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Loterio RK, Thomas DR, Andrade W, Lee YW, Santos LL, Mascarenhas DPA, Steiner TM, Chiaratto J, Fielden LF, Lopes L, Bird LE, Goldman GH, Stojanovski D, Scott NE, Zamboni DS, Newton HJ. Coxiella co-opts the Glutathione Peroxidase 4 to protect the host cell from oxidative stress-induced cell death. Proc Natl Acad Sci U S A 2023; 120:e2308752120. [PMID: 37639588 PMCID: PMC10483631 DOI: 10.1073/pnas.2308752120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/02/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
The causative agent of human Q fever, Coxiella burnetii, is highly adapted to infect alveolar macrophages by inhibiting a range of host responses to infection. Despite the clinical and biological importance of this pathogen, the challenges related to genetic manipulation of both C. burnetii and macrophages have limited our knowledge of the mechanisms by which C. burnetii subverts macrophages functions. Here, we used the related bacterium Legionella pneumophila to perform a comprehensive screen of C. burnetii effectors that interfere with innate immune responses and host death using the greater wax moth Galleria mellonella and mouse bone marrow-derived macrophages. We identified MceF (Mitochondrial Coxiella effector protein F), a C. burnetii effector protein that localizes to mitochondria and contributes to host cell survival. MceF was shown to enhance mitochondrial function, delay membrane damage, and decrease mitochondrial ROS production induced by rotenone. Mechanistically, MceF recruits the host antioxidant protein Glutathione Peroxidase 4 (GPX4) to the mitochondria. The protective functions of MceF were absent in primary macrophages lacking GPX4, while overexpression of MceF in human cells protected against oxidative stress-induced cell death. C. burnetii lacking MceF was replication competent in mammalian cells but induced higher mortality in G. mellonella, indicating that MceF modulates the host response to infection. This study reveals an important C. burnetii strategy to subvert macrophage cell death and host immunity and demonstrates that modulation of the host antioxidant system is a viable strategy to promote the success of intracellular bacteria.
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Affiliation(s)
- Robson K. Loterio
- Department of Cellular and Molecular Biology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP14049-900, Brazil
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC3000, Australia
| | - David R. Thomas
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC3000, Australia
- Infection Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, VIC3800, Australia
| | - Warrison Andrade
- Department of Cellular and Molecular Biology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP14049-900, Brazil
| | - Yi Wei Lee
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC3000, Australia
| | - Leonardo L. Santos
- Department of Cellular and Molecular Biology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP14049-900, Brazil
| | - Danielle P. A. Mascarenhas
- Department of Cellular and Molecular Biology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP14049-900, Brazil
| | - Thiago M. Steiner
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC3000, Australia
| | - Jéssica Chiaratto
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP14040-903, Brazil
| | - Laura F. Fielden
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC3000, Australia
- Department of Biochemistry and Pharmacology and the Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC3052, Australia
| | - Leticia Lopes
- Department of Cellular and Molecular Biology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP14049-900, Brazil
| | - Lauren E. Bird
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC3000, Australia
| | - Gustavo H. Goldman
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP14040-903, Brazil
| | - Diana Stojanovski
- Department of Biochemistry and Pharmacology and the Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC3052, Australia
| | - Nichollas E. Scott
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC3000, Australia
| | - Dario S. Zamboni
- Department of Cellular and Molecular Biology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP14049-900, Brazil
| | - Hayley J. Newton
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC3000, Australia
- Infection Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, VIC3800, Australia
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Debowski AW, Bzdyl NM, Thomas DR, Scott NE, Jenkins CH, Iwasaki J, Kibble EA, Khoo CA, Scheuplein NJ, Seibel PM, Lohr T, Metters G, Bond CS, Norville IH, Stubbs KA, Harmer NJ, Holzgrabe U, Newton HJ, Sarkar-Tyson M. Macrophage infectivity potentiator protein, a peptidyl prolyl cis-trans isomerase, essential for Coxiella burnetii growth and pathogenesis. PLoS Pathog 2023; 19:e1011491. [PMID: 37399210 DOI: 10.1371/journal.ppat.1011491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/14/2023] [Indexed: 07/05/2023] Open
Abstract
Coxiella burnetii is a Gram-negative intracellular pathogen that causes the debilitating disease Q fever, which affects both animals and humans. The only available human vaccine, Q-Vax, is effective but has a high risk of severe adverse reactions, limiting its use as a countermeasure to contain outbreaks. Therefore, it is essential to identify new drug targets to treat this infection. Macrophage infectivity potentiator (Mip) proteins catalyse the folding of proline-containing proteins through their peptidyl prolyl cis-trans isomerase (PPIase) activity and have been shown to play an important role in the virulence of several pathogenic bacteria. To date the role of the Mip protein in C. burnetii pathogenesis has not been investigated. This study demonstrates that CbMip is likely to be an essential protein in C. burnetii. The pipecolic acid derived compounds, SF235 and AN296, which have shown utility in targeting other Mip proteins from pathogenic bacteria, demonstrate inhibitory activities against CbMip. These compounds were found to significantly inhibit intracellular replication of C. burnetii in both HeLa and THP-1 cells. Furthermore, SF235 and AN296 were also found to exhibit antibiotic properties against both the virulent (Phase I) and avirulent (Phase II) forms of C. burnetii Nine Mile Strain in axenic culture. Comparative proteomics, in the presence of AN296, revealed alterations in stress responses with H2O2 sensitivity assays validating that Mip inhibition increases the sensitivity of C. burnetii to oxidative stress. In addition, SF235 and AN296 were effective in vivo and significantly improved the survival of Galleria mellonella infected with C. burnetii. These results suggest that unlike in other bacteria, Mip in C. burnetii is required for replication and that the development of more potent inhibitors against CbMip is warranted and offer potential as novel therapeutics against this pathogen.
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Affiliation(s)
- Aleksandra W Debowski
- Marshall Centre for Infectious Disease Research and Training, School of Biomedical Sciences, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Nicole M Bzdyl
- Marshall Centre for Infectious Disease Research and Training, School of Biomedical Sciences, The University of Western Australia, Nedlands, Western Australia, Australia
| | - David R Thomas
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
- Infection and Immunity Program, Department of Microbiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Australia
| | - Nichollas E Scott
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | | | - Jua Iwasaki
- Marshall Centre for Infectious Disease Research and Training, School of Biomedical Sciences, The University of Western Australia, Nedlands, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Emily A Kibble
- Marshall Centre for Infectious Disease Research and Training, School of Biomedical Sciences, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia
- DMTC Limited, Level 1, Kew, Australia
| | - Chen Ai Khoo
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Nicolas J Scheuplein
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, Würzburg, Germany
| | - Pamela M Seibel
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Theresa Lohr
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, Würzburg, Germany
| | - Georgie Metters
- Defence Science and Technology Laboratory, Porton Down, Salisbury, United Kingdom
- Department of Biosciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter, United Kingdom
| | - Charles S Bond
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Isobel H Norville
- Defence Science and Technology Laboratory, Porton Down, Salisbury, United Kingdom
- Department of Biosciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter, United Kingdom
| | - Keith A Stubbs
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Nicholas J Harmer
- Department of Biosciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter, United Kingdom
- Living Systems Institute, Stocker Road Exeter, United Kingdom
| | - Ulrike Holzgrabe
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, Würzburg, Germany
| | - Hayley J Newton
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
- Infection and Immunity Program, Department of Microbiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Australia
| | - Mitali Sarkar-Tyson
- Marshall Centre for Infectious Disease Research and Training, School of Biomedical Sciences, The University of Western Australia, Nedlands, Western Australia, Australia
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Hachani A, Giulieri SG, Guérillot R, Walsh CJ, Herisse M, Soe YM, Baines SL, Thomas DR, Cheung SD, Hayes AS, Cho E, Newton HJ, Pidot S, Massey RC, Howden BP, Stinear TP. A high-throughput cytotoxicity screening platform reveals agr-independent mutations in bacteraemia-associated Staphylococcus aureus that promote intracellular persistence. eLife 2023; 12:84778. [PMID: 37289634 DOI: 10.7554/elife.84778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
Staphylococcus aureus infections are associated with high mortality rates. Often considered an extracellular pathogen, S. aureus can persist and replicate within host cells, evading immune responses, and causing host cell death. Classical methods for assessing S. aureus cytotoxicity are limited by testing culture supernatants and endpoint measurements that do not capture the phenotypic diversity of intracellular bacteria. Using a well-established epithelial cell line model, we have developed a platform called InToxSa (intracellular toxicity of S. aureus) to quantify intracellular cytotoxic S. aureus phenotypes. Studying a panel of 387 S. aureus bacteraemia isolates, and combined with comparative, statistical, and functional genomics, our platform identified mutations in S. aureus clinical isolates that reduced bacterial cytotoxicity and promoted intracellular persistence. In addition to numerous convergent mutations in the Agr quorum sensing system, our approach detected mutations in other loci that also impacted cytotoxicity and intracellular persistence. We discovered that clinical mutations in ausA, encoding the aureusimine non-ribosomal peptide synthetase, reduced S. aureus cytotoxicity, and increased intracellular persistence. InToxSa is a versatile, high-throughput cell-based phenomics platform and we showcase its utility by identifying clinically relevant S. aureus pathoadaptive mutations that promote intracellular residency.
