26
|
Hill M, Vipler S, Sutherland C, Nolan S. Challenges of treatment of acutely ill patients enrolled in a managed alcohol program. Drug Alcohol Rev 2017; 37 Suppl 1:S143-S144. [PMID: 28868652 DOI: 10.1111/dar.12600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
27
|
McNeilly A, Gao A, Hill A, Gomersall T, Balfour D, Sutherland C, Stewart C. The effect of dietary intervention on the metabolic and behavioural impairments generated by short term high fat feeding in the rat. Physiol Behav 2016; 167:100-109. [DOI: 10.1016/j.physbeh.2016.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/03/2016] [Accepted: 08/31/2016] [Indexed: 01/22/2023]
|
28
|
Walton G, Nolan S, Sutherland C, Ahamad K. Sustained release oral morphine as an alternative to methadone for the treatment of opioid-use disorder post Torsades de Pointes cardiac arrest. BMJ Case Rep 2015; 2015:bcr-2015-210239. [PMID: 26392442 DOI: 10.1136/bcr-2015-210239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In most settings, approved medications for the treatment of opioid-use disorder include methadone and buprenorphine/naloxone, and in some settings, naltrexone. We present a case in which methadone administration was associated with an in-hospital episode of Torsades de Pointes in a patient who was subsequently maintained on sustained release oral morphine (SROM) for treatment of his opioid-use disorder. This transition was made in the context of long-term compliance to methadone maintenance, and with a previous adverse reaction to buprenorphine/naloxone precluding its use. The change to SROM, supported by emerging evidence, resulted in a reduction in the patient's measured QTc interval, prevention of further arrhythmias and continued abstinence from illicit opioid-use. In this context, we believe careful consideration should be given to the use of SROM.
Collapse
|
29
|
Zivanovic R, Milloy MJ, Hayashi K, Dong H, Sutherland C, Kerr T, Wood E. Impact of unstable housing on all-cause mortality among persons who inject drugs. BMC Public Health 2015; 15:106. [PMID: 25884182 PMCID: PMC4389703 DOI: 10.1186/s12889-015-1479-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background Illicit drug injecting is a well-established risk factor for morbidity and mortality. However, a limited number of prospective studies have examined the independent effect of unstable housing on mortality among persons who inject drugs (PWIDs). In this study we sought to identify if a relationship exists between unstable housing and all-cause mortality among PWIDs living in Vancouver, Canada. Methods PWIDs participating in two prospective cohort studies in Vancouver, Canada were followed between May 1996 and December 2012. Cohort data were linked to the provincial vital statistics database to ascertain mortality rates and causes of death. We used multivariate Cox proportional hazards regression to determine factors associated with all-cause mortality and to investigate the independent relationship between unstable housing and time to all-cause mortality. Results During the study period, 2453 individuals were followed for a median of 69 months (Inter-quartile range [IQR]: 34 – 113). In total, there were 515 (21.0%) deaths for an incidence density of 3.1 (95% Confidence Interval [CI]: 2.8 – 3.4) deaths per 100 person years. In multivariate analyses, after adjusting for potential confounders including HIV infection and drug use patterns, unstable housing remained independently associated with all-cause mortality (adjusted hazard ratio [AHR] = 1.30, 95% CI: 1.08 – 1.56). Conclusions These findings demonstrate that unstable housing is an important risk factor for mortality independent of known risk factors including HIV infection and patterns of drug use. This study highlights the urgent need to provide supportive housing interventions to address elevated levels of preventable mortality among this population.
