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Casetta C, Santosh P, Bayley R, Bisson J, Byford S, Dixon C, Drake RJ, Elvins R, Emsley R, Fung N, Hayes D, Howes O, James A, James K, Jones R, Killaspy H, Lennox B, Marchant L, McGuire P, Oloyede E, Rogdaki M, Upthegrove R, Walters J, Egerton A, MacCabe JH. CLEAR - clozapine in early psychosis: study protocol for a multi-centre, randomised controlled trial of clozapine vs other antipsychotics for young people with treatment resistant schizophrenia in real world settings. BMC Psychiatry 2024; 24:122. [PMID: 38355533 PMCID: PMC10865566 DOI: 10.1186/s12888-023-05397-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/22/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Clozapine is an antipsychotic drug with unique efficacy, and it is the only recommended treatment for treatment-resistant schizophrenia (TRS: failure to respond to at least two different antipsychotics). However, clozapine is also associated with a range of adverse effects which restrict its use, including blood dyscrasias, for which haematological monitoring is required. As treatment resistance is recognised earlier in the illness, the question of whether clozapine should be prescribed in children and young people is increasingly important. However, most research to date has been in older, chronic patients, and evidence regarding the efficacy and safety of clozapine in people under age 25 is lacking. The CLEAR (CLozapine in EARly psychosis) trial will assess whether clozapine is more effective than treatment as usual (TAU), at the level of clinical symptoms, patient rated outcomes, quality of life and cost-effectiveness in people below 25 years of age. Additionally, a nested biomarker study will investigate the mechanisms of action of clozapine compared to TAU. METHODS AND DESIGN This is the protocol of a multi-centre, open label, blind-rated, randomised controlled effectiveness trial of clozapine vs TAU (any other oral antipsychotic monotherapy licenced in the British National Formulary) for 12 weeks in 260 children and young people with TRS (12-24 years old). AIM AND OBJECTIVES The primary outcome is the change in blind-rated Positive and Negative Syndrome Scale scores at 12 weeks from baseline. Secondary outcomes include blind-rated Clinical Global Impression, patient-rated outcomes, quality of life, adverse effects, and treatment adherence. Patients will be followed up for 12 months and will be invited to give consent for longer term follow-up using clinical records and potential re-contact for further research. For mechanism of action, change in brain magnetic resonance imaging (MRI) biomarkers and peripheral inflammatory markers will be measured over 12 weeks. DISCUSSION The CLEAR trial will contribute knowledge on clozapine effectiveness, safety and cost-effectiveness compared to standard antipsychotics in young people with TRS, and the results may guide future clinical treatment recommendation for early psychosis. TRIAL REGISTRATION ISRCTN Number: 37176025, IRAS Number: 1004947. TRIAL STATUS In set-up. Protocol version 4.0 01/08/23. Current up to date protocol available here: https://fundingawards.nihr.ac.uk/award/NIHR131175# /.
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Affiliation(s)
- C Casetta
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - P Santosh
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R Bayley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - S Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - C Dixon
- Wonford House Hospital, Devon Partnership NHS Trust, Exeter, UK
| | - R J Drake
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - R Elvins
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - R Emsley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - N Fung
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - D Hayes
- South London and Maudsley NHS Foundation Trust, London, UK
| | - O Howes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A James
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - K James
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - R Jones
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - H Killaspy
- Division of Psychiatry, University College London, London, UK
| | - B Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - L Marchant
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - P McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - E Oloyede
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - M Rogdaki
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Womens and Childrens NHS Foundation Trust, Birmingham, UK
| | - J Walters
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - A Egerton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J H MacCabe
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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O'Connell L, Asad H, Hall G, Jones T, Walters J, Manchipp-Taylor L, Barry J, Keighan D, Jones H, Williams C, Cronin M, Hughes H, Morgan M, Connor TR, Healy B. Detailed analysis of in-hospital transmission of SARS-CoV-2 using whole genome sequencing. J Hosp Infect 2023; 131:23-33. [PMID: 36240955 PMCID: PMC9554319 DOI: 10.1016/j.jhin.2022.09.023] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Hospital transmission of SARS-CoV-2 has proved difficult to control, with healthcare-associated infections troublesome throughout. AIM To understand factors contributing to hospital transmission of infections, which is necessary for containing spread. METHODS An outbreak of 56 staff and patient cases of COVID-19 over a 31-day period in a tertiary referral unit is presented, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). FINDINGS Transmission is documented from staff to staff, staff to patients, and patients to staff, showing disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation, and use of personal protective equipment. There was extensive spread from the index case, despite this patient spending only 10 h bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT = 32) polymerase chain reaction test. CONCLUSION This investigation highlights how effectively and rapidly SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected by using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
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Affiliation(s)
- L O'Connell
- Public Health Wales and Swansea Bay University Health Board, Swansea, UK. lorcan.o'
| | - H Asad
- Health Protection Communicable Disease Surveillance Centre (CDSC), Public Health Wales, Swansea, UK
| | - G Hall
- Swansea Bay University Health Board, Swansea, UK
| | - T Jones
- Swansea Bay University Health Board, Swansea, UK
| | - J Walters
- Quality Improvement Infection Prevention & Control, Infection Prevention & Control Team, Swansea Bay University Health Board, Swansea, UK
| | | | - J Barry
- Swansea Bay University Health Board, Swansea, UK
| | - D Keighan
- Estates, Swansea Bay University Health Board, Swansea, UK
| | - H Jones
- Health Protection CDSC, Public Health Wales, Carmarthen, UK
| | - C Williams
- Health Protection CDSC, Public Health Wales, Carmarthen, UK
| | - M Cronin
- Health Protection CDSC, Public Health Wales, Cardiff, UK
| | - H Hughes
- Public Health Wales and Cardiff University Health Board, Cardiff, UK
| | - M Morgan
- Healthcare Associated Infection, Antimicrobial Resistance & Prescribing Programme, Public Health Wales, Cardiff, UK
| | - T R Connor
- Public Health Wales and Cardiff University, Cardiff, UK
| | - B Healy
- Public Health Wales and Swansea Bay University Health Board, Swansea, UK
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Farakish L, Legge S, Owen M, O’Donovan M, Walters J, Cardno A. Clinical Indicators of Symptom Dimensions and Cognitive Ability in Schizophrenia. Eur Psychiatry 2022. [PMCID: PMC9563343 DOI: 10.1192/j.eurpsy.2022.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Schizophrenia is a heterogeneous disorder and it is unknown what causes individual variability in symptoms and cognitive ability. Objectives
To examine the association between nine clinical predictors measurable at the onset of schizophrenia and five phenotype dimensions: positive, negative (diminished expressivity), negative (motivation and pleasure), disorganised symptoms and cognitive ability. Methods 852 participants (mean age 49 years old) with a diagnosis of schizophrenia or schizoaffective depression were included from the CardiffCOGS cross-sectional sample. Phenotype dimensions were created using confirmatory factor analysis and a 5-factor model. Associations were tested using linear regression, adjusting for age and sex. A Bonferroni correction was applied for (p<1.1x10-3) for multiple testing. Results Age of onset of psychosis was significantly associated with positive symptoms (β=-0.18, p=4.0 x10-6). Lower premorbid IQ was associated with diminished expressivity (β=-0.25, p= 7.0x10-13), reduced motivation and pleasure (β=-0.23, p= 4.3x10-11), disorganised symptoms (β=-0.14, p= 7.6x10-5) and reduced cognition (β=0.54, p= 4.8x10-77). Poor premorbid social adjustment held associations with all except positive. Developmental delay was associated with reduced cognition (β=-0.35, p= 4.3x10-5). Cannabis use (year before onset), psychosocial stressors (within 6 months), childhood abuse and family history of schizophrenia held no associations. Conclusions Clinical indicators measurable at schizophrenia onset are associated with lifetime symptom variability. A younger psychosis onset is associated with more severe positive symptoms, suggesting possible age-targeted management. Pre-established links of lower premorbid IQ with poor premorbid social adjustment and negative symptom severity with cognition are strengthened. Further investigation could potentially improve diagnosis and guide treatment choice for aspects of schizophrenia with poor outcomes. Disclosure No significant relationships.
