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Dykxhoorn J, Osborn D, Walters K, Kirkbride JB, Gnani S, Lazzarino AI. Temporal patterns in the recorded annual incidence of common mental disorders over two decades in the United Kingdom: a primary care cohort study. Psychol Med 2024; 54:663-674. [PMID: 37605881 DOI: 10.1017/s0033291723002349] [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] [Indexed: 08/23/2023]
Abstract
BACKGROUND Common mental disorders (CMDs) including depression, anxiety, and stress are very common, but it is unclear whether the last decades of social, economic, and political change have impacted incidence of CMD. This study explored temporal trends in the recorded incidence of CMD in the United Kingdom. METHODS We used data from general practices in the United Kingdom (Clinical Practice Research Datalink) to estimate the annual recorded incidence of CMD for 2000-2020, including symptoms, diagnosis, or pharmaceutical treatment. Trends were explored by sex, age, ethnicity, region, deprivation, and comorbidity. RESULTS We included 29 480 164 individuals who were followed up for 12.5 years on average (s.d. = 6.4 years). The recorded incidence of CMD episodes was 55.9 per 1000 person-years in 2000 [95% confidence interval (CI) 55.8-56.1], increasing to 79.6 per 1000 person-years in 2019 (95% CI 79.5-79.8). Females had higher recorded incidence rates, as did those living in more deprived areas. We observed striking patterns by age over time, with rates in ages 16-24 increasing from 40.2 per 1000 in 2000 (95% CI 39.8-40.5), to 107.8 per 1000 in 2019 (95% CI 107.0-108.6). In contrast, the rates in those aged ≥55 years decreased since 2014. There were differing patterns of incidence by ethnic group, with a steeper increase in Asian, Black, and mixed groups in recent years. CONCLUSIONS Overall, the incidence of recorded CMD in the UK general practice increased between 2000 and 2019 with a small decrease in 2020. The overall trends obscured important differences across population subgroups, which may have implications for prevention.
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Affiliation(s)
- J Dykxhoorn
- Department of Primary Care and Population Health, UCL, London, UK
- Division of Psychiatry, UCL, London, UK
| | - D Osborn
- Division of Psychiatry, UCL, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - K Walters
- Department of Primary Care and Population Health, UCL, London, UK
| | | | - S Gnani
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Barrio-Perotti R, Martín-Fernández N, Vigil-Díaz C, Walters K, Fernández-Tena A. Predicting particle deposition using a simplified 8-path in silico human lung prototype. J Breath Res 2023; 17:046002. [PMID: 37437567 DOI: 10.1088/1752-7163/ace6c7] [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: 03/14/2023] [Accepted: 07/12/2023] [Indexed: 07/14/2023]
Abstract
Understanding particle deposition in the human lung is crucial for the assessment of environmental pollutants and the design of new drug delivery systems. Traditionally, research has been carried out by experimental analysis, but this generally requires expensive equipment and exposure of volunteers to radiation, resulting in limited data. To overcome these drawbacks, there is an emphasis on the development of numerical models capable of accurate predictive analysis. The most advanced of these computer simulations are based on three-dimensional computational fluid dynamics. Solving the flow equations in a complete, fully resolved lung airway model is currently not feasible due to the computational resources required. In the present work, a simplified lung model is presented and validated for accurate prediction of particle deposition. Simulations are performed for an 8-path approximation to a full lung airway model. A novel boundary condition method is used to ensure accurate results in truncated flow branches. Simulations are performed at a steady inhalation flow rate of 18 l min-1, corresponding to a low activity breathing rate, while the effects of particle size and density are investigated. Comparison of the simulation results with available experimental data shows that reasonably accurate results can be obtained at a small fraction of the cost of a full airway model. The simulations clearly evaluate the effect of both particle size and particle density. Most importantly, the results show an improvement over a previously documented single-path model, both in terms of accuracy and the ability to obtain regional deposition rates. The present model represents an improvement over previously used simplified models, including single-path models. The multi-path reduced airway approach described can be used by researchers for general and patient-specific analyses of particle deposition and for the design of effective drug delivery systems.
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Affiliation(s)
- R Barrio-Perotti
- Departamento de Energía, Universidad de Oviedo, and GRUBIPU-ISPA, Gijón, Spain
| | | | - C Vigil-Díaz
- Hospital Universitario Central de Asturias, and GRUBIPU-ISPA, Oviedo, Spain
| | - K Walters
- College of Engineering, University of Arkansas, Fayetteville, Arkansas, United States of America
| | - A Fernández-Tena
- Facultad de Enfermería, Universidad de Oviedo, Instituto Nacional de Silicosis, and GRUBIPU-ISPA, Gijón, Spain
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3
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Walters K, Yaacob H. Bayesian multivariant fine mapping using the Laplace prior. Genet Epidemiol 2023; 47:249-260. [PMID: 36739616 DOI: 10.1002/gepi.22517] [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] [Received: 07/05/2022] [Revised: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 02/07/2023]
Abstract
Currently, the only effect size prior that is routinely implemented in a Bayesian fine-mapping multi-single-nucleotide polymorphism (SNP) analysis is the Gaussian prior. Here, we show how the Laplace prior can be deployed in Bayesian multi-SNP fine mapping studies. We compare the ranking performance of the posterior inclusion probability (PIP) using a Laplace prior with the ranking performance of the corresponding Gaussian prior and FINEMAP. Our results indicate that, for the simulation scenarios we consider here, the Laplace prior can lead to higher PIPs than either the Gaussian prior or FINEMAP, particularly for moderately sized fine-mapping studies. The Laplace prior also appears to have better worst-case scenario properties. We reanalyse the iCOGS case-control data from the CASP8 region on Chromosome 2. Even though this study has a total sample size of nearly 90,000 individuals, there are still some differences in the top few ranked SNPs if the Laplace prior is used rather than the Gaussian prior. R code to implement the Laplace (and Gaussian) prior is available at https://github.com/Kevin-walters/lapmapr.
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Affiliation(s)
- Kevin Walters
- School of Mathematics and Statistics, University of Sheffield, Sheffield, UK
| | - Hannuun Yaacob
- School of Mathematics and Statistics, University of Sheffield, Sheffield, UK.,Department of Economics and Applied Statistics, Faculty of Business and Economics, Universiti Malaya, Kuala Lumpur, Malaysia
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4
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Poppe M, Duffy L, Marchant NL, Barber JA, Hunter R, Bass N, Minihane AM, Walters K, Higgs P, Rapaport P, Lang IA, Morgan-Trimmer S, Huntley J, Walker Z, Brodaty H, Kales HC, Ritchie K, Burton A, Wenborn J, Betz A, Cooper C. The APPLE Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce-randomised controlled trial. Trials 2022; 23:596. [PMID: 35883143 PMCID: PMC9315085 DOI: 10.1186/s13063-022-06557-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large-scale trials of multidomain interventions show that modifying lifestyle and psychological risk factors can slow cognitive decline. We aim to determine if a lower intensity, personally tailored secondary dementia prevention programme for older people with subjective or mild objective memory decline, informed by behaviour change theory, reduces cognitive decline over 2 years. METHODS A multi-site, single-blind randomised controlled trial recruiting 704 older adults at high dementia risk due to mild cognitive impairment (MCI) or subjective cognitive decline (SCD). Participants are randomised using 1:1 allocation ratio to the APPLE Tree intervention versus control arm (dementia prevention information), stratified by site. The intervention explores and implements strategies to promote healthy lifestyle, increase pleasurable activities and social connections and improve long-term condition self-management. Two facilitators trained and supervised by a clinical psychologist deliver ten, 1-h group video call sessions over 6 months (approximately every fortnight), video-call 'tea breaks' (less structured, facilitated social sessions) in intervening weeks and individual goal-setting phone calls every 2 weeks. From 6 to 12 months, participants meet monthly for 'tea breaks', with those not attending receiving monthly goal-setting phone calls. Participants receive a food delivery, pedometer and website access to cognitive training and information about lifestyle modification. Follow-ups for all outcome measures are at 12 and 24 months. The primary outcome is cognition (Neuropsychological Test Battery (NTB) score) at 24 months. Secondary outcomes are quality of life, cost per quality-adjusted life year (QALY) and wellbeing and lifestyle factors the intervention targets (diet, vascular risk, body weight, activity, sleep, anxiety, depression, social networks and loneliness, alcohol intake and smoking). Participants from purposively selected sites participate in qualitative process evaluation interviews, which will be analysed using thematic analytic methods. DISCUSSION If effective, the intervention design, involving remote delivery and non-clinical facilitators, would facilitate intervention roll-out to older people with memory concerns. TRIAL REGISTRATION ISRCTN17325135 . Registration date 27 November 2019.
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Affiliation(s)
- M Poppe
- UCL Division of Psychiatry, University College London, London, UK
| | - L Duffy
- UCL Division of Psychiatry, University College London, London, UK
| | - N L Marchant
- UCL Division of Psychiatry, University College London, London, UK
| | - J A Barber
- Department of Statistical Science, University College London, London, UK
| | - R Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - N Bass
- UCL Division of Psychiatry, University College London, London, UK
| | - A M Minihane
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - K Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - P Higgs
- UCL Division of Psychiatry, University College London, London, UK
| | - P Rapaport
- UCL Division of Psychiatry, University College London, London, UK
| | - I A Lang
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - S Morgan-Trimmer
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - J Huntley
- UCL Division of Psychiatry, University College London, London, UK
| | - Z Walker
- UCL Division of Psychiatry, University College London, London, UK
| | - H Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - H C Kales
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, USA
| | - K Ritchie
- Institut de Neurosciences de Montpellier (INM), Montpellier, France
| | - A Burton
- Department of Behavioural Science and Health, University College London, London, UK
| | - J Wenborn
- UCL Division of Psychiatry, University College London, London, UK
| | - A Betz
- Queen Mary University London, Centre for Psychiatry and Mental Health, Wolfson Institute for Population Health, London, UK
| | - C Cooper
- Queen Mary University London, Centre for Psychiatry and Mental Health, Wolfson Institute for Population Health, London, UK.
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Avgerinou C, Petersen I, Clegg A, West RM, Osborn D, Walters K. 1071 INCIDENCE OF RECORDED OSTEOPOROSIS, OSTEOPENIA AND FRAGILITY FRACTURE IN OLDER PEOPLE: ANALYSIS OF UK PRIMARY CARE DATA. Age Ageing 2022. [DOI: 10.1093/ageing/afac124.014] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Osteoporosis is common in later life, leading to fragility fractures associated with increased mortality, disability, and costs. There is a surprising lack of data regarding the incidence of osteoporosis. We aimed to estimate the incidence of recorded diagnosis of osteoporosis, osteopenia, and fragility fracture in older people, explore time trends in diagnosis, and differences by age, sex, and social deprivation.
Method
We used de-identified patient data provided as part of routine primary care (IQVIA Medical Research Database (IMRD). All patients aged 50-99y registered with THIN (The Health Improvement Network) participating practices between 1/1/2000–31/12/2018 were included. Crude incidence rates (IR) were estimated per 10,000 person-years (PY). We used Poisson regression to calculate adjusted Incidence Rate Ratios (IRR) accounting for sex, age, calendar year and deprivation.
