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Nichol B, Kemp E, Wilson R, Rodrigues AM, Hesselgreaves H, Robson C, Haighton C. Establishing an updated consensus on the conceptual and operational definitions of Making Every Contact Count (MECC) across experts within research and practice: an international Delphi Study. Public Health 2024; 230:29-37. [PMID: 38484623 DOI: 10.1016/j.puhe.2024.01.023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES The Making Every Contact Count (MECC) initiative is broadly defined as an opportunistic approach to prevention by making use of the thousands of conversations service providers have with service users every day. However, since its conception, the application of MECC has diverged and developed considerably. Thus, the current study aimed to revise the definition according to current research and practice to better describe what is and is not included. STUDY DESIGN A consensus building classic Delphi methodology, completed by an expert panel. METHODS Round 1 asked open questions around the definition of MECC. Content analysis of round 1 identified statements that were rated for agreement in round 2. Statements achieving ≥80% agreement were included in a short, long, or operational definition of MECC that were rated for agreement in round 3 (the minimum number required). An agreement of ≥80% indicated consensus. RESULTS Forty out of 100 contacted experts completed three rounds. Experts in practice and research were recruited internationally although most were from England. From round 1, 274 statements were generated, of which 96 achieved consensus and were included within round 3. The short and long definition received consensus in round 3, the operational definition required four rounds to reach consensus. CONCLUSIONS MECC is a person-centred approach to health behaviour change that, provided an individual possesses the relevant skills, can be delivered by anyone and anywhere. The distinguishing feature of MECC is not in its duration, target behaviour, or conditions for delivery, but rather in the approach taken and the mechanisms applied to conversations. Implications for research and practice are discussed, and the limits for applicability acknowledged.
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Affiliation(s)
- B Nichol
- Department of Social Work, Education, and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom.
| | - E Kemp
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - R Wilson
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - A M Rodrigues
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - H Hesselgreaves
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - C Robson
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - C Haighton
- Department of Social Work, Education, and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
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Robson C, Tan B, Stuart R, Nicholls S, Rogers BA, Sandaradura I. A systematic review of optimal pharmacokinetic/pharmacodynamic parameters for beta-lactam therapy in infective endocarditis. J Antimicrob Chemother 2023; 78:599-612. [PMID: 36691839 DOI: 10.1093/jac/dkad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Beta-lactam antibiotics are the mainstay of therapy for most bacterial causes of infective endocarditis (IE). Traditionally considered as agents with a broad therapeutic index, there is increasing recognition that standard doses may be subtherapeutic or toxic in critically ill patients. Optimizing therapy for efficacy requires a defined pharmacokinetic (PK)/pharmacodynamic (PD) target associated with clinical and microbiological cure. OBJECTIVES To elucidate the factors that influence beta-lactam PK and PD variability in IE and to examine optimal PK/PD target parameters for therapy. METHODS The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical and laboratory in vivo animal or human studies examining PK and/or PD of beta-lactam antibiotics in IE were eligible. Ovid MEDLINE, Embase and Cochrane Central Registry were searched using defined terms. The Office of Health Assessment and Translation (OHAT) tool was used for assessing risk of bias. RESULTS From 2677 abstracts, 62 articles were selected for review and synthesis, comprising: 45 animal studies investigating the broad categories of beta-lactam diffusion into vegetations, PK/PD determinants of outcome, mode of antibiotic delivery and synergistic impact of agents; and 17 human studies totalling 347 participants. Findings supported the importance of time-dependent killing for beta-lactams but heterogeneous data limited the determination of an optimal PK/PD target for IE treatment. CONCLUSION Beta-lactam PK and PD in endocarditis are variable and specific to the particular antibiotic-organism combination. Time-dependent killing is important, consistent with non-endocarditis studies, but there is little agreement on optimal drug exposure. Clinical studies examining PK/PD targets in endocarditis are required to further inform drug selection and dosing.