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Hart E, Kavanagh L, Guy A, Lindsey B, Walters J, Haagsma B, Patil K, Perry M. Robotic cystectomy histopathology outcomes in patients whom have ‘failed’ BCG. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35865-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Avo C, Cawthorne KR, Walters J, Healy B. An observational study to identify types of personal protective equipment breaches on inpatient wards. J Hosp Infect 2020; 106:208-210. [PMID: 32590013 PMCID: PMC7311328 DOI: 10.1016/j.jhin.2020.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/22/2022]
Affiliation(s)
- C Avo
- Swansea University Medical School, Institute of Life Science 2, Swansea, UK.
| | - K-R Cawthorne
- Swansea University Medical School, Institute of Life Science 2, Swansea, UK
| | - J Walters
- Infection Prevention and Control, Morriston Hospital, Swansea, UK
| | - B Healy
- Public Health Wales Microbiology, Swansea and Cardiff, UK; Department of Medical Microbiology, Morriston Hospital, Swansea, UK
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Banerjee E, Griffith J, Kenyon C, Christianson B, Strain A, Martin K, McMahon M, Bagstad E, Laine E, Hardy K, Grilli G, Walters J, Dunn D, Roddy M, Ehresmann K. Containing a measles outbreak in Minnesota, 2017: methods and challenges. Perspect Public Health 2019; 140:162-171. [PMID: 31480896 DOI: 10.1177/1757913919871072] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS We report on a measles outbreak largely occurring in Minnesota's under-vaccinated Somali community in the spring of 2017. The outbreak was already into its third generation when the first two cases were confirmed, and rapid public health actions were needed. The aim of our response was to quickly end transmission and contain the outbreak. METHODS The state public health department performed laboratory testing on suspect cases and activated an Incident Command staffed by subject matter experts that was operational within 2 h of case confirmation. Epidemiologic interviews identified exposures in settings where risk of transmission was high, that is, healthcare, childcare, and school settings. Vaccination status of exposed persons was assessed, and postexposure prophylaxis (PEP) was offered, if applicable. Exposed persons who did not receive PEP were excluded from childcare centers or schools for 21 days. An accelerated statewide measles, mumps, and rubella (MMR) recommendation was made for Somali Minnesota children and children in affected outbreak counties. Partnerships with the Somali Minnesota community were deepened, building off outreach work done with the community since 2008. RESULTS Public health identified 75 measles cases from 30 March to 25 August 2017: 43% were female, 81% Somali Minnesotan, 91% unvaccinated, and 28% hospitalized. The median age of cases was 2 years (range: 3 months-57 years). Most transmission (78%) occurred in childcare centers and households. A secondary attack rate of 91% was calculated for unvaccinated household contacts. Over 51,000 doses of MMR were administered during the outbreak above expected baseline. At least 8490 individuals were exposed to measles; 155 individuals received PEP; and over 500 persons were excluded from childcare and school. State and key public health partners spent an estimated $2.3 million on response. CONCLUSION This outbreak demonstrates the necessity of immediate, targeted disease control actions and strong public health, healthcare, and community partnerships to end a measles outbreak.
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Affiliation(s)
- E Banerjee
- Infectious Disease Epidemiology, Prevention and Control, Minnesota Department of Health, 625 Robert St. N., St. Paul, MN 55164, USA
| | - J Griffith
- Minnesota Department of Health, St. Paul, MN, USA
| | - C Kenyon
- Minnesota Department of Health, St. Paul, MN, USA
| | | | - A Strain
- Minnesota Department of Health, St. Paul, MN, USA
| | - K Martin
- Minnesota Department of Health, St. Paul, MN, USA
| | - M McMahon
- Minnesota Department of Health, St. Paul, MN, USA
| | - E Bagstad
- Hennepin County Human Services and Public Health, Hopkins, MN, USA
| | - E Laine
- Minnesota Department of Health, St. Paul, MN, USA
| | - K Hardy
- Minnesota Department of Health, St. Paul, MN, USA
| | - G Grilli
- Minnesota Department of Health, St. Paul, MN, USA
| | - J Walters
- Minnesota Department of Health, St. Paul, MN, USA
| | - D Dunn
- Minnesota Department of Health, St. Paul, MN, USA
| | - M Roddy
- Minnesota Department of Health, St. Paul, MN, USA
| | - K Ehresmann
- Minnesota Department of Health, St. Paul, MN, USA
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Spangenberg E, Severson PL, Hohsfield LA, Crapser J, Zhang J, Burton EA, Zhang Y, Spevak W, Lin J, Phan NY, Habets G, Rymar A, Tsang G, Walters J, Nespi M, Singh P, Broome S, Ibrahim P, Zhang C, Bollag G, West BL, Green KN. Sustained microglial depletion with CSF1R inhibitor impairs parenchymal plaque development in an Alzheimer's disease model. Nat Commun 2019; 10:3758. [PMID: 31434879 PMCID: PMC6704256 DOI: 10.1038/s41467-019-11674-z] [Citation(s) in RCA: 404] [Impact Index Per Article: 80.8] [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: 01/14/2019] [Accepted: 07/26/2019] [Indexed: 01/07/2023] Open
Abstract
Many risk genes for the development of Alzheimer's disease (AD) are exclusively or highly expressed in myeloid cells. Microglia are dependent on colony-stimulating factor 1 receptor (CSF1R) signaling for their survival. We designed and synthesized a highly selective brain-penetrant CSF1R inhibitor (PLX5622) allowing for extended and specific microglial elimination, preceding and during pathology development. We find that in the 5xFAD mouse model of AD, plaques fail to form in the parenchymal space following microglial depletion, except in areas containing surviving microglia. Instead, Aβ deposits in cortical blood vessels reminiscent of cerebral amyloid angiopathy. Altered gene expression in the 5xFAD hippocampus is also reversed by the absence of microglia. Transcriptional analyses of the residual plaque-forming microglia show they exhibit a disease-associated microglia profile. Collectively, we describe the structure, formulation, and efficacy of PLX5622, which allows for sustained microglial depletion and identify roles of microglia in initiating plaque pathogenesis.
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Affiliation(s)
- Elizabeth Spangenberg
- Department of Neurobiology and Behavior, University of California Irvine (UCI), Irvine, CA, 92697, USA
| | | | - Lindsay A Hohsfield
- Department of Neurobiology and Behavior, University of California Irvine (UCI), Irvine, CA, 92697, USA
| | - Joshua Crapser
- Department of Neurobiology and Behavior, University of California Irvine (UCI), Irvine, CA, 92697, USA
| | | | | | | | | | - Jack Lin
- Plexxikon Inc, Berkeley, CA, 94710, USA
| | - Nicole Y Phan
- Department of Neurobiology and Behavior, University of California Irvine (UCI), Irvine, CA, 92697, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Kim N Green
- Department of Neurobiology and Behavior, University of California Irvine (UCI), Irvine, CA, 92697, USA.
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Vardiabasis N, Mosier B, Walters J, Burgess A, Altman G, Akhavan S. Can We Accurately Predict the Quadruple Hamstring Graft Diameter From Preoperative Magnetic Resonance Imaging? Orthop J Sports Med 2019; 7:2325967119834504. [PMID: 30937321 PMCID: PMC6435877 DOI: 10.1177/2325967119834504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) reconstruction with a quadruple hamstring (QH) autograft is a widely utilized procedure with good outcomes. A graft diameter less than 8 mm, however, has been associated with higher revision rates. Accurately determining the diameter of the hamstring tendon preoperatively can help surgeons plan accordingly. Purpose/Hypothesis: The purpose of our study was to determine whether QH graft size can be reliably predicted from preoperative magnetic resonance imaging (MRI) measurements. We hypothesized that we can achieve a high predicted QH graft size correlation with regard to preoperative and intraoperative measurements. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We evaluated patients undergoing ACL reconstruction using QH autografts. At the time of surgery, the semitendinosus tendon (ST) and gracilis tendon (GT) were harvested and sized and then sized as a QH graft. Preoperative individual ST and GT sizes were determined from T2-weighted fat-saturated MRI at 3 cm above the joint line using correlating axial and coronal images. We then used a predictive chart to predict what the size of the QH graft would be and compared this with the actual measurements. Pearson correlation coefficients between predicted and actual graft sizes were calculated. Results: The predicted GT graft size was within 0.5 mm of the actual size in 45 of 60 (75%) patients and within 1 mm of the actual graft size in 59 of 60 (98%) patients. The predicted GT graft size from MRI measurements correlated with the actual GT graft size (r = 0.62, P < .00001). The predicted ST graft size was within 0.5 mm of the actual size in 45 of 60 (75%) patients and within 1 mm of the actual graft size in 56 of 60 (93%) patients. The predicted ST graft size from MRI measurements correlated with the actual ST graft size (r = 0.71, P < .00001). The predicted QH graft size was within 0.5 mm of the actual size in 52 of 60 (87%) patients and within 1 mm of the actual graft size in 60 of 60 (100%) patients. The predicted QH graft size from MRI measurements correlated with the actual QH graft size (r = 0.81, P < .00001). Conclusion: The current technique can reliably predict the size of a QH graft within 1 mm of the final graft size.
