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Efficacy of Micromobile Foot Compression Device in Increasing Lower Limb Venous Blood Flow

Identifieur interne : 002362 ( Pmc/Checkpoint ); précédent : 002361; suivant : 002363

Efficacy of Micromobile Foot Compression Device in Increasing Lower Limb Venous Blood Flow

Auteurs : Thomas Charles [Nouvelle-Zélande] ; Stephen Mackintosh [Nouvelle-Zélande] ; James Fingleton [Nouvelle-Zélande] ; Irene Braithwaite [Nouvelle-Zélande] ; Mark Weatherall [Nouvelle-Zélande] ; Richard Beasley [Nouvelle-Zélande]

Source :

RBID : PMC:3844263

Abstract

Background. A novel, micromobile foot compression device (MMC) has been developed to reduce the risk of venous thromboembolism associated with prolonged seated immobility. Objective. To compare the efficacy of the MMC with graduated compression stockings in augmenting lower limb venous blood flow. Patients/Methods. Twenty participants were randomised to wear the MMC or a graduated compression stocking (GCS) on either the left or right leg while seated. Doppler ultrasound measurements of popliteal vein blood flow and leg circumference measurements were made −30 and −10 minutes (baseline) and +30 and +60 minutes following application of the interventions. The primary outcome variable was peak systolic velocity. A mixed linear model was used, with covariates including baseline measurement, randomised side, time, and a time by interaction term. Results. The mean popliteal vein peak systolic velocity at 60 minutes with the MMC was 20.1 cm/s which was significantly higher than with the GCS (difference 14.1 cm/s 95% CI 12.1–16.2), representing a 3.8-fold increase from baseline. Conclusion. The MMC resulted in a marked increase in lower limb venous blood flow which suggests that it may have efficacy in reducing the risk of venous thromboembolism associated with prolonged seated immobility, such as long distance air travel.


Url:
DOI: 10.1155/2013/948769
PubMed: 24319596
PubMed Central: 3844263


Affiliations:


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PMC:3844263

Le document en format XML

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<italic>Background</italic>
. A novel, micromobile foot compression device (MMC) has been developed to reduce the risk of venous thromboembolism associated with prolonged seated immobility.
<italic>Objective</italic>
. To compare the efficacy of the MMC with graduated compression stockings in augmenting lower limb venous blood flow.
<italic>Patients/Methods</italic>
. Twenty participants were randomised to wear the MMC or a graduated compression stocking (GCS) on either the left or right leg while seated. Doppler ultrasound measurements of popliteal vein blood flow and leg circumference measurements were made −30 and −10 minutes (baseline) and +30 and +60 minutes following application of the interventions. The primary outcome variable was peak systolic velocity. A mixed linear model was used, with covariates including baseline measurement, randomised side, time, and a time by interaction term.
<italic>Results</italic>
. The mean popliteal vein peak systolic velocity at 60 minutes with the MMC was 20.1 cm/s which was significantly higher than with the GCS (difference 14.1 cm/s 95% CI 12.1–16.2), representing a 3.8-fold increase from baseline.
<italic>Conclusion</italic>
. The MMC resulted in a marked increase in lower limb venous blood flow which suggests that it may have efficacy in reducing the risk of venous thromboembolism associated with prolonged seated immobility, such as long distance air travel.</p>
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</div1>
</back>
</TEI>
<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Int J Vasc Med</journal-id>
<journal-id journal-id-type="iso-abbrev">Int J Vasc Med</journal-id>
<journal-id journal-id-type="publisher-id">IJVM</journal-id>
<journal-title-group>
<journal-title>International Journal of Vascular Medicine</journal-title>
</journal-title-group>
<issn pub-type="ppub">2090-2824</issn>
<issn pub-type="epub">2090-2832</issn>
<publisher>
<publisher-name>Hindawi Publishing Corporation</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">24319596</article-id>
<article-id pub-id-type="pmc">3844263</article-id>
<article-id pub-id-type="doi">10.1155/2013/948769</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Clinical Study</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Efficacy of Micromobile Foot Compression Device in Increasing Lower Limb Venous Blood Flow</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-0534-0074</contrib-id>
<name>
<surname>Charles</surname>
<given-names>Thomas</given-names>
</name>
<xref ref-type="aff" rid="I1">
<sup>1</sup>
</xref>
<xref ref-type="corresp" rid="cor1">*</xref>
</contrib>
<contrib contrib-type="author">
<contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-7540-3969</contrib-id>
<name>
<surname>Mackintosh</surname>
<given-names>Stephen</given-names>
</name>
<xref ref-type="aff" rid="I2">
<sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-9148-196X</contrib-id>
<name>
<surname>Fingleton</surname>
<given-names>James</given-names>
</name>
<xref ref-type="aff" rid="I1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-5327-3027</contrib-id>
<name>
<surname>Braithwaite</surname>
<given-names>Irene</given-names>
</name>
<xref ref-type="aff" rid="I1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Weatherall</surname>
<given-names>Mark</given-names>
</name>
<xref ref-type="aff" rid="I3">
<sup>3</sup>
</xref>
<xref ref-type="aff" rid="I4">
<sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-0337-406X</contrib-id>
<name>
<surname>Beasley</surname>
<given-names>Richard</given-names>
</name>
<xref ref-type="aff" rid="I1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="I3">
<sup>3</sup>
</xref>
</contrib>
</contrib-group>
<aff id="I1">
<sup>1</sup>
Medical Research Institute of New Zealand, Private Bag Box 7902, Wellington 6242, New Zealand</aff>
<aff id="I2">
<sup>2</sup>
Pacific Radiology Ltd., Wellington 5010, New Zealand</aff>
<aff id="I3">
<sup>3</sup>
Capital & Coast District Health Board, Wellington 6242, New Zealand</aff>
<aff id="I4">
<sup>4</sup>
University of Otago Wellington, Wellington 6242, New Zealand</aff>
<author-notes>
<corresp id="cor1">*Thomas Charles:
<email>thom.charles@mrinz.ac.nz</email>
</corresp>
<fn fn-type="other">
<p>Academic Editor: Robert M. Schainfeld</p>
</fn>
</author-notes>
<pub-date pub-type="ppub">
<year>2013</year>
</pub-date>
<pub-date pub-type="epub">
<day>11</day>
<month>11</month>
<year>2013</year>
</pub-date>
<volume>2013</volume>
<elocation-id>948769</elocation-id>
<history>
<date date-type="received">
<day>30</day>
<month>4</month>
<year>2013</year>
</date>
<date date-type="accepted">
<day>24</day>
<month>9</month>
<year>2013</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright © 2013 Thomas Charles et al.</copyright-statement>
<copyright-year>2013</copyright-year>
<license xlink:href="https://creativecommons.org/licenses/by/3.0/">
<license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract>
<p>
<italic>Background</italic>
. A novel, micromobile foot compression device (MMC) has been developed to reduce the risk of venous thromboembolism associated with prolonged seated immobility.
<italic>Objective</italic>
. To compare the efficacy of the MMC with graduated compression stockings in augmenting lower limb venous blood flow.
<italic>Patients/Methods</italic>
. Twenty participants were randomised to wear the MMC or a graduated compression stocking (GCS) on either the left or right leg while seated. Doppler ultrasound measurements of popliteal vein blood flow and leg circumference measurements were made −30 and −10 minutes (baseline) and +30 and +60 minutes following application of the interventions. The primary outcome variable was peak systolic velocity. A mixed linear model was used, with covariates including baseline measurement, randomised side, time, and a time by interaction term.