Results
The IR of osteoporosis was significantly higher in women, 84.32 (95%CI 83.81–84.83) vs. 16.66 (95%CI 16.43–16.90) in men per 10,000PY. In women, recorded IR of osteoporosis reached a peak in 2009. In the adjusted model, older men in most deprived areas had a higher IRR of osteoporosis [1.67 (95% 1.59–1.74)] compared to those in least deprived areas. Women were more likely to be diagnosed with osteopenia compared to men, at any age. Incidence of osteopenia diagnosis increased over time. In the adjusted model, men in most deprived areas had a higher IRR of osteopenia [1.44 (95%CI 1.35–1.53)] compared to least deprived areas. The IR of fragility fracture was higher in women, 84.97 (95%CI 84.45–85.48) vs. 31.15 (95%CI 30.83–31.48) in men per 10,000PY. In the adjusted model, men in most deprived areas had an increased IRR of fragility fracture [1.53 (95%CI 1.48–1.59)] compared to least deprived areas.
Conclusion
Community bone health interventions might be targeted at populations at higher risk of fragility fractures, including older men living in socially deprived areas.
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Affiliation(s)
- C Avgerinou
- Department of Primary Care and Population Health, University College London , UK
| | - I Petersen
- Department of Primary Care and Population Health, University College London , UK
| | - A Clegg
- Academic Unit for Ageing and Stroke Research, University of Leeds , UK
| | - R M West
- Leeds Institute of Health Sciences, University of Leeds , UK
| | - D Osborn
- Division of Psychiatry, University College London , UK
| | - K Walters
- Department of Primary Care and Population Health, University College London , UK
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McCoy L, Newman Carroll S, Walters K. "It's so Natural It Goes Hand in Hand": A Qualitative Study of Maternal Perceptions of Cannabis Use during Pregnancy. J Psychoactive Drugs 2022:1-8. [PMID: 35679475 DOI: 10.1080/02791072.2022.2080615] [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: 10/18/2022]
Abstract
As the market continues to embrace marijuana as a holistic product, perceptions about its uses are increasingly contradictory to public health recommendations. The purpose of this research was to qualitatively analyze the perceived risks and benefits of cannabis use during pregnancy via in-depth semi-structured interviews conducted with nine women. This research is intended to inform patient-provider interactions regarding cannabis use in prenatal clinical settings.
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Affiliation(s)
- Lillian McCoy
- Department of Public Health, Fort Lewis College, Durango, United States
| | - Sara Newman Carroll
- Department of Public Health, Fort Lewis College, Durango, United States.,Health Sciences Department, Eastern Connecticut State University, Willimantic, United States
| | - Kevin Walters
- Department of Psychology, Fort Lewis College, Durango, United States
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7
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Duncan F, Baskin C, McGrath M, Coker JF, Lee C, Dykxhoorn J, Adams EA, Gnani S, Lafortune L, Kirkbride JB, Kaner E, Jones O, Samuel G, Walters K, Osborn D, Oliver EJ. Community interventions for improving adult mental health: mapping local policy and practice in England. BMC Public Health 2021; 21:1691. [PMID: 34530779 PMCID: PMC8444510 DOI: 10.1186/s12889-021-11741-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/29/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Public mental health (PMH) aims to improve wellbeing and prevent poor mental health at the population level. It is a global challenge and a UK priority area for action. Communities play an important role in the provision of PMH interventions. However, the evidence base concerning community-based PMH interventions is limited, meaning it is challenging to compare service provision to need. Without this, the efficient and equitable provision of services is hindered. Here, we sought to map the current range of community-based interventions for improving mental health and wellbeing currently provided in England to inform priority areas for policy and service intervention. METHOD We adopted an established mapping exercise methodology, comparing service provision with demographic and deprivation statistics. Five local authority areas of England were selected based on differing demographics, mental health needs and wider challenging circumstances (i.e. high deprivation). Community-based interventions were identified through: 1) desk-based research 2) established professional networks 3) chain-referral sampling of individuals involved in local mental health promotion and prevention and 4) peer researchers' insight. We included all community-based, non-clinical interventions aimed at adult residents operating between July 2019 and May 2020. RESULTS 407 interventions were identified across the five areas addressing 16 risk/protective factors for PMH. Interventions for social isolation and loneliness were most prevalent, most commonly through social activities and/or befriending services. The most common subpopulations targeted were older adults and people from minority ethnic backgrounds. Interventions focusing on broader structural and environmental determinants were uncommon. There was some evidence of service provision being tailored to local need, though this was inconsistent, meaning some at-risk groups such as men or LGBTQ+ people from minority ethnic backgrounds were missed. Interventions were not consistently evaluated. CONCLUSIONS There was evidence of partial responsiveness to national and local prioritising. Provision was geared mainly towards addressing social and individual determinants of PMH, suggesting more integration is needed to engage wider service providers and policy-makers in PMH strategy and delivery at the community level. The lack of comprehensive evaluation of services to improve PMH needs to be urgently addressed to determine the extent of their effectiveness in communities they serve.
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Affiliation(s)
- F Duncan
- Department of Sport and Exercise Sciences, Durham University, 42 Old Elvet, Durham, DH1 3HN, UK.
| | - C Baskin
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, UK
| | - M McGrath
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - J F Coker
- Cambridge Public Health Interdisciplinary Research Centre, University of Cambridge, Robinson Way, Cambridge, CB2 0SR, UK
| | - C Lee
- Cambridge Public Health Interdisciplinary Research Centre, University of Cambridge, Robinson Way, Cambridge, CB2 0SR, UK
| | - J Dykxhoorn
- Department of Primary Care and Population Health, University College London, Rowland Hill Stress, London, NW3 2PF, UK
| | - E A Adams
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle, NE2 4AX, UK
| | - S Gnani
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, UK
| | - L Lafortune
- Cambridge Public Health Interdisciplinary Research Centre, University of Cambridge, Robinson Way, Cambridge, CB2 0SR, UK
| | - J B Kirkbride
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - E Kaner
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle, NE2 4AX, UK
| | - O Jones
- The McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR, UK
| | - G Samuel
- The McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR, UK
| | - K Walters
- Department of Primary Care and Population Health, University College London, Rowland Hill Stress, London, NW3 2PF, UK
| | - D Osborn
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, London, NW10PE, UK
| | - E J Oliver
- Department of Sport and Exercise Sciences, Durham University, 42 Old Elvet, Durham, DH1 3HN, UK
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8
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Nlebedim VU, Chaudhuri RR, Walters K. Corrigendum to: Probabilistic identification of bacterial essential genes via insertion density using TraDIS data with Tn5 libraries. Bioinformatics 2021; 37:3387. [PMID: 34520517 PMCID: PMC8504638 DOI: 10.1093/bioinformatics/btab610] [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: 11/14/2022] Open
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9
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Nlebedim VU, Chaudhuri RR, Walters K. Probabilistic Identification of Bacterial Essential Genes via insertion density using TraDIS Data with Tn5 libraries. Bioinformatics 2021; 37:4343-4349. [PMID: 34255819 PMCID: PMC8652038 DOI: 10.1093/bioinformatics/btab508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/24/2021] [Accepted: 07/23/2021] [Indexed: 11/29/2022] Open
Abstract
Motivation Probabilistic Identification of bacterial essential genes using transposon-directed insertion-site sequencing (TraDIS) data based on Tn5 libraries has received relatively little attention in the literature; most methods are designed for mariner transposon insertions. Analysis of Tn5 transposon-based genomic data is challenging due to the high insertion density and genomic resolution. We present a novel probabilistic Bayesian approach for classifying bacterial essential genes using transposon insertion density derived from transposon insertion sequencing data. We implement a Markov chain Monte Carlo sampling procedure to estimate the posterior probability that any given gene is essential. We implement a Bayesian decision theory approach to selecting essential genes. We assess the effectiveness of our approach via analysis of both simulated data and three previously published Escherichia coli, Salmonella Typhimurium and Staphylococcus aureus datasets. These three bacteria have relatively well characterized essential genes which allows us to test our classification procedure using receiver operating characteristic curves and area under the curves. We compare the classification performance with that of Bio-Tradis, a standard tool for bacterial gene classification. Results Our method is able to classify genes in the three datasets with areas under the curves between 0.967 and 0.983. Our simulated synthetic datasets show that both the number of insertions and the extent to which insertions are tolerated in the distal regions of essential genes are both important in determining classification accuracy. Importantly our method gives the user the option of classifying essential genes based on the user-supplied costs of false discovery and false non-discovery. Availability and implementation An R package that implements the method presented in this paper is available for download from https://github.com/Kevin-walters/insdens. Supplementary information Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Valentine U Nlebedim
- School of Mathematics and Statistics, University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - Roy R Chaudhuri
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - Kevin Walters
- School of Mathematics and Statistics, University of Sheffield, Sheffield, S10 2TN, United Kingdom
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10
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Kharicha K, Manthorpe J, Iliffe S, Chew-Graham CA, Cattan M, Goodman C, Kirby-Barr M, Whitehouse JH, Walters K. Managing loneliness: a qualitative study of older people's views. Aging Ment Health 2021; 25:1206-1213. [PMID: 32091237 DOI: 10.1080/13607863.2020.1729337] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Engaging with older people who self-identify as lonely may help professionals in mental health and other services understand how they deal with loneliness. The evidence-base for effective interventions to address loneliness is inconclusive. This study aimed to explore how community-dwelling lonely older people in England manage their experiences of loneliness. Twenty eight community-dwelling older people identifying as lonely, based on responses to two loneliness measures (self-report and a standardised instrument), participated in in-depth interviews between 2013 and 2014. Fifteen lived alone. Thematic analysis of transcribed interviews was conducted by a multidisciplinary team including older people.Participants drew on a range of strategies to ameliorate their distress which had been developed over their lives and shaped according to individual coping styles and contexts. Strategies included physical engagement with the world beyond their home, using technologies, planning, and engagement with purpose in an 'outside world', and acceptance, endurance, revealing and hiding, positive attitude and motivation, and distraction within an 'inside world'. Strategies of interests and hobbies, comparative thinking, religion and spirituality and use of alcohol straddled both the inside and outside worlds. Participants conveyed a personal responsibility for managing feelings of loneliness rather than relying on others. This study includes the experiences of those living with loneliness whilst also living with other people. When developing policy and practice responses to loneliness it is important to listen attentively to the views of those who may not be engaging with services designed for 'the lonely' and to consider their own strategies for managing it.
