Publications by authors named "Eleanor Wood"

27 Publications

  • Page 1 of 1

Network-based rTMS to modulate working memory: The difficult choice of effective parameters for online interventions.

Brain Behav 2021 Oct 15:e2361. Epub 2021 Oct 15.

Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, North Carolina, USA.

Background: Online repetitive transcranialmagnetic stimulation (rTMS) has been shown to modulate working memory (WM) performance in a site-specific manner, with behavioral improvements due to stimulation of the dorsolateral prefrontal cortex (DLPFC), and impairment from stimulation to the lateral parietal cortex (LPC). Neurobehavioral studies have demonstrated that subprocesses of WM allowing for the maintenance and manipulation of information in the mind involve unique cortical networks. Despite promising evidence of modulatory effects of rTMS on WM, no studies have yet demonstrated distinct modulatory control of these two subprocesses. The current study therefore sought to explore this possibility through site-specific stimulation during an online task invoking both skills.

Methods: Twenty-nine subjects completed a 4-day protocol, in which active or sham 5Hz rTMS was applied over the DLPFC and LPC in separate blocks of trials while participants performed tasks that required either maintenance alone, or both maintenance and manipulation (alphabetization) of information. Stimulation targets were defined individually based on fMRI activation and structural network properties. Stimulation amplitude was adjusted using electric field modeling to equate induced current in the target region across participants.

Results: Despite the use of advanced techniques, no significant differences or interactions between active and sham stimulation were found. Exploratory analyses testing stimulation amplitude, fMRI activation, and modal controllability showed nonsignificant but interesting trends with rTMS effects.

Conclusion: While this study did not reveal any significant behavioral changes in WM, the results may point to parameters that contribute to positive effects, such as stimulation amplitude and functional activation.
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http://dx.doi.org/10.1002/brb3.2361DOI Listing
October 2021

Variations on Heisenberg's Third Concerto.

Authors:
Eleanor R Wood

Nature 2020 Jun 9. Epub 2020 Jun 9.

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http://dx.doi.org/10.1038/d41586-020-01718-6DOI Listing
June 2020

Algae biostimulants: A critical look at microalgal biostimulants for sustainable agricultural practices.

Biotechnol Adv 2021 Jul-Aug;49:107754. Epub 2021 Apr 21.

Department of Biosciences, College of Science, Swansea University, Swansea, SA2 8PP, UK.

For the growing human population to be sustained during present climatic changes, enhanced quality and quantity of crops are essential to enable food security worldwide. The current consensus is that we need to make a transition from a petroleum-based to a bio-based economy via the development of a sustainable circular economy and biorefinery approaches. Both macroalgae (seaweeds) and microalgae have been long considered a rich source of plant biostimulants with an attractive business opportunity in agronomy and agro-industries. To date, macroalgae biostimulants have been well explored. In contrast, microalgal biostimulants whilst known to have positive effects on development, growth and yields of crops, their commercial implementation is constrained by lack of research and cost of production. The present review highlights the current knowledge on potential biostimulatory compounds, key sources and their quantitative information from algae. Specifically, we provide an overview on the prospects of microalgal biostimulants to advance crop production and quality. Key aspects such as specific biostimulant effects caused by extracts of microalgae, feasibility and potential of co-cultures and later co-application with other biostimulants/biofertilizers are highlighted. An overview of the current knowledge, recent advances and achievements on extraction techniques, application type, application timing, current market and regulatory aspects are also discussed. Moreover, aspects involved in circular economy and biorefinery approaches are also covered, such as: integration of waste resources and implementation of high-throughput phenotyping and -omics tools in isolating novel strains, exploring synergistic interactions and illustrating the underlying mode of microalgal biostimulant action. Overall, this review highlights the current and future potential of microalgal biostimulants, algal biochemical components behind these traits and finally bottlenecks and prospects involved in the successful commercialisation of microalgal biostimulants for sustainable agricultural practices.
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http://dx.doi.org/10.1016/j.biotechadv.2021.107754DOI Listing
June 2021

Towards a circular economy: A novel microalgal two-step growth approach to treat excess nutrients from digestate and to produce biomass for animal feed.