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Affiliation(s)
| | - Brian Mosier
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Jason Walters
- Broward Health Sports Medicine, Fort Lauderdale, Florida, USA
| | - Aaron Burgess
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Greg Altman
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Sam Akhavan
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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Ozer HG, El-Gamal D, Powell B, Hing ZA, Blachly JS, Harrington B, Mitchell S, Grieselhuber NR, Williams K, Lai TH, Alinari L, Baiocchi RA, Brinton L, Baskin E, Cannon M, Beaver L, Goettl VM, Lucas DM, Woyach JA, Sampath D, Lehman AM, Yu L, Zhang J, Ma Y, Zhang Y, Spevak W, Shi S, Severson P, Shellooe R, Carias H, Tsang G, Dong K, Ewing T, Marimuthu A, Tantoy C, Walters J, Sanftner L, Rezaei H, Nespi M, Matusow B, Habets G, Ibrahim P, Zhang C, Mathé EA, Bollag G, Byrd JC, Lapalombella R. BRD4 Profiling Identifies Critical Chronic Lymphocytic Leukemia Oncogenic Circuits and Reveals Sensitivity to PLX51107, a Novel Structurally Distinct BET Inhibitor. Cancer Discov 2018; 8:458-477. [PMID: 29386193 DOI: 10.1158/2159-8290.cd-17-0902] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/12/2017] [Accepted: 01/26/2018] [Indexed: 11/16/2022]
Abstract
Bromodomain and extra-terminal (BET) family proteins are key regulators of gene expression in cancer. Herein, we utilize BRD4 profiling to identify critical pathways involved in pathogenesis of chronic lymphocytic leukemia (CLL). BRD4 is overexpressed in CLL and is enriched proximal to genes upregulated or de novo expressed in CLL with known functions in disease pathogenesis and progression. These genes, including key members of the B-cell receptor (BCR) signaling pathway, provide a rationale for this therapeutic approach to identify new targets in alternative types of cancer. Additionally, we describe PLX51107, a structurally distinct BET inhibitor with novel in vitro and in vivo pharmacologic properties that emulates or exceeds the efficacy of BCR signaling agents in preclinical models of CLL. Herein, the discovery of the involvement of BRD4 in the core CLL transcriptional program provides a compelling rationale for clinical investigation of PLX51107 as epigenetic therapy in CLL and application of BRD4 profiling in other cancers.Significance: To date, functional studies of BRD4 in CLL are lacking. Through integrated genomic, functional, and pharmacologic analyses, we uncover the existence of BRD4-regulated core CLL transcriptional programs and present preclinical proof-of-concept studies validating BET inhibition as an epigenetic approach to target BCR signaling in CLL. Cancer Discov; 8(4); 458-77. ©2018 AACR.This article is highlighted in the In This Issue feature, p. 371.
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MESH Headings
- Animals
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Cell Cycle Proteins
- Cell Line, Tumor
- Cell Proliferation
- Gene Expression Profiling
- Gene Expression Regulation, Leukemic
- Humans
- Isoxazoles/pharmacology
- Isoxazoles/therapeutic use
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/physiopathology
- Mice
- Mice, SCID
- Nuclear Proteins/genetics
- Nuclear Proteins/metabolism
- Pyridines/pharmacology
- Pyridines/therapeutic use
- Pyrroles/pharmacology
- Pyrroles/therapeutic use
- Signal Transduction
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Hatice Gulcin Ozer
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | - Dalia El-Gamal
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | | | - Zachary A Hing
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - James S Blachly
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Bonnie Harrington
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Shaneice Mitchell
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Nicole R Grieselhuber
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Katie Williams
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Tzung-Huei Lai
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Lapo Alinari
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Robert A Baiocchi
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Lindsey Brinton
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Elizabeth Baskin
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Matthew Cannon
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Larry Beaver
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Virginia M Goettl
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - David M Lucas
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Jennifer A Woyach
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Deepa Sampath
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Amy M Lehman
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Lianbo Yu
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | | | - Yan Ma
- Plexxikon Inc., Berkeley, California
| | | | | | | | | | | | | | | | - Ken Dong
- Plexxikon Inc., Berkeley, California
| | | | | | | | | | | | | | | | | | | | | | | | - Ewy A Mathé
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | | | - John C Byrd
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio.
| | - Rosa Lapalombella
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio.
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Fixmer C, Lane M, Johnson B, Chee S, Walters J, Ottensmeier C. Emerging role of clinical trials assistants (CTAs) – integrating clinical research into standard care. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- P. J. Cameron
- National Nuclear Corporation, General Engineering Division, Warrington Road, Risley, Warrington, Cheshire, WA 36B2, United Kingdom
| | - J. Walters
- National Nuclear Corporation, Research and Development Division, Risley, United Kingdom
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Ong S, Rodriguez-Garcia C, Grabczynska S, Carton J, Osborn M, Walters J, Kubba F, Stefanato CM. Alopecia areata incognita in Cronkhite-Canada syndrome. Br J Dermatol 2016; 177:531-534. [PMID: 28029683 DOI: 10.1111/bjd.15293] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2016] [Indexed: 11/30/2022]
Abstract
Cronkhite-Canada syndrome is an acquired inflammatory polyposis syndrome in which alopecia, onychomadesis and hyperpigmentation occur concurrently with gastrointestinal symptoms. The pathophysiology of alopecia in Cronkhite-Canada syndrome has not been definitively elucidated. We present evidence for alopecia areata incognita as a possible mechanism of hair loss.
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Affiliation(s)
- S Ong
- Department of Dermatology, Amersham Hospital, Buckinghamshire Healthcare NHS Trust, Whielden Street, Amersham, HP7 0JD, U.K
| | - C Rodriguez-Garcia
- Department of Dermatology, Amersham Hospital, Buckinghamshire Healthcare NHS Trust, Whielden Street, Amersham, HP7 0JD, U.K
| | - S Grabczynska
- Department of Dermatology, Amersham Hospital, Buckinghamshire Healthcare NHS Trust, Whielden Street, Amersham, HP7 0JD, U.K
| | - J Carton
- Department of Histopathology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - M Osborn
- Department of Histopathology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - J Walters
- Department of Gastroenterology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - F Kubba
- Department of Histopathology, London Northwest Healthcare NHS Trust, London, U.K
| | - C M Stefanato
- Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London, U.K
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Tansey KE, Rees E, Linden DE, Ripke S, Chambert KD, Moran JL, McCarroll SA, Holmans P, Kirov G, Walters J, Owen MJ, O'Donovan MC. Common alleles contribute to schizophrenia in CNV carriers. Mol Psychiatry 2016; 21:1153. [PMID: 26643540 PMCID: PMC7609344 DOI: 10.1038/mp.2015.170] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Mehta D, Winton L, Walters J, Hsu CH, Nodora J, Martinez ME, Bouton M, Komenaka IK. Abstract P6-12-06: Preoperative chemotherapy regimens and breast cancer subtype in an underinsured Hispanic population. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-12-06] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Although the Hispanic population is among the fastest growing in the United States, however, less is known about them then other populations. Breast cancer in different racial/ethnic populations display different behaviors. The current study was performed to examine response to preoperative chemotherapy regimen and by breast cancer subtype in a Hispanic safety net population.
Methods: A retrospective review of Hispanic breast cancer patients who underwent preoperative chemotherapy from July 2001 to February May 2015 at a safety net hospital. Sociodemographic, clinical, and treatment variables were evaluated. Response to chemotherapy regimen was recorded. Breast cancer subtypes were divided based on IHC and FISH testing. Luminal B subtype was classified based on Ki67 (>15%) and PR (<20%).