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Affiliation(s)
- K Kharicha
- Department of Primary Care and Population Health, University College London, Royal Free Campus, London, UK
| | - J Manthorpe
- NIHR Policy Research Unit on Health and Social Care Workforce, King's College London, London, UK
| | - S Iliffe
- Department of Primary Care and Population Health, University College London, Royal Free Campus, London, UK
| | - C A Chew-Graham
- School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - M Cattan
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - C Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - M Kirby-Barr
- Patient and Public Involvement Member, London, UK
| | | | - K Walters
- Department of Primary Care and Population Health, University College London, Royal Free Campus, London, UK
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11
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Kalkeri R, Walters K, Van Der Pol W, McFarland BC, Fisher N, Koide F, Morrow CD, Singh VK. Changes in the gut microbiome community of nonhuman primates following radiation injury. BMC Microbiol 2021; 21:93. [PMID: 33781201 PMCID: PMC8008626 DOI: 10.1186/s12866-021-02146-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/18/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Composition and maintenance of the microbiome is vital to gut homeostasis. However, there is limited knowledge regarding the impact of high doses of radiation, which can occur as a result of cancer radiation therapy, nuclear accidents or intentional release of a nuclear or radioactive weapon, on the composition of the gut microbiome. Therefore, we sought to analyze alterations to the gut microbiome of nonhuman primates (NHPs) exposed to high doses of radiation. Fecal samples were collected from 19 NHPs (Chinese rhesus macaques, Macaca mulatta) 1 day prior and 1 and 4 days after exposure to 7.4 Gy cobalt-60 gamma-radiation (LD70-80/60). The 16S V4 rRNA sequences were extracted from each sample, followed by bioinformatics analysis using the QIIME platform. RESULTS Alpha Diversity (Shannon Diversity Index), revealed no major difference between pre- and post-irradiation, whereas Beta diversity analysis showed significant differences in the microbiome after irradiation (day + 4) compared to baseline (pre-irradiation). The Firmicutes/Bacteriodetes ratio, a factor known to be associated with disruption of metabolic homeostasis, decreased from 1.2 to less than 1 post-radiation exposure. Actinobacillus, Bacteroides, Prevotella (Paraprevotellaceae family) and Veillonella genera were significantly increased by more than 2-fold and Acinetobacter and Aerococcus genus were decreased by more than 10-fold post-irradiation. Fifty-two percent (10/19) of animals exposed to radiation demonstrated diarrhea at day 4 post-irradiation. Comparison of microbiome composition of feces from animals with and without diarrhea at day 4 post-irradiation revealed an increase in Lactobacillus reuteri associated with diarrhea and a decrease of Lentisphaerae and Verrucomicrobioa phyla and Bacteroides in animals exhibiting diarrhea. Animals with diarrhea at day 4 post-irradiation, had significantly lower levels of Lentisphaere and Verrucomicrobia phyla and Bacteroides genus at baseline before irradiation, suggesting a potential association between the prevalence of microbiomes and differential susceptibility to radiation-induced diarrhea. CONCLUSIONS Our findings demonstrate that substantial alterations in the microbiome composition of NHPs occur following radiation injury and provide insight into early changes with high-dose, whole-body radiation exposure. Future studies will help identify microbiome biomarkers of radiation exposure and develop effective therapeutic intervention to mitigate the radiation injury.
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Affiliation(s)
| | | | - William Van Der Pol
- Center for Clinical Translational Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Braden C McFarland
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Casey D Morrow
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vijay K Singh
- Division of Radioprotectants, Department of Pharmacology and Molecular Therapeutics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. .,Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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12
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Walters K, Cox A, Yaacob H. The utility of the Laplace effect size prior distribution in Bayesian fine-mapping studies. Genet Epidemiol 2021; 45:386-401. [PMID: 33410201 DOI: 10.1002/gepi.22375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/18/2020] [Revised: 11/28/2020] [Accepted: 12/16/2020] [Indexed: 11/10/2022]
Abstract
The Gaussian distribution is usually the default causal single-nucleotide polymorphism (SNP) effect size prior in Bayesian population-based fine-mapping association studies, but a recent study showed that the heavier-tailed Laplace prior distribution provided a better fit to breast cancer top hits identified in genome-wide association studies. We investigate the utility of the Laplace prior as an effect size prior in univariate fine-mapping studies. We consider ranking SNPs using Bayes factors and other summaries of the effect size posterior distribution, the effect of prior choice on credible set size based on the posterior probability of causality, and on the noteworthiness of SNPs in univariate analyses. Across a wide range of fine-mapping scenarios the Laplace prior generally leads to larger 90% credible sets than the Gaussian prior. These larger credible sets for the Laplace prior are due to relatively high prior mass around zero which can yield many noncausal SNPs with relatively large Bayes factors. If using conventional credible sets, the Gaussian prior generally yields a better trade off between including the causal SNP with high probability and keeping the set size reasonable. Interestingly when using the less well utilised measure of noteworthiness, the Laplace prior performs well, leading to causal SNPs being declared noteworthy with high probability, whilst generally declaring fewer than 5% of noncausal SNPs as being noteworthy. In contrast, the Gaussian prior leads to the causal SNP being declared noteworthy with very low probability.
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Affiliation(s)
- Kevin Walters
- School of Mathematics and Statistics, University of Sheffield, Sheffield, UK
| | - Angela Cox
- Department of Oncology, Sheffield Cancer Research Centre, University of Sheffield Medical School, Sheffield, UK
| | - Hannuun Yaacob
- School of Mathematics and Statistics, University of Sheffield, Sheffield, UK
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13
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Nimmons D, Hatter L, Davies N, Sampson EL, Walters K, Schrag A. Experiences of advance care planning in Parkinson's disease and atypical parkinsonian disorders: a mixed methods systematic review. Eur J Neurol 2020; 27:1971-1987. [PMID: 32603525 DOI: 10.1111/ene.14424] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 02/05/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Advance care planning allows people to plan for their future care needs and can include medical, psychological and social aspects. However, little is known on the use, experience of and attitudes towards advance care planning in patients with parkinsonian disorders, their family carers and healthcare professionals. METHODS A systematic search of online databases was conducted in April 2019 using a narrative synthesis approach with thematic analysis and tabulation to synthesize the findings. RESULTS In all, 507 articles were identified and 27 were included. There were five overarching themes: (i) what is involved in advance care planning discussions, (ii) when and how advance care planning discussions are initiated, (iii) barriers to advance care planning, (iv) the role of healthcare professionals and (v) the role of the family carer. This evidence was used to highlight eight effective components to support optimal advance care planning in parkinsonian disorders: advance care planning discussions should be individualized in content, timing and approach; patients should be invited to discuss advance care planning early and regularly; palliative care services should be introduced early; a skilled professional should deliver advance care planning; support to family carers should be offered in the advance care planning process; healthcare professionals should be educated on parkinsonian disorders and palliative care; advance care planning should be clearly documented and shared with relevant services; and healthcare professionals should be enabled to conduct effective advance care planning. CONCLUSIONS These components can inform best practice in advance care planning in patients with parkinsonian disorders.
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Affiliation(s)
- D Nimmons
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - L Hatter
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - N Davies
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK.,Division of Psychiatry, Marie Curie Palliative Care Research Department, Centre for Dementia Palliative Care Research, UCL, London, UK
| | - E L Sampson
- Division of Psychiatry, Marie Curie Palliative Care Research Department, Centre for Dementia Palliative Care Research, UCL, London, UK
| | - K Walters
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - A Schrag
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, UCL, London, UK
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14
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Prow NA, Liu L, McCarthy MK, Walters K, Kalkeri R, Geiger J, Koide F, Cooper TH, Eldi P, Nakayama E, Diener KR, Howley PM, Hayball JD, Morrison TE, Suhrbier A. The vaccinia virus based Sementis Copenhagen Vector vaccine against Zika and chikungunya is immunogenic in non-human primates. NPJ Vaccines 2020; 5:44. [PMID: 32550013 PMCID: PMC7265471 DOI: 10.1038/s41541-020-0191-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/16/2019] [Accepted: 04/24/2020] [Indexed: 01/09/2023] Open
Abstract
The Sementis Copenhagen Vector (SCV) is a new vaccinia virus-derived, multiplication-defective, vaccine technology assessed herein in non-human primates. Indian rhesus macaques (Macaca mulatta) were vaccinated with a multi-pathogen recombinant SCV vaccine encoding the structural polyproteins of both Zika virus (ZIKV) and chikungunya virus (CHIKV). After one vaccination, neutralising antibody responses to ZIKV and four strains of CHIKV, representative of distinct viral genotypes, were generated. A second vaccination resulted in significant boosting of neutralising antibody responses to ZIKV and CHIKV. Following challenge with ZIKV, SCV-ZIKA/CHIK-vaccinated animals showed significant reductions in viremias compared with animals that had received a control SCV vaccine. Two SCV vaccinations also generated neutralising and IgG ELISA antibody responses to vaccinia virus. These results demonstrate effective induction of immunity in non-human primates by a recombinant SCV vaccine and illustrates the utility of SCV as a multi-disease vaccine platform capable of delivering multiple large immunogens.
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Affiliation(s)
- Natalie A Prow
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4029 Australia.,Australian Infectious Disease Research Centre, Brisbane, QLD 4029 and 4072 Australia.,Experimental Therapeutics Laboratory, School of Pharmacy and Medical Sciences, UniSA Cancer Research Institute, University of South Australia, Adelaide, SA 5000 Australia
| | - Liang Liu
- Experimental Therapeutics Laboratory, School of Pharmacy and Medical Sciences, UniSA Cancer Research Institute, University of South Australia, Adelaide, SA 5000 Australia
| | - Mary K McCarthy
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO 80045 USA
| | - Kevin Walters
- Department of Infectious Disease Research, Southern Research Institute, Frederick, MD 21701 USA
| | - Raj Kalkeri
- Department of Infectious Disease Research, Southern Research Institute, Frederick, MD 21701 USA
| | - Jillian Geiger
- Department of Infectious Disease Research, Southern Research Institute, Frederick, MD 21701 USA
| | - Fusataka Koide
- Department of Infectious Disease Research, Southern Research Institute, Frederick, MD 21701 USA
| | - Tamara H Cooper
- Experimental Therapeutics Laboratory, School of Pharmacy and Medical Sciences, UniSA Cancer Research Institute, University of South Australia, Adelaide, SA 5000 Australia
| | - Preethi Eldi
- Experimental Therapeutics Laboratory, School of Pharmacy and Medical Sciences, UniSA Cancer Research Institute, University of South Australia, Adelaide, SA 5000 Australia
| | - Eri Nakayama
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4029 Australia.,Department of Virology I, National Institute of Infectious Diseases, Tokyo, 162-8640 Japan
| | - Kerrilyn R Diener
- Experimental Therapeutics Laboratory, School of Pharmacy and Medical Sciences, UniSA Cancer Research Institute, University of South Australia, Adelaide, SA 5000 Australia.,Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, SA 5005 Australia
| | | | - John D Hayball
- Experimental Therapeutics Laboratory, School of Pharmacy and Medical Sciences, UniSA Cancer Research Institute, University of South Australia, Adelaide, SA 5000 Australia
| | - Thomas E Morrison
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO 80045 USA
| | - Andreas Suhrbier
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4029 Australia.,Australian Infectious Disease Research Centre, Brisbane, QLD 4029 and 4072 Australia
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15
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Vance CK, King EH, Bowers SD, Ryan PL, Walters K, Shappell NW. Reproductive Performance of Mares Fed Dietary Zearalenone. Front Vet Sci 2019; 6:423. [PMID: 32039244 PMCID: PMC6988787 DOI: 10.3389/fvets.2019.00423] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/08/2019] [Indexed: 11/13/2022] Open
Abstract
It is known that zearalenone (ZON) interacts directly with estrogen receptors, and its in vivo effects on reproduction have been well-documented in several species. In contrast, reports of ZON's impact on horse reproduction are conflicting and inconclusive, some studies confounded by the presence of mycotoxins such as deoxynivalenol in the feed. This study assesses the effect of chronic consumption of zearalenone on reproduction in cycling mares fed >95% pure ZON (0, 2, or 8 mg/da; n = 7 mares/treatment) for three estrous cycles, followed by artificial insemination, through 16 days of pregnancy. Animals were on ZON treatment for between 70 and 121 days (average 84) depending on individual cycle patterns. ZON-induced changes in serum concentration of estradiol (E2) and progesterone (P4), and total estrogenicity were measured using RIAs and the E-screen assay, respectively. Effects on reproductive physiology and pregnancy were monitored by ultrasound and clinical parameters. No significant changes were found in reproductive hormone levels of E2, or P4 for mares on ZON treatments compared to controls, although there was a significant (P < 0.01) increase in P4 levels across Cycle number in High ZON (8 mg/da) treated mares. There was also an increasing trend in the interovulatory interval in the High ZON treatment group. The overall estrogenicity was similar across treatments and over time, not differing from controls or between ZON treatment groups. Adverse uterine and ovarian effects were also not observed, but pregnancy rates were mixed with only 4 of 7 mares on Low ZON becoming pregnant, and only 3 maintaining pregnancy and fetal heartbeat by Day 30, compared to 5 of 6 control mares and all 7 mares on High ZON. Because reproductive efficiency and hormone concentrations are highly variable across individuals, this study did not demonstrate that ZON at 2 or 8 mg/da was detrimental to mares' reproduction. Yet, inferring that ZON treatments were completely without effect is also not appropriate, as the absence of measurable significant differences could be attributed to the limited sample size. Most importantly, there were no extreme signs of toxicology, in contrast to previous reports when ZON was fed at these "doses."