Bioresour Technol 2021 Jan 2;320(Pt A):124349. Epub 2020 Nov 2.

College of Science, Bioscience Department, Swansea University, Singleton Park, SA2 8PP Swansea, United Kingdom.

Implementing a circular economy aimed at reusing resources is becoming increasingly important for industry. Microalgae fit within a circular economy by being able to bioremediate nutrient waste and as a source of biomass for several commercial applications. Here, we report a novel validation of a circular economy concept using microalgae at a relevant industrial scale with a new two-phase process. During the first phase biomass was grown autotrophically, biomass was then concentrated using membrane technology for the second phase where mixotrophic conditions were applied to boost growth further. Microalgae cultures were able to grow (13.8 g/L), uptake and bioremediate nutrients (Nitrogen > 134 mg/L/day) from an anaerobic digestion side-stream (digestate), obtaining high quality microalgae biomass (>45% protein content) suitable for use as animal feed, closing the circular economy loop for industrial applications.
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http://dx.doi.org/10.1016/j.biortech.2020.124349DOI Listing
January 2021

Valorising nutrient-rich digestate: Dilution, settlement and membrane filtration processing for optimisation as a waste-based media for microalgal cultivation.

Waste Manag 2020 Dec 3;118:197-208. Epub 2020 Sep 3.

Algal Research Group, Bioscience Department, College of Science, Swansea University, Singleton Park, Swansea SA2 8PP, UK.

Digestate produced from the anaerobic digestion of food and farm waste is primarily returned to land as a biofertiliser for crops, with its potential to generate value through alternative processing methods at present under explored. In this work, valorisation of a digestate resulting from the treatment of kitchen and food waste was investigated, using dilution, settlement and membrane processing technology. Processed digestate was subsequently tested as a nutrient source for the cultivation of Chlorella vulgaris, up to pilot-scale (800L). Dilution of digestate down to 2.5% increased settlement rate and induced release of valuable compounds for fertiliser usage such as nitrogen and phosphorus. Settlement, as a partial processing of digestate offered a physical separation of liquid and solid fractions at a low cost. Membrane filtration demonstrated efficient segregation of nutrients, with micro-filtration recovering 92.38% of phosphorus and the combination of micro-filtration, ultra-filtration, and nano-filtration recovering a total of 94.35% of nitrogen from digestate. Nano-filtered and micro-filtered digestates at low concentrations were suitable substrates to support growth of Chlorella vulgaris. At pilot-scale, the microalgae grew successfully for 28 days with a maximum growth rate of 0.62 day and dry weight of 0.86  g⋅L. Decline in culture growth beyond 28 days was presumably linked to ammonium and heavy metal accumulation in the cultivation medium. Processed digestate provided a suitable nutrient source for successful microalgal cultivation at pilot-scale, evidencing potential to convert excess nutrients into biomass, generating value from excess digestate and providing additional markets to the anaerobic digestion sector.
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http://dx.doi.org/10.1016/j.wasman.2020.08.037DOI Listing
December 2020

The potential and challenges of utilising multiprofessional in situ simulation.

Frontline Gastroenterol 2020 31;11(5):341-342. Epub 2020 Mar 31.

Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK.

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http://dx.doi.org/10.1136/flgastro-2019-101403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447272PMC
March 2020

Blueberries and cardiovascular disease prevention.

Food Funct 2019 Dec;10(12):7621-7633

Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK.

