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Biomedical subjects

Paul R Burton

Publications and source records attributed to Paul R Burton.

At least 19 recordsLinked to original sources
PubMed2006

Atopy, eczema and breast milk fatty acids in a high-risk cohort of children followed from birth to 5 yr.

BACKGROUND: The incidence of atopic diseases such as eczema is increasing in westernized societies. The suggestion that there is a "protective" association between the unique fatty acid composition of breast milk, particularly the omega-3 (n-3) and omega-6 (n-6) essential polyunsaturated fatty acid content, and the development of atopic disease in children was investigated in a cohort study of 263 infants born into families with a history of allergy (one or both parents had asthma, hayfever, eczema). The objectives of this study were to determine the lipid profile [specifically in relation to long-chain polyunsaturated fatty acid (LC-PUFA) composition] in maternal breast milk samples collected at 6 wk and at 6 months following birth, and to investigate the potential role of these fatty acids in modulating the phenotype of children at high genetic risk of developing atopic disease. METHOD: Breast milk samples were available from 91 atopic mothers at their child's ages of 6 wk and 6 months. These samples were analysed for the fatty acid spectrum. Analysis of variance was used to detect differences between groups of outcomes (no atopy or eczema, non-atopic eczema, atopy, atopic eczema) at ages 6 months and 5 yr, and a multiple comparisons procedure was conducted to isolate the parameters producing the different results (F-test, LSD test). For the exposure variables, n-3 and n-6 fatty acids are expressed as weight percentage and as a ratio (at both time-points). RESULTS: The fatty acid profiles of maternal breast milk at 6 wk and 6 months were similar. An increased ratio of n-6: n-3 fatty acids in both 6 wk and 6 month milk samples was associated with non-atopic eczema (p < 0.005) but not atopy alone or atopic eczema. CONCLUSION: We found milk fatty acids were a significant modulator of non-atopic eczema but not atopy or atopic eczema in infants at 6 months. In mothers with a history of asthma, hayfever or eczema, their 6-month-old infants were more likely to develop non-atopic eczema if their milk had a higher ratio of n-6: n-3 LC-PUFA.

Child, Preschool↗
PubMed2005

Association of WNK1 gene polymorphisms and haplotypes with ambulatory blood pressure in the general population.

BACKGROUND: Blood pressure (BP) is a heritable trait of major public health concern. The WNK1 and WNK4 genes, which encode proteins in the WNK family of serine-threonine kinases, are involved in renal electrolyte homeostasis. Mutations in the WNK1 and WNK4 genes cause a rare monogenic hypertensive syndrome, pseudohypoaldosteronism type II. We investigated whether polymorphisms in these WNK genes influence BP in the general population. METHODS AND RESULTS: Associations between 9 single-nucleotide polymorphisms (SNPs) in WNK1 and 1 in WNK4 with ambulatory BP were studied in a population-based sample of 996 subjects from 250 white European families. The heritability estimates of mean 24-hour systolic BP (SBP) and diastolic BP (DBP) were 63.4% and 67.9%, respectively. We found statistically significant (P<0.05) associations of several common SNPs and haplotypes in WNK1 with mean 24-hour SBP and/or DBP. The minor allele (C) of rs880054, with a frequency of 44%, reduced mean 24-hour SBP and DBP by 1.37 (95% confidence interval, -2.45 to -0.23) and 1.14 (95% confidence interval, -1.93 to -0.38) mm Hg, respectively, per copy of the allele. CONCLUSIONS: Common variants in WNK1 contribute to BP variation in the general population. This study shows that a gene causing a rare monogenic form of hypertension also plays a significant role in BP regulation in the general population. The findings provide a basis to identify functional variants of WNK1, elucidate any interactions of these variants with dietary intake or with response to antihypertensive drugs, and determine their impact on cardiovascular morbidity and mortality.

Adolescent↗
PubMed2005

Adjusting for treatment effects in studies of quantitative traits: antihypertensive therapy and systolic blood pressure.