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Affiliation(s)
- Carrie K Vance
- Department of Biochemistry, Molecular Biology, Entomology and Plant Pathology, Mississippi State University, Starkville, MS, United States
| | - E Heath King
- Department of Pathobiology and Population Medicine, Mississippi State University, Starkville, MS, United States
| | - Susan D Bowers
- Department of Pathobiology and Population Medicine, Mississippi State University, Starkville, MS, United States
| | - Peter L Ryan
- Department of Pathobiology and Population Medicine, Mississippi State University, Starkville, MS, United States
| | - Kevin Walters
- Department of Pathobiology and Population Medicine, Mississippi State University, Starkville, MS, United States
| | - Nancy W Shappell
- Animal Metabolism-Agricultural Chemicals Research Unit, Bioscience Research Laboratory, Edward T. Shaffer Agricultural Research Service, USDA, Fargo, ND, United States
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16
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Okunoye O, Schrag A, Walters K, Marston L. Trends in the incidence of Parkinson's disease between 2006 and 2016: Analysis of a large primary care database. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1470] [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: 11/25/2022]
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17
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Alenazi AA, Cox A, Juarez M, Lin W, Walters K. Bayesian variable selection using partially observed categorical prior information in fine‐mapping association studies. Genet Epidemiol 2019; 43:690-703. [DOI: 10.1002/gepi.22213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/24/2019] [Accepted: 05/07/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Abdulaziz A. Alenazi
- School of Mathematics and StatisticsUniversity of SheffieldSheffield UK
- Department of MathematicsNorthern Border UniversityArar Saudi Arabia
| | - Angela Cox
- Department of Oncology, Sheffield Cancer Research CentreUniversity of Sheffield Medical SchoolSheffield UK
| | - Miguel Juarez
- School of Mathematics and StatisticsUniversity of SheffieldSheffield UK
| | - Wei‐Yu Lin
- Department of Oncology, Sheffield Cancer Research CentreUniversity of Sheffield Medical SchoolSheffield UK
- Northern Institute for Cancer Research, Medical SchoolUniversity of NewcastleNewcastle UK
| | - Kevin Walters
- School of Mathematics and StatisticsUniversity of SheffieldSheffield UK
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18
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Walters K, Cox A, Yaacob H. Using GWAS top hits to inform priors in Bayesian fine‐mapping association studies. Genet Epidemiol 2019; 43:675-689. [DOI: 10.1002/gepi.22212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/04/2019] [Accepted: 05/07/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Kevin Walters
- School of Mathematics and StatisticsUniversity of SheffieldSheffield UK
| | - Angela Cox
- Department of Oncology, Sheffield Cancer Research CentreUniversity of Sheffield Medical SchoolSheffield UK
| | - Hannuun Yaacob
- School of Mathematics and StatisticsUniversity of SheffieldSheffield UK
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19
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Walters K, Sarsenov R, Too WS, Hare RK, Paterson IC, Lambert DW, Brown S, Bradford JR. Comprehensive functional profiling of long non-coding RNAs through a novel pan-cancer integration approach and modular analysis of their protein-coding gene association networks. BMC Genomics 2019; 20:454. [PMID: 31159744 PMCID: PMC6547491 DOI: 10.1186/s12864-019-5850-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/18/2019] [Accepted: 05/27/2019] [Indexed: 12/11/2022] Open
Abstract
Background Long non-coding RNAs (lncRNAs) are emerging as crucial regulators of cellular processes in diseases such as cancer, although the functions of most remain poorly understood. To address this, here we apply a novel strategy to integrate gene expression profiles across 32 cancer types, and cluster human lncRNAs based on their pan-cancer protein-coding gene associations. By doing so, we derive 16 lncRNA modules whose unique properties allow simultaneous inference of function, disease specificity and regulation for over 800 lncRNAs. Results Remarkably, modules could be grouped into just four functional themes: transcription regulation, immunological, extracellular, and neurological, with module generation frequently driven by lncRNA tissue specificity. Notably, three modules associated with the extracellular matrix represented potential networks of lncRNAs regulating key events in tumour progression. These included a tumour-specific signature of 33 lncRNAs that may play a role in inducing epithelial-mesenchymal transition through modulation of TGFβ signalling, and two stromal-specific modules comprising 26 lncRNAs linked to a tumour suppressive microenvironment and 12 lncRNAs related to cancer-associated fibroblasts. One member of the 12-lncRNA signature was experimentally supported by siRNA knockdown, which resulted in attenuated differentiation of quiescent fibroblasts to a cancer-associated phenotype. Conclusions Overall, the study provides a unique pan-cancer perspective on the lncRNA functional landscape, acting as a global source of novel hypotheses on lncRNA contribution to tumour progression. Electronic supplementary material The online version of this article (10.1186/s12864-019-5850-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kevin Walters
- School of Mathematics and Statistics, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Radmir Sarsenov
- Sheffield RNAi Screening Facility (SRSF), Department of Biomedical Science, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Wen Siong Too
- Sheffield RNAi Screening Facility (SRSF), Department of Biomedical Science, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Roseanna K Hare
- Department of Biomedical Science, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Ian C Paterson
- Department of Oral and Craniofacial Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Daniel W Lambert
- Sheffield Institute for Nucleic Acids (SInFoNiA), Integrated Biosciences, School of Clinical Dentistry, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Stephen Brown
- Sheffield RNAi Screening Facility (SRSF), Department of Biomedical Science, University of Sheffield, Sheffield, South Yorkshire, UK
| | - James R Bradford
- Sheffield Institute for Nucleic Acids (SInFoNiA), Department of Oncology and Metabolism, University of Sheffield, Sheffield, South Yorkshire, UK. .,Almac Diagnostic Services, Craigavon, Northern Ireland, UK.
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20
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Kojima G, Avgerinou C, Iliffe S, Jivraj S, Sekiguchi K, Walters K. Erratum to: Fruit and Vegetable Consumption and Frailty: A Systematic Review. J Nutr Health Aging 2018. [DOI: 10.1007/s12603-018-1074-9] [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: 10/28/2022]
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21
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Kojima G, Avgerinou C, Iliffe S, Jivraj S, Sekiguchi K, Walters K. 15FRUIT AND VEGETABLE CONSUMPTION AND FRAILTY: A SYSTEMATIC REVIEW. Age Ageing 2018. [DOI: 10.1093/ageing/afy134.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Kojima
- Department of Primary Care and Population Health, University College London
| | - C Avgerinou
- Department of Primary Care and Population Health, University College London
| | - S Iliffe
- Department of Primary Care and Population Health, University College London
| | - S Jivraj
- Department of Epidemiology and Public Health, University College London
| | - K Sekiguchi
- Department of General Medicine, Shinshu University School of Medicine
| | - K Walters
- Department of Primary Care and Population Health, University College London
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22
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Walters K, Falcaro M, Freemantle N, King M, Ben-Shlomo Y. Sociodemographic inequalities in the management of depression in adults aged 55 and over: an analysis of English primary care data. Psychol Med 2018; 48:1504-1513. [PMID: 29017624 DOI: 10.1017/s0033291717003014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND We do not know how primary care treatment of depression varies by age across both psychotropic medication and psychological therapies. METHODS Cohort study including 19 710 people aged 55+ with GP recorded depression diagnoses and 26 276 people with recorded depression symptoms during the period 2009-2013, from 373 General Practices in The Health Improvement Network (THIN) database in England. Main outcomes were initiation of treatment with anti-depressants, anxiolytics, hypnotics, anti-psychotic drugs, referrals to psychological therapies within 6 months of onset. RESULTS Treatment rates with antidepressants are high for those recorded with new depression diagnoses (87.1%) or symptoms of depression (58.7%). Treatment in those with depression diagnoses varies little by age. In those with depressive symptoms there was a J-shaped pattern with reduced antidepressant treatment in those in their 60s and 70s followed by increased treatment in the oldest age groups (85+ years), compared with those aged 55-59 years. Other psychotropic drug prescribing (hypnotics/anxiolytics, antipsychotics) all increase with increasing age. Recorded referrals for psychological therapies were low, and decreased steadily with increasing age, such that women aged 75-79 years with depression diagnoses had around six times lower odds of referral (OR 0.17, 95% CI 0.1-0.29) than those aged 55-59 years, and men aged 80-84 years had around seven times lower (OR 0.14, 95% CI 0.05-0.36). CONCLUSIONS The oldest age groups with new depression diagnoses and symptoms have fewer recorded referrals to psychological therapies, and higher psychotropic drug treatment rates in primary care. This suggests potential inequalities in access to psychological therapies.