Collapse
|
30
|
Sutherland C, Oldmeadow J, Young A. Are first impressions the same for male and female faces? J Vis 2014. [DOI: 10.1167/14.10.1275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
31
|
Sutherland C, Elston DA, Lambin X. Accounting for false positive detection error induced by transient individuals. WILDLIFE RESEARCH 2013. [DOI: 10.1071/wr12166] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Context
In metapopulations, colonisation is the result of dispersal from neighbouring occupied patches, typically juveniles dispersing from natal to breeding sites. When occupancy dynamics are dispersal driven, occupancy should refer to the presence of established, breeding populations. The detection of transient individuals at sites that are, by definition, unoccupied (i.e. false positive detections), may result in misleading conclusions about metapopulation dynamics. Until recently, the issue of false positives has been considered negligible and current efforts to account for such error have been restricted to the context of species misidentification. However, the detection of transient individuals visiting multiple sites while dispersing is a distinct source of false positives that can bias estimates of occupancy because visited sites do not contribute to metapopulation dynamics in the same way as do sites occupied by established, reproducing populations. Although transient-induced false positive error presents a challenge to occupancy studies aiming to account for all sources of detection error and estimate occupancy without bias, accounting for it has received little attention.
Aims
Using a novel application of an existing occupancy model, we sought to account for false positives that result from transient individuals being observed at truly unoccupied sites (i.e. where no establishment has occurred).
Methods
We applied a Bayesian multi-season occupancy model correcting for false negative and false positive errors, to 3 years of detection or non-detection data from a metapopulation of water voles, Arvicola amphibious, in which both types of patch-state misclassification are suspected.
Key results
We provide evidence that transient individuals can cause false positive detection errors. We then demonstrate the flexibility of the occupancy model to account for both false negative and false positive detection errors beyond the typical application to species misidentification. Accounting for both types of observation error reduces the bias in estimates of occupancy and avoids misleading conclusions about the status of (meta) populations by allowing for the distinction to be made between resident and transient occupancy.
Conclusion
In many species, transience may result in patch-state misclassification which needs to be accounted for so as to draw correct inference about metapopulation status. Making the distinction between occupancy by established populations and visitation by transients will influence how we interpret patch occupancy dynamics, with important implications for the management of wildlife.
Implications
The ability to estimate occupancy free of bias induced by false positive detections can help ensure that downward trends in occupancy are detected despite such declines being accompanied by increasing frequency of transients associated with, for example, reductions in mate availability or failure to establish. Our approach can be applied to any occupancy study in which false positive detections are suspected because of the behaviour of the focal species.
Collapse
|
32
|
McNeilly AD, Williamson R, Balfour DJK, Stewart CA, Sutherland C. A high-fat-diet-induced cognitive deficit in rats that is not prevented by improving insulin sensitivity with metformin. Diabetologia 2012; 55:3061-70. [PMID: 22898768 DOI: 10.1007/s00125-012-2686-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 07/13/2012] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS We previously demonstrated that animals fed a high-fat (HF) diet for 10 weeks developed insulin resistance and behavioural inflexibility. We hypothesised that intervention with metformin would diminish the HF-feeding-evoked cognitive deficit by improving insulin sensitivity. METHODS Rats were trained in an operant-based matching and non-matching to position task (MTP/NMTP). Animals received an HF (45% of kJ as lard; n = 24), standard chow (SC; n = 16), HF + metformin (144 mg/kg in diet; n = 20) or SC + metformin (144 mg/kg in diet; n = 16) diet for 10 weeks before retesting. Body weight and plasma glucose, insulin and leptin were measured. Protein lysates from various brain areas were analysed for alterations in intracellular signalling or production of synaptic proteins. RESULTS HF-fed animals developed insulin resistance and an impairment in switching task contingency from matching to non-matching paradigm. Metformin attenuated the insulin resistance and weight gain associated with HF feeding, but had no effect on performance in either MTP or NMTP tasks. No major alteration in proteins associated with insulin signalling or synaptic function was detected in response to HF diet in the hypothalamus, hippocampus, striatum or cortex. CONCLUSIONS/INTERPRETATION Metformin prevented the metabolic but not cognitive alterations associated with HF feeding. The HF diet protocol did not change basal insulin signalling in the brain, suggesting that the brain did not develop insulin resistance. These findings indicate that HF diet has deleterious effects on neuronal function over and above those related to insulin resistance and suggest that weight loss may not be sufficient to reverse some damaging effects of poor diet.