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Affiliation(s)
- Abderrahman Hachani
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Stefano G Giulieri
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Romain Guérillot
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Calum J Walsh
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Marion Herisse
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Ye Mon Soe
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Sarah L Baines
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Australia
| | - David R Thomas
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Australia
- Infection and Immunity Program, Department of Microbiology and Biomedicine Discovery Institute, Monash University, Clayton, Australia
| | - Shane Doris Cheung
- Biological Optical Microscopy Platform, University of Melbourne, Melbourne, Australia
| | - Ashleigh S Hayes
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Ellie Cho
- Biological Optical Microscopy Platform, University of Melbourne, Melbourne, Australia
| | - Hayley J Newton
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Australia
- Infection and Immunity Program, Department of Microbiology and Biomedicine Discovery Institute, Monash University, Clayton, Australia
| | - Sacha Pidot
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Ruth C Massey
- School of Microbiology, University College Cork, Cork, Ireland
- School of Medicine, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Benjamin P Howden
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Timothy P Stinear
- Department of Microbiology and Immunology, Doherty Institute, University of Melbourne, Melbourne, Australia
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Thomas DR, Newton HJ. Complex Signaling Networks Control Coxiella burnetii. J Bacteriol 2023; 205:e0001323. [PMID: 36847508 PMCID: PMC10029709 DOI: 10.1128/jb.00013-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 03/01/2023] Open
Abstract
A recent study by S. Wachter, C. L. Larson, K. Virtaneva, K. Kanakabandi, et al. (J Bacteriol 205:e00416-22, 2023, https://doi.org/10.1128/JB.00416-22) utilizes new technologies to examine the role of two-component systems in Coxiella burnetii. This research demonstrates that the zoonotic pathogen C. burnetii mediates complex transcriptional control, throughout different bacterial phases and environmental conditions, with relatively few regulatory elements.
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Affiliation(s)
- David R. Thomas
- Infection Program, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Hayley J. Newton
- Infection Program, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
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Simm C, Weerasinghe H, Thomas DR, Harrison PF, Newton HJ, Beilharz TH, Traven A. Disruption of Iron Homeostasis and Mitochondrial Metabolism Are Promising Targets to Inhibit Candida auris. Microbiol Spectr 2022; 10:e0010022. [PMID: 35412372 PMCID: PMC9045333 DOI: 10.1128/spectrum.00100-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/21/2022] [Indexed: 11/20/2022] Open
Abstract
Fungal infections are a global threat, but treatments are limited due to a paucity in antifungal drug targets and the emergence of drug-resistant fungi such as Candida auris. Metabolic adaptations enable microbial growth in nutrient-scarce host niches, and they further control immune responses to pathogens, thereby offering opportunities for therapeutic targeting. Because it is a relatively new pathogen, little is known about the metabolic requirements for C. auris growth and its adaptations to counter host defenses. Here, we establish that triggering metabolic dysfunction is a promising strategy against C. auris. Treatment with pyrvinium pamoate (PP) induced metabolic reprogramming and mitochondrial dysfunction evident in disrupted mitochondrial morphology and reduced tricarboxylic acid (TCA) cycle enzyme activity. PP also induced changes consistent with disrupted iron homeostasis. Nutrient supplementation experiments support the proposition that PP-induced metabolic dysfunction is driven by disrupted iron homeostasis, which compromises carbon and lipid metabolism and mitochondria. PP inhibited C. auris replication in macrophages, which is a relevant host niche for this yeast pathogen. We propose that PP causes a multipronged metabolic hit to C. auris: it restricts the micronutrient iron to potentiate nutritional immunity imposed by immune cells, and it further causes metabolic dysfunction that compromises the utilization of macronutrients, thereby curbing the metabolic plasticity needed for growth in host environments. Our study offers a new avenue for therapeutic development against drug-resistant C. auris, shows how complex metabolic dysfunction can be caused by a single compound triggering antifungal inhibition, and provides insights into the metabolic needs of C. auris in immune cell environments. IMPORTANCE Over the last decade, Candida auris has emerged as a human pathogen around the world causing life-threatening infections with wide-spread antifungal drug resistance, including pandrug resistance in some cases. In this study, we addressed the mechanism of action of the antiparasitic drug pyrvinium pamoate against C. auris and show how metabolism could be inhibited to curb C. auris proliferation. We show that pyrvinium pamoate triggers sweeping metabolic and mitochondrial changes and disrupts iron homeostasis. PP-induced metabolic dysfunction compromises the utilization of both micro- and macronutrients by C. auris and reduces its growth in vitro and in immune phagocytes. Our findings provide insights into the metabolic requirements for C. auris growth and define the mechanisms of action of pyrvinium pamoate against C. auris, demonstrating how this compound works by inhibiting the metabolic flexibility of the pathogen. As such, our study characterizes credible avenues for new antifungal approaches against C. auris.
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Affiliation(s)
- Claudia Simm
- Infection Program and the Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Victoria, Australia
- Centre to Impact AMR, Monash University, Victoria, Australia
| | - Harshini Weerasinghe
- Infection Program and the Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Victoria, Australia
- Centre to Impact AMR, Monash University, Victoria, Australia
| | - David R. Thomas
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | | | - Hayley J. Newton
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Traude H. Beilharz
- Development and Stem Cells Program and the Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Victoria, Australia
| | - Ana Traven
- Infection Program and the Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Victoria, Australia
- Centre to Impact AMR, Monash University, Victoria, Australia
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Lau N, Thomas DR, Lee YW, Knodler LA, Newton HJ. Perturbation of ATG16L1 function impairs the biogenesis of Salmonella and Coxiella replication vacuoles. Mol Microbiol 2022; 117:235-251. [PMID: 34874584 PMCID: PMC8844213 DOI: 10.1111/mmi.14858] [Citation(s) in RCA: 1] [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] [Received: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023]
Abstract
Anti-bacterial autophagy, known as xenophagy, is a host innate immune response that targets invading pathogens for degradation. Some intracellular bacteria, such as the enteric pathogen Salmonella enterica serovar Typhimurium (S. Typhimurium), utilize effector proteins to interfere with autophagy. One such S. Typhimurium effector, SopF, inhibits recruitment of ATG16L1 to damaged Salmonella-containing vacuoles (SCVs), thereby inhibiting the host xenophagic response. SopF is also required to maintain the integrity of the SCV during the early stages of infection. Here we show disruption of the SopF-ATG16L1 interaction leads to an increased proportion of cytosolic S. Typhimurium. Furthermore, SopF was utilized as a molecular tool to examine the requirement for ATG16L1 in the intracellular lifestyle of Coxiella burnetii, a bacterium that requires a functional autophagy pathway to replicate efficiently and form a single, spacious vacuole called the Coxiella-containing vacuole (CCV). ATG16L1 is required for CCV expansion and fusion but does not influence C. burnetii replication. In contrast, SopF did not affect CCV formation or replication, demonstrating that the contribution of ATG16L1 to CCV biogenesis is via its role in autophagy, not xenophagy. This study highlights the diverse capabilities of bacterial effector proteins to dissect the molecular details of host-pathogen interactions.
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Affiliation(s)
- Nicole Lau
- The Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - David R Thomas
- The Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Yi Wei Lee
- The Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Leigh A Knodler
- The Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.,Paul G. Allen School for Global Health, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Hayley J Newton
- The Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
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Shechter S, Thomas DR, Jans DA. Application of In Silico and HTS Approaches to Identify Nuclear Import Inhibitors for Venezuelan Equine Encephalitis Virus Capsid Protein: A Case Study. Front Chem 2020; 8:573121. [PMID: 33505952 PMCID: PMC7832173 DOI: 10.3389/fchem.2020.573121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/12/2020] [Indexed: 01/16/2023] Open
Abstract
The development of new drugs is costly and time-consuming, with estimates of over $US1 billion and 15 years for a product to reach the market. As understanding of the molecular basis of disease improves, various approaches have been used to target specific molecular interactions in the search for effective drugs. These include high-throughput screening (HTS) for novel drug identification and computer-aided drug design (CADD) to assess the properties of putative drugs before experimental work begins. We have applied conventional HTS and CADD approaches to the problem of identifying antiviral compounds to limit infection by Venezuelan equine encephalitis virus (VEEV). Nuclear targeting of the VEEV capsid (CP) protein through interaction with the host nuclear import machinery has been shown to be essential for viral pathogenicity, with viruses incapable of this interaction being greatly attenuated. Our previous conventional HTS and in silico structure-based drug design (SBDD) screens were successful in identifying novel inhibitors of CP interaction with the host nuclear import machinery, thus providing a unique opportunity to assess the relative value of the two screening approaches directly. This focused review compares and contrasts the two screening approaches, together with the properties of the inhibitors identified, as a case study for parallel use of the two approaches to identify antivirals. The utility of SBDD screens, especially when used in parallel with traditional HTS, in identifying agents of interest to target the host-pathogen interface is highlighted.
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Affiliation(s)
- Sharon Shechter
- Shechter Computational Solutions, Andover, MA, United States.,Department of Chemistry, College of Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - David R Thomas
- Nuclear Signalling Laboratory, Department of Biochemistry and Molecular Biology, Biomedical Discovery Institute, Monash University, Monash, VIC, Australia
| | - David A Jans
- Nuclear Signalling Laboratory, Department of Biochemistry and Molecular Biology, Biomedical Discovery Institute, Monash University, Monash, VIC, Australia
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Thomas DR, Scott NE. Glycoproteomics: growing up fast. Curr Opin Struct Biol 2020; 68:18-25. [PMID: 33278752 DOI: 10.1016/j.sbi.2020.10.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 02/06/2023]
Abstract
Glycoproteomics is a rapidly growing field which seeks to identify and characterise glycosylation events at a proteome scale. Over the last few years considerable effort has been made in developing new technologies, enrichment systems, and analysis strategies to enhance the quality of glycoproteomic studies. Within this review we discuss the recent developments in glycoproteomics and the current state of the art approaches for analysing glycosylated substrates. We highlight key improvements in mass spectrometry instrumentation coupled with the advancements in enrichment approaches for key classes of glycosylation including mucin-O-glycosylation, O-GlcNAc glycosylation and N-linked glycosylation which now allow the identification/quantification of hundreds to thousands of glycosylation sites within individual experiments. Finally, we summarise the emerging trends within glycoproteomics to illustrate how the field is moving away from studies simply focused on identifying glycosylated substrates to studying specific mechanisms and disease states.