Blueberries are a rich source of (poly)phenols, particularly anthocyanins. Epidemiological studies indicate that anthocyanin-rich foods including blueberries are associated with a reduction in the risk of cardiovascular disease. These observational findings are supported by a number of randomized-controlled trials showing improvements in biomarkers of cardiovascular disease risk. The beneficial effects of blueberry (poly)phenols are particularly clear when measuring flow-mediated dilation over various timeframes and study populations. However, other outcomes are less clear, such as effects on blood pressure, arterial stiffness and blood lipid profile. This may be due to the heterogeneity existing in study designs, such as duration of the intervention, and the health status of participants. Longer-term RCTs using gold standard methods in relevant populations which can be translated to the general public are needed to clarify and strengthen the evidence available. While circulating phenolic blueberry metabolites have been linked with improvements in vascular function, the biological activities and mechanisms of action of individual metabolites and their interaction in vivo are still unknown. Evaluating the bioactivities of metabolites alone and together, and analysing their structure-activity relationship in well-designed and physiologically relevant experimental and human studies are needed to understand the mechanisms of how these metabolites affect vascular function.
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http://dx.doi.org/10.1039/c9fo02291kDOI Listing
December 2019

Diabetes Mobile Care: Aggregating and Visualizing Data from Multiple Mobile Health Technologies.

AMIA Jt Summits Transl Sci Proc 2019 6;2019:202-211. Epub 2019 May 6.

Duke University, Durham, NC.

As the appeal and use of mobile health (mHealth) technologies continues to grow, where does mHealth fit into clinical practice? This article explores the approach and obstacles encountered when integrating mHealth data into existing clinical frameworks and explores data visualization design tradeoffs. Specifically, this paper discusses the successes and challenges that arose when using commercial mHealth technologies, synthesizing multiple mHealth device data, and tailoring visualizations based on iterative feedback from type II diabetes mellitus patients. This research aims to influence the development of patient portals within electronic health records by understanding and addressing the challenges involved in acquiring, interpreting, and displaying this data set. In particular, we need to ensure that the presentation of these data is accessible and understandable by diverse populations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6568104PMC
May 2019

Improving safety and reducing error in endoscopy: simulation training in human factors.

Frontline Gastroenterol 2019 Apr 9;10(2):160-166. Epub 2019 Jan 9.

Department of Gastroenterology, Homerton University Hospital, London, UK.

Patient safety incidents occur throughout healthcare and early reports have exposed how deficiencies in 'human factors' have contributed to mortality in endoscopy. Recognising this, in the UK, the Joint Advisory Group for Gastrointestinal Endoscopy have implemented a number of initiatives including the 'Improving Safety and Reducing Error in Endoscopy' (ISREE) strategy. Within this, simulation training in human factors and Endoscopic Non-Technical Skills (ENTS) is being developed. Across healthcare, simulation training has been shown to improve team skills and patient outcomes. Although the literature is sparse, integrated and in situ simulation modalities have shown promise in endoscopy. Outcomes demonstrate improved individual and team performance and development of skills that aid clinical practice. Additionally, the use of simulation training to detect latent errors in the working environment is of significant value in reducing error and preventing harm. Implementation of simulation training at local and regional levels can be successfully achieved with collaboration between organisational, educational and clinical leads. Nationally, simulation strategies are a key aspect of the ISREE strategy to improve ENTS training. These may include integration of simulation into current training or development of novel simulation-based curricula. However used, it is evident that simulation training is an important tool in developing safer endoscopy.
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http://dx.doi.org/10.1136/flgastro-2018-101078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540271PMC
April 2019

Enhancing Diabetes Self-Management Through Collection and Visualization of Data From Multiple Mobile Health Technologies: Protocol for a Development and Feasibility Trial.

JMIR Res Protoc 2019 Jun 3;8(6):e13517. Epub 2019 Jun 3.

Duke University School of Nursing, Durham, NC, United States.

Background: Self-management is integral for control of type 2 diabetes mellitus (T2DM). Patient self-management is improved when they receive real-time information on their health status and behaviors and ongoing facilitation from health professionals. However, timely information for these behaviors is notably absent in the health care system. Providing real-time data could help improve patient understanding of the dynamics of their illness and assist clinicians in developing targeted approaches to improve health outcomes and in delivering personalized care when and where it is most needed. Mobile technologies (eg, wearables, apps, and connected scales) have the potential to make these patient-provider interactions a reality. What strategies might best help patients overcome self-management challenges using self-generated diabetes-related data? How might clinicians effectively guide patient self-management with the advantage of real-time data?