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Affiliation(s)
- K Walters
- Research Department of Primary Care & Population Health,University College London (UCL),Rowland Hill St,London,UK
| | - M Falcaro
- Research Department of Primary Care & Population Health,University College London (UCL),Rowland Hill St,London,UK
| | - N Freemantle
- Research Department of Primary Care & Population Health,University College London (UCL),Rowland Hill St,London,UK
| | - M King
- Division of Psychiatry,UCL,Sixth Floor Maple House,147 Tottenham Court Rd,London,UK
| | - Y Ben-Shlomo
- School of Social and Community Medicine,University of Bristol,39 Whatley Road, Bristol,UK
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23
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Walters K, Wake E, Campbell D, Wullschleger M, Chalasani A, Ho D, Fomin I, Winearls J. Critical evaluation of a targeted point of care ROTEM guided coagulation and haemostasis management programme in severe trauma. Aust Crit Care 2018. [DOI: 10.1016/j.aucc.2017.12.014] [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] Open
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24
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Blackburn R, Osborn D, Walters K, Nazareth I, Petersen I. Statin prescribing for prevention of cardiovascular disease amongst people with severe mental illness: Cohort study in UK primary care. Schizophr Res 2018; 192:219-225. [PMID: 28599749 DOI: 10.1016/j.schres.2017.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Severe mental illness (SMI) is associated with excess cardiovascular disease (CVD) morbidity, but little is known on provision of preventative interventions. We investigated statin initiation for primary CVD prevention in individuals with and without SMI. METHODS We used primary care data from The Health Improvement Network from 2006 to 2015 for UK patients aged 30-99years with no pre-existing CVD conditions and selected individuals with schizophrenia (n=13,252) or bipolar disorder (n=11,994). In addition, we identified samples of individuals without schizophrenia (n=66,060) and bipolar disorder (n=59,765), but with similar age and gender distribution. Missing data on CVD covariates were estimated using multiple imputation. Statin prescribing differences between individuals with and without SMI were investigated using multivariable Poisson regression models. RESULTS Initiation of statin prescribing was between 2 and 3 fold higher in people aged 30-59years with SMI than in those without after adjusting for CVD covariates. The rates in those aged 60-74years with SMI were similar or slightly higher relative to those without SMI. The incidence rate ratio (IRR) was 1.15 (95% CI 1.03-1.28) for bipolar disorder and 1.00 (0.91-1.11) for schizophrenia. The rate of statin prescribing was lower (IRR 0.81 (0.66-0.98)) amongst the oldest (aged 75+years) with schizophrenia relative to those without schizophrenia. CONCLUSIONS Despite higher rates of new statin prescriptions to younger individuals with SMI relative to individuals without SMI, there was evidence of lower rates of statin initiation for older individuals with schizophrenia, and this group may benefit from additional measures to prevent CVD.
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Affiliation(s)
- R Blackburn
- Division of Psychiatry, W1T 7NF and Institute for Health Informatics, UCL, NW1 2DA, UK.
| | - D Osborn
- Psychiatric Epidemiology, Division of Psychiatry, UCL, W1T 7NF and Camden and Islington NHS Foundation Trust, London NW1 0PE, UK
| | - K Walters
- Primary Care and Population Health, UCL, NW3 2PF, UK
| | - I Nazareth
- Primary Care and Population Health, UCL, NW3 2PF, UK; Primary Care and Population Science, Primary Care and Population Health, UCL, NW3 2PF, UK
| | - I Petersen
- Primary Care and Population Health, UCL, NW3 2PF, UK; Epidemiology and Statistics, Primary Care and Population Health, UCL, NW3 2PF, Department of Clinical Epidemiology, Aarhus University, 8200 Aarhus N, Denmark
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25
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Kojima G, Avgerinou C, Iliffe S, Jivraj S, Sekiguchi K, Walters K. Fruit and Vegetable Consumption and Frailty: A Systematic Review. J Nutr Health Aging 2018; 22:1010-1017. [PMID: 30272107 PMCID: PMC6182506 DOI: 10.1007/s12603-018-1069-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify currently available evidence on fruit and vegetable consumption in association with frailty by conducting a systematic review of the literature and to summarise and critically evaluate it. DESIGN Systematic review. SETTING Four electronic databases (Embase, MEDLINE, CINAHL and PsycINFO) were systematically searched in August 2017 for observational cohort studies providing cross-sectional or prospective associations between fruit and vegetable consumption and frailty risks. Additional studies were searched by manually reviewing the reference lists of the included studies and related review papers and conducting forward citation tracking of the included studies. The methodological quality of prospective studies was assessed using the Newcastle-Ottawa scale. PARTICIPANTS Community-dwelling general populations. RESULTS A total of 6251 studies were identified, of which five prospective studies with follow-up periods of 2-10.5 years and two cross-sectional studies were included. Among the five prospective studies, three had adequate methodological quality. Because of different measurements and statistical methodologies, a meta-analysis was not possible. The two studies of good quality showed that fruit and vegetable consumption was mostly associated with lower risk of incident frailty. The other study as a sub-analysis retrospectively examined baseline fruit and vegetable consumption of those who developed frailty and those who did not at follow-up and showed no significant associations. CONCLUSIONS Although good quality studies on this topic are scarce, there is some suggestion that higher fruit and vegetable consumption may be associated with lower frailty risk. More high quality research is needed.
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Affiliation(s)
- G Kojima
- Gotaro Kojima, MD, Department of Primary Care and Population Health, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK, Phone: +44 (0)20 7794 0500, Fax: +44 (0)20 7472 6871,
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26
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Kharicha K, Iliffe S, Manthorpe J, Chew-Graham C, Cattan M, Kirby-Barr M, Goodman C, Walters K. HOW DO OLDER PEOPLE MANAGE LONELINESS FOR THEMSELVES? A QUALITATIVE STUDY IN ENGLAND. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3427] [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: 11/15/2022] Open
Affiliation(s)
- K. Kharicha
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, University College London, London, United Kingdom,
| | - S. Iliffe
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, University College London, London, United Kingdom,
| | | | | | - M. Cattan
- Northumbria University, Newcastle upon Tyne, United Kingdom,
| | - M. Kirby-Barr
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, University College London, London, United Kingdom,
| | - C. Goodman
- University of Hertfordshire, Hertfordshire, United Kingdom
| | - K. Walters
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, University College London, London, United Kingdom,
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Osborn D, Marston L, Nazareth I, King MB, Petersen I, Walters K. Relative risks of cardiovascular disease in people prescribed olanzapine, risperidone and quetiapine. Schizophr Res 2017; 183:116-123. [PMID: 27884434 DOI: 10.1016/j.schres.2016.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/28/2016] [Accepted: 11/09/2016] [Indexed: 12/25/2022]
Abstract
UNLABELLED Antipsychotics may confer long term benefits and risks, including cardiovascular disease (CVD) risk. Several studies using routine clinical data have reported associations between antipsychotics and CVD but potential confounding factors and unclear classification of drug exposure limits their interpretation. METHOD We used data from The Health Improvement Network, a large UK primary care database to determine relative risks of (CVD) comparing similar groups of people only prescribed olanzapine versus either risperidone or quetiapine. We included participants over 18 between 1995 and 2011. To assess confounding factors we created propensity scores for being prescribed each antipsychotic. We used propensity score matching and Poisson regression to calculate the CVD incidence rate ratios for olanzapine versus the other two drugs. RESULTS We identified 18,319 people who received a single antipsychotic during follow-up (n=5090 risperidone, 7797 olanzapine and 4613 quetiapine). In unmatched analyses, the CVD incidence rate ratio (IRR) for olanzapine versus risperidone was 0.63 (0.51-0.77) but the propensity score matched IRR was 0.78 (0.61-1.02). In the unmatched olanzapine versus quetiapine analysis the IRR adjusted for age and sex for olanzapine was 1.52 (1.16-1.98) but the propensity score matched analysis gave an IRR of 1.08 (0.79-1.46). CONCLUSIONS After propensity score matching, we found no statistical differences in CVD incidence between olanzapine and either risperidone or quetiapine. Analyses which did not account for confounding factors produced very different results. Researchers must address confounding factors when designing observational studies to assess adverse outcomes of drugs, including antipsychotics.
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Affiliation(s)
- Dpj Osborn
- UCL Division of Psychiatry, UCL, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | - L Marston
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - I Nazareth
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - M B King
- UCL Division of Psychiatry, UCL, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - I Petersen
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - K Walters
- Research Department of Primary Care and Population Health, UCL, London, UK; Department of Clinical Epidemiology, Aarhus University, Denmark
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Abstract
OBJECTIVES To estimate the 'real-world effectiveness of statins for primary prevention of cardiovascular disease (CVD) and for lipid modification in people with severe mental illnesses (SMI), including schizophrenia and bipolar disorder. DESIGN Series of staggered cohorts. We estimated the effect of statin prescribing on CVD outcomes using a multivariable Poisson regression model or linear regression for cholesterol outcomes. SETTING 587 general practice (GP) surgeries across the UK reporting data to The Health Improvement Network. PARTICIPANTS All permanently registered GP patients aged 40-84 years between 2002 and 2012 who had a diagnosis of SMI. Exclusion criteria were pre-existing CVD, statin-contraindicating conditions or a statin prescription within the 24 months prior to the study start. EXPOSURE One or more statin prescriptions during a 24-month 'baseline' period (vs no statin prescription during the same period). MAIN OUTCOME MEASURES The primary outcome was combined first myocardial infarction and stroke. All-cause mortality and total cholesterol concentration were secondary outcomes. RESULTS We identified 2944 statin users and 42 886 statin non-users across the staggered cohorts. Statin prescribing was not associated with significant reduction in CVD events (incident rate ratio 0.89; 95% CI 0.68 to 1.15) or all-cause mortality (0.89; 95% CI 0.78 to 1.02). Statin prescribing was, however, associated with statistically significant reductions in total cholesterol of 1.2 mmol/L (95% CI 1.1 to 1.3) for up to 2 years after adjusting for differences in baseline characteristics. On average, total cholesterol decreased from 6.3 to 4.6 in statin users and 5.4 to 5.3 mmol/L in non-users. CONCLUSIONS We found that statin prescribing to people with SMI in UK primary care was effective for lipid modification but not CVD events. The latter finding may reflect insufficient power to detect a smaller effect size than that observed in randomised controlled trials of statins in people without SMI.