Results: The average age of the 133 patients was 45 years. 93% of the patients were insured with Medicaid or uninsured (70%). The average size of the cancers at presentation was 5cm. Overall 86% of patients had a clinical response to preoperative chemotherapy and 35% had pathologic complete response (pCR). AC and TC regimens had the lowest rate of pCR at 16%. AC/T (every 3 week and weekly) had similar rates of pCR 23% and 29%, while dose dense regimens showed pCR 40%. Herceptin containing regimens had pCR 57%. 7 patients received TAC and 71% had pCR.
By subtype, Luminal A and B patients had low rates of pCR 9% and 14% respectively. Luminal B patients did benefit from preoperative chemotherapy as 86% of patients who were not candidates for breast conservation at presentation were able to undergo lumpectomy after preoperative chemotherapy. Her2 subtype patients who got Herceptin had pCR 57%. Triple negative patients had pCR 54%.
Conclusions: In this underinsured, Hispanic population who presented at advanced stages, differences in response to preoperative chemotherapy were seen based on breast cancer subtype. Differences were also seen based on chemotherapy regimen. TAC maybe a particularly effective regimen in triple negative Hispanic women.
Citation Format: Mehta D, Winton L, Walters J, Hsu C-H, Nodora J, Martinez ME, Bouton M, Komenaka IK. Preoperative chemotherapy regimens and breast cancer subtype in an underinsured Hispanic population. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-06.
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Affiliation(s)
- D Mehta
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfironia, San Diego, San Diego, CA
| | - L Winton
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfironia, San Diego, San Diego, CA
| | - J Walters
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfironia, San Diego, San Diego, CA
| | - C-H Hsu
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfironia, San Diego, San Diego, CA
| | - J Nodora
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfironia, San Diego, San Diego, CA
| | - ME Martinez
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfironia, San Diego, San Diego, CA
| | - M Bouton
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfironia, San Diego, San Diego, CA
| | - IK Komenaka
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfironia, San Diego, San Diego, CA
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Komenaka IK, Djenic B, Walters J, Hsu CH, Nodora JN, Martinez ME, Bouton M, Mehta D. Abstract P6-12-07: The benefit of preoperative chemotherapy in an underinsured Hispanic population with poor use of screening mammography. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-12-07] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Despite prospective clinical trials demonstrating the safety and effectiveness of preoperative chemotherapy for nearly 2 decades, it may still be underutilized in underserved, uninsured populations most likely to present with advanced cancers. The current study was performed to evaluate the effect of preoperative chemotherapy (PC) in a Hispanic safety net population.
Methods: A retrospective review of Hispanic breast cancer patients who presented at clinical stage 2 or higher and were treated from July 2001 to February May 2015 at a safety net hospital. Sociodemographic, clinical, and treatment variables were evaluated. Surgical outcomes were evaluated. Margin status was determined for those who underwent breast conservation.
Results: The average age of the 266 patients was 45 years. 93% of the patients were insured with Medicaid or uninsured (70%). Only 24% of patients underwent screening mammography. 133 underwent PC and 133 had primary operations. Patients who underwent PC presented with larger cancers (5cm vs 3.5cm, p < 0.001). 96% of patients in PC group were not candidates for lumpectomy at presentation. However, lumpectomy was performed more often in those who underwent PC (75% vs. 57%, p = 0.01). Re-excision for margins were necessary less often in those who underwent PC (10.3% vs 27%, p = 0.01). Patients who underwent PC were also less likely to require an ALND (33% vs 47%, p = 0.04). Despite presentation at higher average clinical stage in patients who underwent PC, at average follow up of 52 months, risk of IBTR and risk of regional recurrence were similar in the PC and no-PC groups (IBTR: 4.4% vs 3%, p = 0.99 and Regional: 1.5% vs. 1.5%, p = 0.99). Breast cancer specific survival was 86.5% in the PC group compared to 84% in the no-PC group (p = 0.68). Patients in the no-PC group were less likely to comply with recommended chemotherapy.Conclusions: In this underinsured, Hispanic population who did not use screening mammography, preoperative chemotherapy allowed many women to undergo breast conservation, undergo fewer operations, and were less likely to require ALND. Risk of local and regional recurrence is low in these patients and comparable to those who underwent primary operation.
Citation Format: Komenaka IK, Djenic B, Walters J, Hsu C-H, Nodora JN, Martinez ME, Bouton M, Mehta D. The benefit of preoperative chemotherapy in an underinsured Hispanic population with poor use of screening mammography. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-07.
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Affiliation(s)
- IK Komenaka
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfornia, San Diego, San Diego, CA
| | - B Djenic
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfornia, San Diego, San Diego, CA
| | - J Walters
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfornia, San Diego, San Diego, CA
| | - C-H Hsu
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfornia, San Diego, San Diego, CA
| | - JN Nodora
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfornia, San Diego, San Diego, CA
| | - ME Martinez
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfornia, San Diego, San Diego, CA
| | - M Bouton
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfornia, San Diego, San Diego, CA
| | - D Mehta
- Maricopa Medical Center, Phoenix, AZ; University of Arizona, Tucson, AZ; University of Calfornia, San Diego, San Diego, CA
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Held M, Laubscher M, von Bormann R, Walters J, Roche S, Banderker A, Navsaria P, Nicol A, Maqungo S. High rate of popliteal artery injuries and limb loss in 96 knee dislocations. SA orthop j 2016. [DOI: 10.17159/2309-8309/2016/v15n1a8] [Citation(s) in RCA: 4] [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] [Indexed: 11/05/2022] Open
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18
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Fleming N, Walters J, Grounds J, Fife L, Finch A. Acute response to barefoot running in habitually shod males. Hum Mov Sci 2015; 42:27-37. [DOI: 10.1016/j.humov.2015.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 04/16/2015] [Accepted: 04/18/2015] [Indexed: 10/23/2022]
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Smirnova D, Walters J, Fine J, Muchnik-Rozanov Y, Paz M, Lerner V, Belmaker RH, Bersudsky Y. Second language as a compensatory resource for maintaining verbal fluency in bilingual immigrants with schizophrenia. Neuropsychologia 2015; 75:597-606. [PMID: 26162616 DOI: 10.1016/j.neuropsychologia.2015.06.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 02/09/2015] [Revised: 06/08/2015] [Accepted: 06/28/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Due to the large migrations over the past three decades, large numbers of individuals with schizophrenia are learning a second language and being seen in clinics in that second language. We conducted within-subject comparisons to clarify the contribution of clinical, linguistic and bilingual features in the first and second languages of bilinguals with schizophrenia. METHODS Ten bilingual Russian(L1) and Hebrew(L2) proficient patients, who developed clinical schizophrenia after achieving proficiency in both languages, were selected from 60 candidates referred for the study; they were resident in Israel 7-32 years with 3-10 years from immigration to diagnosis. Clinical, linguistic and fluency markers were coded in transcripts of clinical interviews. RESULTS There was a trend toward more verbal productivity in the first language (L1) than the second language (L2). Clinical speech markers associated with thought disorder and cognitive impairment (blocking and topic shift) were similar in both languages. Among linguistic markers of schizophrenia, Incomplete syntax and Speech role reference were significantly more frequent in L2 than L1; Lexical repetition and Unclear reference demonstrated a trend in the same direction. For fluency phenomena, Discourse markers were more prevalent in L1 than L2, and Codeswitching was similar across languages, showing that the patients were attuned to the socio-pragmatics of language use. CONCLUSIONS More frequent linguistic markers of schizophrenia in L2 show more impairment in the syntactic/semantic components of language, reflecting greater thought and cognitive dysfunction. Patients are well able to acquire a second language. Nevertheless, schizophrenia finds expression in that language. Finally, more frequent fluency markers in L1 suggests motivation to maintain fluency, evidenced in particular by codeswitched L2 lexical items, a compensatory resource.