Objective: This study aims to describe the protocol for an ongoing study (June 2016-May 2019) that examines trajectories of symptoms, health behaviors, and associated challenges among individuals with T2DM utilizing multiple mobile technologies, including a wireless body scale, wireless glucometer, and a wrist-worn accelerometer over a 6-month period.

Methods: We are conducting an explanatory sequential mixed methods study of 60 patients with T2DM recruited from a primary care clinic. Patients were asked to track relevant clinical data for 6 months using a wireless body scale, wireless glucometer, a wrist-worn accelerometer, and a medication adherence text message (short message service, SMS) survey. Data generated from the devices were then analyzed and visualized. A subset of patients is currently being interviewed to discuss their challenges and successes in diabetes self-management, and they are being shown visualizations of their own data. Following the data collection period, we will conduct interviews with study clinicians to explore ways in which they might collaborate with patients.

Results: This study has received regulatory approval. Patient enrollment ongoing with a sample size of 60 patients is complete, and up to 20 clinicians will be enrolled. At the patient level, data collection is complete, but data analysis is pending. At the clinician level, data collection is currently ongoing.

Conclusions: This study seeks to expand the use of mobile technologies to generate real-time data to enhance self-management strategies. It also seeks to obtain both patient and provider perspectives on using real-time data to develop algorithms for software that will facilitate real-time self-management strategies. We expect that the findings of this study will offer important insight into how to support patients and providers using real-time data to manage a complex chronic illness.

International Registered Report Identifier (irrid): DERR1-10.2196/13517.
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http://dx.doi.org/10.2196/13517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746071PMC
June 2019

Effects of aronia berry (poly)phenols on vascular function and gut microbiota: a double-blind randomized controlled trial in adult men.

Am J Clin Nutr 2019 08;110(2):316-329

Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.

Background: Aronia melanocarpa is a rich source of (poly)phenols. Previous research has demonstrated that these berries may provide cardiovascular health benefits in high-risk populations. However, very few studies have investigated the effects of daily consumption of dietary achievable amounts of the berries in healthy subjects.

Objectives: The aim of this study was to investigate the effects of aronia berries on vascular function and gut microbiota composition in a healthy population.

Methods: A double-blind, placebo-controlled, parallel designed study was conducted in 66 healthy men randomly allocated to consume a (poly)phenol-rich extract (116 mg, 75 g berries), a whole fruit powder (12 mg, 10 g berries), or placebo (maltodextrin) for 12 wk. Flow-mediated dilation (FMD), arterial stiffness, blood pressure, heart rate, and serum biochemistry were assessed. Plasma (poly)phenol metabolites were analyzed by LC-MS. Gut microbiota composition was determined via 16S rRNA sequencing in stool samples.

Results: Consumption of aronia whole fruit and extract powder for 12 wk led to a significant increase in FMD over control of 0.9% ± 0.4% (95% CI: 0.13%, 1.72%) and 1.2% ± 0.4% (95% CI: 0.36%, 1.97%), respectively. Acute improvements in FMD were also observed 2 h after consumption of aronia extract on day 1 (1.1% ± 0.3%, P = 0.003) and 12 wk later (1.5% ± 0.4%, P = 0.0001). Circulating plasma phenolic metabolites increased upon consumption of the aronia treatments. Although no changes were found in gut microbiota diversity, consumption of aronia extract increased the growth of Anaerostipes (+10.6%, P = 0.01), whereas aronia whole fruit showed significant increases in Bacteroides (+193%, P = 0.01). Correlation analysis identified significant associations between changes in FMD, aronia-derived phenolic metabolites, and specific gut microbial genera.