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Affiliation(s)
- David R Thomas
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne 3000, Australia
| | - Nichollas E Scott
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne 3000, Australia.
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Thomas DR, Newton P, Lau N, Newton HJ. Interfering with Autophagy: The Opposing Strategies Deployed by Legionella pneumophila and Coxiella burnetii Effector Proteins. Front Cell Infect Microbiol 2020; 10:599762. [PMID: 33251162 PMCID: PMC7676224 DOI: 10.3389/fcimb.2020.599762] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022] Open
Abstract
Autophagy is a fundamental and highly conserved eukaryotic process, responsible for maintaining cellular homeostasis and releasing nutrients during times of starvation. An increasingly important function of autophagy is its role in the cell autonomous immune response; a process known as xenophagy. Intracellular pathogens are engulfed by autophagosomes and targeted to lysosomes to eliminate the threat to the host cell. To counteract this, many intracellular bacterial pathogens have developed unique approaches to overcome, evade, or co-opt host autophagy to facilitate a successful infection. The intracellular bacteria Legionella pneumophila and Coxiella burnetii are able to avoid destruction by the cell, causing Legionnaires' disease and Q fever, respectively. Despite being related and employing homologous Dot/Icm type 4 secretion systems (T4SS) to translocate effector proteins into the host cell, these pathogens have developed their own unique intracellular niches. L. pneumophila evades the host endocytic pathway and instead forms an ER-derived vacuole, while C. burnetii requires delivery to mature, acidified endosomes which it remodels into a large, replicative vacuole. Throughout infection, L. pneumophila effectors act at multiple points to inhibit recognition by xenophagy receptors and disrupt host autophagy, ensuring it avoids fusion with destructive lysosomes. In contrast, C. burnetii employs its effector cohort to control autophagy, hypothesized to facilitate the delivery of nutrients and membrane to support the growing vacuole and replicating bacteria. In this review we explore the effector proteins that these two organisms utilize to modulate the host autophagy pathway in order to survive and replicate. By better understanding how these pathogens manipulate this highly conserved pathway, we can not only develop better treatments for these important human diseases, but also better understand and control autophagy in the context of human health and disease.
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Affiliation(s)
| | | | | | - Hayley J. Newton
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
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10
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Stanton J, Thomas DR, Jarbin M, MacKay P. Self-determination theory in acute child and adolescent mental health inpatient care. A qualitative exploratory study. PLoS One 2020; 15:e0239815. [PMID: 33064721 PMCID: PMC7567378 DOI: 10.1371/journal.pone.0239815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction There is a dearth of research to guide acute adolescent mental health inpatient care. Self-determination Theory provides evidence that meeting needs for relatedness, autonomy and competence is likely to increase wellbeing and intrinsic motivation. These needs may be able to be met in the inpatient environment. Method This qualitative study aimed to explore young people’s experience of acute mental health inpatient care with particular attention to meeting of these three needs. Fifteen young people were interviewed. The importance of relatedness with staff, other young people and families was identified. Results Relatedness with staff and peers were valued parts of admission. Some young people describe enhanced relatedness with family. They described loss of autonomy as a negative experience but appreciated opportunities to be involved in choices around their care and having more freedom. Coming into hospital was associated with loss of competence but they described building competence during the admission. Engaging in activities was experienced positively and appeared to enhance meeting of all three needs. Meeting of the three needs was associated with an experience of increased safety. Conclusions Engaging young people in activities with a focus on relatedness, autonomy and competence may have specific therapeutic potential. Autonomy, experience of competence and connection with staff may enhance safety more effectively than physical containment. Peer contact may have untapped therapeutic value we understand little of. This study supports the value of Self-determination Theory as a guide day to day inpatient care to meet the needs of adolescents for relatedness, autonomy and competence.
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Affiliation(s)
- Josephine Stanton
- Child and Family Unit, Auckland District Health Board, Auckland, New Zealand
| | - David R Thomas
- Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Maarten Jarbin
- Faculty of Medicine and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Pauline MacKay
- Child and Family Unit, Auckland District Health Board, Auckland, New Zealand
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11
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Thomas DR, Hodges ID. Dietary Research on Coffee: Improving Adjustment for Confounding. Curr Dev Nutr 2020; 4:nzz142. [PMID: 31938763 PMCID: PMC6949275 DOI: 10.1093/cdn/nzz142] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/01/2019] [Accepted: 11/26/2019] [Indexed: 12/17/2022] Open
Abstract
Meta-analyses have reported higher levels of coffee consumption to be associated with lower mortality. In contrast, some systematic reviews have linked coffee consumption to increased risks for lung cancer and hypertension. Given these inconsistencies, this narrative review critically evaluated the methods and analyses of cohort studies investigating coffee and mortality. A specific focus was adjustment for confounding related to smoking, healthy and unhealthy foods, and alcohol. Assessment of 36 cohort samples showed that many did not adequately adjust for smoking. Consuming 1-5 cups of coffee per day was related to lower mortality among never smokers, in studies that adjusted for pack-years of smoking, and in studies adjusting for healthy and unhealthy foods. Possible reduced health benefits for coffee with added sugar have not been adequately investigated. Research on coffee and health should report separate analyses for never smokers, adjust for consumption of healthy and unhealthy foods, and for sugar added to coffee.
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Affiliation(s)
- David R Thomas
- Social and Community Health, University of Auckland, Auckland, New Zealand
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12
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DeBono A, Thomas DR, Lundberg L, Pinkham C, Cao Y, Graham JD, Clarke CL, Wagstaff KM, Shechter S, Kehn-Hall K, Jans DA. Novel RU486 (mifepristone) analogues with increased activity against Venezuelan Equine Encephalitis Virus but reduced progesterone receptor antagonistic activity. Sci Rep 2019; 9:2634. [PMID: 30796232 PMCID: PMC6385310 DOI: 10.1038/s41598-019-38671-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 12/27/2018] [Indexed: 12/21/2022] Open
Abstract
There are currently no therapeutics to treat infection with the alphavirus Venezuelan equine encephalitis virus (VEEV), which causes flu-like symptoms leading to neurological symptoms in up to 14% of cases. Large outbreaks of VEEV can result in 10,000 s of human cases and mass equine death. We previously showed that mifepristone (RU486) has anti-VEEV activity (EC50 = 20 μM) and only limited cytotoxicity (CC50 > 100 μM), but a limitation in its use is its abortifacient activity resulting from its ability to antagonize the progesterone receptor (PR). Here we generate a suite of new mifepristone analogues with enhanced antiviral properties, succeeding in achieving >11-fold improvement in anti-VEEV activity with no detectable increase in toxicity. Importantly, we were able to derive a lead compound with an EC50 of 7.2 µM and no detectable PR antagonism activity. Finally, based on our SAR analysis we propose avenues for the further development of these analogues as safe and effective anti-VEEV agents.
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Affiliation(s)
- Aaron DeBono
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, 3052, Australia
| | - David R Thomas
- Nuclear Signaling Laboratory, Department of Biochemistry and Molecular Biology School of Biomedical Sciences, Monash University, Melbourne, Australia
| | - Lindsay Lundberg
- National Center for Biodefense and Infectious Diseases, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - Chelsea Pinkham
- National Center for Biodefense and Infectious Diseases, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - Ying Cao
- Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - J Dinny Graham
- Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Christine L Clarke
- Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Kylie M Wagstaff
- Nuclear Signaling Laboratory, Department of Biochemistry and Molecular Biology School of Biomedical Sciences, Monash University, Melbourne, Australia
| | | | - Kylene Kehn-Hall
- National Center for Biodefense and Infectious Diseases, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - David A Jans
- Nuclear Signaling Laboratory, Department of Biochemistry and Molecular Biology School of Biomedical Sciences, Monash University, Melbourne, Australia.
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13
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Shechter S, Thomas DR, Lundberg L, Pinkham C, Lin SC, Wagstaff KM, Debono A, Kehn-Hall K, Jans DA. Author Correction: Novel inhibitors targeting Venezuelan equine encephalitis virus capsid protein identified using In Silico Structure-Based-Drug-Design. Sci Rep 2018; 8:13487. [PMID: 30177745 PMCID: PMC6120891 DOI: 10.1038/s41598-018-31644-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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14
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Wagstaff KM, Headey S, Telwatte S, Tyssen D, Hearps AC, Thomas DR, Tachedjian G, Jans DA. Molecular dissection of an inhibitor targeting the HIV integrase dependent preintegration complex nuclear import. Cell Microbiol 2018; 21:e12953. [PMID: 30216959 PMCID: PMC6585680 DOI: 10.1111/cmi.12953] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 08/26/2018] [Accepted: 08/29/2018] [Indexed: 12/14/2022]
Abstract
Human immunodeficiency virus (HIV) continues to be a major contributor to morbidity and mortality worldwide, particularly in developing nations where high cost and logistical issues severely limit the use of current HIV therapeutics. This, combined HIV's high propensity to develop resistance, means that new antiviral agents against novel targets are still urgently required. We previously identified novel anti-HIV agents directed against the nuclear import of the HIV integrase (IN) protein, which plays critical roles in the HIV lifecycle inside the cell nucleus, as well as in transporting the HIV preintegration complex (PIC) into the nucleus. Here we investigate the structure activity relationship of a series of these compounds for the first time, including a newly identified anti-IN compound, budesonide, showing that the extent of binding to the IN core domain correlates directly with the ability of the compound to inhibit IN nuclear transport in a permeabilised cell system. Importantly, compounds that inhibited the nuclear transport of IN were found to significantly decrease HIV viral replication, even in a dividing cell system. Significantly, budesonide or its analogue flunisolide, were able to effect a significant reduction in the presence of specific nuclear forms of the HIV DNA (2-LTR circles), suggesting that the inhibitors work though blocking IN, and potentially PIC, nuclear import. The work presented here represents a platform for further development of these specific inhibitors of HIV replication with therapeutic and prophylactic potential.