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Affiliation(s)
- D Smirnova
- Samara State Medical University, Department of Psychiatry, Samara, Russia
| | - J Walters
- Bar-Ilan University, Department of English Literature and Linguistics, Ramat Gan, Israel
| | - J Fine
- Bar-Ilan University, Department of English Literature and Linguistics, Ramat Gan, Israel
| | - Y Muchnik-Rozanov
- Bar-Ilan University, Department of English Literature and Linguistics, Ramat Gan, Israel
| | - M Paz
- Ben-Gurion University of the Negev, Ministry of Health Mental Health Center, Beer-Sheba, Israel
| | - V Lerner
- Ben-Gurion University of the Negev, Ministry of Health Mental Health Center, Beer-Sheba, Israel
| | | | - Y Bersudsky
- Ben-Gurion University of the Negev, Ministry of Health Mental Health Center, Beer-Sheba, Israel.
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Smirnova D, Walters J, Fine J, Muchnik-Rozanov Y, Paz M, Lerner V, Belmaker H, Bersudsky Y. Schizophrenia in Bilingual Immigrants: is Verbal Fluency Preserved in Second Language Acquisition? Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)31288-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Collier D, Achilla E, Breen G, Curran S, Dima D, Flanagan R, Frank J, Frangou S, Gasse C, Giegling I, Rietschel M, Rujescu D, Maccabe J, McCrone P, Mill J, Sigurdsson E, Stefansson H, Walters J, Verbelen M, Helthuis M. How Can Pharmacogenomics Biomarkers Be Translated into Patient Benefit. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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22
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Szatkiewicz JP, O'Dushlaine C, Chen G, Chambert K, Moran JL, Neale BM, Fromer M, Ruderfer D, Akterin S, Bergen SE, Kähler A, Magnusson PKE, Kim Y, Crowley JJ, Rees E, Kirov G, O'Donovan MC, Owen MJ, Walters J, Scolnick E, Sklar P, Purcell S, Hultman CM, McCarroll SA, Sullivan PF. Copy number variation in schizophrenia in Sweden. Mol Psychiatry 2014; 19:762-73. [PMID: 24776740 PMCID: PMC4271733 DOI: 10.1038/mp.2014.40] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 02/25/2014] [Accepted: 03/20/2014] [Indexed: 12/13/2022]
Abstract
Schizophrenia (SCZ) is a highly heritable neuropsychiatric disorder of complex genetic etiology. Previous genome-wide surveys have revealed a greater burden of large, rare copy number variations (CNVs) in SCZ cases and identified multiple rare recurrent CNVs that increase risk of SCZ although with incomplete penetrance and pleiotropic effects. Identification of additional recurrent CNVs and biological pathways enriched for SCZ CNVs requires greater sample sizes. We conducted a genome-wide survey for CNVs associated with SCZ using a Swedish national sample (4719 cases and 5917 controls). High-confidence CNV calls were generated using genotyping array intensity data, and their effect on risk of SCZ was measured. Our data confirm increased burden of large, rare CNVs in SCZ cases as well as significant associations for recurrent 16p11.2 duplications, 22q11.2 deletions and 3q29 deletions. We report a novel association for 17q12 duplications (odds ratio=4.16, P=0.018), previously associated with autism and mental retardation but not SCZ. Intriguingly, gene set association analyses implicate biological pathways previously associated with SCZ through common variation and exome sequencing (calcium channel signaling and binding partners of the fragile X mental retardation protein). We found significantly increased burden of the largest CNVs (>500 kb) in genes present in the postsynaptic density, in genomic regions implicated via SCZ genome-wide association studies and in gene products localized to mitochondria and cytoplasm. Our findings suggest that multiple lines of genomic inquiry--genome-wide screens for CNVs, common variation and exonic variation--are converging on similar sets of pathways and/or genes.
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Affiliation(s)
- J P Szatkiewicz
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - C O'Dushlaine
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - G Chen
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - K Chambert
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - J L Moran
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - B M Neale
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - M Fromer
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - D Ruderfer
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - S Akterin
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - S E Bergen
- 1] Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA [2] Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - A Kähler
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - P K E Magnusson
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Y Kim
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - J J Crowley
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - E Rees
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - G Kirov
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - M C O'Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - M J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - J Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - E Scolnick
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - P Sklar
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - S Purcell
- 1] Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA [2] Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - C M Hultman
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - S A McCarroll
- 1] Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA [2] Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - P F Sullivan
- 1] Department of Genetics, University of North Carolina, Chapel Hill, NC, USA [2] Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden
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Walters J, Evans R, LeRoith T, Sriranganathan N, McElroy A, Pierson FW. Experimental Comparison of Hemolytic and NonhemolyticOrnithobacterium rhinotrachealeField IsolatesIn Vivo. Avian Dis 2014; 58:78-82. [DOI: 10.1637/10637-081313-reg.1] [Citation(s) in RCA: 3] [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] [Indexed: 11/05/2022]
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Schmechtig A, Lees J, Perkins A, Altavilla A, Craig KJ, Dawson GR, William Deakin JF, Dourish CT, Evans LH, Koychev I, Weaver K, Smallman R, Walters J, Wilkinson LS, Morris R, Williams SCR, Ettinger U. The effects of ketamine and risperidone on eye movement control in healthy volunteers. Transl Psychiatry 2013; 3:e334. [PMID: 24326395 PMCID: PMC4030328 DOI: 10.1038/tp.2013.109] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 10/15/2013] [Accepted: 10/21/2013] [Indexed: 02/06/2023] Open
Abstract
The non-competitive N-methyl-D-aspartate receptor antagonist ketamine leads to transient psychosis-like symptoms and impairments in oculomotor performance in healthy volunteers. This study examined whether the adverse effects of ketamine on oculomotor performance can be reversed by the atypical antipsychotic risperidone. In this randomized double-blind, placebo-controlled study, 72 healthy participants performed smooth pursuit eye movements (SPEM), prosaccades (PS) and antisaccades (AS) while being randomly assigned to one of four drug groups (intravenous 100 ng ml(-1) ketamine, 2 mg oral risperidone, 100 ng ml(-1) ketamine plus 2 mg oral risperidone, placebo). Drug administration did not lead to harmful adverse events. Ketamine increased saccadic frequency and decreased velocity gain of SPEM (all P < 0.01) but had no significant effects on PS or AS (all P > or = 0.07). An effect of risperidone was observed for amplitude gain and peak velocity of PS and AS, indicating hypometric gain and slower velocities compared with placebo (both P < or = 0.04). No ketamine by risperidone interactions were found (all P > or = 0.26). The results confirm that the administration of ketamine produces oculomotor performance deficits similar in part to those seen in schizophrenia. The atypical antipsychotic risperidone did not reverse ketamine-induced deteriorations. These findings do not support the cognitive enhancing potential of risperidone on oculomotor biomarkers in this model system of schizophrenia and point towards the importance of developing alternative performance-enhancing compounds to optimise pharmacological treatment of schizophrenia.