A population-based study of a quantitative trait may be seriously compromised when the trait is subject to the effects of a treatment. For example, in a typical study of quantitative blood pressure (BP) 15 per cent or more of middle-aged subjects may take antihypertensive treatment. Without appropriate correction, this can lead to substantial shrinkage in the estimated effect of aetiological determinants of scientific interest and a marked reduction in statistical power. Correction relies upon imputation, in treated subjects, of the underlying BP from the observed BP having invoked one or more assumptions about the bioclinical setting. There is a range of different assumptions that may be made, and a number of different analytical models that may be used. In this paper, we motivate an approach based on a censored normal regression model and compare it with a range of other methods that are currently used or advocated. We compare these methods in simulated data sets and assess the estimation bias and the loss of power that ensue when treatment effects are not appropriately addressed. We also apply the same methods to real data and demonstrate a pattern of behaviour that is consistent with that in the simulation studies. Although all approaches to analysis are necessarily approximations, we conclude that two of the adjustment methods appear to perform well across a range of realistic settings. These are: (1) the addition of a sensible constant to the observed BP in treated subjects; and (2) the censored normal regression model. A third, non-parametric, method based on averaging ordered residuals may also be advocated in some settings. On the other hand, three approaches that are used relatively commonly are fundamentally flawed and should not be used at all. These are: (i) ignoring the problem altogether and analysing observed BP in treated subjects as if it was underlying BP; (ii) fitting a conventional regression model with treatment as a binary covariate; and (iii) excluding treated subjects from the analysis. Given that the more effective methods are straightforward to implement, there is no argument for undertaking a flawed analysis that wastes power and results in excessive bias.

Aged↗
PubMed2005

Robust estimation of experimentwise P values applied to a genome scan of multiple asthma traits identifies a new region of significant linkage on chromosome 20q13.

Over 30 genomic regions show linkage to asthma traits. Six asthma genes have been cloned, but the putative loci in many linked regions have not been identified. To search for asthma susceptibility loci, we performed genomewide univariate linkage analyses of seven asthma traits, using 202 Australian families ascertained through a twin proband. House-dust mite sensitivity (Dpter) exceeded the empirical threshold for significant linkage at 102 cM on chromosome 20q13, near marker D20S173 (empirical pointwise P = .00001 and genomewide P = .005, both uncorrected for multiple-trait testing). Atopy, bronchial hyperresponsiveness (BHR), and forced expiratory volume in 1 s (FEV1) were also linked to this region. In addition, 16 regions were linked to at least one trait at the suggestive level, including 12q24, which has consistently shown linkage to asthma traits in other studies. Some regions were expected to be false-positives arising from multiple-trait testing. To address this, we developed a new approach to estimate genomewide significance that accounts for multiple-trait testing and for correlation between traits and that does not require a Bonferroni correction. With this approach, Dpter remained significantly linked to 20q13 (empirical genomewide P = .042), and airway obstruction remained linked to 12q24 at the suggestive level. Finally, we extended this method to show that the linkage of Dpter, atopy, BHR, FEV1, asthma, and airway obstruction to chromosome 20q13 is unlikely to be due to chance and may result from a quantitative trait locus in this region that affects several of these traits.

Adult↗
PubMed2005

How vague is vague? A simulation study of the impact of the use of vague prior distributions in MCMC using WinBUGS.

There has been a recent growth in the use of Bayesian methods in medical research. The main reasons for this are the development of computer intensive simulation based methods such as Markov chain Monte Carlo (MCMC), increases in computing power and the introduction of powerful software such as WinBUGS. This has enabled increasingly complex models to be fitted. The ability to fit these complex models has led to MCMC methods being used as a convenient tool by frequentists, who may have no desire to be fully Bayesian. Often researchers want 'the data to dominate' when there is no prior information and thus attempt to use vague prior distributions. However, with small amounts of data the use of vague priors can be problematic. The results are potentially sensitive to the choice of prior distribution. In general there are fewer problems with location parameters. The main problem is with scale parameters. With scale parameters, not only does one have to decide the distributional form of the prior distribution, but also whether to put the prior distribution on the variance, standard deviation or precision. We have conducted a simulation study comparing the effects of 13 different prior distributions for the scale parameter on simulated random effects meta-analysis data. We varied the number of studies (5, 10 and 30) and compared three different between-study variances to give nine different simulation scenarios. One thousand data sets were generated for each scenario and each data set was analysed using the 13 different prior distributions. The frequentist properties of bias and coverage were investigated for the between-study variance and the effect size. The choice of prior distribution was crucial when there were just five studies. There was a large variation in the estimates of the between-study variance for the 13 different prior distributions. With a large number of studies the choice of prior distribution was less important. The effect size estimated was not biased, but the precision with which it was estimated varied with the choice of prior distribution leading to varying coverage intervals and, potentially, to different statistical inferences. Again there was less of a problem with a larger number of studies. There is a particular problem if the between-study variance is close to the boundary at zero, as MCMC results tend to produce upwardly biased estimates of the between-study variance, particularly if inferences are based on the posterior mean. The choice of 'vague' prior distribution can lead to a marked variation in results, particularly in small studies. Sensitivity to the choice of prior distribution should always be assessed.