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Affiliation(s)
- Kylie M Wagstaff
- Infection and Immunity Program, Monash Biomedicine Discovery Institute, and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Australia
| | - Stephen Headey
- Medicinal Chemistry and Drug Action, Monash Institute of Pharmaceutical Sciences, Parkville, Australia
| | | | - David Tyssen
- Life Science Division, Burnet Institute, Melbourne, Australia
| | - Anna C Hearps
- Life Science Division, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, Melbourne University, Melbourne, Australia
| | - David R Thomas
- Infection and Immunity Program, Monash Biomedicine Discovery Institute, and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Australia
| | | | - David A Jans
- Infection and Immunity Program, Monash Biomedicine Discovery Institute, and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Australia
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15
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Atkinson SC, Audsley MD, Lieu KG, Marsh GA, Thomas DR, Heaton SM, Paxman JJ, Wagstaff KM, Buckle AM, Moseley GW, Jans DA, Borg NA. Recognition by host nuclear transport proteins drives disorder-to-order transition in Hendra virus V. Sci Rep 2018; 8:358. [PMID: 29321677 PMCID: PMC5762688 DOI: 10.1038/s41598-017-18742-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/15/2017] [Indexed: 01/04/2023] Open
Abstract
Hendra virus (HeV) is a paramyxovirus that causes lethal disease in humans, for which no vaccine or antiviral agent is available. HeV V protein is central to pathogenesis through its ability to interact with cytoplasmic host proteins, playing key antiviral roles. Here we use immunoprecipitation, siRNA knockdown and confocal laser scanning microscopy to show that HeV V shuttles to and from the nucleus through specific host nuclear transporters. Spectroscopic and small angle X-ray scattering studies reveal HeV V undergoes a disorder-to-order transition upon binding to either importin α/β1 or exportin-1/Ran-GTP, dependent on the V N-terminus. Importantly, we show that specific inhibitors of nuclear transport prevent interaction with host transporters, and reduce HeV infection. These findings emphasize the critical role of host-virus interactions in HeV infection, and potential use of compounds targeting nuclear transport, such as the FDA-approved agent ivermectin, as anti-HeV agents.
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Affiliation(s)
- Sarah C Atkinson
- Infection & Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Michelle D Audsley
- Infection & Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Kim G Lieu
- Infection & Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Glenn A Marsh
- CSIRO Livestock Industries, Australian Animal Health Laboratory, Victoria, Australia
| | - David R Thomas
- Infection & Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Steven M Heaton
- Infection & Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Jason J Paxman
- La Trobe Institute for Molecular Sciences and Department of Biochemistry and Genetics, La Trobe University, Melbourne, Victoria, Australia
| | - Kylie M Wagstaff
- Infection & Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Ashley M Buckle
- Infection & Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Gregory W Moseley
- Infection & Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - David A Jans
- Infection & Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia.
| | - Natalie A Borg
- Infection & Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia.
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16
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Thomas DR. Dairy fat and cardiovascular disease: adjusting for potential confounders. Am J Clin Nutr 2017; 106:323. [PMID: 28673904 PMCID: PMC5486205 DOI: 10.3945/ajcn.117.155564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- David R Thomas
- From Social and Community Health, University of Auckland, New Zealand (e-mail: )
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17
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Abstract
Undernutrition is defined as a state induced by nutrient deficiency that may be improved solely by administration of nutrients. By this definition, provision of adequate protein and energy sources should reverse the clinical presentation and correct the problem. However, a large number of patients who seem to be undernourished fail to respond to refeeding. A developing understanding of the acute-phase inflammatory response to illness and the role of cytokines in the pathophysiology of chronic illness has challenged the current diagnostic paradigm of undernutrition. In the presence of adequate food, weight loss is most often due to cytokine-associated cachexia and anorexia. Failure of appetite, or anorexia, may play a role in involuntary weight loss. Intervention for involuntary weight loss should aim first at the provision of adequate calories and protein, often in the form of high-density nutrition supplements. However, cytokine-mediated cachexia is remarkably resistant to hypercaloric feeding. With continued weight loss, the use of an orexigenic drug should be considered. Orexigenic drugs have been demonstrated to improve appetite and produce weight gain. The mechanism is unknown but may relate to suppression of proinflammatory cytokines. General guidelines for the use of orexigenic agents are presented. Although much work remains to be done, anticytokine drugs seem to be a promising avenue for the treatment of involuntary weight loss.
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Affiliation(s)
- David R Thomas
- Division of Geriatric Medicine, St Louis Universit Health Sciences Center, St Louis, MO, USA.
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18
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Abstract
Interaction distances of same-sex and mixed-sex groups were studied by photographing groups sitting or lying on a public beach. Male-female distances were significantly smaller than both male-male and female-female distances. Furthermore, clothed individuals were closer together than persons wearing bathing suits. The results are related to the findings of previous studies which have shown that opposite-sex strangers tend to exhibit less intimacy than same-sex strangers, and it is suggested that where “sexual interaction” is regarded as inappropriate, greater distance is shown by mixed-sex groups, but where “sexual interaction” is appropriate less distance is shown, compared to same-sex groups.
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19
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Arnold DL, Fisher E, Brinar VV, Cohen JA, Coles AJ, Giovannoni G, Hartung HP, Havrdova E, Selmaj KW, Stojanovic M, Weiner HL, Lake SL, Margolin DH, Thomas DR, Panzara MA, Compston DAS. Superior MRI outcomes with alemtuzumab compared with subcutaneous interferon β-1a in MS. Neurology 2016; 87:1464-1472. [PMID: 27590291 PMCID: PMC5075976 DOI: 10.1212/wnl.0000000000003169] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 06/16/2016] [Indexed: 12/18/2022] Open
Abstract
Objective: To describe detailed MRI results from 2 head-to-head phase III trials, Comparison of Alemtuzumab and Rebif Efficacy in Multiple Sclerosis Study I (CARE-MS I; NCT00530348) and Study II (CARE-MS II; NCT00548405), of alemtuzumab vs subcutaneous interferon β-1a (SC IFN-β-1a) in patients with active relapsing-remitting multiple sclerosis (RRMS). Methods: The impact of alemtuzumab 12 mg vs SC IFN-β-1a 44 μg on MRI measures was evaluated in patients with RRMS who were treatment-naive (CARE-MS I) or who had an inadequate response, defined as at least one relapse, to prior therapy (CARE-MS II). Results: Both treatments prevented T2-hyperintense lesion volume increases from baseline. Alemtuzumab was more effective than SC IFN-β-1a on most lesion-based endpoints in both studies (p < 0.05), including decreased risk of new/enlarging T2 lesions over 2 years and gadolinium-enhancing lesions at year 2. Reduced risk of new T1 lesions (p < 0.0001) and gadolinium-enhancing lesion conversion to T1-hypointense black holes (p = 0.0078) were observed with alemtuzumab vs SC IFN-β-1a in CARE-MS II. Alemtuzumab slowed brain volume loss over 2 years in CARE-MS I (p < 0.0001) and II (p = 0.012) vs SC IFN-β-1a. Conclusions: Alemtuzumab demonstrated greater efficacy than SC IFN-β-1a on MRI endpoints in active RRMS. The superiority of alemtuzumab was more prominent during the second year of both studies. These findings complement the superior clinical efficacy of alemtuzumab over SC IFN-β-1a in RRMS. ClinicalTrials.gov identifier: NCT00530348 and NCT00548405. Classification of evidence: The results reported here provide Class I evidence that, for patients with active RRMS, alemtuzumab is superior to SC IFN-β-1a on multiple MRI endpoints.