Collapse
|
33
|
Chowdhry S, Zhang Y, McMahon M, Sutherland C, Cuadrado A, Hayes JD. Nrf2 is controlled by two distinct β-TrCP recognition motifs in its Neh6 domain, one of which can be modulated by GSK-3 activity. Oncogene 2012; 32:3765-81. [PMID: 22964642 PMCID: PMC3522573 DOI: 10.1038/onc.2012.388] [Citation(s) in RCA: 470] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/11/2012] [Accepted: 07/13/2012] [Indexed: 02/07/2023]
Abstract
Identification of regulatable mechanisms by which transcription factor NF-E2 p45-related factor 2 (Nrf2) is repressed will allow strategies to be designed that counter drug resistance associated with its up-regulation in tumours that harbour somatic mutations in Kelch-like ECH-associated protein-1 (Keap1), a gene that encodes a joint adaptor and substrate receptor for the Cul3-Rbx1/Roc1 ubiquitin ligase. We now show that mouse Nrf2 contains two binding sites for β-transducin repeat-containing protein (β-TrCP), which acts as a substrate receptor for the Skp1-Cul1-Rbx1/Roc1 ubiquitin ligase complex. Deletion of either binding site in Nrf2 decreased β-TrCP-mediated ubiquitylation of the transcription factor. The ability of one of the two β-TrCP-binding sites to serve as a degron could be both increased and decreased by manipulation of glycogen synthase kinase-3 (GSK-3) activity. Biotinylated-peptide pull-down assays identified DSGIS338 and DSAPGS378 as the two β-TrCP-binding motifs in Nrf2. Significantly, our pull-down assays indicated that β-TrCP binds a phosphorylated version of DSGIS more tightly than its non-phosphorylated counterpart, whereas this was not the case for DSAPGS. These data suggest that DSGIS, but not DSAPGS, contains a functional GSK-3 phosphorylation site. Activation of GSK-3 in Keap1-null mouse embryonic fibroblasts (MEFs), or in human lung A549 cells that contain mutant Keap1, by inhibition of the phosphoinositide 3-kinase (PI3K) – protein kinase B (PKB)/Akt pathway markedly reduced endogenous Nrf2 protein and decreased to 10-50% of normal the levels of mRNA for prototypic Nrf2-regulated enzymes, including the glutamate-cysteine ligase catalytic and modifier subunits, glutathione S-transferases Alpha-1 and Mu-1, heme oxygenase-1 and NAD(P)H:quinone oxidoreductase-1. Pre-treatment of Keap1−/− MEFs or A549 cells with the LY294002 PI3K inhibitor or the MK-2206 PKB/Akt inhibitor increased their sensitivity to acrolein, chlorambucil and cisplatin between 1.9-fold and 3.1-fold, and this was substantially attenuated by simultaneous pre-treatment with the GSK-3 inhibitor CT99021.
Collapse
|
34
|
Abstract
For many years, the development of insulin resistance has been seen as the core defect responsible for the development of Type 2 diabetes. However, despite extensive research, the initial factors responsible for insulin resistance development have not been elucidated. If insulin resistance can be overcome by enhanced insulin secretion, then hyperglycaemia will never develop. Therefore, a β-cell defect is clearly required for the development of diabetes. There is a wealth of evidence to suggest that disorders in insulin secretion can lead to the development of decreased insulin sensitivity. In this review, we describe the potential initiating defects in Type 2 diabetes, normal pulsatile insulin secretion and the effects that disordered secretion may have on both β-cell function and hepatic insulin sensitivity. We go on to examine evidence from physiological and epidemiological studies describing β-cell dysfunction in the development of insulin resistance. Finally, we describe how disordered insulin secretion may cause intracellular insulin resistance and the implications this concept has for diabetes therapy. In summary, disordered insulin secretion may contribute to development of insulin resistance and hence represent an initiating factor in the progression to Type 2 diabetes.