Anti-Bacterial Agents↗
PubMed2005

Covariance components models for longitudinal family data.

A longitudinal family study is an epidemiological design that involves repeated measurements over time in a sample that includes families. Such studies, that may also include relative pairs and unrelated individuals, allow closer investigation of not only the factors that cause a disease to arise, but also the genetic and environmental determinants that modulate the subsequent progression of that disease. Knowledge of such determinants may pay high dividends in terms of prognostic assessment and in the development of new treatments that may be tailored to the prognostic profile of individual patients. Unfortunately longitudinal family studies are difficult to analyse. They conflate the complex within-family correlation structure of a cross-sectional family study with the correlation over time that is intrinsic to longitudinal repeated measures. Here we describe an approach to analysis that is relatively straightforward to implement, yet is flexible in its application. It represents a natural extension of a Gibbs-sampling-based approach to the analysis of cross-sectional family studies that we have described previously. The approach can be applied to pedigrees of arbitrary complexity. It is applicable to continuous traits, repeated binary disease states, and repeated counts or rates with a Poisson distribution. It not only supports the analysis of observed determinants, including measured genotypes, but also allows decomposition of the correlation structure, thereby permitting conclusions to be drawn about the effect of unobserved genes and environment on key features of disease progression, and hence to estimate the heritability of these features. We demonstrate the efficacy of our methods using a range of simulated data analyses, and illustrate its practical application to longitudinal blood pressure data measured in families from the Framingham Heart Study.

Blood Pressure↗
PubMed2005

The split radial technique: an alternative to the Y-graft for total arterial myocardial revascularisation.

There is evidence that the use of Y-grafts attached to the left internal mammary artery - to - left anterior descending artery graft may compromise the patency of the distal limb of the left internal mammary artery. We describe a technique (split radial technique) that avoids the use of Y-grafts by constructing two aorto-coronary grafts from a single radial artery. The split radial technique requires the harvesting of the radial artery in its entirety from the brachial bifurcation to the radial styloid. The first radial artery distal anastomosis is performed and the required length of conduit is determined. The conduit is transected, leaving a sufficiently long radial segment for a second aorto-coronary graft. A clinical follow-up 41 weeks after surgery of the first 37 patients in whom the split radial technique was used showed no deaths or major complications. This suggests that the split radial technique is a useful and safe way to maximise the use of radial artery conduit and to avoid the potential risk of compromising internal mammary artery patency with Y-grafts. There is evidence that the use of Y-grafts attached to the left internal mammary artery may compromise the patency of the distal limb of the left internal mammary artery. We describe the split radial technique of constructing two aorto-coronary graft segments from a single radial artery that can be used to avoid the use of Y-grafts.

Aged↗
PubMed2004

The analysis of peak expiratory flow data using a three-level hierarchical model.

Peak expiratory flow (PEF) is a measure commonly used in clinical practice and research for respiratory diseases such as asthma. In research, PEF is usually recorded in a diary for a 2-week period with two or more measurements per day. Interest may lie in whether certain groups of individuals tend to have higher or lower PEF. In addition the variability of PEF may be of interest as, for example, asthmatics tend to have more variable airways. In this paper we develop a three-level hierarchical model that can simultaneously model the mean level and variability of PEF. The variability is broken down into three components, between-subject variability, between-day within-subject variability, and within-day within-subject variability. The latter two components are of specific clinical interest. We fit both classical and Bayesian models. The Bayesian models have the advantage of taking the uncertainty in the variance component estimates into account when estimating the standard errors of the fixed effects. In addition, the Bayesian models provide an intuitive and simple way to investigate the within-subject variance components.

Asthma↗
PubMed2004

Genotypes and haplotypes predisposing to myocardial infarction: a multilocus case-control study.