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Affiliation(s)
- Christopher Robson
- Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Bryan Tan
- Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia
| | - Rhonda Stuart
- Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,South Eastern Public Health Unit, Monash Health, Clayton, VIC, Australia
| | - Stephen Nicholls
- Monash Heart, Monash Health, Clayton, VIC, Australia.,Victorian Heart Institute, Monash University, Clayton, VIC, Australia
| | - Benjamin A Rogers
- Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Indy Sandaradura
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, Australia.,School of Medicine, University of Sydney, Sydney, Australia
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Robson C, Tan B, Rogers B, Sandaradura I. 79: WHAT IS THE OPTIMAL PK/PD TARGET FOR BETA-LACTAM THERAPYOF INFECTIVE ENDOCARDITIS? A SYSTEMATIC REVIEW. J Glob Antimicrob Resist 2022. [DOI: 10.1016/s2213-7165(22)00358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Wintermark M, Anderson J, Gupta V, Kennedy TA, Loevner LA, Riascos RF, Robson C, Saigal G, Glastonbury C. Recommendations for Neuroradiology Training during Radiology Residency by the American Society of Neuroradiology Section Chiefs Leadership Group. AJNR Am J Neuroradiol 2021; 42:E7-E9. [PMID: 33541904 DOI: 10.3174/ajnr.a6968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M Wintermark
- From the Department of Radiology (M.W.), Neuroradiology Section, Stanford University and Healthcare, Stanford, California
| | - J Anderson
- Department of Radiology (J.A.), Neuroradiology Section, Oregon Health and Science University, Portland, Oregon
| | - V Gupta
- Department of Radiology (V.G.), Division of Neuroradiology, Mayo Clinic, Jacksonville, Florida
| | - T A Kennedy
- Department of Radiology, Division of Neuroradiology (T.A.K,), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - L A Loevner
- Department of Radiology (L.A.L.), Division of Neuroradiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - R F Riascos
- Department of Diagnostic and Interventional Imaging (R.F.R.), Division of Neuroradiology, University of Texas Health Houston, Houston, Texas
| | - C Robson
- Department of Radiology (C.R.), Neuroradiology Division, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - G Saigal
- Department of Radiology (G.S.), Neuroradiology Section, University of Miami Miller School of Medicine, Miami, Florida
| | - C Glastonbury
- Department of Radiology and Biomedical Imaging (C.G.), Neuroradiology section, University of California, San Francisco, San Francisco, California
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Talenti G, Robson C, Severino MS, Alves CA, Chitayat D, Dahmoush H, Smith L, Muntoni F, Blaser SI, D'Arco F. Characteristic Cochlear Hypoplasia in Patients with Walker-Warburg Syndrome: A Radiologic Study of the Inner Ear in α-Dystroglycan-Related Muscular Disorders. AJNR Am J Neuroradiol 2021; 42:167-172. [PMID: 33122211 DOI: 10.3174/ajnr.a6858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/16/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Walker-Warburg syndrome, muscle-eye-brain disease, and Fukuyama congenital muscular dystrophy are α-dystroglycan-related muscular disorders associated with brain malformations and eye abnormalities in which no structural inner ear abnormality has been described radiologically. We collected patients from 6 tertiary pediatric hospitals and reported the radiologic features and frequency of inner ear dysplasias. MATERIALS AND METHODS Patients previously diagnosed clinicoradiologically with Walker-Warburg syndrome, muscle-eye-brain disease, or Fukuyama congenital muscular dystrophy were included. We recorded the pathogenic variant, when available. Brain MR imaging and/or CT findings were reviewed in consensus, and inner ear anomalies were classified according to previous description in the literature. We then correlated the clinicoradiologic phenotype with the inner ear phenotype. RESULTS Thirteen patients fulfilled the criteria for the Walker-Warburg syndrome phenotype, 8 for muscle-eye-brain disease, and 3 for Fukuyama congenital muscular dystrophy. A dysplastic cochlea was demonstrated in 17/24. The most frequent finding was a pronounced cochlear hypoplasia type 4 with a very small anteriorly offset turn beyond the normal-appearing basal turn (12/13 patients with Walker-Warburg syndrome and 1/11 with muscle-eye-brain disease or Fukuyama congenital muscular dystophy). Two of 8 patients with muscle-eye-brain disease, 1/3 with Fukuyama congenital muscular dystrophy, and 1/13 with Walker-Warburg syndrome showed a less severe cochlear hypoplasia type 4. The remaining patients without Walker-Warburg syndrome were healthy. The vestibule and lateral semicircular canals of all patients were normal. Cranial nerve VIII was present in all patients with diagnostic MR imaging. CONCLUSIONS Most patients with the severe α-dystroglycanopathy Walker-Warburg syndrome phenotype have a highly characteristic cochlear hypoplasia type 4. Patients with the milder variants, muscle-eye-brain disease and Fukuyama congenital muscular dystrophy, more frequently have a normal cochlea or milder forms of hypoplasia.