Collapse
|
35
|
Williamson R, Sutherland C. Neuronal membranes are key to the pathogenesis of Alzheimer's disease: the role of both raft and non-raft membrane domains. Curr Alzheimer Res 2011; 8:213-21. [PMID: 21222605 DOI: 10.2174/156720511795256008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 07/02/2010] [Indexed: 11/22/2022]
Abstract
Membrane rafts are sterol- and sphingolipid-enriched domains that compartmentalize cellular processes. Membrane rafts isolated from post-mortem AD brain are enriched in both β-amyloid and phosphorylated tau. Proteolytic processing of APP to generate β-amyloid, the principle component of amyloid plaques, can occur in membrane rafts, implicating them in the pathogenesis of Alzheimer's disease (AD). Secondary to their role in β-amyloid generation, membrane rafts have more recently been implicated in the accumulation, aggregation and degradation of β-amyloid, with evidence supporting a specific role for membrane raft gangliosides in the binding and aggregation of β-amyloid. In addition, membrane domain composition has a direct impact on both the generation of β-amyloid and its subsequent toxic actions and as such is a key target for the development of therapeutic strategies. This mini-review will focus on recent advances in our understanding of the relevance of membrane composition, of both raft and non-raft domains, to AD progression in models and in human disease. We will discuss how manipulation of membrane composition can alter both the proteolytic processing of APP and the subsequent binding and aggregation of β-amyloid peptide.
Collapse
|
36
|
|
37
|
Sutherland C. The Oxford Handbook of Women's Health Nursing. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2011. [DOI: 10.1136/jfprhc.2011.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
38
|
Clayton E, Sue N, Smillie K, O’Leary T, Bache N, Cheung G, Cole A, Wyllie D, Sutherland C, Robinson P, Cousin M. Dynamin I phosphorylation by GSK3 controls activity-dependent bulk endocytosis of synaptic vesicles. Nat Neurosci 2010; 13:845-51. [PMID: 20526333 PMCID: PMC2894011 DOI: 10.1038/nn.2571] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 05/06/2010] [Indexed: 01/02/2023]
Abstract
Glycogen synthase kinase 3 (GSK3) is a critical enzyme in neuronal physiology; however, it is not yet known whether it has any specific role in presynaptic function. We found that GSK3 phosphorylates a residue on the large GTPase dynamin I (Ser-774) both in vitro and in primary rat neuronal cultures. This was dependent on prior phosphorylation of Ser-778 by cyclin-dependent kinase 5. Using both acute inhibition with pharmacological antagonists and silencing of expression with short hairpin RNA, we found that GSK3 was specifically required for activity-dependent bulk endocytosis (ADBE) but not clathrin-mediated endocytosis. Moreover we found that the specific phosphorylation of Ser-774 on dynamin I by GSK3 was both necessary and sufficient for ADBE. These results demonstrate a presynaptic role for GSK3 and they indicate that a protein kinase signaling cascade prepares synaptic vesicles for retrieval during elevated neuronal activity.