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Affiliation(s)
- R Blackburn
- Institute for Health Informatics, UCL, London, UK
| | - D Osborn
- Division of Psychiatry, UCL, London, UK
| | - K Walters
- Primary Care and Population Health, UCL, London, UK
| | - M Falcaro
- Primary Care and Population Health, UCL, London, UK
| | - I Nazareth
- Primary Care and Population Health, UCL, London, UK
| | - I Petersen
- Primary Care and Population Health, UCL, London, UK
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Liljas AEM, Carvalho LA, Papachristou E, Ramsay SE, Wannamethee SG, De Oliveira C, Walters K. OP67 Hearing impairment and incident frailty in older English community-dwelling men and women: a 4-year follow-up study. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.67] [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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Kojima G, Iliffe S, Walters K. 61SMOKING AS A PREDICTOR OF FRAILTY: A SYSTEMATIC REVIEW. Age Ageing 2016. [DOI: 10.1093/ageing/afw033.05] [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: 11/12/2022] Open
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Spencer AV, Cox A, Lin W, Easton DF, Michailidou K, Walters K. Incorporating Functional Genomic Information in Genetic Association Studies Using an Empirical Bayes Approach. Genet Epidemiol 2016; 40:176-87. [PMID: 26833494 PMCID: PMC4832271 DOI: 10.1002/gepi.21956] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 03/24/2015] [Revised: 12/04/2015] [Accepted: 12/14/2015] [Indexed: 01/01/2023]
Abstract
There is a large amount of functional genetic data available, which can be used to inform fine-mapping association studies (in diseases with well-characterised disease pathways). Single nucleotide polymorphism (SNP) prioritization via Bayes factors is attractive because prior information can inform the effect size or the prior probability of causal association. This approach requires the specification of the effect size. If the information needed to estimate a priori the probability density for the effect sizes for causal SNPs in a genomic region isn't consistent or isn't available, then specifying a prior variance for the effect sizes is challenging. We propose both an empirical method to estimate this prior variance, and a coherent approach to using SNP-level functional data, to inform the prior probability of causal association. Through simulation we show that when ranking SNPs by our empirical Bayes factor in a fine-mapping study, the causal SNP rank is generally as high or higher than the rank using Bayes factors with other plausible values of the prior variance. Importantly, we also show that assigning SNP-specific prior probabilities of association based on expert prior functional knowledge of the disease mechanism can lead to improved causal SNPs ranks compared to ranking with identical prior probabilities of association. We demonstrate the use of our methods by applying the methods to the fine mapping of the CASP8 region of chromosome 2 using genotype data from the Collaborative Oncological Gene-Environment Study (COGS) Consortium. The data we analysed included approximately 46,000 breast cancer case and 43,000 healthy control samples.
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Affiliation(s)
- Amy V. Spencer
- Advanced Analytics CentreGlobal Medicines DevelopmentAstraZenecaAlderley ParkMacclesfieldUnited Kingdom
- School of Mathematics and StatisticsUniversity of SheffieldSheffieldUnited Kingdom
| | - Angela Cox
- Department of OncologySheffield Cancer Research CentreUniversity of Sheffield Medical SchoolBeech Hill RoadSheffieldUnited Kingdom
| | - Wei‐Yu Lin
- Department of OncologySheffield Cancer Research CentreUniversity of Sheffield Medical SchoolBeech Hill RoadSheffieldUnited Kingdom
- Cardiovascular Epidemiology UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
| | - Douglas F. Easton
- Department of Public Health and Primary CareCentre for Cancer Genetic EpidemiologyUniversity of CambridgeCambridgeUnited Kingdom
- Department of OncologyCentre for Cancer Genetic EpidemiologyUniversity of CambridgeCambridgeUnited Kingdom
| | - Kyriaki Michailidou
- Department of Public Health and Primary CareCentre for Cancer Genetic EpidemiologyUniversity of CambridgeCambridgeUnited Kingdom
| | - Kevin Walters
- School of Mathematics and StatisticsUniversity of SheffieldSheffieldUnited Kingdom
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Boggis EM, Milo M, Walters K. eQuIPS: eQTL Analysis Using Informed Partitioning of SNPs - A Fully Bayesian Approach. Genet Epidemiol 2016; 40:273-83. [DOI: 10.1002/gepi.21961] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 11/11/2022]
Affiliation(s)
- E. M. Boggis
- School of Mathematics and Statistics; University of Sheffield; Sheffield United Kingdom
| | - M. Milo
- Department of Biomedical Science; University of Sheffield; Sheffield United Kingdom
| | - K. Walters
- School of Mathematics and Statistics; University of Sheffield; Sheffield United Kingdom
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Zomer E, Osborn D, Nazareth I, Blackburn R, Burton A, Hardoon S, Holt R, King M, Marston L, Morris S, Omar R, Petersen I, Walters K, Hunter R. Effectiveness and cost-effectiveness of a cardiovascular risk prediction algorithm for people with severe mental illness. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.433] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IntroductionCardiovascular risk prediction tools are important for cardiovascular disease (CVD) prevention, however, which algorithms are appropriate for people with severe mental illness (SMI) is unclear.Objectives/aimsTo determine the cost-effectiveness using the net monetary benefit (NMB) approach of two bespoke SMI-specific risk algorithms compared to standard risk algorithms for primary CVD prevention in those with SMI, from an NHS perspective.MethodsA microsimulation model was populated with 1000 individuals with SMI from The Health Improvement Network Database, aged 30–74 years without CVD. Four cardiovascular risk algorithms were assessed; (1) general population lipid, (2) general population BMI, (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those high-risk (> 10%) were assumed to be prescribed statin therapy, others received usual care. Individuals entered the model in a ‘healthy’ free of CVD health state and with each year could retain their current health state, have cardiovascular events (non-fatal/fatal) or die from other causes according to transition probabilities.ResultsThe SMI-specific BMI and general population lipid algorithms had the highest NMB of the four algorithms resulting in 12 additional QALYs and a cost saving of approximately £37,000 (US$ 58,000) per 1000 patients with SMI over 10 years.ConclusionsThe general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of a SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Walters K, Hardoon S, Petersen I, Iliffe S, Omar RZ, Nazareth I, Rait G. Predicting dementia risk in primary care: development and validation of the Dementia Risk Score using routinely collected data. BMC Med 2016; 14:6. [PMID: 26797096 PMCID: PMC4722622 DOI: 10.1186/s12916-016-0549-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [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: 09/30/2015] [Accepted: 12/16/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Existing dementia risk scores require collection of additional data from patients, limiting their use in practice. Routinely collected healthcare data have the potential to assess dementia risk without the need to collect further information. Our objective was to develop and validate a 5-year dementia risk score derived from primary healthcare data. METHODS We used data from general practices in The Health Improvement Network (THIN) database from across the UK, randomly selecting 377 practices for a development cohort and identifying 930,395 patients aged 60-95 years without a recording of dementia, cognitive impairment or memory symptoms at baseline. We developed risk algorithm models for two age groups (60-79 and 80-95 years). An external validation was conducted by validating the model on a separate cohort of 264,224 patients from 95 randomly chosen THIN practices that did not contribute to the development cohort. Our main outcome was 5-year risk of first recorded dementia diagnosis. Potential predictors included sociodemographic, cardiovascular, lifestyle and mental health variables. RESULTS Dementia incidence was 1.88 (95% CI, 1.83-1.93) and 16.53 (95% CI, 16.15-16.92) per 1000 PYAR for those aged 60-79 (n = 6017) and 80-95 years (n = 7104), respectively. Predictors for those aged 60-79 included age, sex, social deprivation, smoking, BMI, heavy alcohol use, anti-hypertensive drugs, diabetes, stroke/TIA, atrial fibrillation, aspirin, depression. The discrimination and calibration of the risk algorithm were good for the 60-79 years model; D statistic 2.03 (95% CI, 1.95-2.11), C index 0.84 (95% CI, 0.81-0.87), and calibration slope 0.98 (95% CI, 0.93-1.02). The algorithm had a high negative predictive value, but lower positive predictive value at most risk thresholds. Discrimination and calibration were poor for the 80-95 years model. CONCLUSIONS Routinely collected data predicts 5-year risk of recorded diagnosis of dementia for those aged 60-79, but not those aged 80+. This algorithm can identify higher risk populations for dementia in primary care. The risk score has a high negative predictive value and may be most helpful in 'ruling out' those at very low risk from further testing or intensive preventative activities.
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Affiliation(s)
- K Walters
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK.
| | - S Hardoon
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
| | - I Petersen
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
| | - S Iliffe
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
| | - R Z Omar
- Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - I Nazareth
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
| | - G Rait
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
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White J, Zaninotto P, Walters K, Kivimäki M, Demakakos P, Shankar A, Kumari M, Gallacher J, Batty GD. Severity of depressive symptoms as a predictor of mortality: the English longitudinal study of ageing. Psychol Med 2015; 45:2771-2779. [PMID: 25936473 DOI: 10.1017/s0033291715000732] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Major depressive disorder and subthreshold depression have been associated with premature mortality. We investigated the association between depressive symptoms and mortality across the full continuum of severity. METHOD We used Cox proportional hazards models to examine the association between depressive symptom severity, assessed using the eight-item Center for Epidemiological Studies Depression Scale (CES-D; range 0-8), and the risk of all-cause mortality over a 9-year follow-up, in 11 104 members of the English Longitudinal Study of Ageing. RESULTS During follow-up, one fifth of study members died (N = 2267). Depressive symptoms were associated with increased mortality across the full range of severity (p trend < 0.001). Relative to study members with no symptoms, an increased risk of mortality was found in people with depressive symptoms of a low [hazard ratio (HR) for a score of 2 was 1.59, 95% confidence interval (CI) 1.40-1.82], moderate (score of 4: HR 1.80, 95% CI 1.52-2.13) and high (score of 8: HR 2.27, 95% CI 1.69-3.04) severity, suggesting risk emerges at low levels but plateaus thereafter. A third of participants (36.4%, 95% CI 35.5-37.3) reported depressive symptoms associated with an increased mortality risk. Adjustment for physical activity, physical illnesses, and impairments in physical and cognitive functioning attenuated this association (p trend = 0.25). CONCLUSIONS Depressive symptoms are associated with an increased mortality risk even at low levels of symptom severity. This association is explained by physical activity, physical illnesses, and impairments in physical and cognitive functioning.
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Affiliation(s)
- J White
- School of Medicine,Cardiff University,Cardiff,UK
| | - P Zaninotto
- Department of Epidemiology and Public Health,University College London,London,UK
| | - K Walters
- Department of Primary Care and Population Health,University College London,London,UK
| | - M Kivimäki
- Department of Epidemiology and Public Health,University College London,London,UK
| | - P Demakakos
- Department of Epidemiology and Public Health,University College London,London,UK
| | - A Shankar
- Department of Epidemiology and Public Health,University College London,London,UK
| | - M Kumari
- Institute for Social and Economic Research,University of Essex,Colchester,UK
| | - J Gallacher
- School of Medicine,Cardiff University,Cardiff,UK
| | - G D Batty
- Department of Epidemiology and Public Health,University College London,London,UK
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Liljas AEM, Wannamethee S, Whincup P, Papacosta O, Walters K, Iliffe S, Lennon L, Carvalho L, Ramsay S. 52SENSORY IMPAIRMENTS AND MORTALITY IN OLDER BRITISH COMMUNITY-DWELLING MEN: A 10-YEAR FOLLOW-UP STUDY. Age Ageing 2015. [DOI: 10.1093/ageing/afv109.05] [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: 11/12/2022] Open
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37
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Liljas AEM, Wannamethee SG, Whincup PH, Papacosta O, Walters K, Iliffe S, Lennon LT, Carvalho LA, Ramsay SE. OP07 Sensory impairments and mortality in older british community-dwelling men: a 10-year follow-up study. J Epidemiol Community Health 2015. [DOI: 10.1136/jech-2015-206256.7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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38
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Liljas AEM, Wannamethee SG, Whincup PH, Papacosta O, Walters K, Iliffe S, Lennon LT, Carvalho LA, Ramsay SE. Socio-demographic characteristics, lifestyle factors and burden of morbidity associated with self-reported hearing and vision impairments in older British community-dwelling men: a cross-sectional study. J Public Health (Oxf) 2015; 38:e21-8. [PMID: 26177816 DOI: 10.1093/pubmed/fdv095] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 11/13/2022] Open
Abstract
BACKGROUND Hearing and vision problems are common in older adults. We investigated the association of self-reported sensory impairment with lifestyle factors, chronic conditions, physical functioning, quality of life and social interaction. METHODS A population-based cross-sectional study of participants of the British Regional Heart Study aged 63-85 years. RESULTS A total of 3981 men (82% response rate) provided data. Twenty-seven per cent (n = 1074) reported hearing impairment including being able to hear with aid (n = 482), being unable to hear (no aid) (n = 424) and being unable to hear despite aid (n = 168). Three per cent (n = 124) reported vision impairment. Not being able to hear, irrespective of use of hearing aid, was associated with poor quality of life, poor social interaction and poor physical functioning. Men who could not hear despite hearing aid were more likely to report coronary heart disease (CHD) [age-adjusted odds ratios (ORs) 1.89 (95% confidence interval 1.36-2.63)]. Vision impairment was associated with symptoms of CHD including breathlessness [OR 2.06 (1.38-3.06)] and chest pain [OR 1.58 (1.07-2.35)]. Vision impairment was also associated with poor quality of life, poor social interaction and poor physical functioning. CONCLUSIONS Sensory impairment is associated with poor physical functioning, poor health and poor social interaction in older men. Further research is warranted on pathways underlying these associations.