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Affiliation(s)
- A Schmechtig
- Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK,Department of Neuroimaging, CNS Building PO89, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. E-mail:
| | - J Lees
- Neuroscience and Psychiatry Unit, School of Community Based Medicine, The University of Manchester, Manchester, UK
| | - A Perkins
- Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
| | - A Altavilla
- School of Psychology, Cardiff University, Cardiff, UK
| | - K J Craig
- P1vital Ltd, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - G R Dawson
- P1vital Ltd, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - J F William Deakin
- Neuroscience and Psychiatry Unit, School of Community Based Medicine, The University of Manchester, Manchester, UK
| | - C T Dourish
- P1vital Ltd, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - L H Evans
- School of Psychology, Cardiff University, Cardiff, UK
| | - I Koychev
- Neuroscience and Psychiatry Unit, School of Community Based Medicine, The University of Manchester, Manchester, UK
| | - K Weaver
- Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
| | - R Smallman
- Neuroscience and Psychiatry Unit, School of Community Based Medicine, The University of Manchester, Manchester, UK
| | - J Walters
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - L S Wilkinson
- School of Psychology, Cardiff University, Cardiff, UK,Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - R Morris
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - S C R Williams
- Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
| | - U Ettinger
- Department of Psychology, University of Bonn, Bonn, Germany
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Frandsen M, Walters J, Ferguson SG. Exploring the Viability of Using Online Social Media Advertising as a Recruitment Method for Smoking Cessation Clinical Trials. Nicotine Tob Res 2013; 16:247-51. [DOI: 10.1093/ntr/ntt157] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Donohoe G, Walters J, Hargreaves A, Rose E, Morris D, Fahey C, Bellini S, Cummins E, Giegling I, Hartmann A, Möller HJ, Muglia P, Owen M, Gill M, O'Donovan M, Tropea D, Rujescu D, Corvin A. Neuropsychological effects of theCSMD1genome-wide associated schizophrenia risk variant rs10503253. Genes, Brain and Behavior 2013; 12:203-9. [DOI: 10.1111/gbb.12016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 12/05/2012] [Accepted: 12/20/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | - J. Walters
- Department of Psychological Medicine; University of Cardiff; Cardiff; UK
| | - A. Hargreaves
- Neuropsychiatric Genetics Group, Department of Psychiatry; Institute of Molecular Medicine, Trinity College Dublin, St. James Hospital; Dublin; Ireland
| | | | | | - C. Fahey
- Neuropsychiatric Genetics Group, Department of Psychiatry; Institute of Molecular Medicine, Trinity College Dublin, St. James Hospital; Dublin; Ireland
| | - S. Bellini
- Neuropsychiatric Genetics Group, Department of Psychiatry; Institute of Molecular Medicine, Trinity College Dublin, St. James Hospital; Dublin; Ireland
| | - E. Cummins
- Neuropsychiatric Genetics Group, Department of Psychiatry; Institute of Molecular Medicine, Trinity College Dublin, St. James Hospital; Dublin; Ireland
| | - I. Giegling
- Department of Psychiatry and Psychotherapy; University of Munich (LMU); Munich; Germany
| | - A.M. Hartmann
- Department of Psychiatry and Psychotherapy; University of Munich (LMU); Munich; Germany
| | - H.-J. Möller
- Department of Psychiatry and Psychotherapy; University of Munich (LMU); Munich; Germany
| | - P. Muglia
- Medical Genetics; GlaxoSmithKline R&D; Verona; Italy
| | - M.J. Owen
- Department of Psychological Medicine; University of Cardiff; Cardiff; UK
| | | | - M.C. O'Donovan
- Department of Psychological Medicine; University of Cardiff; Cardiff; UK
| | - D. Tropea
- Neuropsychiatric Genetics Group, Department of Psychiatry; Institute of Molecular Medicine, Trinity College Dublin, St. James Hospital; Dublin; Ireland
| | - D. Rujescu
- Department of Psychiatry and Psychotherapy; University of Munich (LMU); Munich; Germany
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Davies KJ, Kerslake ID, Walters J, Thomas MJ. Survival benefit for patients receiving antibiotics following out-of-hospital cardiac arrest. Crit Care 2012. [PMCID: PMC3363694 DOI: 10.1186/cc10883] [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: 11/21/2022] Open
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Dunsmore KA, Lowery RP, Duncan NM, Davis GS, Rathmacher JA, Baier SM, Sikorski EM, Morrison TJ, Naimo MA, Walters J, Wilson SMC, Wilson JM. Effects of 12 weeks of beta-hydroxy-beta-methylbutyrate free acid gel supplementation on muscle mass, strength, and power in resistance trained individuals. J Int Soc Sports Nutr 2012. [PMCID: PMC3500730 DOI: 10.1186/1550-2783-9-s1-p5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Davis GS, Lowery RP, Duncan NM, Sikorski EM, Rathmacher JA, Baier SM, Morrison TJ, Dunsmore KA, Naimo MA, Walters J, Joy J, Wilson SMC, Wilson JM. The effects of beta-hydoxy-beta-methylbutyrate free acid supplementation on muscle damage, hormonal status, and performance following a high volume 2-week overreaching cycle. J Int Soc Sports Nutr 2012. [PMCID: PMC3500734 DOI: 10.1186/1550-2783-9-s1-p4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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30
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Sikorski EM, Wilson JM, Lowery RP, Duncan NM, Davis GS, Rathmacher JA, Baier SM, Naimo MA, Wilson SMC, Dunsmore KA, Walters J, Joy J, Morrison TJ. The acute effects of a free acid beta-hydoxy-beta-methyl butyrate supplement on muscle damage following resistance training: a randomized, double-blind, placebo-controlled study. J Int Soc Sports Nutr 2012. [PMCID: PMC3500739 DOI: 10.1186/1550-2783-9-s1-p27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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McNider RT, Steeneveld GJ, Holtslag AAM, Pielke RA, Mackaro S, Pour-Biazar A, Walters J, Nair U, Christy J. Response and sensitivity of the nocturnal boundary layer over land to added longwave radiative forcing. ACTA ACUST UNITED AC 2012. [DOI: 10.1029/2012jd017578] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Coertse J, Nel LH, Sabeta CT, Weyer J, Grobler A, Walters J, Markotter W. A case study of rabies diagnosis from formalin-fixed brain material. J S Afr Vet Assoc 2012; 82:250-3. [PMID: 22616442 DOI: 10.4102/jsava.v82i4.83] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Rabies is caused by several Lyssavirus species, a group of negative sense RNA viruses. Although rabies is preventable, it is often neglected particularly in developing countries in the face of many competing public and veterinary health priorities. Epidemiological information based on laboratory-based surveillance data is critical to adequately strategise control and prevention plans. In this regard the fluorescent antibody test for rabies virus antigen in brain tissues is still considered the basic requirement for laboratory confirmation of animal cases. Occasionally brain tissues from suspected rabid animals are still submitted in formalin, although this has been discouraged for a number of years. Immunohistochemical testing or a modified fluorescent antibody technique can be performed on such samples. However, this method is cumbersome and cannot distinguish between different Lyssavirus species. Owing to RNA degradation in formalin-fixed tissues, conventional RT-PCR methodologies have also been proven to be unreliable. This report is concerned with a rabies case in a domestic dog from an area in South Africa where rabies is not common. Typing of the virus involved was therefore important, but the only available sample was submitted as a formalin-fixed specimen. A real-time RT-PCR method was therefore applied and it was possible to confirm rabies and obtain phylogenetic information that indicated a close relationship between this virus and the canid rabies virus variants from another province (KwaZulu-Natal) in South Africa.
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Affiliation(s)
- J Coertse
- Department of Microbiology and Plant Pathology, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, 0001, South Africa
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Walters J. 174 Horizontal saccade slowing in a patient with facial onset sensory and motor neuronopathy (FOSMN). J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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34
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Banik S, Johnston JA, Hinds NP, Walters J, Hill M. 155 A case series; a Miller Fisher Syndrome epidemic. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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35
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Carroll LS, Williams HJ, Walters J, Kirov G, O'Donovan MC, Owen MJ. Mutation screening of the 3q29 microdeletion syndrome candidate genes DLG1 and PAK2 in schizophrenia. Am J Med Genet B Neuropsychiatr Genet 2011; 156B:844-9. [PMID: 21850710 DOI: 10.1002/ajmg.b.31231] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 07/26/2011] [Indexed: 11/11/2022]
Abstract
Deletion of chromosome 3q29, which is associated with mental retardation and autism, was recently identified as being present in excess or occurring de novo in schizophrenia cases, being present in approximately 1/1,000 cases and 1/40,000 unscreened controls. Of the ∼20 genes in the commonly deleted region two are prominent candidates for involvement in the behavioral features of the microdeletion syndrome: DLG1 and PAK2. We report the result of mutation screening of the entire protein coding sequence of both genes in a sample of 234 unrelated cases and 272 unrelated controls from the UK. We find no evidence for any amino acid changing genetic variants in PAK2. We observe several rare and singleton non-synonymous genetic variations at DLG1, however there is no excess of these variants in cases when compared to controls. Our sample was underpowered to detect very rare or low-penetrance disease relevant alleles in the studied genes. Therefore very rare, low-to-moderate penetrance protein coding mutations or non-coding mutations at DLG1 and/or PAK2, or a nearby gene, may reproduce the behavioral characteristics of the 3q29 microdeletion.
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Affiliation(s)
- L S Carroll
- MRC Centre for Neuropsychiatric Genetics and Genomics, Department of Psychological Medicine and Neurology, School of Medicine, Cardiff University, UK.