<italic>Results</italic>
. The mean popliteal vein peak systolic velocity at 60 minutes with the MMC was 20.1 cm/s which was significantly higher than with the GCS (difference 14.1 cm/s 95% CI 12.1–16.2), representing a 3.8-fold increase from baseline.
<italic>Conclusion</italic>
. The MMC resulted in a marked increase in lower limb venous blood flow which suggests that it may have efficacy in reducing the risk of venous thromboembolism associated with prolonged seated immobility, such as long distance air travel.</p>
</abstract>
</article-meta>
</front>
<floats-group>
<fig id="fig1" orientation="portrait" position="float">
<label>Figure 1</label>
<caption>
<p>The MMC sandal which houses the compression device within the sole.</p>
</caption>
<graphic xlink:href="IJVM2013-948769.001"></graphic>
</fig>
<fig id="fig2" orientation="portrait" position="float">
<label>Figure 2</label>
<caption>
<p>A lateral cross-section of the MMC sandal showing the embedded compression device in the sole. The pressure pad is in the elevated position.</p>
</caption>
<graphic xlink:href="IJVM2013-948769.002"></graphic>
</fig>
<fig id="fig3" orientation="portrait" position="float">
<label>Figure 3</label>
<caption>
<p>A lateral cross-section of the MMC sandal showing the embedded compression device in the sole. The pressure pad is in the retracted position.</p>
</caption>
<graphic xlink:href="IJVM2013-948769.003"></graphic>
</fig>
<fig id="fig4" orientation="portrait" position="float">
<label>Figure 4</label>
<caption>
<p>Peak systolic velocity measured in the popliteal vein at 30 and 10 minutes prior to the application of the GCS and MMC interventions and 30 and 60 minutes following their application.</p>
</caption>
<graphic xlink:href="IJVM2013-948769.004"></graphic>
</fig>
<table-wrap id="tab1" orientation="portrait" position="float">
<label>Table 1</label>
<caption>
<p>Characteristics of participants.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" rowspan="1" colspan="1">Variable</th>
<th align="center" rowspan="1" colspan="1">Mean (SD)</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Age (years)</td>
<td align="center" rowspan="1" colspan="1">35.6 (11.8)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Height (m)</td>
<td align="center" rowspan="1" colspan="1">1.77 (0.08)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Weight (kg)</td>
<td align="center" rowspan="1" colspan="1">68.6 (9.9)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">BMI (kg/m
<sup>2</sup>
)</td>
<td align="center" rowspan="1" colspan="1">21.9 (2.5)</td>
</tr>
<tr>
<td align="left" colspan="2" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1">
<italic>N</italic>
/
<italic>N</italic>
(%)</td>
</tr>
<tr>
<td align="left" colspan="2" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Sex, female</td>
<td align="center" rowspan="1" colspan="1">8/19 (42.10%)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>BMI: body mass index.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tab2" orientation="portrait" position="float">
<label>Table 2</label>
<caption>
<p>Clinical measurements with the MMC and GCS interventions, during seated immobility. Data are presented as mean (SD).</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" rowspan="3" colspan="1">Variable</th>
<th align="center" colspan="4" rowspan="1">Time in minutes</th>
</tr>
<tr>
<th align="center" rowspan="1" colspan="1">−30</th>
<th align="center" rowspan="1" colspan="1">−10</th>
<th align="center" rowspan="1" colspan="1">30</th>
<th align="center" rowspan="1" colspan="1">60</th>
</tr>
<tr>
<th align="center" colspan="4" rowspan="1">Mean (SD)</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Peak systolic velocity (cm/s)</td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> MMC</td>
<td align="center" rowspan="1" colspan="1">5.65 (1.08)</td>
<td align="center" rowspan="1" colspan="1">5.27 (1.01)</td>
<td align="center" rowspan="1" colspan="1">20.1 (6.77)</td>
<td align="center" rowspan="1" colspan="1">20.1 (8.05)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> GCS</td>
<td align="center" rowspan="1" colspan="1">5.61 (1.05)</td>
<td align="center" rowspan="1" colspan="1">4.99 (1.02)</td>
<td align="center" rowspan="1" colspan="1">5.66 (1.17)</td>
<td align="center" rowspan="1" colspan="1">5.63 (1.13)</td>
</tr>
<tr>
<td align="left" colspan="5" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Mean flow velocity (cm/s)</td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> MMC</td>
<td align="center" rowspan="1" colspan="1">2.30 (0.53)</td>
<td align="center" rowspan="1" colspan="1">2.04 (0.47)</td>
<td align="center" rowspan="1" colspan="1">5.78 (1.85)</td>
<td align="center" rowspan="1" colspan="1">5.86 (2.08)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> GCS</td>
<td align="center" rowspan="1" colspan="1">2.38 (0.48)</td>
<td align="center" rowspan="1" colspan="1">2.06 (0.41)</td>
<td align="center" rowspan="1" colspan="1">2.45 (0.48)</td>
<td align="center" rowspan="1" colspan="1">2.38 (0.44)</td>
</tr>
<tr>
<td align="left" colspan="5" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Total volume flow (L/min)</td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> MMC</td>
<td align="center" rowspan="1" colspan="1">0.10 (0.03)</td>
<td align="center" rowspan="1" colspan="1">0.10 (0.04)</td>
<td align="center" rowspan="1" colspan="1">0.29 (0.15)</td>
<td align="center" rowspan="1" colspan="1">0.30 (0.17)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> GCS</td>
<td align="center" rowspan="1" colspan="1">0.12 (0.03)</td>