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Affiliation(s)
- G Talenti
- From the Department of Diagnostics and Pathology (G.T.), Neuroradiology Unit, Verona University Hospital, Verona, Italy
| | - C Robson
- Division of Neuroradiology (C.R.), Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - M S Severino
- Neuroradiology Unit (M.S.S.), Istituti di Ricovero e Cura a Carattere Scientifico, Istituto Giannina Gaslini, Genova, Italy
| | - C A Alves
- Departments of Radiology and Division of Neuroradiology (C.A.A.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - D Chitayat
- The Prenatal Diagnosis and Medical Genetics Program (D.C.), Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - H Dahmoush
- Department of Radiology (H.D.), Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
| | - L Smith
- Dental and Maxillofacial Surgery Department (L.S.), Great Ormond Street Hospital, London, UK
| | - F Muntoni
- Dubowitz Neuromuscular Centre (F.M.), UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, UK
| | - S I Blaser
- Division of Neuroradiology (S.I.B.), Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - F D'Arco
- Neuroradiology Unit (F.D.), Department of Radiology, Great Ormond Street Hospital for Children, National Health Service Trust, London, UK felice.d'
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Uddin MA, Robson C, Dotel R. Disease of the past re-emerging in modern Australian society. BMJ Case Rep 2019; 12:12/4/e228448. [PMID: 31005867 DOI: 10.1136/bcr-2018-228448] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 28-year-old man with fever, atraumatic lower limb pain and rash was noted to have multiple areas of ecchymosis involving both lower limbs. He was anaemic and also had a grossly swollen left leg. Differential diagnoses of compartment syndrome, vascular tear, platelet and clotting factor disorders, vasculitis and myositis were ruled out. Scurvy was only considered after failing to reach a diagnosis. A dietary history revealed consumption of a restricted diet with no fresh fruits or vegetables. Diagnosis was supported by an undetectable vitamin C level in blood and a rapid improvement of symptoms on oral vitamin C replacement. Prevalence of vitamin C deficiency in developed countries is also discussed.
