizel
- Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - B O'Sullivan
- Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J A Ridge
- Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - W M Lydiatt
- Clinical Professor, Creighton Department of Surgery, Omaha, NE, USA
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Wilkie MD, Tahery J. Laser-assisted tympanomastoidectomy for active mucosal chronic otitis media. B-ENT 2016; 12:125-130. [PMID: 29553617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
UNLABELLED Laser-assisted tympanomastoidectomy for active mucosal chronic otitis media. OBJECTIVES Achieving disease control in the context of active granulating mucosal chronic otitis media (COM) is typically challenging. Adjuvant laser use in cholesteatomatous COM surgery enhances disease clearance, yet its role in mucosal COM remains unexplored. The purpose of this study is to present the outcomes and our experience of the latter, and to attempt to define the role of this approach in managing mucosal COM. METHODS Patients that underwent primary laser-assisted tympanomastoidectomy (2007-2012) for active granulating mucosal COM with at least six months follow-up were studied. Disease control was defined by successful tympanic membrane repair and resolution of otorrhoea. Time-to-event analysis using the Kaplan-Meier method was used to gain a temporal estimate of disease control. RESULTS Seventy ears (66 patients) were included with mean follow-up of 22 months (6-50 months). Disease control was achieved in 94.3% of cases at latest follow-up, while one- and two-year temporal estimates of control were 97.1% and 91.8% respectively. A mean post-operative four-frequency air-bone gap of 20 dB was achieved in 52 cases (74.3%). Surgical complications included transient vertigo (n = 2), wound infection (n = 2), and temporary facial nerve palsy (n = 1). CONCLUSIONS We present disease control rates favourable to other published series of active mucosal COM, supporting the use of the laser as an efficacious adjunct to tympanomastoid surgery in this context. This initial report should foster further appraisal of this approach in larger prospective studies.
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Lightbody KA, Wilkie MD, Kinshuck AJ, Gilmartin E, Lewis-Jones H, Jones TM, Lancaster J. Injection of botulinum toxin for the treatment of post-laryngectomy pharyngoesophageal spasm-related disorders. Ann R Coll Surg Engl 2015; 97:508-12. [PMID: 26414361 DOI: 10.1308/rcsann.2015.0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Pharyngoesophageal spasm (PES) can cause dysphagia, central valve leak (CVL), and dypshonia in post-laryngectomy patients. Botulinum toxin has been used effectively for the treatment of PES, but data regarding patient-reported outcomes and efficacy for CVL are limited. We evaluated the results of botox injection for PES spasm using subjective and objective measures. Methods Data were collected prospectively (February 2010 to August 2013) on 13 patients undergoing botox injection for PES as identified by video fluoroscopy. We collected digital voice recordings, air-pressure measurements (APMs) for speech, and quality of life (QoL) data before and after the procedure: University of Washington QoL questionnaire (UW-QoL), MD Anderson Swallowing Inventory (MDADI) and the Voice Handicap Index (VHI-30). Results APMs for a sustained vowel decreased by 18% after botox injection, whereas maximum phonatory times increased by 63% (mean increase, 8 to 13 seconds). Sustained vowel amplitude decreased (mean, 87db to 83db) with an associated reduction in sustained vowel frequency (117Hz to 77Hz). MDADI scores improved by 10.2% overall, and UW-QoL scores showed an improvement in score of 7.6%. Mean scores for VHI-30 deteriorated by 2% overall but, when considering only those patients experiencing dysphonia, an improvement of 9.4% was seen. There was an overall net reduction for the CVL cohort of 12 speech valves in the year after injection. Conclusions Our series confirm the safety and objective efficacy of botox injection for PES. QoL measurements were less convincing, and this disparity between subjective and objective measurements must be considered when treating such patients.
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Affiliation(s)
| | - M D Wilkie
- Aintree University Hospitals NHS Foundation Trust.,Liverpool Cancer Research Centre , UK
| | - A J Kinshuck
- Aintree University Hospitals NHS Foundation Trust
| | - E Gilmartin
- Aintree University Hospitals NHS Foundation Trust
| | | | - T M Jones
- Aintree University Hospitals NHS Foundation Trust.,Liverpool Cancer Research Centre , UK
| | - J Lancaster
- Aintree University Hospitals NHS Foundation Trust
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Williams SP, Wilkie MD, Tahery J. Microscope-assisted thyroidectomy: Our experience in one hundred and twenty-one consecutive cases. Clin Otolaryngol 2015; 39:307-11. [PMID: 25042640 DOI: 10.1111/coa.12284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
- S P Williams
- ENT Department, Countess of Chester Hospital, Chester, UK
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Lau AS, Upile NS, Wilkie MD, Leong SC, Swift AC. The rising rate of admissions for tonsillitis and neck space abscesses in England, 1991-2011. Ann R Coll Surg Engl 2014; 96:307-10. [PMID: 24780025 DOI: 10.1308/003588414x13946184900363] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Sore throats and tonsillitis represent a considerable health burden as well as a significant source of expenditure for the National Health Service (NHS). As part of the recent NHS savings drive, the introduction of 'procedures of low clinical effectiveness' (PoLCE) lists has reinforced a large reduction in the number of tonsillectomies performed. We carried out a cross-sectional study of trends in emergency sore throat admissions in the context of the number of tonsillectomies performed. METHODS Hospital Episode Statistics (HES) data were extracted. Office for National Statistics data were also used. RESULTS Between 1991 and 2011, the overall tonsillectomy rate fell by 44%. In the same time, the admission rate for tonsillitis rose by 310% (Pearson's r=-0.67, p=0.01). The peritonsillar abscess admission rate rose by 31% (r=-0.79, p<0.01). Between 1996 and 2011, the overall tonsillectomy rate fell by 41% and the retro and parapharyngeal abscess admission rate rose by 39% (r=-0.55, p=0.026). There was a 14% overall increase in tonsillectomy and sore throat associated bed days. This was despite the large fall in tonsillectomy numbers and the reduction in length of hospital stay. CONCLUSIONS Efforts to reduce the tonsillectomy rate are correlated with a significant rise in emergency admissions. The rise in the retro and parapharyngeal abscess rate is perhaps most alarming given the very high mortality of these conditions. Bed day data suggest that no net saving has been made despite the new measures.
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Affiliation(s)
- A S Lau
- Aintree University Hospital NHS Foundation Trust, UK
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