Collapse
|
39
|
Soutar MPM, Thornhill P, Cole AR, Sutherland C. Increased CRMP2 phosphorylation is observed in Alzheimer's disease; does this tell us anything about disease development? Curr Alzheimer Res 2009; 6:269-78. [PMID: 19519308 DOI: 10.2174/156720509788486572] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Collapsin response mediator protein-2 (CRMP2) was recently identified as a physiological substrate for GSK3 and Cdk5, two protein kinases suggested to exhibit greater activity in Alzheimer's disease (AD). Indeed, phosphorylation of CRMP2, at the residues targeted by GSK3 and Cdk5, is relatively high in cortex isolated from human AD brain, as well as in the brains of animal models of AD, while phospho-CRMP2 is found in neurofibrillary tangles. In mouse models of AD, increased phosphorylation occurs prior to pathology. Although CRMP2 has no known enzymatic activity, a great deal of information is appearing on its importance in neuronal development and polarity, as well as in axon growth and guidance. In this mini-review, we examine what is known about CRMP2 function, how that is controlled by phosphorylation, what alterations in molecular mechanisms could lead to the abnormally high CRMP2 phosphorylation in AD, and whether this is likely to be specific to AD or occur in other forms of neurodegeneration. This will include discussion of the evidence for increased GSK3 or Cdk5 activity, for decreased phosphatase activity, or the upregulation of other CRMP2 protein kinases in AD. Importantly, we will compare the processes that may contribute to increased CRMP2 phosphorylation with those known to increase tau hyperphosphorylation in AD, and whether these are likely to be part of disease development or a useful early marker for AD.
Collapse
|
40
|
Tsuji LJS, Wainman BC, Martin ID, Weber JP, Sutherland C, Liberda EN, Nieboer E. Elevated blood-lead levels in first nation people of Northern Ontario Canada: policy implications. BULLETIN OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2008; 80:14-18. [PMID: 17917695 DOI: 10.1007/s00128-007-9281-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 09/05/2007] [Indexed: 05/25/2023]
Abstract
We evaluated the preliminary impact of the Canadian "non-toxic" shotshell policy, for the hunting of migratory game birds, by examining blood-lead levels of First Nations people living in sub-arctic Canada. If the use of lead shotshell was the major source of lead exposure as has been postulated and the ban on the use of lead shotshell for hunting migratory birds was immediately effective, we would expect that blood-lead levels would be typical of a geographic area remote from industrialization. Our findings present some concern in that approximately 18% of the 196 First Nations people examined had blood-lead levels > or =100 microg/L.
Collapse
|
41
|
Sutherland C. LXXVII: Asthma in the British Army. 1942. J ROY ARMY MED CORPS 2006; 152:269-72; discussion 268-9. [PMID: 17508650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|
42
|
Liu HK, Perrier S, Lipina C, Finlay D, McLauchlan H, Hastie CJ, Hundal HS, Sutherland C. Functional characterisation of the regulation of CAAT enhancer binding protein alpha by GSK-3 phosphorylation of Threonines 222/226. BMC Mol Biol 2006; 7:14. [PMID: 16600022 PMCID: PMC1456981 DOI: 10.1186/1471-2199-7-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Accepted: 04/06/2006] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Glycogen Synthase Kinase-3 (GSK3) activity is repressed following insulin treatment of cells. Pharmacological inhibition of GSK3 mimics the effect of insulin on Phosphoenolpyruvate Carboxykinase (PEPCK), Glucose-6 Phosphatase (G6Pase) and IGF binding protein-1 (IGFBP1) gene expression. CAAT/enhancer binding protein alpha (C/EBPalpha) regulates these gene promoters in liver and is phosphorylated on two residues (T222/T226) by GSK3, although the functional outcome of the phosphorylation has not been established. We aimed to establish whether CEBPalpha is a link between GSK3 and these gene promoters. RESULTS C/EBPalpha represses the IGFBP1 thymine-rich insulin response element (TIRE), but mutation of T222 or T226 of C/EBPalpha to non-phosphorylatable alanines has no effect on C/EBPalpha activity in liver cells (towards the TIRE or a consensus C/EBP binding sequence). Phosphorylation of T222/T226 is decreased by GSK3 inhibition, suggesting GSK3 does phosphorylate T222/226 in intact cells. However, phosphorylation was not altered by treatment of liver cells with insulin. Meanwhile C/EBPalpha activity in 3T3 L1 preadipocytes was enhanced by mutation of T222/T226 and/or S230 to alanine residues. Finally, we demonstrate that C/EBPalpha is a very poor substrate for GSK3 in vitro and in cells. CONCLUSION The work demonstrates an important role for this domain in the regulation of C/EBPalpha activity in adipocytes but not hepatocytes, however GSK3 phosphorylation of these residues does not mediate regulation of this C/EBP activity. In short, we find no evidence that C/EBPalpha activity is regulated by direct phosphorylation by GSK3.