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Affiliation(s)
- Mohammed Arif Uddin
- Department of Infectious Diseases, Blacktown Hospital, Blacktown, New South Wales, Australia.,Medical Workforce Unit, BMDH, Western Sydney Local Health District, Penrith, New South Wales, Australia
| | - Christopher Robson
- Department of Infectious Diseases, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Ravindra Dotel
- Department of Infectious Diseases, Blacktown Hospital, Blacktown, New South Wales, Australia
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Abstract
Quadrivalent influenza vaccination is recommended annually for adults and children aged six months to 64 years High-dose or adjuvanted trivalent vaccines are recommended annually for people 65 years and over If started early enough neuraminidase inhibitors reduce symptom duration by approximately one day Treatment should be considered in patients with severe disease requiring hospitalisation or who are at risk of complications Chemoprophylaxis is not a substitute for vaccination but can be considered in high-risk individuals with an inadequate or ineffective vaccination status
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Affiliation(s)
- Christopher Robson
- Department of Infectious Diseases, Westmead Hospital, Sydney.,National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney.,School of Medicine, University of Sydney.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney.,Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
| | - Sai Rupa Baskar
- Department of Infectious Diseases, Westmead Hospital, Sydney.,National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney.,School of Medicine, University of Sydney.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney.,Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
| | - Robert Booy
- Department of Infectious Diseases, Westmead Hospital, Sydney.,National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney.,School of Medicine, University of Sydney.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney.,Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
| | - Patricia E Ferguson
- Department of Infectious Diseases, Westmead Hospital, Sydney.,National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney.,School of Medicine, University of Sydney.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney.,Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
| | - Nicole Gilroy
- Department of Infectious Diseases, Westmead Hospital, Sydney.,National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney.,School of Medicine, University of Sydney.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney.,Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
| | - Jen Kok
- Department of Infectious Diseases, Westmead Hospital, Sydney.,National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney.,School of Medicine, University of Sydney.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney.,Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
| | - Indy Sandaradura
- Department of Infectious Diseases, Westmead Hospital, Sydney.,National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney.,School of Medicine, University of Sydney.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney.,Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
| | - Dominic Dwyer
- Department of Infectious Diseases, Westmead Hospital, Sydney.,National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney.,School of Medicine, University of Sydney.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney.,Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
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Al-Omary M, Sugito S, Al-Khalil H, Senanayake T, Robson C, Boyle A, Sverdlov A. Characteristics and Outcomes After Index Heart Failure Admission to Hunter New England LHD by Speciality of Admission. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.076] [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: 11/16/2022]
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Robson C, O'Sullivan MVN, Sivagnanam S. Salmonella enterica Serovar Typhi: An Unusual Cause of Infective Endocarditis. Trop Med Infect Dis 2018; 3:tropicalmed3010035. [PMID: 30274432 PMCID: PMC6136621 DOI: 10.3390/tropicalmed3010035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 01/04/2023] Open
Abstract
While typhoid fever is a common infection, Salmonella enterica serovar Typhi is a rare cause of endocarditis. We describe the case of a 20-year-old male who was treated for a primary episode of microbiologically-confirmed typhoid fever. He presented six weeks post-discharge with fever and lethargy. S. Typhi was again identified in blood cultures, and echocardiography identified a mitral valve lesion. Our case suggests that a relapse of typhoid should prompt further investigation for a deep-seated infection, including consideration of echocardiographic evaluation to rule out infective endocarditis.
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Affiliation(s)
- Christopher Robson
- Department of Infectious Diseases, Blacktown Hospital, Blacktown, NSW 2148, Australia.
| | - Matthew V N O'Sullivan
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW 2145, Australia.
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead, NSW 2145, Australia.
| | - Shobini Sivagnanam
- Department of Infectious Diseases, Blacktown Hospital, Blacktown, NSW 2148, Australia.