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Olds TS, Ferrar K, Gomersall S, Walters J, Maher C. Promoting physical activity to children: Modeling ripple effects in time use. Obes Res Clin Pract 2011. [DOI: 10.1016/j.orcp.2011.08.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Stergiakouli E, Langley K, Williams H, Walters J, Williams NM, Suren S, Giegling I, Wilkinson LS, Owen MJ, O'Donovan MC, Rujescu D, Thapar A, Davies W. Steroid sulfatase is a potential modifier of cognition in attention deficit hyperactivity disorder. Genes Brain Behav 2011; 10:334-44. [PMID: 21255266 PMCID: PMC3664024 DOI: 10.1111/j.1601-183x.2010.00672.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Deletions encompassing the X-linked STS gene (encoding steroid sulfatase) have been observed in subjects with neurodevelopmental disorders, including attention deficit hyperactivity disorder (ADHD). Recently, two single nucleotide polymorphisms (SNPs) within STS (rs12861247 and rs17268988) have been reported to be associated with ADHD risk and inattentive symptoms in ADHD, respectively. Using a UK sample of ADHD subjects (aged 5-18 years), we tested the hypothesis that rs12861247 is associated with ADHD risk using a case-control approach (comparing 327 ADHD cases with 358 male controls from the Wellcome Trust Case Control Consortium). Using a subset of males from the ADHD sample, we also examined whether variation within STS is associated with symptomatology/cognitive function in ADHD. We then tested whether SNPs associated with cognitive function in ADHD were also associated with cognitive function in healthy male subjects using a German sample (n = 143, aged 18-30 years), and whether STS was expressed in brain regions pertinent to ADHD pathology during development. We did not replicate the previously identified association with rs12861247. However, in ADHD males, variation at rs17268988 was associated with inattentive symptoms, while variation within STS was significantly associated with performance on three cognitive measures. Three SNPs associated with cognitive function in ADHD males were not associated with cognitive function in healthy males. STS was highly expressed in the developing cerebellar neuroepithelium, basal ganglia, thalamus, pituitary gland, hypothalamus and choroid plexus. These data suggest that genetic variants affecting STS expression and/or activity could influence the function of brain regions perturbed in ADHD.
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Affiliation(s)
- E Stergiakouli
- MRC Centre for Neuropsychiatric Genetics and Genomics and Department of Psychological Medicine and Neurology, School of Medicine, Cardiff University, Cardiff, UK
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Abstract
Azithromycin enhances the response to root planing and produces anti-inflammatory effects in treating chronic lung disease. This led us to hypothesize that azithromycin inhibits inflammatory mediator production in gingiva, leading to decreased gingival crevicular fluid (GCF) volume. To test this hypothesis, ten periodontally healthy volunteers received azithromycin every 24 hours for 48 hours. GCF samples were collected from 12 maxillary interproximal sites prior to azithromycin (baseline) and 2, 4, 7, and 14 days later. Samples were assayed for IL-1beta, IL-8, TNF-alpha, VEGF, IL-6, and IL-10. With azithromycin treatment, GCF volume decreased significantly on days 2 through 7 (P < 0.05), but increased toward baseline levels on day 14. This was accompanied by a transient decrease in the content of IL-1beta, IL-8, TNF-alpha, and VEGF (P < 0.05). IL-6 and IL-10 were not detected. Since plaque was absent throughout the study, the findings suggest that azithromycin produces anti-inflammatory effects in gingiva.
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Affiliation(s)
- W Ho
- Division of Periodontology, College of Dentistry, 305 West 12th Avenue
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39
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Nagerl H, Walters J, Frosch KH, Dumont C, Kubein-Meesenburg D, Fanghanel J, Wachowski MM. Knee motion analysis of the non-loaded and loaded knee: a re-look at rolling and sliding. J Physiol Pharmacol 2009; 60 Suppl 8:69-72. [PMID: 20400796] [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] [Received: 10/22/2009] [Accepted: 12/18/2009] [Indexed: 05/29/2023]
Abstract
Many studies of knee motion have been reported in the literature over more than 100 years. Of particular interest to the analysis presented here is the work of the Freeman group, who elegantly measured tibio-femoral kinematics in studies made on cadavers and the knees of living individuals using MRI, anatomical dissection and RSA. We examined and re-evaluated the data collected by Freeman's group and suggest that their conclusion should be considered to be incorrect, since their methods of evaluation were oversimplified from the mathematical and physical perspectives. By applying appropriate methods, however, it is possible to show that the same data yield important insights into physiological knee kinematics and reveal that the rolling-sliding relationship depends on the degree of flexion and on joint load in the medial and lateral compartment, as well. In the initial range of flexion, a considerable amount of rolling was found to occur. Based on this analysis, it is possible to gain useful insights of value for the design of total knee replacements.
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Affiliation(s)
- H Nagerl
- Department of Orthodontics, Georg-August-University, Gottingen, Germany
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Nikles J, Mitchell G, Walters J, Hardy J, Good P, Rowett D, Shelby-James T, Currow D. Prioritising drugs for single patient (n-of-1) trials in palliative care. Palliat Med 2009; 23:623-34. [PMID: 19605605 DOI: 10.1177/0269216309106461] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many of the drugs prescribed commonly to palliative care patients have potentially significant side-effects and are of unproven benefit. The acquisition of evidence to support the prescribing of these drugs has been very slow. Single patient trials (SPTs) (also known as n-of-1 trials) offer a potential means of obtaining the evidence necessary to support or refute the use of several of the drugs and interventions whose use is currently based on physician experience or anecdote alone. A list of SPTs considered "most urgent", for commonly employed treatments and for the most common and most troublesome symptoms in palliative care is presented. These are drugs for which the gap between evidence and practice is greatest, where the evidence of efficacy is most lacking, where significant side effects potentially lead to the greatest morbidity, or where cost is a major patient burden. Although not all the drugs used in palliative care are suitable, SPTs provide a potential alternative method of gathering evidence in palliative care.
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Affiliation(s)
- J Nikles
- Discipline of General Practice, The University of Queensland, Herston, Brisbane, Queensland, Australia.
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41
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Irvin C, Walters J, Sills R. 245: Should the Deeply Comatose Trauma Patient Be Intubated by EMS? Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Smith DJ, Forty L, Russell E, Caesar S, Walters J, Cooper C, Jones I, Jones L, Craddock N. Sub-threshold manic symptoms in recurrent major depressive disorder are a marker for poor outcome. Acta Psychiatr Scand 2009; 119:325-9. [PMID: 19120045 DOI: 10.1111/j.1600-0447.2008.01324.x] [Citation(s) in RCA: 38] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A small but significant proportion of patients with major depressive disorder (MDD) report mild manic symptoms which are below the diagnostic threshold for a hypomanic episode. METHOD We tested for an association between sub-threshold manic symptoms and clinical outcome in almost 600 patients with recurrent MDD who also had no known family history of bipolar disorder. RESULTS 9.6% of this large sample had a life-time history of sub-threshold manic symptoms. These patients were significantly more likely to have a history of poor response to antidepressants (OR 2.84; 95% CI 1.23-6.56; P < 0.02) and more likely to have experienced psychosis (OR 2.07; 95% CI 1.05-4.09; P < 0.04). They had also experienced more depressive episodes on average (P = 0.006) and were more likely to have been admitted to hospital (P < 0.03). CONCLUSION Sub-threshold manic symptoms in patients with recurrent MDD may be a useful clinical marker for poor response to antidepressants and a more morbid long-term clinical course.
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Affiliation(s)
- D J Smith
- Department of Psychological Medicine, School of Medicine, Cardiff University, University Hospital of Wales, Cardiff, UK.