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Affiliation(s)
- Douglas L Arnold
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA.
| | - Elizabeth Fisher
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
| | - Vesna V Brinar
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
| | - Jeffrey A Cohen
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
| | - Alasdair J Coles
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
| | - Gavin Giovannoni
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
| | - Hans-Peter Hartung
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
| | - Eva Havrdova
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
| | - Krzysztof W Selmaj
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
| | - Miroslav Stojanovic
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
| | - Howard L Weiner
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
| | - Stephen L Lake
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
| | - David H Margolin
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
| | - David R Thomas
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
| | - Michael A Panzara
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
| | - D Alastair S Compston
- From NeuroRx Research (D.L.A.) and Department of Neurology and Neurosurgery (D.L.A.), Montréal Neurological Institute, McGill University, Québec, Canada; Department of Biomedical Engineering (E.F.) and Mellen Center (J.A.C.), Cleveland Clinic, OH; Zagreb Medical School and University Hospital Center (V.V.B.), Croatia; Department of Clinical Neurosciences (A.J.C., D.A.S.C.), University of Cambridge, UK; Queen Mary University of London (G.G.), Barts and the London School of Medicine, UK; Department of Neurology and Center for Neuropsychiatry (H.-P.H.), Heinrich-Heine University, Düsseldorf, Germany; Department of Neurology (E.H.), First Medical Faculty, Charles University in Prague, Czech Republic; Department of Neurology (K.W.S.), Medical University of Łódź, Poland; Clinical Centre Kragujevac (M.S.), Clinic of Neurology, Serbia; Brigham and Women's Hospital Center for Neurologic Diseases (H.L.W.), Boston, MA; Sanofi Genzyme (S.L.L., D.H.M., M.A.P.), Cambridge, MA; and Evidence Scientific Solutions (D.R.T.), Horsham, West Sussex, UK. Dr. Panzara is currently with Wave Life Sciences, Cambridge, MA
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Hooper L, Abdelhamid A, Attreed NJ, Campbell WW, Channell AM, Chassagne P, Culp KR, Fletcher SJ, Fortes MB, Fuller N, Gaspar PM, Gilbert DJ, Heathcote AC, Kafri MW, Kajii F, Lindner G, Mack GW, Mentes JC, Merlani P, Needham RA, Olde Rikkert MGM, Perren A, Powers J, Ranson SC, Ritz P, Rowat AM, Sjöstrand F, Smith AC, Stookey JJD, Stotts NA, Thomas DR, Vivanti A, Wakefield BJ, Waldréus N, Walsh NP, Ward S, Potter JF, Hunter P. Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people. Cochrane Database Syst Rev 2015; 2015:CD009647. [PMID: 25924806 PMCID: PMC7097739 DOI: 10.1002/14651858.cd009647.pub2] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is evidence that water-loss dehydration is common in older people and associated with many causes of morbidity and mortality. However, it is unclear what clinical symptoms, signs and tests may be used to identify early dehydration in older people, so that support can be mobilised to improve hydration before health and well-being are compromised. OBJECTIVES To determine the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs and tests to be used as screening tests for detecting water-loss dehydration in older people by systematically reviewing studies that have measured a reference standard and at least one index test in people aged 65 years and over. Water-loss dehydration was defined primarily as including everyone with either impending or current water-loss dehydration (including all those with serum osmolality ≥ 295 mOsm/kg as being dehydrated). SEARCH METHODS Structured search strategies were developed for MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL, LILACS, DARE and HTA databases (The Cochrane Library), and the International Clinical Trials Registry Platform (ICTRP). Reference lists of included studies and identified relevant reviews were checked. Authors of included studies were contacted for details of further studies. SELECTION CRITERIA Titles and abstracts were scanned and all potentially relevant studies obtained in full text. Inclusion of full text studies was assessed independently in duplicate, and disagreements resolved by a third author. We wrote to authors of all studies that appeared to have collected data on at least one reference standard and at least one index test, and in at least 10 people aged ≥ 65 years, even where no comparative analysis has been published, requesting original dataset so we could create 2 x 2 tables. DATA COLLECTION AND ANALYSIS Diagnostic accuracy of each test was assessed against the best available reference standard for water-loss dehydration (serum or plasma osmolality cut-off ≥ 295 mOsm/kg, serum osmolarity or weight change) within each study. For each index test study data were presented in forest plots of sensitivity and specificity. The primary target condition was water-loss dehydration (including either impending or current water-loss dehydration). Secondary target conditions were intended as current (> 300 mOsm/kg) and impending (295 to 300 mOsm/kg) water-loss dehydration, but restricted to current dehydration in the final review.We conducted bivariate random-effects meta-analyses (Stata/IC, StataCorp) for index tests where there were at least four studies and study datasets could be pooled to construct sensitivity and specificity summary estimates. We assigned the same approach for index tests with continuous outcome data for each of three pre-specified cut-off points investigated.Pre-set minimum sensitivity of a useful test was 60%, minimum specificity 75%. As pre-specifying three cut-offs for each continuous test may have led to missing a cut-off with useful sensitivity and specificity, we conducted post-hoc exploratory analyses to create receiver operating characteristic (ROC) curves where there appeared some possibility of a useful cut-off missed by the original three. These analyses enabled assessment of which tests may be worth assessing in further research. A further exploratory analysis assessed the value of combining the best two index tests where each had some individual predictive ability. MAIN RESULTS There were few published studies of the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs or tests to be used as screening tests for detecting water-loss dehydration in older people. Therefore, to complete this review we sought, analysed and included raw datasets that included a reference standard and an index test in people aged ≥ 65 years.We included three studies with published diagnostic accuracy data and a further 21 studies provided datasets that we analysed. We assessed 67 tests (at three cut-offs for each continuous outcome) for diagnostic accuracy of water-loss dehydration (primary target condition) and of current dehydration (secondary target condition).Only three tests showed any ability to diagnose water-loss dehydration (including both impending and current water-loss dehydration) as stand-alone tests: expressing fatigue (sensitivity 0.71 (95% CI 0.29 to 0.96), specificity 0.75 (95% CI 0.63 to 0.85), in one study with 71 participants, but two additional studies had lower sensitivity); missing drinks between meals (sensitivity 1.00 (95% CI 0.59 to 1.00), specificity 0.77 (95% CI 0.64 to 0.86), in one study with 71 participants) and BIA resistance at 50 kHz (sensitivities 1.00 (95% CI 0.48 to 1.00) and 0.71 (95% CI 0.44 to 0.90) and specificities of 1.00 (95% CI 0.69 to 1.00) and 0.80 (95% CI 0.28 to 0.99) in 15 and 22 people respectively for two studies, but with sensitivities of 0.54 (95% CI 0.25 to 0.81) and 0.69 (95% CI 0.56 to 0.79) and specificities of 0.50 (95% CI 0.16 to 0.84) and 0.19 (95% CI 0.17 to 0.21) in 21 and 1947 people respectively in two other studies). In post-hoc ROC plots drinks intake, urine osmolality and axillial moisture also showed limited diagnostic accuracy. No test was consistently useful in more than one study.Combining two tests so that an individual both missed some drinks between meals and expressed fatigue was sensitive at 0.71 (95% CI 0.29 to 0.96) and specific at 0.92 (95% CI 0.83 to 0.97).There was sufficient evidence to suggest that several stand-alone tests often used to assess dehydration in older people (including fluid intake, urine specific gravity, urine colour, urine volume, heart rate, dry mouth, feeling thirsty and BIA assessment of intracellular water or extracellular water) are not useful, and should not be relied on individually as ways of assessing presence or absence of dehydration in older people.No tests were found consistently useful in diagnosing current water-loss dehydration. AUTHORS' CONCLUSIONS There is limited evidence of the diagnostic utility of any individual clinical symptom, sign or test or combination of tests to indicate water-loss dehydration in older people. Individual tests should not be used in this population to indicate dehydration; they miss a high proportion of people with dehydration, and wrongly label those who are adequately hydrated.Promising tests identified by this review need to be further assessed, as do new methods in development. Combining several tests may improve diagnostic accuracy.
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Tan J, Frey MP, Knezevic S, Poulin Y, Lynde CW, Gulliver WP, Gupta AK, Sebaldt RJ, Thomas DR, Sapra S. The Relationship Between Dermatologist- and Patient-Reported Acne Severity Measures and Treatment Recommendations. J Cutan Med Surg 2015; 19:464-9. [DOI: 10.1177/1203475415576464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Acne treatment recommendations for individual patients may be derived from multiple factors including dermatologist- and patient-reported constructs. Objectives: To evaluate the effects of dermatologist- and patient-reported measures on acne treatment recommendations by dermatologists. Methods: An observational cross-sectional survey of acne patients was conducted with patient-reported quality of life and dermatologist-reported measures of primary and secondary (scar) acne severity using 3 assessment approaches: maximal regional grade, total grade, and facial grade. Results: The most highly associated factors with acne treatment recommendations were patient emotions, maximal regional acne severity, and total acne scar grade. Better acne-specific quality of life was negatively related to acne treatment recommendation intensity, while all 3 grading approaches were positively related to acne treatment recommendations. Conclusions: For dermatologists, overall acne severity is most highly associated with maximal regional acne grade, total scar grade, and patient’s emotional response to acne.
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Affiliation(s)
- Jerry Tan
- Department of Medicine, University of Western Ontario, London, ON, Canada
| | - Marc P. Frey
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Sanja Knezevic
- Department of Medicine, University of Western Ontario, London, ON, Canada
| | - Yves Poulin
- Hôpital Hôtel-Dieu de Québec and Centre de Recherche Dermatologique du Québec métropolitain, Quebec City, QC, Canada
| | | | - Wayne P. Gulliver
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NF, Canada
| | - Aditya K. Gupta
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rolf J. Sebaldt
- Department of Medicine and Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - David R. Thomas
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Sheetal Sapra
- Institute of Cosmetic and Laser Surgery, Oakville, ON, Canada
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Abstract
This is the seventh article in the series of Clinical Updates on Nursing Home Care. The topics covered are antiresorptive drugs, hip fracture, hypertension, orthostatic hypotension, depression, undernutrition, anorexia, cachexia, sarcopenia, exercise, pain, and behavioral and psychological symptoms of dementia.