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Affiliation(s)
- G.M. Gutman
- Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - C. Robson
- Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - J. Marchbank
- Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - K. Blair
- Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
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Robson C, Cheong P, Walker I, Garbharran U. 1494AT Vs Cam In Diagnosis Of Delirium: A Junior Doctor's View. Age Ageing 2017. [DOI: 10.1093/ageing/afx060.149] [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: 11/14/2022] Open
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12
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McClurg U, Dransfield D, Namdev N, Jacoby D, Chit N, Nakjang S, Edwards J, McCracken S, Robson C. A novel anti-androgen candidate galeterone acts by targeting USP12, a deubiquitinating enzyme that controls prostate cancer growth and survival. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32654-5] [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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13
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Bedaj M, Rao K, Robson C, McCracken S. Targeting cell metabolism to improve prostate cancer therapeutics. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61508-3] [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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Audsley J, Robson C, Aitchison S, Matthews GV, Iser D, Sasadeusz J, Lewin SR. Liver Fibrosis Regression Measured by Transient Elastography in Human Immunodeficiency Virus (HIV)-Hepatitis B Virus (HBV)-Coinfected Individuals on Long-Term HBV-Active Combination Antiretroviral Therapy. Open Forum Infect Dis 2016; 3:ofw035. [PMID: 27006960 PMCID: PMC4800457 DOI: 10.1093/ofid/ofw035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/09/2016] [Indexed: 12/21/2022] Open
Abstract
Transient elastography (TE) data in HIV-HBV co-infection are lacking. The majority of this cohort had mild-moderate fibrosis, however over 28% of those with >1 TE showed liver fibrosis regression and the prevalence of advanced fibrosis (≥F3) decreased 12.3% (32.7 to 20.4%) over a median 31 months Background. Advanced fibrosis occurs more commonly in human immunodeficiency virus (HIV)-hepatitis B virus (HBV) coinfected individuals; therefore, fibrosis monitoring is important in this population. However, transient elastography (TE) data in HIV-HBV coinfection are lacking. We aimed to assess liver fibrosis using TE in a cross-sectional study of HIV-HBV coinfected individuals receiving combination HBV-active (lamivudine and/or tenofovir/tenofovir-emtricitabine) antiretroviral therapy, identify factors associated with advanced fibrosis, and examine change in fibrosis in those with >1 TE assessment. Methods. We assessed liver fibrosis in 70 HIV-HBV coinfected individuals on HBV-active combination antiretroviral therapy (cART). Change in fibrosis over time was examined in a subset with more than 1 TE result (n = 49). Clinical and laboratory variables at the time of the first TE were collected, and associations with advanced fibrosis (≥F3, Metavir scoring system) and fibrosis regression (of least 1 stage) were examined. Results. The majority of the cohort (64%) had mild to moderate fibrosis at the time of the first TE, and we identified alanine transaminase, platelets, and detectable HIV ribonucleic acid as associated with advanced liver fibrosis. Alanine transaminase and platelets remained independently advanced in multivariate modeling. More than 28% of those with >1 TE subsequently showed liver fibrosis regression, and higher baseline HBV deoxyribonucleic acid was associated with regression. Prevalence of advanced fibrosis (≥F3) decreased 12.3% (32.7%–20.4%) over a median of 31 months. Conclusions. The observed fibrosis regression in this group supports the beneficial effects of cART on liver stiffness. It would be important to study a larger group of individuals with more advanced fibrosis to more definitively assess factors associated with liver fibrosis regression.
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Affiliation(s)
- Jennifer Audsley
- Department of Infectious Diseases, Monash University; Department of Infectious Diseases, The Alfred Hospital; The Peter Doherty Institute for Infection and Immunity, Melbourne
| | | | | | | | - David Iser
- St Vincent's Hospital , Melbourne , Australia
| | - Joe Sasadeusz
- Department of Infectious Diseases , The Alfred Hospital
| | - Sharon R Lewin
- Department of Infectious Diseases, Monash University; Department of Infectious Diseases, The Alfred Hospital; The Peter Doherty Institute for Infection and Immunity, Melbourne
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Japp D, Robson C, Colledge N. 13 * STRATEGIES TO IMPROVE VISUAL ASSESSMENT IN PATIENTS ATTENDING A DAY HOSPITAL: A CLOSED AUDIT LOOP. Age Ageing 2014. [DOI: 10.1093/ageing/afu036.13] [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: 11/13/2022] Open
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16
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Fisher A, Kucukmetin A, Cross P, Robson C, Edmondson R. P1007 An immunohistochemical study of the met/hepatocyte growth factor (HGF) pathway in ovarian cancer: Analysis of clinical outcomes. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)62493-0] [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: 11/16/2022]
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Abstract
AIMS To investigate the diagnoses made for children referred to a "fits, faints, and funny turns" clinic. METHODS Prospective study of 380 children referred to a dedicated secondary care clinic over an eight year period. RESULTS Twenty three per cent of children were given a final diagnosis of one of the childhood epilepsies, with 48% of these having a specific epilepsy syndrome. Syncope was the commonest cause of a non-epileptic event (syncope and reflex anoxic seizures comprised 100/238, 42%) but there were a wide variety of other causes. Fifty three events (14%) were unclassified and managed without a diagnostic label or treatment. CONCLUSIONS In children with funny turns referred to secondary care, the diagnostic possibilities are numerous; among non-epileptic events, syncopes predominate. The majority do not have epilepsy. Unclassifiable events with no clear epileptic or non-epileptic cause are common and can be safely managed expectantly.