<td align="center" rowspan="1" colspan="1">0.11 (0.03)</td>
<td align="center" rowspan="1" colspan="1">0.13 (0.04)</td>
<td align="center" rowspan="1" colspan="1">0.12 (0.04)</td>
</tr>
<tr>
<td align="left" colspan="5" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Vein area (cm
<sup>2</sup>
)</td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> MMC</td>
<td align="center" rowspan="1" colspan="1">0.74 (0.20)</td>
<td align="center" rowspan="1" colspan="1">0.80 (0.24)</td>
<td align="center" rowspan="1" colspan="1">0.83 (0.24)</td>
<td align="center" rowspan="1" colspan="1">0.83 (0.27)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> GCS</td>
<td align="center" rowspan="1" colspan="1">0.86 (0.24)</td>
<td align="center" rowspan="1" colspan="1">0.87 (0.26)</td>
<td align="center" rowspan="1" colspan="1">0.89 (0.26)</td>
<td align="center" rowspan="1" colspan="1">0.82 (0.21)</td>
</tr>
<tr>
<td align="left" colspan="5" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Circumference (cm)</td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> MMC </td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">  Ankle</td>
<td align="center" rowspan="1" colspan="1">22.1 (1.6)</td>
<td align="center" rowspan="1" colspan="1">22.2 (1.5)</td>
<td align="center" rowspan="1" colspan="1">22.3 (1.5)</td>
<td align="center" rowspan="1" colspan="1">22.4 (1.6)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">  Calf</td>
<td align="center" rowspan="1" colspan="1">38.0 (2.5)</td>
<td align="center" rowspan="1" colspan="1">38.3 (2.5)</td>
<td align="center" rowspan="1" colspan="1">38.5 (2.5)</td>
<td align="center" rowspan="1" colspan="1">38.7 (2.5)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> GCS </td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
<td align="center" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">  Ankle</td>
<td align="center" rowspan="1" colspan="1">22.1 (1.6)</td>
<td align="center" rowspan="1" colspan="1">22.3 (1.8)</td>
<td align="center" rowspan="1" colspan="1">22.5 (1.5)</td>
<td align="center" rowspan="1" colspan="1">22.6 (1.7)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">  Calf</td>
<td align="center" rowspan="1" colspan="1">38.0 (2.8)</td>
<td align="center" rowspan="1" colspan="1">38.6 (2.5)</td>
<td align="center" rowspan="1" colspan="1">37.6 (2.2)</td>
<td align="center" rowspan="1" colspan="1">37.6 (2.2)</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="tab3" orientation="portrait" position="float">
<label>Table 3</label>
<caption>
<p>Participant subjective feedback responses.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" rowspan="1" colspan="1"></th>
<th align="center" rowspan="1" colspan="1">Mean (SD)</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Please rate your experience of the following aspects of the foot compression device (MMC)
<sup>#</sup>
:</td>
<td align="center" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> Ease of application</td>
<td align="center" rowspan="1" colspan="1">4.42 (0.69)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> Comfort (when not in operation)</td>
<td align="center" rowspan="1" colspan="1">4.00 (0.88)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> Comfort of the rhythmical compression</td>
<td align="center" rowspan="1" colspan="1">4.42 (0.51)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> Overall experience </td>
<td align="center" rowspan="1" colspan="1">4.05 (0.40)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Please rate the likelihood that you would consider wearing this device to help prevent DVT in the following settings*:</td>
<td align="center" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> Hospital</td>
<td align="center" rowspan="1" colspan="1">4.42 (0.69)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> Air travel</td>
<td align="center" rowspan="1" colspan="1">3.37 (1.30)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> Seated at home</td>
<td align="center" rowspan="1" colspan="1">2.79 (1.23)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1"> Seated at work</td>
<td align="center" rowspan="1" colspan="1">2.79 (1.23)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>
<sup>#</sup>
Scoring system 1 = very poor, 2 = poor, 3 = neutral, 4 = good, 5 = very good. </p>
</fn>
<fn>
<p>*Scoring system 1 = very low, 2 = low, 3 = neutral, 4 = high, 5 = very high.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations>
<list>
<country>
<li>Nouvelle-Zélande</li>
</country>
</list>
<tree>
<country name="Nouvelle-Zélande">
<noRegion>
<name sortKey="Charles, Thomas" sort="Charles, Thomas" uniqKey="Charles T" first="Thomas" last="Charles">Thomas Charles</name>
</noRegion>
<name sortKey="Beasley, Richard" sort="Beasley, Richard" uniqKey="Beasley R" first="Richard" last="Beasley">Richard Beasley</name>
<name sortKey="Beasley, Richard" sort="Beasley, Richard" uniqKey="Beasley R" first="Richard" last="Beasley">Richard Beasley</name>
<name sortKey="Braithwaite, Irene" sort="Braithwaite, Irene" uniqKey="Braithwaite I" first="Irene" last="Braithwaite">Irene Braithwaite</name>
<name sortKey="Fingleton, James" sort="Fingleton, James" uniqKey="Fingleton J" first="James" last="Fingleton">James Fingleton</name>
<name sortKey="Mackintosh, Stephen" sort="Mackintosh, Stephen" uniqKey="Mackintosh S" first="Stephen" last="Mackintosh">Stephen Mackintosh</name>
<name sortKey="Weatherall, Mark" sort="Weatherall, Mark" uniqKey="Weatherall M" first="Mark" last="Weatherall">Mark Weatherall</name>
<name sortKey="Weatherall, Mark" sort="Weatherall, Mark" uniqKey="Weatherall M" first="Mark" last="Weatherall">Mark Weatherall</name>
</country>
</tree>
</affiliations>
</record>

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