Collapse
|
43
|
Ong CT, Dandekar PK, Sutherland C, Nightingale CH, Nicolau DP. Intrapulmonary Concentrations of Telithromycin: Clinical Implications for Respiratory Tract Infections due to Streptococcus pneumoniae. Chemotherapy 2005; 51:339-46. [PMID: 16224186 DOI: 10.1159/000088958] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Accepted: 05/02/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antimicrobial efficacy is dependent on the ability of the agent to reach the site of infection. To assess the bronchopulmonary drug disposition of a novel ketolide, telithromycin (TEL), the epithelial lining fluid (ELF) and alveolar macrophage (AM) concentrations were utilized as a surrogate marker for lung penetration. METHODS Adult subjects scheduled for diagnostic bronchoscopy received oral TEL 800 mg once daily for 5 days. Plasma and bronchoalveolar lavage (BAL) samples were collected 2, 8, 12, or 24 h after the last TEL dose. TEL concentrations in the ELF and AM were determined using a validated HPLC assay. ELF drug concentrations were calculated using the urea dilution method. RESULTS Seventeen subjects with a mean age 65 +/- 13 years and a mean weight of 81 +/- 25 kg completed this open-label study. The median (range) TEL concentrations in plasma and ELF, respectively, were 1.09 mg/l (1.00-4.81) and 3.91 mg/l (2.64-9.59) at 2 h (n = 6), 0.48 and 1.09 mg/l at 8 h (n = 1), 0.65 mg/l (0.18-1.55) and 1.81 mg/l (0.61-10.0) at 12 h (n = 5), and 0.11 mg/l (0.09-0.24) and 0.69 mg/l (0.15-1.58) at 24 h (n = 5). The median AM concentrations obtained from these subjects were 53.35 mg/l at 2 h, 32.55 mg/l at 8 h, 65.96 mg/l at 12 h, and 26.43 mg/l at 24 h. Overall TEL was well tolerated. No discontinuation was required due to an adverse event. CONCLUSIONS TEL displayed high intrapulmonary penetration with ELF concentrations exceeding that of plasma at all time points. AM intracellular concentrations were multiple times higher than in the ELF and plasma. These data support the clinical efficacy of TEL against intracellular and extracellular pathogens, particularly with Streptococcus pneumoniae having an MIC(90 )well below achievable concentrations at the site of infection.
Collapse
|
44
|
Tsuji LJS, Wainman BC, Martin ID, Weber JP, Sutherland C, Nieboer E. Elevated levels of PCBs in first nation communities of the Western James Bay region of Northern Ontario, Canada: the use of correspondence analysis to identify source of exposure. BULLETIN OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2005; 75:903-9. [PMID: 16400577 DOI: 10.1007/s00128-005-0835-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 08/26/2005] [Indexed: 05/06/2023]
|
45
|
McWilliam CL, Ward-Griffin C, Sweetland D, Sutherland C, O'Halloran L. The experience of empowerment in in-home services delivery. Home Health Care Serv Q 2002; 20:49-71. [PMID: 12068966 DOI: 10.1300/j027v20n04_03] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In-home health services strive for client-centredness, involvement, and ultimately, empowerment, but economic constraint may undermine these aims. The purpose of this study was to explore the everyday experience of in-home care, with particular attention to the enactment of empowerment in the care partnership. In-depth interviews with a maximally varied sample of clients, informal caregivers, and providers uncovered relationships largely reflecting the traditional expert model of care. Findings afford insights into the unrecognized and undervalued personal knowledge of clients, caregivers, and in-home service providers, the professional and structural hegemony and consequent disempowered group behaviour of those who share the experience of care, and the hesitance of clients to engage as equitable partners in care. Strategies to achieve empowerment approaches to in-home health services are identified.