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Affiliation(s)
- D Hindley
- Fairfield General Hospital, Bury, UK.
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Ballard DJ, Phillips C, Wright G, Thacker CR, Robson C, Revoir AP, Court DS. A study of mutation rates and the characterisation of intermediate, null and duplicated alleles for 13 Y chromosome STRs. Forensic Sci Int 2005; 155:65-70. [PMID: 16216713 DOI: 10.1016/j.forsciint.2004.12.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2004] [Revised: 11/30/2004] [Accepted: 12/03/2004] [Indexed: 10/25/2022]
Abstract
Previously reported Y chromosome STR haplotype databases for three UK population groups, plus additionally analysed samples, have been scrutinised for the presence of non-standard (intermediate, null and duplicated) alleles. These alleles have been characterised by sequencing, some showing changes in the repeat structure, and the frequencies reported. Mutation rates for each of the 13 STRs have been calculated when analysis of father-son pairs has been possible. An example illustrating the use of non-standard alleles in a large family tree is outlined.
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Affiliation(s)
- D J Ballard
- Department of Haematology, Barts and The London, Queen Mary's School of Medicine and Dentistry, Turner Street, London E1 2AD, UK.
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Ballard DJ, Phillips C, Thacker CR, Robson C, Revoir AP, Syndercombe Court D. Y chromosome STR haplotypes in three UK populations. Forensic Sci Int 2005; 152:289-305. [PMID: 15978358 DOI: 10.1016/j.forsciint.2004.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2004] [Revised: 10/15/2004] [Accepted: 10/15/2004] [Indexed: 11/15/2022]
Abstract
Eleven Y chromosome short tandem repeat markers: DYS19, DYS385, DYS389I, DYS389II, DYS390, DYS391, DYS392, DYS393, DYS437, DYS438 and DYS439, have been typed in the three main UK population groups: Caucasians, Afro-Caribbeans and South Asians. Existing PCR reactions were adapted to incorporate DYS437, DYS438 and DYS439. The observed 11 loci haplotypes and the individual allele frequencies for each locus are presented. Distinct differences for most markers were observed between the population groups studied.
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Affiliation(s)
- D J Ballard
- Department of Haematology, Barts and The London, Queen Mary's School of Medicine and Dentistry, Turner Street, London E1 2AD, UK.