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Affiliation(s)
- A E M Liljas
- Department of Primary Care and Population Health, University College London, London, UK
| | - S G Wannamethee
- Department of Primary Care and Population Health, University College London, London, UK
| | - P H Whincup
- Population Health Research Centre, Division of Population Health Sciences and Education, St George's, University of London, London, UK
| | - O Papacosta
- Department of Primary Care and Population Health, University College London, London, UK
| | - K Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - S Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
| | - L T Lennon
- Department of Primary Care and Population Health, University College London, London, UK
| | - L A Carvalho
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - S E Ramsay
- Department of Primary Care and Population Health, University College London, London, UK
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Hayes JF, Miles J, Walters K, King M, Osborn DPJ. A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatr Scand 2015; 131:417-25. [PMID: 25735195 PMCID: PMC4939858 DOI: 10.1111/acps.12408] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [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] [Accepted: 02/09/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To review and complete meta-analysis of studies estimating standardised mortality ratios (SMRs) in bipolar affective disorder (BPAD) for all-cause and cause-specific mortalities. METHOD Cause-specific mortality was grouped into natural and unnatural causes. These subgroups were further divided into circulatory, respiratory, neoplastic and infectious causes, and suicide and other violent deaths. Summary SMRs were calculated using random-effects meta-analysis. Heterogeneity was examined via subgroup analysis and meta-regression. RESULTS Systematic searching found 31 studies meeting inclusion criteria. Summary SMR for all-cause mortality = 2.05 (95% CI 1.89-2.23), but heterogeneity was high (I(2) = 96.2%). This heterogeneity could not be accounted for by date of publication, cohort size, mid-decade of data collection, population type or geographical region. Unnatural death summary SMR = 7.42 (95% CI 6.43-8.55) and natural death = 1.64 (95% CI 1.47-1.83). Specifically, suicide SMR = 14.44 (95% CI 12.43-16.78), other violent death SMR = 3.68 (95% CI 2.77-4.90), deaths from circulatory disease = 1.73 (95% CI 1.54-1.94), respiratory disease = 2.92 (95% CI 2.00-4.23), infection = 2.25 (95% CI 1.70-3.00) and neoplasm = 1.14 (95% CI 1.10-1.21). CONCLUSION Despite considerable heterogeneity, all summary SMR estimates and a large majority of individual studies showed elevated mortality in BPAD compared to the general population. This was true for all causes of mortality studied.
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Affiliation(s)
- J. F. Hayes
- Division of PsychiatryUCLLondonUK,Camden & Islington NHS Foundation TrustNHSLondonUK
| | - J. Miles
- Camden & Islington NHS Foundation TrustNHSLondonUK
| | - K. Walters
- Department of Primary Care and Population HealthUCLLondonUK
| | - M. King
- Division of PsychiatryUCLLondonUK
| | - D. P. J. Osborn
- Division of PsychiatryUCLLondonUK,Camden & Islington NHS Foundation TrustNHSLondonUK
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Spencer AV, Cox A, Lin W, Easton DF, Michailidou K, Walters K. Novel bayes factors that capture expert uncertainty in prior density specification in genetic association studies. Genet Epidemiol 2015; 39:239-48. [PMID: 25727067 PMCID: PMC4406822 DOI: 10.1002/gepi.21891] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 10/21/2014] [Accepted: 11/05/2014] [Indexed: 02/04/2023]
Abstract
Bayes factors (BFs) are becoming increasingly important tools in genetic association studies, partly because they provide a natural framework for including prior information. The Wakefield BF (WBF) approximation is easy to calculate and assumes a normal prior on the log odds ratio (logOR) with a mean of zero. However, the prior variance (W) must be specified. Because of the potentially high sensitivity of the WBF to the choice of W, we propose several new BF approximations with logOR ∼N(0,W), but allow W to take a probability distribution rather than a fixed value. We provide several prior distributions for W which lead to BFs that can be calculated easily in freely available software packages. These priors allow a wide range of densities for W and provide considerable flexibility. We examine some properties of the priors and BFs and show how to determine the most appropriate prior based on elicited quantiles of the prior odds ratio (OR). We show by simulation that our novel BFs have superior true-positive rates at low false-positive rates compared to those from both P-value and WBF analyses across a range of sample sizes and ORs. We give an example of utilizing our BFs to fine-map the CASP8 region using genotype data on approximately 46,000 breast cancer case and 43,000 healthy control samples from the Collaborative Oncological Gene-environment Study (COGS) Consortium, and compare the single-nucleotide polymorphism ranks to those obtained using WBFs and P-values from univariate logistic regression.
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Affiliation(s)
- Amy V. Spencer
- School of Mathematics and StatisticsUniversity of SheffieldSheffieldUK
| | - Angela Cox
- Department of OncologySheffield Cancer Research CentreUniversity of Sheffield Medical SchoolSheffieldUK
| | - Wei‐Yu Lin
- Department of OncologySheffield Cancer Research CentreUniversity of Sheffield Medical SchoolSheffieldUK
- Department of NeurosurgeryChang Gung Memorial HospitalTaoyuan CountyTaiwan
| | - Douglas F. Easton
- Department of Public Health and Primary CareCentre for Cancer Genetic EpidemiologyUniversity of CambridgeCambridgeUK
- Department of OncologyCentre for Cancer Genetic EpidemiologyUniversity of CambridgeCambridgeUK
| | - Kyriaki Michailidou
- Department of Public Health and Primary CareCentre for Cancer Genetic EpidemiologyUniversity of CambridgeCambridgeUK
| | - Kevin Walters
- School of Mathematics and StatisticsUniversity of SheffieldSheffieldUK
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Spencer AV, Cox A, Walters K. Comparing the efficacy of SNP filtering methods for identifying a single causal SNP in a known association region. Ann Hum Genet 2013; 78:50-61. [PMID: 24205929 PMCID: PMC4282378 DOI: 10.1111/ahg.12043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 04/09/2013] [Accepted: 09/05/2013] [Indexed: 01/20/2023]
Abstract
Genome-wide association studies have successfully identified associations between common diseases and a large number of single nucleotide polymorphisms (SNPs) across the genome. We investigate the effectiveness of several statistics, including p-values, likelihoods, genetic map distance and linkage disequilibrium between SNPs, in filtering SNPs in several disease-associated regions. We use simulated data to compare the efficacy of filters with different sample sizes and for causal SNPs with different minor allele frequencies (MAFs) and effect sizes, focusing on the small effect sizes and MAFs likely to represent the majority of unidentified causal SNPs. In our analyses, of all the methods investigated, filtering on the ranked likelihoods consistently retains the true causal SNP with the highest probability for a given false positive rate. This was the case for all the local linkage disequilibrium patterns investigated. Our results indicate that when using this method to retain only the top 5% of SNPs, even a causal SNP with an odds ratio of 1.1 and MAF of 0.08 can be retained with a probability exceeding 0.9 using an overall sample size of 50,000.
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Affiliation(s)
- Amy Victoria Spencer
- School of Mathematics and Statistics, University of Sheffield, Sheffield, S3 7RH, UK
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42
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Bonello N, Sampson J, Burn J, Wilson IJ, McGrown G, Margison GP, Thorncroft M, Crossbie P, Povey AC, Santibanez-Koref M, Walters K. Bayesian inference supports a location and neighbour-dependent model of DNA methylation propagation at the MGMT gene promoter in lung tumours. J Theor Biol 2013; 336:87-95. [PMID: 23911575 DOI: 10.1016/j.jtbi.2013.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 12/14/2012] [Revised: 07/12/2013] [Accepted: 07/19/2013] [Indexed: 11/29/2022]
Abstract
We exploit model-based Bayesian inference methodologies to analyse lung tumour-derived methylation data from a CpG island in the O6-methylguanine-DNA methyltransferase (MGMT) promoter. Interest is in modelling the changes in methylation patterns in a CpG island in the first exon of the promoter during lung tumour development. We propose four competils of methylation state propagation based on two mechanisms. The first is the location-dependence mechanism in which the probability of a gain or loss of methylation at a CpG within the promoter depends upon its location in the CpG sequence. The second mechanism is that of neighbour-dependence in which gain or loss of methylation at a CpG depends upon the methylation status of the immediately preceding CpG. Our data comprises the methylation status at 12 CpGs near the 5' end of the CpG island in two lung tumour samples for both alleles of a nearby polymorphism. We use approximate Bayesian computation, a computationally intensive rejection-sampling algorithm to infer model parameters and compare models without the need to evaluate the likelihood function. We compare the four proposed models using two criteria: the approximate Bayes factors and the distribution of the Euclidean distance between the summary statistics of the observed and simulated datasets. Our model-based analysis demonstrates compelling evidence for both location and neighbour dependence in the process of aberrant DNA methylation of this MGMT promoter CpG island in lung tumours. We find equivocal evidence to support the hypothesis that the methylation patterns of the two alleles evolve independently.