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Raza M, Walters J, Soto H, Sharma M, Chockalingam S. Probable association of interatrial septal aneurysm with cerebral embolic episode. Clin Cardiol 2009; 22:814. [PMID: 10626085 PMCID: PMC6655729 DOI: 10.1002/clc.4960221212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- M Raza
- Mount Sinai Services, Queens Hospitals Center, Jamaica, New York 11432, USA
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Russo EA, Harris AW, Campbell S, Lindsay J, Hart A, Arebi N, Milestone A, Tsai HH, Walters J, Carpani M, Westaby D, Thillainayagam A, Bansi D, Ghosh S. Experience of maintenance infliximab therapy for refractory ulcerative colitis from six centres in England. Aliment Pharmacol Ther 2009; 29:308-14. [PMID: 19035973 DOI: 10.1111/j.1365-2036.2008.03890.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Infliximab is used for treatment of Crohn's disease and, following the Active Ulcerative Colitis Trials (ACT) 1 and 2, it has been used as rescue and maintenance therapy in moderate and severe ulcerative colitis (UC). AIM To report on English experience with maintenance infliximab in terms of response and colectomy rates and side-effect profile in UC. METHODS A retrospective audit conducted by using a web-based questionnaire filled in by 12 gastroenterologists from six English centres. RESULTS Of the 38 patients receiving induction with infliximab, 28 (73.6%) maintained an ongoing response (8-weekly infusions 5 mg/kg) for a mean duration of 16.8 months (range 4-59), with 21 (55.3%) being in remission. Three of 38 patients (7.9%) who also responded had a secondary loss of response after an average of 10 months (range 8-13); seven of 38 patients (18.4%) showed no response. The colectomy rate was seven of 38 (18.4%, five non-responders and two with secondary loss of response). Adverse effects occurred in five patients (13.2%). Two discontinued infliximab (alopecia, invasive breast cancer). The three less-severe adverse effects were acute and delayed-type hypersensitivity reactions and one persistent otitis media. CONCLUSION Our experience suggests acceptable response rates, colectomy rates and side-effect profile of maintenance therapy with infliximab in moderate and severe UC.
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Affiliation(s)
- E A Russo
- Imperial College Healthcare NHS Trust, London, UK
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Hamson-Utley JJ, Martin S, Walters J. Athletic trainers' and physical therapists' perceptions of the effectiveness of psychological skills within sport injury rehabilitation programs. J Athl Train 2008; 43:258-64. [PMID: 18523575 DOI: 10.4085/1062-6050-43.3.258] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Psychological skills are alleged to augment sport-injury rehabilitation; however, implementation of mental imagery within rehabilitation programs is limited. OBJECTIVE To examine attitudes of athletic trainers (ATs) and physical therapists (PTs) on the effectiveness of mental imagery, goal setting, and positive self-talk to improve rehabilitation adherence and recovery speed of injured athletes. DESIGN The ATs and PTs were contacted via electronic or physical mailings to complete a single administration survey that measured their beliefs about the effectiveness of psychological skills for increasing adherence and recovery speed of injured athletes undergoing rehabilitation. SETTING Professional member databases of the National Athletic Trainers' Association and the American Physical Therapy Association. PATIENTS OR OTHER PARTICIPANTS Of the 1000 ATs and 1000 PTs who were selected randomly, 309 ATs (age = 34.18 +/- 8.32 years, years in profession = 10.67 +/- 7.34) and 356 PTs (age = 38.58 +/- 7.51 years, years in profession = 13.18 +/- 6.17) responded. MAIN OUTCOME MEASURE(S) The Attitudes About Imagery (AAI) survey measures attitudes about psychological skills for enhancing adherence and recovery speed of injured athletes. The AAI includes demographic questions and 15 items on a 7-point Likert scale measuring attitudes about the effectiveness of mental imagery, self-talk, goal setting, and pain control on rehabilitation adherence and recovery speed of injured athletes. Test-retest reliability ranged from .60 to .84 and Cronbach alphas ranged from .65 to .90. We calculated 1-way analyses of variance to determine whether differences existed in attitudes as a result of the professionals' education, training experience, and interest. RESULTS Mean differences were found on attitudes about effectiveness of psychological skills for those who reported formal training and those who reported interest in receiving formal training (P < .05). In addition, ATs held more positive attitudes than PTs on 9 of 15 AAI items (P < .05). CONCLUSIONS Overall, ATs and PTs held positive attitudes on the effectiveness of psychological skills to augment the rehabilitation process. Clinical implications regarding the use of mental skills are discussed.
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Travers S, Geran L, Kinzeler N, Walters J. Functional studies of brainstem taste processing. Appetite 2008. [DOI: 10.1016/j.appet.2008.04.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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47
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van der Jagt D, Golele R, Govender S, Lukhele M, Shipley JA, Vlok GJ, Walters J. Orthopaedic injuries in state hospitals compromised. S Afr Med J 2008; 98:601-602. [PMID: 18928035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Sparano BA, Egorin MJ, Parise RA, Walters J, Komazec KA, Redner RL, Beumer JH. Effect of antacid co-medication on imatinib disposition: A healthy volunteer study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.2547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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49
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Granger R, Walters J, Poole PJ, Lasserson TJ, Mangtani P, Cates CJ, Wood-Baker R. Injectable vaccines for preventing pneumococcal infection in patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006:CD001390. [PMID: 17054135 DOI: 10.1002/14651858.cd001390.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND As chronic obstructive pulmonary disease (COPD) progresses, exacerbations can occur with increasing frequency. One goal of therapy in COPD is to try and prevent these exacerbations, thereby reducing disease morbidity and associated healthcare costs. Pneumococcal vaccinations are considered to be one strategy for reducing the risk of infective exacerbations. OBJECTIVES To determine the safety and efficacy of pneumococcal vaccination in COPD. The primary outcome assessed was acute exacerbations. Secondary outcomes of interest included episodes of pneumonia, hospital admissions, adverse events related to treatment, disability, change in lung function, mortality, and cost effectiveness. SEARCH STRATEGY We searched the Cochrane Airways Group COPD trials register using pre-specified terms. We also conducted additional handsearches of conference abstracts. The last round of searches were performed in April 2006. SELECTION CRITERIA Only randomised controlled trials assessing the effects of injectable pneumococcal vaccine in people with COPD were included. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and three review authors independently assessed trial quality. MAIN RESULTS Although 10 studies cited in 11 publications were identified that met the inclusion criteria for this review, only four of these provided data on participants with COPD. The studies which did provide data for this review consisted of two trials using a 14-valent vaccine, and two using a 23-valent injectable vaccine. Data for the primary outcome, acute exacerbation of COPD, was available from only one of the four studies. The odds ratio of 1.43 (95% confidence interval (CI) 0.31 to 6.69) between interventions was not statistically significant. Of the secondary outcomes for which data were available and could be extracted, none reached statistical significance. Three studies provided dichotomous data for persons who developed pneumonia (OR 0.89, 95% CI 0.58 to 1.37, n = 748). Rates of hospital admissions and emergency department visits came from a single study. There was no significant reduction in the odds of all-cause mortality 1 to 48 months post-vaccination (Peto odds ratio 0.94, 95% CI 0.67 to 1.33, n = 888), or for death from cardiorespiratory causes (OR 1.07, 95% CI 0.69 to 1.66). AUTHORS' CONCLUSIONS There is no evidence from randomised controlled trials that injectable pneumococcal vaccination in persons with COPD has a significant impact on morbidity or mortality. Further large randomised controlled trials would be needed to ascertain if the small benefits suggested by individual studies are real.
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Affiliation(s)
- R Granger
- University of Tasmania, Medicine, GPO Box 252-34, Hobart, Tasmania, Australia
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O'Toole MS, Ohlsen RI, Taylor TM, Purvis R, Walters J, Pilowsky LS. Treating first episode psychosis--the service users' perspective: a focus group evaluation. J Psychiatr Ment Health Nurs 2004; 11:319-26. [PMID: 15149380 DOI: 10.1111/j.1365-2850.2004.00730.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UK national guidance has prioritized developing specialist services for first episode psychosis. Such services are in the early stages of development and a definitive treatment model has yet to be established. The aim of this study was to explore service users' experiences of a first episode intervention designed along evidence-based 'best practice' guidelines and to establish specific elements seen as effective to help inform future service planning and provision. Twelve users of a specialist first episode service participated in focus groups. These were then analyzed using Interpretative Phenomenological Analysis, a specialized form of content analysis. Key elements identified by the service users included the 'human' approach as a key to the recovery process, being involved in treatment decisions, flexibility of appointments, high nurse to patient ratio, reduction in psychotic symptoms, increased confidence and independence and the provision of daily structure. To our knowledge, this is the first systematic qualitative evaluation of users' experience of a specialist first episode treatment intervention. Our findings indicate that adherence to best practice guidelines was appreciated. Regular focus groups provide a continuous audit cycle incorporating service improvements in line with government recommendations, centrally informed by the service users' and caregivers' perspective.
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Affiliation(s)
- M S O'Toole
- Institute of Psychiatry, London and South London and Maudsley (NHS) Trust, UK
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