AIM: To identify polymorphisms and haplotypes in candidate genes that predispose to myocardial infarction (MI) using a multilocus approach. METHODS AND RESULTS: 1052 subjects, comprising 547 acute MI cases and 505 controls were studied. The association between MI and 58 SNPs in 35 candidate genes (generating 61 016 individual genotypes), and between MI and estimated haplotypes at 14 loci encompassing 16 genes was investigated. Two individual gene variants and haplotypes at two loci showed statistical association with MI. The alpha-adducin 460trp variant (OR 0.73, 95% CI 0.59-0.91, P=0.006) and the cholesteryl ester transfer protein -629A variant (OR 0.82, 95% CI 0.68-0.97, P=0.025) were both associated with a significant protective effect on MI, as was the paraoxonase 1/paraoxonase 2 haplotype comprising met55 and gln192 in paraoxonase 1 and cys311 in paraoxonase 2 (OR 0.52, 95% CI 0.39-0.77, P=0.001). The apolipoprotein C III haplotypes CCTTCG and ATCCCG at positions -641*-482*-455*1100*3175*3206 were associated with an increased risk of MI, odds ratios 1.41 (95% CI 1.06-1.76, P=0.023) and 1.71 (95% CI 1.28-2.14, P=0.038), respectively. CONCLUSIONS: We report associations of two polymorphisms and haplotypes at two loci with risk of MI that warrants testing in future studies. Furthermore, we demonstrate the application of a multilocus assay in the setting of a large association study and the additional benefit gained from the study of haplotypes to identify variants influencing risk of coronary heart disease.

Case-Control Studies↗
PubMed2004

The Western Australian Register of Childhood Multiples: effects of questionnaire design and follow-up protocol on response rates and representativeness.

Twin registers have been established worldwide to study the roles of genes and the environment in health and behaviour. While questionnaire surveys are thought to be the most cost-effective way of collecting large amounts of data, low response rates can result in response bias. Many different strategies have been proposed to maximise response rates. A register of all multiple births occurring in Western Australia (WA) from 1980 onwards has been established using probabilistic record linkage techniques. Families who had not experienced the death of one or more of their multiples were invited to participate in the Western Australian Twin Child Health (WATCH) study, which studied the genetic and environmental determinants of childhood asthma and atopy. Several questionnaire designs and follow-up methods were assessed. We have shown that it was feasible to use a population-based register of multiple births to contact families for a questionnaire study. Questionnaire length, mode of follow-up, the number of responses required and the of participants all seemed to affect response.

Follow-Up Studies↗
PubMed2003

Genome-wide linkage analysis of longitudinal phenotypes using sigma2A random effects (SSARs) fitted by Gibbs sampling.

The study of change in intermediate phenotypes over time is important in genetics. In this paper we explore a new approach to phenotype definition in the genetic analysis of longitudinal phenotypes. We utilized data from the longitudinal Framingham Heart Study Family Cohort to investigate the familial aggregation and evidence for linkage to change in systolic blood pressure (SBP) over time. We used Gibbs sampling to derive sigma-squared-A-random-effects (SSARs) for the longitudinal phenotype, and then used these as a new phenotype in subsequent genome-wide linkage analyses. Additive genetic effects (sigma2A.time) were estimated to account for approximately 9.2% of the variance in the rate of change of SBP with age, while additive genetic effects (sigma2A) were estimated to account for approximately 43.9% of the variance in SBP at the mean age. The linkage results suggested that one or more major loci regulating change in SBP over time may localize to chromosomes 2, 3, 4, 6, 10, 11, 17, and 19. The results also suggested that one or more major loci regulating level of SBP may localize to chromosomes 3, 8, and 14. Our results support a genetic component to both SBP and change in SBP with age, and are consistent with a complex, multifactorial susceptibility to the development of hypertension. The use of SSARs derived from quantitative traits as input to a conventional linkage analysis appears to be valuable in the linkage analysis of genetically complex traits. We have now demonstrated in this paper the use of SSARs in the context of longitudinal family data.

Adult↗
PubMed2003

Longitudinal variance components models for systolic blood pressure, fitted using Gibbs sampling.

This paper describes an analysis of systolic blood pressure (SBP) in the Genetic Analysis Workshop 13 (GAW13) simulated data. The main aim was to assess evidence for both general and specific genetic effects on the baseline blood pressure and on the rate of change (slope) of blood pressure with time. Generalized linear mixed models were fitted using Gibbs sampling in WinBUGS, and the additive polygenic random effects estimated using these models were then used as continuous phenotypes in a variance components linkage analysis. The first-stage analysis provided evidence for general genetic effects on both the baseline and slope of blood pressure, and the linkage analysis found evidence of several genes, again for both baseline and slope.

Adult Children↗
PubMed2003

Correcting for nonrandom ascertainment in generalized linear mixed models (GLMMs), fitted using Gibbs sampling.