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Affiliation(s)
- Nicolas Bonello
- School of Mathematics and Statistics, University of Sheffield, Sheffield S3 7RH, UK
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43
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Bedson J, Belcher J, Martino OI, Ndlovu M, Rathod T, Walters K, Dunn KM, Jordan KP. The effectiveness of national guidance in changing analgesic prescribing in primary care from 2002 to 2009: an observational database study. Eur J Pain 2012; 17:434-43. [PMID: 22865816 PMCID: PMC3592995 DOI: 10.1002/j.1532-2149.2012.00189.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2012] [Indexed: 11/08/2022]
Abstract
Background Numerous national guidelines have been issued to assist general practitioners’ safe analgesic prescribing. Their effectiveness is unclear. The objective of this study was to examine trends in general practitioners’ prescribing behaviour in relation to national guidelines. Methods This was a retrospective observational database study of registered adult patients prescribed an analgesic (2002–2009) from the Consultations in Primary Care Archive – 12 North Staffordshire general practices. Prescribing guidance from the UK Medicines Regulatory Health Authority (MHRA) regarding non-steroidal anti-inflammatory drugs (NSAIDs) and co-proxamol, and the National Institute for Health and Clinical Excellence (NICE) osteoarthritis (OA) management guidelines were considered. Analgesic prescribing rates were examined, arranged according to a classification of six equipotent medication groups: (1) basic analgesics; (2)–(5) increasingly potent opioids and (6) NSAIDs. In each quarter from 2002 to 2009, the number of patients per 10,000 registered population receiving a prescription for the first time from each group was determined. Quarters associated with significant changes in the underlying prescribing trend were determined using joinpoint regression. Results A significant decrease in incident co-proxamol and Cox-2 prescribing occurred around the time of the first MHRA advice to stop using them and were rarely prescribed thereafter. The new prescribing of weak analgesics (e.g., co-codamol 8/500) increased at this same time. Initiating topical NSAIDs significantly increased around the time of the NICE OA guidelines. Conclusions Significant prescribing changes occurred when national advice and guidelines were issued. The effectiveness of this advice may vary depending upon the content and method of dissemination. Further evaluation of the optimal methods for delivering prescribing guidance is required.
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Affiliation(s)
- J Bedson
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK.
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44
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Rao N, Eastwood SV, Jain A, Shah M, Leurent B, Harvey D, Robertson L, Walters K, Persaud JW, Mikhailidis DP, Nair DR. Cardiovascular risk assessment of South Asians in a religious setting: a feasibility study. Int J Clin Pract 2012; 66:262-9. [PMID: 22151579 DOI: 10.1111/j.1742-1241.2011.02773.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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: 11/30/2022] Open
Abstract
AIMS South Asians in the UK have high cardiovascular disease (CVD) mortality. Therefore, this population is likely to benefit from screening programmes. To address this issue, an initiative was set up between the Royal Free Hampstead NHS Trust, H.E.A.R.T. UK and two Hindu temples in North London to provide screening for CVD risk factors in the community. METHODS A total of 434 individuals of Gujarati Indian origin were screened. Measurements included anthropometry, blood pressure and lipid profiles. Three different scoring systems: Framingham, Joint British Societies' 2 and QRISK2 were used to estimate CVD risk. RESULTS At least one modifiable CVD risk factor was present in 92% of the individuals screened; 52% were hypertensive, 40% were obese, 75% had central adiposity and 10% had total cholesterol/high density lipoprotein cholesterol ratio > 6. In addition, 37% of a subset of 104 individuals with a fasting sample fulfilled the diagnostic criteria for metabolic syndrome. Overall, 15% of participants screened had a 10-year CV risk score > 20% using QRISK2. The three risk score calculators showed moderate agreement: QRISK2 and JBS2 (kappa 0.61, 95% CI 0.54-0.67), QRISK2 and Framingham (kappa 0.63, 95% CI 0.57-0.70) and JBS2 and Framingham (kappa 0.70, 95% CI 0.64-0.75). CONCLUSIONS A high prevalence of modifiable risk factors for CVD was detected in the population screened.
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Affiliation(s)
- N Rao
- Department of Clinical Biochemistry, Royal Free Hospital, Pond Street, London, NW3 UK
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Fidler MJ, Morrison LE, Basu S, Buckingham L, Walters K, Batus M, Jacobson KK, Jewell SS, Coon J, Bonomi PD. PTEN and PIK3CA gene copy numbers and poor outcomes in non-small cell lung cancer patients with gefitinib therapy. Br J Cancer 2011; 105:1920-6. [PMID: 22095222 PMCID: PMC3251891 DOI: 10.1038/bjc.2011.494] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
METHODS Fluorescent in situ hybridisation analyses of PTEN, PIK3CA, EGFR and CEN7 were performed on tumour specimens from patients treated on the expanded access gefitinib trial. Progression-free survival (PFS) and overall survival (OS) were correlated with outcomes in all patients and EGFR wild-type patients. RESULTS Progression-free survival (hazard ratio=2.54, P<0.001) and OS (hazard ratio=4.04, P<0.001) were significantly shorter in patients whose tumours had all of the following molecular patterns: CEN7 <4 copies per cell, PTEN loss (<2 copies in at least 20% of cells), and PIK3CA gain (>2 copies in at least 40% of cells) both in all and EGFR wild-type only patients. CONCLUSION The combination of low CEN7 copy number, PTEN loss, and PI3KCA gain may be useful for identifying NSCLC patients unlikely to benefit from treatment with EGFR (TKIs), specifically in wild-type EGFR cases.
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Affiliation(s)
- M J Fidler
- Section of Medical Oncology, Rush University Medical Center, 1725 West Harrison Street 821, Chicago, IL 60612, USA.
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Welch C, Petersen I, Walters K, Morris RW, Nazareth I, Kalaitzaki E, White IR, Marston L, Carpenter J. Two-stage method to remove population- and individual-level outliers from longitudinal data in a primary care database. Pharmacoepidemiol Drug Saf 2011; 21:725-732. [PMID: 22052713 DOI: 10.1002/pds.2270] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 08/24/2011] [Accepted: 09/20/2011] [Indexed: 11/10/2022]
Abstract
PURPOSE: In the UK, primary care databases include repeated measurements of health indicators at the individual level. As these databases encompass a large population, some individuals have extreme values, but some values may also be recorded incorrectly. The challenge for researchers is to distinguish between records that are due to incorrect recording and those which represent true but extreme values. This study evaluated different methods to identify outliers. METHODS: Ten percent of practices were selected at random to evaluate the recording of 513,367 height measurements. Population-level outliers were identified using boundaries defined using Health Survey for England data. Individual-level outliers were identified by fitting a random-effects model with subject-specific slopes for height measurements adjusted for age and sex. Any height measurements with a patient-level standardised residual more extreme than ±10 were identified as an outlier and excluded. The model was subsequently refitted twice after removing outliers at each stage. This method was compared with existing methods of removing outliers. RESULTS: Most outliers were identified at the population level using the boundaries defined using Health Survey for England (1550 of 1643). Once these were removed from the database, fitting the random-effects model to the remaining data successfully identified only 75 further outliers. This method was more efficient at identifying true outliers compared with existing methods. CONCLUSIONS: We propose a new, two-stage approach in identifying outliers in longitudinal data and show that it can successfully identify outliers at both population and individual level. Copyright © 2011 John Wiley & Sons, Ltd.
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Affiliation(s)
- C Welch
- Department of Primary Care & Population Health, University College London, London, UK
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Gowers IR, Walters K, Kiss-Toth E, Read RC, Duff GW, Wilson AG. Age-related loss of CpG methylation in the tumour necrosis factor promoter. Cytokine 2011; 56:792-7. [PMID: 22004920 DOI: 10.1016/j.cyto.2011.09.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 09/12/2011] [Accepted: 09/19/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dysregulated production of TNF has been implicated in the pathogenesis and severity of inflammatory rheumatic diseases, many of which show age-related increased incidence. Ageing is also associated with changes in the immune system including higher systemic levels of pro-inflammatory cytokines. Methylation of DNA is an important regulator of gene expression and changes with age. OBJECTIVE In this study we investigated whether the DNA methylation status of the TNF promoter changed with age in peripheral blood leucocytes and macrophages. METHODS AND RESULTS Using pyrosequencing assays we detected age-related demethylation of CpG motifs (-304, -245 and -239) in the TNF promoter in human peripheral blood cells from 312 healthy controls (0.8% per decade, confidence interval (CI)=0.44-1.13%, p=1×10(-5)) and primary monocyte-derived macrophages (MDM) from a separate population of 78 healthy controls (1.4% per decade, CI=0.79-2.13%, p=7×10(-5)). Methylation a TNF promoter fragment (-345-+154) resulted in 78% reduction of reporter gene activity compared with the unmethylated promoter construct. CONCLUSIONS These data suggest a potential role of accrued changes in DNA methylation in the development of age-related inflammatory diseases, such as rheumatoid arthritis and polymyalgia rheumatica, in which TNF is a pivotal mediator.
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Affiliation(s)
- Isobel R Gowers
- Department of Infection & Immunity, Medical School, University of Sheffield, Sheffield S10 2RX, United Kingdom
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Vasilopoulos Y, Sagoo GS, Cork MJ, Walters K, Tazi-Ahnini R. HLA-C, CSTA and DS12346 susceptibility alleles confer over 100-fold increased risk of developing psoriasis: evidence of gene interaction. J Hum Genet 2011; 56:423-7. [DOI: 10.1038/jhg.2011.33] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [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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Adams JM, Walters K. Effect of filler morphology and surface chemistry on the rheological properties of filled polypropylenes. ACTA ACUST UNITED AC 2011. [DOI: 10.1002/masy.19930680118] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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50
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Sformo T, Walters K, Jeannet K, Wowk B, Fahy GM, Barnes BM, Duman JG. Deep supercooling, vitrification and limited survival to –100°C in the Alaskan beetle Cucujus clavipes puniceus (Coleoptera: Cucujidae) larvae. J Exp Biol 2010; 213:502-9. [DOI: 10.1242/jeb.035758] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
SUMMARY
Larvae of the freeze-avoiding beetle Cucujus clavipes puniceus (Coleoptera: Cucujidae) in Alaska have mean supercooling points in winter of –35 to –42°C, with the lowest supercooling point recorded for an individual of –58°C. We previously noted that some larvae did not freeze when cooled to –80°C, and we speculated that these larvae vitrified. Here we present evidence through differential scanning calorimetry that C. c. puniceus larvae transition into a glass-like state at temperatures <–58°C and can avoid freezing to at least –150°C. This novel finding adds vitrification to the list of insect overwintering strategies. While overwintering beneath the bark of fallen trees, C. c. puniceus larvae may experience low ambient temperatures of around –40°C (and lower) when microhabitat is un-insulated because of low snow cover. Decreasing temperatures in winter are correlated with loss of body water from summer high levels near 2.0 to winter lows near 0.4 mg mg–1 dry mass and concomitant increases in glycerol concentrations (4–6 mol l–1) and thermal hysteresis. Finally, we provide direct evidence that Cucujus from Wiseman, Alaska, survive temperatures to –100°C.
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Affiliation(s)
- T. Sformo
- Institute of Arctic Biology, University of Alaska, Fairbanks, AK 99775, USA
| | - K. Walters
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN 46556, USA
| | - K. Jeannet
- Institute of Arctic Biology, University of Alaska, Fairbanks, AK 99775, USA
| | - B. Wowk
- 1st Century Medicine, Inc., Fontana, CA, USA
| | - G. M. Fahy
- 1st Century Medicine, Inc., Fontana, CA, USA
| | - B. M. Barnes
- Institute of Arctic Biology, University of Alaska, Fairbanks, AK 99775, USA
| | - J. G. Duman
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN 46556, USA
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