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Nicole trained at Bird College of Performing Arts. Anthony Cragg Male swing. As a child he appeared in musicals that came through his hometown and got the love from an early age. Anthony is excited and looking forward to performing in Frankfurt for the first time. Joe recently graduated from the Guildford School of Acting and is making his professional debut in Spamalot. Soophia Foroughi Lady of the Lake. Soophia trained at London School of Musical Theatre. Jemma trained at Masters Performing Arts College. International tours: Madonna Forever Indian Tour. Matthew trained at Mountview Academy of Theatre Arts. Nic Kyle King Arthur. London Palladium ; Jet Set Go! Jermyn Street Theatre ; H. Jo trained at Guildford School of Acting. Lisa Blair Director. Daniel Smith Musical Director London. Leigh Thompson Musical Director Frankfurt. He has also worked extensively as a music director on cruise ships, travelling to all continents and working with artists such as The Four Aces, The Temptations, Lorna Luft, Claire Sweeney and Iris Williams. Rebecca Howell Choreographer. Rebecca Howell trained at the London Studio Centre. Derek Anderson Lighting Designer. Max Pappenheim Sound Designer London. Regular collaborator with Silent Opera. Stephan Weber Sound Designer Frankfurt. Born in Karlsruhe, Stephan started his theatre career in Ettlingen, where he did the operating and sound design for several musicals at the Schlossfestspiele Ettlingen. He has created sound designs for musicals in other German theatres and has worked with several large productions, including those with live orchestras. Stephan has worked for The English Theatre Frankfurt since Lia Given Assistant choreographer. Press Contact. Stephan Weber Sound Designer Frankfurt Born in Karlsruhe, Stephan started his theatre career in Ettlingen, where he did the operating and sound design for several musicals at the Schlossfestspiele Ettlingen. Kaiserstrasse 34 Frankfurt am Main Germany.