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Simms I, Wallace L, Thomas DR, Emmett L, Shankar AG, Vinson M, Padfield S, Andrady U, Whiteside C, Williams CJ, Midgley C, Johnman C, McLellan A, Currie A, Logan J, Leslie G, Licence K, Hughes G. Recent outbreaks of infectious syphilis, United Kingdom, January 2012 to April 2014. ACTA ACUST UNITED AC 2014; 19. [PMID: 24970371 DOI: 10.2807/1560-7917.es2014.19.24.20833] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Six outbreaks of infectious syphilis in the United Kingdom, ongoing since 2012, have been investigated among men who have sex with men (MSM) and heterosexual men and women aged under 25 years. Interventions included case finding and raising awareness among healthcare professionals and the public. Targeting at-risk populations was complicated as many sexual encounters involved anonymous partners. Outbreaks among MSM were influenced by the use of geospatial real-time networking applications that allow users to locate other MSM within close proximity.
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Affiliation(s)
- I Simms
- HIV&STI Department, Health Protection Services, Public Health England, London, United Kingdom
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Rolland Y, Resnick B, Katz PR, Little MO, Ouslander JG, Bonner A, Geary CR, Schumacher KL, Thompson S, Martin FC, Wilbers J, Zúñiga F, Ausserhofer D, Schwendimann R, Schüssler S, Dassen T, Lohrmann C, Levy C, Whitfield E, de Souto Barreto P, Etherton-Beer C, Dilles T, Azermai M, Bourgeois J, Orrell M, Grossberg GT, Kergoat H, Thomas DR, Visschedijk J, Taylor SJ, Handajani YS, Widjaja NT, Turana Y, Rantz MJ, Skubic M, Morley JE. Nursing Home Research: The First International Association of Gerontology and Geriatrics (IAGG) Research Conference. J Am Med Dir Assoc 2014; 15:313-25. [DOI: 10.1016/j.jamda.2014.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 03/07/2014] [Indexed: 11/25/2022]
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Thomas DR, Thomas YLN. Interventions to reduce injuries when transferring patients: a critical appraisal of reviews and a realist synthesis. Int J Nurs Stud 2014; 51:1381-94. [PMID: 24767612 DOI: 10.1016/j.ijnurstu.2014.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/05/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES There has been extensive investment in programmes to reduce injuries among health care staff caused by moving and handling patients or residents. Given conflicting evidence regarding the effectiveness of such programmes, the present paper conducted a critical appraisal of systematic reviews assessing the effectiveness of interventions in reducing back pain and injuries among healthcare staff. A realist synthesis was conducted on a second set of reports to identify best practices for moving and handling programmes. DESIGN A critical appraisal of systematic reviews and a realist synthesis to identify best practices for moving and handling programmes. DATA SOURCES A literature search of five databases (Medline, EMBASE, CINAHL, PsycINFO and ScienceDirect) located 150 reports assessing programme outcomes published in refereed journals between 2000 and 2013. REVIEW METHODS The critical appraisal included six systematic reviews. The realist synthesis included 47 studies that provided descriptive information about programme mechanisms. RESULTS Five of the six systematic reviews covered interventions involving either staff training or training and equipment supply. One review covered multi-component interventions. All concluded that training staff by itself was ineffective. There were differing conclusions regarding the effectiveness of training and equipment interventions and multi-component programmes. The reviews provided little information about the content of programme components. The realist synthesis noted the need for management commitment and support, and six core programme components; a policy requiring safe transfer practices, ergonomic assessment of spaces where people are transferred, transfer equipment including lifts, specific risk assessment protocols, adequate training of all care staff, and coordinators coaches or resource staff. These programme components are likely to be synergistic; omitting one component weakens the impact of the other components. CONCLUSIONS Five systematic reviews provided little information regarding the core components of effective programmes. Given the absence of experimental trials for multi-component programmes, the best available evidence for the effectiveness of multi-component programmes is from pre-post studies and large-scale surveys. The realist synthesis provided detailed information about the core components for effective programmes. Further studies, which include qualitative data, are needed to provide evidence about the specific mechanisms through which components contribute to effective patient handling programmes.
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Affiliation(s)
- David R Thomas
- Social and Community Health, School of Population Health, University of Auckland, New Zealand.
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Huhmann MB, Perez V, Alexander DD, Thomas DR. A self-completed nutrition screening tool for community-dwelling older adults with high reliability: a comparison study. J Nutr Health Aging 2013; 17:339-44. [PMID: 23538656 DOI: 10.1007/s12603-013-0015-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Malnutrition is common in community-dwelling older adults and is associated with poor outcomes including hospitalization and mortality. Recently, a 6-question short form mini nutritional assessment (SF-MNA) was validated for rapid nutrition screening. Ideally, nutrition screening could be performed by individuals or their caregivers prior to or during an outpatient clinical visit, thus allowing for the ongoing monitoring of nutritional status among older adults. DESIGN We compared the SF-MNA administered by a healthcare professional (HCP) to a 6-item self-administered screening tool (Self-MNA) in 463 community dwelling older adults who gave informed consent. The population was 60% women with a mean age of 76.8±6.8 years. The HCP was blinded to the results of the Self-MNA questionnaire. RESULTS Using the SF-MNA, 27% of subjects were malnourished, 38% were at risk, and 35% had normal nutrition status. The agreement between the Self-MNA and the SF-MNA was 99% (Self-MNA sensitivity 99%, specificity 98%, false negative rate 1%, false positive rate 2%) for identifying Malnourished subjects and 83% (sensitivity 89%, specificity 77%, false negative rate 11%, false positive rate 23%) for identifying At Risk of Malnutrition compared to the MNA-SF administered by a HCP. CONCLUSION We found that the Self-MNA demonstrates sufficient inter-rater reliability for use in nutrition screening among community-dwelling older adults. Further validation studies and the possible impact of language translation should be pursued.
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Stolley RM, Duong HA, Thomas DR, Louie J. The discovery of [Ni(NHC)RCN]2 species and their role as cycloaddition catalysts for the formation of pyridines. J Am Chem Soc 2012; 134:15154-62. [PMID: 22917161 PMCID: PMC3480329 DOI: 10.1021/ja3075924] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [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] [Indexed: 11/29/2022]
Abstract
The reaction of Ni(COD)(2), IPr, and nitrile affords dimeric [Ni(IPr)RCN](2) in high yields. X-ray analysis revealed these species display simultaneous η(1)- and η(2)-nitrile binding modes. These dimers are catalytically competent in the formation of pyridines from the cycloaddition of diynes and nitriles. Kinetic analysis showed the reaction to be first order in [Ni(IPr)RCN](2), zeroth order in added IPr, zeroth order in nitrile, and zeroth order in diyne. Extensive stoichiometric competition studies were performed, and selective incorporation of the exogenous, not dimer bound, nitrile was observed. Post cycloaddition, the dimeric state was found to be largely preserved. Nitrile and ligand exchange experiments were performed and found to be inoperative in the catalytic cycle. These observations suggest a mechanism whereby the catalyst is activated by partial dimer-opening followed by binding of exogenous nitrile and subsequent oxidative heterocoupling.
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Affiliation(s)
- Ryan M. Stolley
- Department of Chemistry, University of Utah, 315 South 1400 East, Salt Lake City, Utah 84112-0850
| | - Hung A. Duong
- Department of Chemistry, University of Utah, 315 South 1400 East, Salt Lake City, Utah 84112-0850
| | - David R. Thomas
- Department of Chemistry, University of Utah, 315 South 1400 East, Salt Lake City, Utah 84112-0850
| | - Janis Louie
- Department of Chemistry, University of Utah, 315 South 1400 East, Salt Lake City, Utah 84112-0850
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Messinger-Rapport BJ, Cruz-Oliver DM, Thomas DR, Morley JE. Clinical Update on Nursing Home Medicine: 2012. J Am Med Dir Assoc 2012; 13:581-94. [DOI: 10.1016/j.jamda.2012.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 01/24/2023]
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Hooper L, Attreed NJ, Campbell WW, Channell AM, Chassagne P, Culp KR, Fletcher SJ, Fuller N, Gaspar PM, Gilbert DJ, Heathcote AC, Lindner G, Mack GW, Mentes JC, Needham RA, Olde Rikkert MGM, Ranson SC, Ritz P, Rowat AM, Smith AC, Stookey JJD, Thomas DR, Wakefield BJ, Ward S, Potter JF, Hunter PR. Clinical and physical signs for identification of impending and current water-loss dehydration in older people. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Karki AJ, Thomas DR, Chestnutt IG. Why has oral health promotion and prevention failed children requiring general anaesthesia for dental extractions? Community Dent Health 2011; 28:255-258. [PMID: 22320061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Many children in the UK still require dental treatment under general anaesthesia (DGA). Why oral health promotion and prevention, in this cohort of children, has failed is poorly understood. By questioning the parents/carers of children undergoing DGA this study aimed to establish: 1 previous exposure to oral health education and promotion activities; 2 beliefs and behaviours about dental caries and prevention; and 3 what parents perceive useful in preventing dental caries. BASIC RESEARCH DESIGN A cross-sectional questionnaire based study. CLINICAL SETTING Dental general anaesthetic centres in Wales, UK. PARTICIPANTS 207 consecutively attending parents of children aged < 10 years requiring a DGA. RESULTS In total, 150 (76%) parents/carers claimed to have received previous oral health advice and 103 (52%) had received toothbrushing instruction from a dentist. Only 18 (9%) reported the application of topical fluoride. Sixty seven (34%) believed "tooth decay runs in families" and 53 (27%) it was simply bad luck that their child had dental decay. The majority (89%) believed that information leaflets on oral health would be useful and 133 (67%) would find information on a website helpful. CONCLUSIONS This study suggests that there is a significant scope for increasing the exposure of high risk children to fluoride. A sense of fatalism and erroneous beliefs were evident amongst some parents/carers of children needing DGA. These issues need to be addressed in the future design of oral health promotion/prevention activities.