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Robson C, Wright KA, Twentyman PR, Lambert PA, Griffin RJ. Chemical synthesis and biological properties of novel fluorescent antifolates in Pgp- and MRP-overexpressing tumour cell lines. Biochem Pharmacol 1998; 56:807-16. [PMID: 9774142 DOI: 10.1016/s0006-2952(98)00068-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We have synthesised a series of fluorescent analogues of methylbenzoprim, a diaminopyrimidine antifolate which we have previously shown to exhibit in vivo antitumour activity in a methotrexate (MTX) "transport-resistant" tumour cell line. The analogues bear the dansyl, nitrobenzoxodiazole or methoxycoumarin fluorophores. The cytotoxicity of the compounds was evaluated using the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) colorimetric assay against two human lung cancer cell lines, together with their multidrug resistant (MDR) sublines. H69/P is a small cell line and its multidrug resistant subline H69/LX4 overexpresses P-glycoprotein (Pgp). COR-L23/P is a large cell line and its multidrug resistant subline COR-L23/R overexpresses the multidrug resistance associated protein (MRP). IC50 values for the compounds (i.e. concentration to reduce cell growth by 50%) in the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assay ranged from 0.20 to 0.81 microM in the H69 parental line and from 0.83 to 5.10 microM in the COR-L23 parent line. The MDR sublines both showed clear cross-resistance to each of the compounds, with resistance factors (ratio of IC50 value in resistant vs parental cell line) ranging from 16 to 137 in H69/LX4 and from 5 to 16 in COR-L23/R. For compounds (10) and (11) where drug accumulation was studied using flow cytometry, resistance was associated with an approximately 10-fold reduction in cellular drug accumulation over a period of 30 min. The drug resistance modifiers verapamil (used at 6.6 microM) and cyclosporin A (used at 4.2 microM) were tested for their ability to sensitise the resistant lines. Whereas verapamil showed little activity, cyclosporin A partially restored the activity of compound (10), and fully restored the activity of compound (11) in H69/LX4 cells. This sensitisation of H69/LX4 by cyclosporin A was associated with a partial restoration of the drug accumulation deficit in this line. Hence, these novel lipophilic antifolates appear to be substrates for both the P-glycoprotein and MRP resistance mechanisms. Therefore, although they have been designed to overcome one mechanism of methotrexate resistance, namely impaired drug transport, this has been achieved only at the cost of rendering them susceptible to alternative mechanisms.
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Affiliation(s)
- C Robson
- Department of Chemistry, University of Newcastle, Newcastle upon Tyne, UK
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Kengatharan KM, De Kimpe S, Robson C, Foster SJ, Thiemermann C. Mechanism of gram-positive shock: identification of peptidoglycan and lipoteichoic acid moieties essential in the induction of nitric oxide synthase, shock, and multiple organ failure. J Exp Med 1998; 188:305-15. [PMID: 9670043 PMCID: PMC2212447 DOI: 10.1084/jem.188.2.305] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The incidence of septic shock caused by gram-positive bacteria has risen markedly in the last few years. It is largely unclear how gram-positive bacteria (which do not contain endotoxin) cause shock and multiple organ failure. We have discovered recently that two cell wall fragments of the pathogenic gram-positive bacterium Staphylococcus aureus, lipoteichoic acid (LTA) and peptidoglycan (PepG), synergize to cause the induction of nitric oxide (NO) formation, shock, and organ injury in the rat. We report here that a specific fragment of PepG, N-acetylglucosamine-beta-[1--> 4]-N-acetylmuramyl-L-alanine-D-isoglutamine, is the moiety within the PepG polymer responsible for the synergism with LTA (or the cytokine interferon gamma) to induce NO formation in the murine macrophage cell line J774.2. However, this moiety is also present in the PepG of the nonpathogenic bacterium Bacillus subtilis. We have discovered subsequently that S. aureus LTA synergizes with PepG from either bacterium to cause enhanced NO formation, shock, and organ injury in the rat, whereas the LTA from B. subtilis does not synergize with PepG of either bacterium. Thus, we propose that the structure of LTA determines the ability of a particular bacterium to cause shock and multiple organ failure (pathogenicity), while PepG acts to amplify any response induced by LTA.