Gibbs sampling-based generalized linear mixed models (GLMMs) provide a convenient and flexible way to extend variance components models for multivariate normally distributed continuous traits to other classes of phenotype. This includes binary traits and right-censored failure times such as age-at-onset data. The approach has applications in many areas of genetic epidemiology. However, the required GLMMs are sensitive to nonrandom ascertainment. In the absence of an appropriate correction for ascertainment, they can exhibit marked positive bias in the estimated grand mean and serious shrinkage in the estimated magnitude of variance components. To compound practical difficulties, it is currently difficult to implement a conventional adjustment for ascertainment because of the need to undertake repeated integration across the distribution of random effects. This is prohibitively slow when it must be repeated at every iteration of the Markov chain Monte Carlo (MCMC) procedure. This paper motivates a correction for ascertainment that is based on sampling random effects rather than integrating across them and can therefore be implemented in a general-purpose Gibbs sampling environment such as WinBUGS. The approach has the characteristic that it returns ascertainment-adjusted parameter estimates that pertain to the true distribution of determinants in the ascertained sample rather than in the general population. The implications of this characteristic are investigated and discussed. This paper extends the utility of Gibbs sampling-based GLMMs to a variety of settings in which family data are ascertained nonrandomly.

Age of Onset↗
PubMed2003

Associations between polymorphisms of the high-affinity immunoglobulin E receptor and late-onset airflow obstruction in older populations.

OBJECTIVES: To test the hypothesis that genetic polymorphisms in the beta subunit of the high-affinity immunoglobulin E (IgE) receptor are associated with late-onset airflow obstruction. DESIGN: Case-control candidate gene association study. SETTING: Department of Medicine for the Elderly and Respiratory Medicine in three teaching hospitals in Leicester and Manchester, United Kingdom. PARTICIPANTS: Cases with late-onset airflow obstruction with age-, sex-, and geographically matched controls. MEASUREMENTS: Subjects were genotyped for two polymorphisms of the beta subunit of the high-affinity IgE receptor (RsaI intron 2 and RsaI exon 7). The association between the polymorphisms and phenotypes was examined using contingency tables and linear regression models. RESULTS: Two hundred eighty-three cases and 144 controls were genotyped. RsaI exon 7 AA was associated with eczema (odds ratio (OR)=2.27, 95% confidence interval (CI)=1.17-4.38, P=.015). No other associations were found. Total serum IgE levels were significantly higher in cases than controls (adjusted OR for high/low IgE=2.56, 95% CI=1.53-4.28, P<.001). CONCLUSION: Serum IgE levels, but not the high-affinity IgE receptor polymorphisms, were associated with late-onset airflow obstruction, suggesting that interaction between environmental and genetic factors controlling serum IgE levels and disease pathogenesis may differ between early- and late-onset airflow obstruction phenotypes.

Age Factors↗
PubMed2002

Using imprecise probabilities to address the questions of inference and decision in randomized clinical trials.

Randomized controlled clinical trials play an important role in the development of new medical therapies. There is, however, an ethical issue surrounding the use of randomized treatment allocation when the patient is suffering from a life threatening condition and requires immediate treatment. Such patients can only benefit from the treatment they actually receive and not from the alternative therapy, even if it ultimately proves to be superior. We discuss a novel new way to analyse data from such clinical trials based on the use of the recently developed theory of imprecise probabilities. This work draws an explicit distinction between the related but nevertheless distinct questions of inference and decision in clinical trials. The traditional question of scientific interest asks 'Which treatment offers the greater chance of success?' and is the primary reason for conducting the clinical trial. The question of decision concerns the welfare of the patients in the clinical trial, asking whether the accumulated evidence favours one treatment over the other to such an extent that the next patient should decline randomization and instead express a preference for one treatment. Consideration of the decision question within the framework of imprecise probabilities leads to a mathematical definition of equipoise and a method for governing the randomization protocol of a clinical trial. This paper describes in detail the protocol for the conduct of clinical trials based on this new method of analysis, which is illustrated in a retrospective analysis of data from a clinical trial comparing the anti-emetic drugs ondansetron and droperidol in the treatment of postoperative nausea and vomiting. The proposed methodology is compared quantitatively using computer simulation studies with conventional clinical trial designs and is shown to maintain high statistical power with reduced sample sizes, at the expense of a high type I error rate that we argue is irrelevant in some specific circumstances. Particular emphasis is placed on describing the type of medical conditions and treatment comparisons where the new methodology is expected to provide the greatest benefit.

Antiemetics↗