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Affiliation(s)
- A J Karki
- Dental Public Health, Public Health Wales, Mamhilad House, Mamhilad Park Estate, Pontypool, NP4 0YP.
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Messinger-Rapport BJ, Morley JE, Thomas DR, Gammack JK. Clinical Update on Nursing Home Medicine: 2011. J Am Med Dir Assoc 2011; 12:615-626.e6. [DOI: 10.1016/j.jamda.2011.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 08/17/2011] [Indexed: 12/30/2022]
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Abstract
The science and policy of pharmaceuticals produced and/or delivered by plants has evolved over the past twenty-one years from a backyard remedy to regulated, purified products. After seemingly frozen at Phase I human clinical trials with six orally delivered plant-made vaccines not progressing past this stage over seven years, plant-made pharmaceuticals have made a breakthrough with several purified plant-based products advancing to Phase II trials and beyond. Though fraught with the usual difficulties of pharmaceutical development, pharmaceuticals made by plants have achieved pertinent milestones albeit slowly compared to other pharmaceutical production systems and are now at the cusp of reaching the consumer. Though the current economic climate begs for cautious investment as opposed to trail blazing, it is perhaps a good time to look to the future of plant-made pharmaceutical technology to assist in planning for future developments in order not to slow this technology's momentum. To encourage continued progress, we highlight the advances made so far by this technology, particularly the change in paradigms, comparing developmental timelines, and summarizing the current status and future possibilities of plant-made pharmaceuticals.
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Affiliation(s)
- David R. Thomas
- School of Biological Sciences, Monash University, Clayton, Victoria 3800, Australia; E-Mails: (D.R.T.); (C.A.P.); (A.M.)
| | - Claire A. Penney
- School of Biological Sciences, Monash University, Clayton, Victoria 3800, Australia; E-Mails: (D.R.T.); (C.A.P.); (A.M.)
| | - Amrita Majumder
- School of Biological Sciences, Monash University, Clayton, Victoria 3800, Australia; E-Mails: (D.R.T.); (C.A.P.); (A.M.)
| | - Amanda M. Walmsley
- School of Biological Sciences, Monash University, Clayton, Victoria 3800, Australia; E-Mails: (D.R.T.); (C.A.P.); (A.M.)
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Penney CA, Thomas DR, Deen SS, Walmsley AM. Plant-made vaccines in support of the Millennium Development Goals. Plant Cell Rep 2011; 30:789-98. [PMID: 21243362 PMCID: PMC3075396 DOI: 10.1007/s00299-010-0995-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 12/23/2010] [Accepted: 12/24/2010] [Indexed: 05/02/2023]
Abstract
Vaccines are one of the most successful public health achievements of the last century. Systematic immunisation programs have reduced the burden of infectious diseases on a global scale. However, there are limitations to the current technology, which often requires costly infrastructure and long lead times for production. Furthermore, the requirement to keep vaccines within the cold-chain throughout manufacture, transport and storage is often impractical and prohibitively expensive in developing countries-the very regions where vaccines are most needed. In contrast, plant-made vaccines (PMVs) can be produced at a lower cost using basic greenhouse agricultural methods, and do not need to be kept within such narrow temperature ranges. This increases the feasibility of developing countries producing vaccines locally at a small-scale to target the specific needs of the region. Additionally, the ability of plant-production technologies to rapidly produce large quantities of strain-specific vaccine demonstrates their potential use in combating pandemics. PMVs are a proven technology that has the potential to play an important role in increasing global health, both in the context of the 2015 Millennium Development Goals and beyond.
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Affiliation(s)
- Claire A. Penney
- Department of Biological Sciences, Monash University, Clayton, VIC Australia
| | - David R. Thomas
- Department of Biological Sciences, Monash University, Clayton, VIC Australia
| | - Sadia S. Deen
- Department of Biological Sciences, Monash University, Clayton, VIC Australia
| | - Amanda M. Walmsley
- Department of Biological Sciences, Monash University, Clayton, VIC Australia
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Pebody R, Hardelid P, Fleming DM, McMenamin J, Andrews N, Robertson C, Thomas DR, Sebastianpillai P, Ellis J, Carman W, Wreghitt T, Zambon M, Watson JM. Effectiveness of seasonal 2010/11 and pandemic influenza A(H1N1)2009 vaccines in preventing influenza infection in the United Kingdom: mid-season analysis 2010/11. Euro Surveill 2011. [DOI: 10.2807/ese.16.06.19791-en] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study provides mid-season estimates of the effectiveness of 2010/11 trivalent influenza vaccine and previous vaccination with monovalent influenza A(H1N1)2009 vaccine in preventing confirmed influenza A(H1N1)2009 infection in the United Kingdom in the 2010/11 season. The adjusted vaccine effectiveness was 34% (95% CI: -10 - 60%) if vaccinated only with monovalent vaccine in the 2009/10 season; 46% (95% CI: 7 - 69%) if vaccinated only with trivalent influenza vaccine in the 2010/11 season and 63% (95% CI: 37 - 78%) if vaccinated in both seasons.
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Affiliation(s)
- R Pebody
- Health Protection Agency Health Protection Services – Colindale, London, United Kingdom
| | - P Hardelid
- Health Protection Agency Health Protection Services – Colindale, London, United Kingdom
| | - D M Fleming
- Royal College of General Practitioners Research and Surveillance Centre, Birmingham, United Kingdom
| | - J McMenamin
- Health Protection Scotland, Glasgow, United Kingdom
| | - N Andrews
- Health Protection Agency Health Protection Services – Colindale, London, United Kingdom
| | - C Robertson
- University of Strathclyde, Glasgow, United Kingdom
- Health Protection Scotland, Glasgow, United Kingdom
| | - D R Thomas
- Public Health Wales, Cardiff, United Kingdom
| | - P Sebastianpillai
- Health Protection Agency Microbiology Services – Colindale, London, United Kingdom
| | - J Ellis
- Health Protection Agency Microbiology Services – Colindale, London, United Kingdom
| | - W Carman
- West of Scotland Specialist Virology Centre, Glasgow, United Kingdom
| | - T Wreghitt
- Health Protection Agency Microbiology Services, Cambridge, United Kingdom
| | - M Zambon
- Health Protection Agency Microbiology Services – Colindale, London, United Kingdom
| | - J M Watson
- Health Protection Agency Health Protection Services – Colindale, London, United Kingdom
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Keramarou M, Cottrell S, Evans MR, Moore C, Stiff RE, Elliott C, Thomas DR, Lyons M, Salmon RL. Two waves of pandemic influenza A(H1N1) 2009 in Wales--the possible impact of media coverage on consultation rates, April-December 2009. Euro Surveill 2011; 16:19772. [PMID: 21262184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
In the United Kingdom, the influenza A(H1N1) 2009 pandemic had a distinct two-wave pattern of general practice consultations for influenza-like illness (ILI). We describe the epidemiology of the influenza pandemic in Wales between April and December 2009 using integrated data from a number of independent sources: GP surveillance, community virology surveillance, hospital admissions and deaths, and media enquiries monitoring. The first wave peaked in late July at 100 consultations per 100,000 general practice population and attracted intensive media coverage. The positivity rate for the A(H1N1)2009 influenza did not exceed 25% and only 44 hospitalisations and one death were recorded. By contrast, the second wave peaked in late October and although characterised by lower ILI consultation rates (65 consultations per 100,000 general practice population) and low profile media activity, was associated with much higher positivity rates for pandemic influenza A(H1N1)2009 (60%) and substantially more hospital admissions (n=379) and deaths (n=26). The large number of ILI-related consultations during the first wave in Wales probably reflected the intensive media activity rather than influenza virus circulating in the community. Data from community surveillance schemes may therefore have considerably overestimated the true incidence of influenza. This has implications for the future interpretation of ILI surveillance data and their use in policy making, and underlines the importance of using integrated epidemiological, virological and hospital surveillance data to monitor influenza activity.
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Affiliation(s)
- M Keramarou
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom.
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Keramarou M, Cottrell S, Evans MR, Moore C, Stiff RE, Elliott C, Thomas DR, Lyons M, Salmon RL. Two waves of pandemic influenza A(H1N1)2009 in Wales – the possible impact of media coverage on consultation rates, April – December 2009. Euro Surveill 2011. [DOI: 10.2807/ese.16.03.19772-en] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In the United Kingdom, the influenza A(H1N1)2009 pandemic had a distinct two-wave pattern of general practice consultations for influenza-like illness (ILI). We describe the epidemiology of the influenza pandemic in Wales between April and December 2009 using integrated data from a number of independent sources: GP surveillance, community virology surveillance, hospital admissions and deaths, and media enquiries monitoring. The first wave peaked in late July at 100 consultations per 100,000 general practice population and attracted intensive media coverage. The positivity rate for the A(H1N1)2009 influenza did not exceed 25% and only 44 hospitalisations and one death were recorded. By contrast, the second wave peaked in late October and although characterised by lower ILI consultation rates (65 consultations per 100,000 general practice population) and low profile media activity, was associated with much higher positivity rates for pandemic influenza A(H1N1)2009 (60%) and substantially more hospital admissions (n=379) and deaths (n=26). The large number of ILI-related consultations during the first wave in Wales probably reflected the intensive media activity rather than influenza virus circulating in the community. Data from community surveillance schemes may therefore have considerably overestimated the true incidence of influenza. This has implications for the future interpretation of ILI surveillance data and their use in policy making, and underlines the importance of using integrated epidemiological, virological and hospital surveillance data to monitor influenza activity.