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Affiliation(s)
- K M Kengatharan
- William Harvey Research Institute, St. Bartholomew's and the Royal London School of Medicine and Dentistry, London EC1M 6BQ, United Kingdom
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Robson C, Meek MA, Grunwaldt JD, Lambert PA, Queener SF, Schmidt D, Griffin RJ. Nonclassical 2,4-diamino-5-aryl-6-ethylpyrimidine antifolates: activity as inhibitors of dihydrofolate reductase from Pneumocystis carinii and Toxoplasma gondii and as antitumor agents. J Med Chem 1997; 40:3040-8. [PMID: 9301666 DOI: 10.1021/jm970055k] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [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] [Indexed: 02/05/2023]
Abstract
Twelve novel 2,4-diamino-5-(4'-benzylamino)- and 2,4-diamino-5[4'-(N-methylbenzylamino)-3'-nitrophenyl]-6-ethylp yrimidines bearing 4-substituents on the benzylamino or N-methylbenzylamino aryl ring were synthesized and evaluated as nonclassical inhibitors of Pneumocystis carinii and Toxoplasma gondii dihydrofolate reductase (DHFR). Compounds were prepared by reaction of 2,4-diamino-5-(4'-chloro-3'-nitrophenyl)- (8) or 2,4-diamino-5-(4'-fluoro-3'-nitrophenyl)-6-ethylpyrimidine (15) with the appropriate 4-substituted (CO2H, CO2Me, SO2NH2, dioxolan-2-yl, CHO, dimethyloxazolin-2-yl) benzylamine or N-methylbenzylamine derivative. Compounds 25-29 were synthesized from 2,4-diamino-5-{4'-[N-(4"-carboxybenzyl)amino]-3'-nitrophenyl}-6- ethylpyrimidine (10) and the corresponding amine (NH3, MeNH2, Me2NH, piperidine, diethyl L-glutamate) via isobutyl mixed anhydride coupling; hydrolysis of the diethyl L-glutamate 29 afforded the L-glutamate analogue 30. The compounds exhibited potent inhibitory activity against T. gondii (IC50 values 0.0018-0.14 microM) and rat liver (IC50 values 0.0029-0.27 microM) DHFR, with a 4-substituent invariably enhancing binding to both enzymes relative to the unsubstituted benzoprim (5) or methylbenzoprim (6). Modest selectivity for T. gondii enzyme was observed with several analogues, whereas all of the compounds were relatively weak inhibitors of P. carinii DHFR and exhibited no selectivity. Selected analogues were evaluated for in vivo antitumor activity against the methotrexate-resistant M5076 murine reticulosarcoma, with 2,4-diamino-5-{4'-[N-[4"-(N"-methylcarbamoyl)benzyl]-N- methylamino]-3'-nitrophenyl}-6-ethylpyrimidine (14) (Ki for rat liver DHFR = 0.00035 +/- 0.00029 nM) combining significant antitumor activity with minimal toxicity.
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Affiliation(s)
- C Robson
- Department of Chemistry, University, Newcastle upon Tyne, U.K
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Robson C. Issues in the development of language intervention programmes. J Ment Defic Res 1984; 28 ( Pt 2):89-100. [PMID: 6748058 DOI: 10.1111/j.1365-2788.1984.tb01000.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
An attempt has been made in this paper to address some issues involved in the development of language intervention programmes. The relative neglect of 'language' in the paper is justified by the importance of more general issues. After cursory attention to prescriptiveness in programmes, the concentration has been on the 'training of the trainers' and the need for an adequate and effective instructional model. Particular attention is given to evaluation and the need for a design which while acknowledging the practicalities of life in the field can nevertheless assist in determining the effects of the intervention (with a nod in the direction of casting the net sufficiently wide to encompass possible unintended effects). Finally, there is discussion of implementation, covering guidelines to bear in mind the developing the intervention and stressing that without successful implementation even the most effective programme fails, as it disappears like water in to the sands of the desert.
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Jones A, Robson C. Within course effects of a training package for teachers of the severely mentally handicapped. Spec Educ Forward Trends 1983; 10:17-20. [PMID: 6879308 DOI: 10.1111/j.1467-8578.1983.tb00149.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Robson C. Paired Comparison Technique for measuring Stimulus Control Functions in the Pigeon after Training with Discrete Trials. Nature 1970; 228:1112-3. [PMID: 16058797 DOI: 10.1038/2281112a0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/1970] [Indexed: 11/09/2022]
Affiliation(s)
- C Robson
- Psychology Department, Birkbeck College, University of London
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