Collapse
|
46
|
Tami A, Grundmann H, Sutherland C, McBride JS, Cavanagh DR, Campos E, Snounou G, Barnabé C, Tibayrenc M, Warhurst DC. Restricted genetic and antigenic diversity of Plasmodium falciparum under mesoendemic transmission in the Venezuelan Amazon. Parasitology 2002; 124:569-81. [PMID: 12118712 DOI: 10.1017/s0031182002001713] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The study of genetic diversity in malaria populations is expected to provide new insights for the deployment of control measures. Plasmodium falciparum diversity in Africa and Asia is thought to reflect endemicity. In comprehensive epidemiological surveys reported here the genetic and antigenic structure of P. falciparum in the Venezuelan Amazon were studied over a 2-year period. DNA polymorphisms in glutamate-rich protein (GLURP), merozoite-surface protein 1 (MSP1) and MSP2 genes, in a multicopy element (PfRRM), all showed low diversity, 1 predominant genotype, and virtually no multi-clonal infections. Moreover, linkage disequilibrium was seen between GLURP, MSP1 and MSP2. Specific antibody responses against MSP1 and MSP2 recombinant antigens reflected the low genetic diversity observed in the parasite population. This is unexpected in a mesoendemic area, and suggests that the low diversity here may not only relate to endemicity but to other influences such as a bottleneck effect. Linkage disequilibrium and a predominant genotype may imply that P. falciparum frequently propagates with an epidemic or clonal population structure in the Venezuelan Amazon.
Collapse
|
47
|
McWilliam CL, Stewart M, Sangster J, Cohen I, Mitchell J, Sutherland C, Ryan B. Work in progress. Integrating physicians' services in the home. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2001; 47:2502-9. [PMID: 11785281 PMCID: PMC2018482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE While increasing acuity levels and the concomitant complexity of service demand that physicians be involved in in-home care, conflicting evidence and opinions do not show how this can best be achieved. DESIGN A phenomenologic research design was used to obtain insights into the challenges and opportunities of integrating physicians' services into the usual in-home services in London, Ont. SETTING Home care in London, Ont. PARTICIPANTS Twelve participants included three patients, two family caregivers, two family physicians, the program's nurse practitioner, two case managers, and two community nurses. METHOD In-depth interviews with a maximally varied purposeful sample of patients, caregivers, and providers were analyzed using immersion and crystallization techniques. MAIN FINDINGS Findings revealed the potential for enhanced continuity of care and interdisciplinary team functioning. Having a nurse practitioner, interdisciplinary team-building exercises and meetings, regular face-to-face contact among all providers, support for family caregivers, and 24-hour coverage for physicians were found to be essential for success. CONCLUSION Integration of services takes time, money, and sustained commitment, particularly when undertaken in geographically isolated communities. Informed choice and a fair remuneration system remain important considerations for family physicians.