Cast & Creatives – Spamalot

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Official websites use. Share sensitive information only on official, secure websites. Competing Interests: The authors have declared that no competing interests exist. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Transmission clusters were analysed by phylogenetic analyses using approximate maximum-likelihood. Univariate and multivariate logistic regression analyses were performed on epidemiological data collected at NSID and SDCF to determine risk factors associated with cocaine use. The proportion of female cases enrolled between — was higher than the proportion among cases enrolled prior to Latest estimates report around Nevertheless, several large local outbreaks were described in Europe and, more recently, in the United States, which demanded effective scaled-up prevention responses \[ 3 — 8 \]. Combination of harm reduction programs with HIV testing and councelling, antiretroviral therapy and condom distribution are required for effective prevention against HIV in this target population \[ 9 \]. More than users daily attend the national supervised drug consumption facility SDCF \[ 13 \]. Intravenous heroin and cocaine use is the predominant pattern for primary use associated to poly-drug use in combination with crack or free base cocaine, speedball, crystal meth or LSD. Injecting cocaine has becoming increasingly popular in recent years \[ 14 \]. A rapid increase in cocaine supply has indeed been reported in Luxembourg in drug users from the SDCF early in parallell with seizures of cocaine, changing the drug market landscape and restricting access to heroin. The main objective of the present study was to investigate the potential causes of the HIV outbreak observed among PWID between and All participants provided written informed consent. Any adults having injected once any illicit drugs were recruited. HIV-seropositive individuals, whose diagnosis was confirmed, were further referred to NSID, as for other testing centers, and baseline data prior to ART initiation were extracted up to december including routine baseline virological sequences for phylogenetic analyses. Sequences were aligned using mafft. Confidence values of the tree topology were assessed by the Shimodaira-Hasegawa SH test \[ 17 \]. After the initial selection, all sequences were further subjected to quality control analysis using an in house quality control tool and subtype confirmation using COMET v1. Duplicate sequences were identified and only one sequence per patient was used. From these initially collected sequences globally, the phylogenetically closest sequences, reference sequences and specially selected representative sequences from different regions of the world and Europe were selected. RELIS is a nationwide monitoring system collecting harmonized core data on drug users in contact with national drug demand reduction and drug supply reduction services. Comparable data of to drug users are collected routinely and anonymously on a yearly basis to edit the national drug report as well as for strategic planning, policy and research purposes. All participants provided informed consent. RELIS is a monitoring system to estimate trends in the extent prevalence, incidence and pattern of problem drug use. HIV testing should be crossed with drug use behaviors injecting, needle sharing , and the testing history should be verified as far as possible by the treatment centers and the SDCF. The national SDCF is an integrated centre for legal use of intravenous drugs providing multiple services for drug users. These include safer use and risk reduction offers, provision of sterile injection paraphernalia, a clean, quiet and secure environment for supervised licit and illicit drug consumption both injecting and blowing. An average of 1, users were registered annually since to use illicit drugs in a supervised way with clean material, and to be treated in case of overdose. However, SDCF provides multiple services for drug users such as an emergency night shelter located in the same building. Collection of routine programatic data are collected for all clients of the SCDF but were not used in the epidemiological analysis. The number of users per year can not be provided as for various reasons only the cumulative number of user contracts over the years and daily, weekly, monthly and yearly consumption episodes within the SDCF are registered. Continuous variables of the questionnaire were described with median and interquartile intervals IQR whereas categorical variables were described with frequencies and percentages. Differences between the group of cocaine injectors showing concomitant heroin injection use or not and the group of heroin injectors without cocaine injection use were tested with the Chi-square test, except for age and age at first consumption which were tested with the Mann-Whitney test. All statistical analyses were performed using the SAS software version 9. All p-values are two-sided. The phylogenetic analysis revealed two main transmission clusters among PWID. This cluster of 52 sequences from Luxembourg are related to sequences from Luxembourg, Italy and Spain. All other SH values in the cluster were above 0. Diamonds represent the node of a sequence in the tree. This cluster of 10 sequences from Luxembourg are closely related to sequences from Spain and Portugal. The female PWID diagnosed during the outbreak described trading sex for drugs or money. Table 1 depicted the epidemiological and clinical data of these new cases according to clusters. These data suggest that most of the drug users newly infected with HIV were attending frequently the drug treatment facilities, were probably living in Luxembourg for years and counselled on the risks of infectious diseases transmission via not sterile injection paraphernalia by the drug treatment services. Among PWID, 17 reported injecting only cocaine, 90 reported injecting both cocaine and heroin, and 63 reporting injecting only heroin. In addition, they described more often to inject heroin or cocaine regularly at least daily than heroin users Therefore, older individuals were less likely to consume both cocaine and heroin, whereas cocaine users were more likely to be younger, to have piercing, to share drugs, and to consume frequently. The analysis of Maximum Likelihood Estimates failed to link HIV seropositivity to cocaine and heroin users or to heroin users only. The sensitivity analysis included 3 more variables in the full multivariable model Syringe sharing, Condom use, Prostitution. Manual backward variable selection lead to a final model with significant variables being age, piercing and drug sharing S1 Table. Regular consumption was no more significant in this last model which may indicate a lower robust association with cocaine use. Data routinely collected at SDCF showed the higher frequency of injections per day for cocaine users, leading to increased needs of sterile injection paraphernalia. Moreover, it is tempting to speculate that the introduction of cocaine injection contributed to a major change in psychosocial behavior challenging existing prevention measures against HIV infection. Since , introduction of cocaine in Luxembourg had a major impact on the life-style and marginalisation of PWID. Change in psychosocial behavior combined with higher frequency of injections per day, described as well by cocaine addicts from SDCF, might have impacted on HIV transmission among cocaine injectors. We hypothesize that marginalized homeless drug users, having less access to NSP, and injecting often cocaine in combination with heroin \[ 14 \] may have higher risk behaviors. This precarious behavior could have fostered HIV transmission among other drug users. Stimulant use and high-risks behaviours were highly associated in recent outbreaks among PWID \[ 5 , 6 , 9 \]. Cocaine is the predominant illicit stimulant used in Southern and Western European countries; however, injection of cocaine is less common. In Luxembourg, cocaine reached a high level as primary or secondary drug in the last 3 years. Recent market indicators suggest a rise of cocaine availability in certain parts of Europe, and increasing seizures were reported since in France and Belgium \[ 19 \]. No substitution treatement for cocaine misuse currently exists. Cocaine abuse facilitates violence and problems in decision-making \[ 20 \] which may have a negative impact on established prevention and harm reduction measures. More frequent daily injections in cocaine users compared to heroin users and its correlates in terms of risk behaviours might explain to some extend the observed increase in the HIV transmission rate \[ 21 \]. From the multivariable analysis, piercing, regular consumption, drug sharing and age remained independently associated with cocaine use as compared to heroin use only. Interestingly, sharing of drugs was often described by cocaine users to inject more often and to avoid craving but this behaviour was generally not perceived as a risk transmission behaviour by recruited users. Moreover, the number of sterile syringes distributed via the national NSP programme decreased from to \[ 15 \], at the onset of the HIV outbreak, although harm reduction offers have been further developped nationally, and a higher amount of syringes was potentially needed due to higher frequency of cocaine injections. Since , the numbers of clean syringes distributed have been increasing moving Luxembourg towards a high NSP coverage country as compared to previous estimates showing medium coverage \[ 22 \]. Ultimately, efforts should be pursued to further facilitate access to sterile injection paraphernalia and maintain a high national NSP coverage. Sexual transmission might have also contributed largely to the HIV outbreak in cocaine users \[ 21 , 23 \]. Cocaine users have a higher incidence of risky sexual behavior than non-users and cocaine use increases sexual appetence \[ 23 \]. This might be explained by a higher sexual activity in younger cocaine addicts leading them to report more frequently the use of condom as compared to older heroin users. Casualization and homelessness were also counfounding risk factors; both increased in parallell with cocaine injection use at the SDCF. This might have contributed to some extend to the higher number of detected cases in and Outreach offers targeting injectors and marginalised drug users were further developped. Preexposure prophylaxis in active PWID might also be considered as an additional tool in the near future \[ 24 \], especially for women and cocaine injectors for which no substitution therapy exists. Ultimately, the recurring of HIV infection in PWID in the recent years emphasises the added value of continuous drug monitoring systems in the detection of emerging drug use patterns. Epidemiological information of injector drug users interviewed at the SDCF between October and December using a standardized questionnaire including: demographic and social characteristics, drug use patterns, risk and harm reduction behaviours and infectious diseases status. All relevant data are within the paper and in the supporting information file S1 Dataset. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. PLoS One. Find articles by Vic Arendt. Find articles by Laurence Guillorit. Find articles by Alain Origer. Find articles by Nicolas Sauvageot. Find articles by Michel Vaillant. Find articles by Henri Goedertz. Find articles by Ivailo Alexiev. Find articles by Carole Seguin-Devaux. Michel Vaillant : Investigation, Methodology. Henri Goedertz : Data curation, Investigation, Resources. Received Jun 18; Accepted Apr 4; Collection date Open in a new tab. S1 Dataset. HCV-UD dataset. Click here for additional data file. S1 Table. Adjusted odd ratios from the multivariable sensitivity analysis. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Luxembourg : Without evidence of exposure: 5. G1a:

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