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Affiliation(s)
- M Keramarou
- European Programme on Intervention Epidemiology Training (EPIET)
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom
| | - S Cottrell
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom
| | - M R Evans
- Department of Primary Care and Public Health, Cardiff University, United Kingdom
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom
| | - C Moore
- Public Health Wales Microbiology, Cardiff, United Kingdom
| | - R E Stiff
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom
| | - C Elliott
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom
| | - D R Thomas
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom
| | - M Lyons
- Health Protection Services, Public Health Wales, Cardiff, United Kingdom
| | - R L Salmon
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom
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Teevale T, Thomas DR, Scragg R, Faeamani G, Nosa V. The role of sociocultural factors in obesity aetiology in Pacific adolescents and their parents: a mixed-methods study in Auckland, New Zealand. N Z Med J 2010; 123:26-36. [PMID: 21326397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM To explore sociocultural factors that may promote or prevent obesity in Pacific communities in New Zealand. Specific objectives were to describe the behaviours, beliefs and values of Pacific adolescents and their parents, related to food consumption and physical activity and to examine the patterns among obese and non-obese Pacific adolescents and their parents. METHODS A self-completion questionnaire was administered to 2495 Pacific students who participated in the New Zealand arm of the Obesity Prevention In Communities (OPIC) project, with quantitative comparisons between 782 obese and 814 healthy weight students. Sixty-eight people (33 adolescents and 35 parents) from 30 Pacific households were interviewed in the qualitative phase of the study. RESULTS Healthy eating and higher levels of physical activity were related to parental presence at home, parental occupational type (non-shift) and better health education and experience. Obese adolescents held the same attitudes, beliefs and values about food and physical activity as their healthy-weight counterparts, but these factors were not protective for obesity-risk. CONCLUSION This study indicates that social status and environmental factors related to poverty affect the health-promoting behaviours of Pacific communities in New Zealand. To address obesity in Pacific youth, specific macro-environmental changes are recommended including food pricing control policies to mitigate healthy food costs, revising sustained employment hour policies, making changes to school food and physical activity environments.
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Affiliation(s)
- Tasileta Teevale
- School of Population Health,University of Auckland, Auckland, New Zealand.
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Lo D, Paniagua MA, Thomas DR. Missed Opportunities: Nursing Home Providers’ Ability to Identify and Recognize Depressive Symptoms. J Am Med Dir Assoc 2010; 11:680-3. [DOI: 10.1016/j.jamda.2010.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 07/28/2010] [Indexed: 10/19/2022]
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Kaiser MJ, Bauer JM, Rämsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony PS, Charlton KE, Maggio M, Tsai AC, Vellas B, Sieber CC. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc 2010; 58:1734-8. [PMID: 20863332 DOI: 10.1111/j.1532-5415.2010.03016.x] [Citation(s) in RCA: 570] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To provide pooled data on the prevalence of malnutrition in elderly people as evaluated using the Mini Nutritional Assessment (MNA). DESIGN Retrospective pooled analysis of previously published datasets. SETTING Hospital, rehabilitation, nursing home, community. PARTICIPANTS Four thousand five hundred seven people (75.2% female) with a mean age of 82.3. MEASUREMENTS The prevalence of malnutrition in the combined database and in the four settings was examined. RESULTS Twenty-four data sets with information on full MNA classification from researchers from 12 countries were submitted. In the combined database, the prevalence of malnutrition was 22.8%, with considerable differences between the settings (rehabilitation, 50.5%; hospital, 38.7%; nursing home, 13.8%; community, 5.8%). In the combined database, the "at risk" group had a prevalence of 46.2%. Consequently, approximately two-thirds of study participants were at nutritional risk or malnourished. CONCLUSION The MNA has gained worldwide acceptance and shows a high prevalence of malnutrition in different settings, except for the community. Because of its specific geriatric focus, the MNA should be recommended as the basis for nutritional evaluation in older people.
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Affiliation(s)
- Matthias J Kaiser
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
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Thomas DR, Arlidge B, Arroll B, Elder H. General practitioners' views about diagnosing and treating depression in Maori and non-Maori patients. J Prim Health Care 2010; 2:208-216. [PMID: 21069116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION The study investigated general practitioners' (GPs') views about recognising and treating depression among patients to establish possible reasons for reported lower levels of diagnosis and treatment of depression among Maori compared to non-Maori patients. METHODS Semi-structured interviews with 23 GPs in the Auckland region, including both Maori and non-Maori GPs, elicited GPs' views about risk factors for depression, recognising depression and circumstances in which GPs would prescribe medication or recommend other treatments for depression. FINDINGS A framework was developed which incorporated the strategies GPs reported using to diagnose and treat depression. This consisted of three categories: (a) how depression is identified, (b) factors influencing treatment decisions, and (c) treatment outcomes. Reasons reported by GPs as most likely to lead to ethnic differences in diagnosing depression were greater stigma relating to admitting depression among Maori patients, Maori patients being less likely to talk about being depressed, and the need for patients to have effective communication with their GP. Effective communication, where Maori patients felt free to talk about personal feelings, was more likely when there was an established relationship between the GP and patient. CONCLUSION The findings are consistent with previous reports that depression is less likely to be diagnosed by GPs among Maori patients, compared to non-Maori patients. GPs who are able to establish effective communication with patients, gain their trust and take account of the reluctance of some Maori patients to talk about personal feelings, are more likely to diagnose and treat depression effectively.
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Affiliation(s)
- David R Thomas
- Social and Community Health, School of Population Health, The University of Auckland, PB 92019, Auckland, New Zealand.
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Engberg LA, Hansen G, Welker RL, Thomas DR. Acquisition of Key-Pecking via Autoshaping as a Function of Prior Experience: "Learned Laziness"? Science 2010; 178:1002-4. [PMID: 17774512 DOI: 10.1126/science.178.4064.1002] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A group of pigeons that had previously received noncontingent food delivery acquired the key-peck response (in autoshape training) more slowly than did a naive control group; key-peck acquisition was most rapid for a group given operant treadle-press training in the initial phase.
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Abstract
Three experiments examined the assertion that presession handling cues that accompany training with reinforcement might account for spontaneous recovery when they reoccur following extinction. In Experiment 1, after extensive training on a variable-interval schedule, key pecking in pigeons was extinguished following either normal or distinctively different handling and transportational cues. Those cues resulted in enhanced spontaneous recovery 24 hr later when normal cues were reinstated. In Experiment 2, however, subjects tested following the normal handling cues showed no more spontaneous recovery than did subjects that spent the entire extinction-test interval in the experimental chambers and thus were tested without handling cues altogether. In Experiment 3, a group whose test for recovery began 10 min after being placed in the chambers yielded as much spontaneous recovery as did a group tested normally. Furthermore, a group for which extinction began at mid-session and for which handling therefore could not be a discriminative cue for extinction showed no more spontaneous recovery than did the other two groups. Handling cues thus contributed to spontaneous recovery only after explicit discrimination training, as provided in Experiment 1.
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Abstract
In an experiment designed to investigate odors as potential retrieval cues in pigeons' memory (i.e., as conditional stimuli), 8 pigeons first learned to peck a red keylight (S+, reinforced) and not a blue one (S-, extinguished) in the presence of either a eucalyptus oil or isoamyl acetate odor. They were repeatedly switched between two chambers with the same odor to habituate any reaction to the switching that would be required for eventual testing for conditional control by the odors. Next, the birds learned the reversal (blue S+, red S-) in the presence of the alternative odor in one of these chambers. When the birds were then switched to the alternative chamber for additional training, although the odor was still appropriate to the reversal problem, behavior appropriate to the original training condition recurred. Testing indicated that reversal performance was specific to the one chamber in which it had been trained.
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Abstract
An attempt was made to vary systematically the behavior of two elementary school teachers to determine the effects on classroom behavior of Rules, Ignoring Inappropriate Behaviors, and showing Approval for Appropriate Behavior. Behaviors of two children in one class and one child in the other class were recorded by observers, as were samples of the teachers' behavior. Following baseline recordings, Rules, Ignoring, and Approval conditions were introduced one at a time. In one class a reversal of conditions was carried out. The main conclusions were that: (a) Rules alone exerted little effect on classroom behavior, (b) Ignoring Inappropriate Behavior and showing Approval for Appropriate Behavior (in combination) were very effective in achieving better classroom behavior, and (c) showing Approval for Appropriate Behaviors is probably the key to effective classroom management.
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Thomas DR, Becker WC, Armstrong M. Production and elimination of disruptive classroom behavior by systematically varying teacher's behavior. J Appl Behav Anal 2010; 1:35-45. [PMID: 16795158 PMCID: PMC1310973 DOI: 10.1901/jaba.1968.1-35] [Citation(s) in RCA: 239] [Impact Index Per Article: 17.1] [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]
Abstract
The effects of teacher behaviors on the classroom behaviors of children were investigated by systematically varying approving (praise, smiles, contacts, etc.) and disapproving (verbal reprimands, physical restraint, etc.) classes of teacher behavior. Measures were taken on both teacher and child behaviors. Each day a sample of 10 children was observed. The subject pool was a class of 28 well-behaved children in a middle-primary public school class. The results demonstrated that approving teacher responses served a positive reinforcing function in maintaining appropriate classroom behaviors. Disruptive behaviors increased each time approving teacher behavior was withdrawn. When the teacher's disapproving behaviors were tripled, increases appeared most markedly in the gross motor and noise-making categories of disruptive behavior. The findings emphasize again the important role of the teacher in producing, maintaining, and eliminating disruptive as well as pro-social classroom behavior.
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Affiliation(s)
- D R Thomas
- University of Illinois, Urbana, Illinois
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