Collapse
|
48
|
Kjos SL, Schaefer-Graf U, Sardesi S, Peters RK, Buley A, Xiang AH, Bryne JD, Sutherland C, Montoro MN, Buchanan TA. A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Diabetes Care 2001; 24:1904-10. [PMID: 11679455 DOI: 10.2337/diacare.24.11.1904] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare management based on maternal glycemic criteria with management based on relaxed glycemic criteria and fetal abdominal circumference (AC) measurements in order to select patients for insulin treatment of gestational diabetes mellitus (GDM) with fasting hyperglycemia. RESEARCH DESIGN AND METHODS In a pilot study, 98 women with fasting plasma glucose (FPG) concentrations of 105-120 mg/dl were randomized. The standard group received insulin treatment. The experimental group received insulin if the AC, measured monthly, was > or =70th percentile and/or if any venous FPG measurement was >120 mg/dl. Power was projected to detect a 250-g difference in birth weights. RESULTS Gestational ages, maternal glycemia, and AC percentiles were similar at randomization. After initiation of protocol, venous FPG (P = 0.003) and capillary blood glucose levels (P = 0.049) were significantly lower in the standard group. Birth weights (3,271 +/- 458 vs. 3,369 +/- 461 g), frequencies of birth weights >90th percentile (6.3 vs 8.3%), and neonatal morbidity (25 vs. 25%) did not differ significantly between the standard and experimental groups, respectively. The cesarean delivery rate was significantly lower (14.6 vs. 33.3%, P = 0.03) in the standard group; this difference was not explained by birth weights. In the experimental group, infants of women who did not receive insulin had lower birth weights than infants of mothers treated with insulin (3,180 +/- 425 vs. 3,482 +/- 451 g, P = 0.03). CONCLUSIONS In women with GDM and fasting hyperglycemia, glucose plus fetal AC measurements identified pregnancies at low risk for macrosomia and resulted in the avoidance of insulin therapy in 38% of patients without increasing rates of neonatal morbidity.
Collapse
MESH Headings
- Adult
- Anthropometry
- Birth Weight
- Blood Glucose/metabolism
- Body Mass Index
- Diabetes Mellitus/blood
- Diabetes Mellitus/drug therapy
- Diabetes, Gestational/blood
- Diabetes, Gestational/drug therapy
- Diabetes, Gestational/rehabilitation
- Fasting
- Female
- Gestational Age
- Glucose Tolerance Test
- Humans
- Hyperglycemia/blood
- Hypoglycemic Agents/therapeutic use
- Infant, Newborn
- Infant, Newborn, Diseases/classification
- Infant, Newborn, Diseases/epidemiology
- Infant, Small for Gestational Age
- Insulin/therapeutic use
- Intensive Care Units, Neonatal
- Male
- Obesity
- Parity
- Patient Education as Topic
- Pilot Projects
- Pregnancy
- Skinfold Thickness
- Ultrasonography, Prenatal
Collapse
|
49
|
Patel S, Lochhead PA, Rena G, Sutherland C. Antagonistic effects of phorbol esters on insulin regulation of insulin-like growth factor-binding protein-1 (IGFBP-1) but not glucose-6-phosphatase gene expression. Biochem J 2001; 359:611-9. [PMID: 11672436 PMCID: PMC1222183 DOI: 10.1042/0264-6021:3590611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Glucose-6-phosphatase (G6Pase) and insulin-like growth factor-binding protein-1 (IGFBP-1) genes contain a homologous promoter sequence that is required for gene repression by insulin. Interestingly, this element interacts with members of the forkhead family of transcription factors [e.g. HNF3 (hepatic nuclear factor 3), FKHR (forkhead in rhabdomyosarcoma)] in vitro, while insulin promotes the phosphorylation and inactivation of FKHR in a phosphatidylinositol 3-kinase- and protein kinase B (PKB)-dependent manner. This mechanism has been proposed to underlie insulin action on G6Pase and IGFBP-1 gene transcription. However, we find that treatment of cells with phorbol esters mimics the effect of insulin on G6Pase, but not IGFBP-1, gene expression. Indeed, phorbol ester treatment actually blocks the ability of insulin to repress IGFBP-1 gene expression. In addition, the action of phorbol esters is significantly reduced by inhibition of the p42/p44 mitogen-activated protein (MAP) kinase pathway. However insulin-induced phosphorylation of PKB or FKHR is not affected by the presence of phorbol esters. Therefore we suggest that activation of p42/p44 MAP kinases will reduce the sensitivity of the IGFBP-1 gene promoter, but not the G6Pase gene promoter, to insulin. Importantly, the activation of PKB and phosphorylation of FKHR is not, in itself, sufficient to reduce IGFBP-1 gene expression in the presence of phorbol esters.
Collapse
|
50
|
|