Conclusions: In healthy men, consumption of aronia berry (poly)phenols improved endothelial function and modulated gut microbiota composition, indicating that regular aronia consumption has the potential to maintain cardiovascular health in individuals at low risk of cardiovascular disease. This trial was registered at CLINICALTRIALs.gov as NCT03041961.
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http://dx.doi.org/10.1093/ajcn/nqz075DOI Listing
August 2019

Systematic Review of the Effects of Blueberry on Cognitive Performance as We Age.

J Gerontol A Biol Sci Med Sci 2019 06;74(7):984-995

School of Psychology & Clinical Language Sciences, University of Reading, UK.

The effect of flavonoid-rich food, such as blueberries, on cognitive function has been subject to a growing amount of research interest in recent years. Epidemiological, prospective, preclinical, and clinical trials have revealed positive cognitive benefits from flavonoid interventions, particularly in relation to the amelioration of cognitive decline in older adults. This review will specifically consider the existing clinical research from both acute and chronic blueberry interventions on cognition in human subjects. The results of 11 studies are reported with 4 studies considering blueberry intervention with children aged 7-10 years, 4 considering adults aged 60 years and older, and 3 considering adults suffering from mild cognitive impairment (MCI). Findings from these studies indicate that cognitive benefits may be found for delayed memory and executive function in children and for delayed memory, executive function, and psychomotor function in older healthy and MCI adults. There is less evidence to suggest positive benefits of blueberry intervention on working memory. Recommendations for future research, including dose used, cognitive tasks, and age groups considered, are proposed.
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http://dx.doi.org/10.1093/gerona/glz082DOI Listing
June 2019

Best Practice Recommendations for Prevention and Management of Skin Tears in Aged Skin: An Overview.

J Wound Ostomy Continence Nurs 2018 Nov/Dec;45(6):540-542

Kimberly LeBlanc, PhD, RN, NSWOC, WOCC(C), IIWCC, KDS Professional Consulting, NSWOCC Institute, Western University, London, Ontario, Canada. Karen E. Campbell, PhD, RN, Western University and Lawson Research Institute, London, Ontario, Canada. Eleanor Wood, BA, Wounds UK and Wounds International, London, United Kingdom. Dimitri Beeckman, PhD, MSc, RN, FEANS, University Centre of Nursing and Midwifery at Ghent University, Ghent, Belgium.

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http://dx.doi.org/10.1097/WON.0000000000000481DOI Listing
November 2019

A New Look at Familial Risk of Inflammatory Bowel Disease in the Ashkenazi Jewish Population.

Dig Dis Sci 2018 11 3;63(11):3049-3057. Epub 2018 Sep 3.

Centre for Molecular Medicine, Division of Medicine, University College London, London, UK.

Background And Aims: The inflammatory bowel diseases (IBD) are particularly common among the Ashkenazi Jewish (AJ) population. Population-specific estimates of familial risk are important for counseling; however, relatively small cohorts of AJ IBD patients have been analyzed for familial risk to date. This study aimed to recruit a new cohort of AJ IBD patients, mainly from the UK, to determine the familial occurrence of disease.

Methods: A total of 864 AJ IBD patients were recruited through advertisements, hospital clinics, and primary care. Participants were interviewed about their Jewish ancestry, disease phenotype, age of diagnosis, and family history of disease. Case notes were reviewed.

Results: The 864 probands comprised 506 sporadic and 358 familial cases, the latter with a total of 625 affected relatives. Of the UK cases, 40% had a positive family history with 25% having at least one affected first-degree relative. These percentages were lower among those recruited through hospital clinics and primary care (33% for all relatives and 22% among first-degree relatives). Examining all probands, the relative risk of IBD for offspring, siblings, and parents was 10.5, 7.4, and 4, respectively. Age of diagnosis was significantly lower in familial versus sporadic patients with Crohn's disease.

Conclusions: This study reports familial risk estimates for a significant proportion of the AJ IBD population in the UK. The high rate of a positive family history in this cohort may reflect the greater genetic burden for IBD among AJs. These data are of value in predicting the likelihood of future recurrence of IBD in AJ families.
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http://dx.doi.org/10.1007/s10620-018-5219-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182437PMC
November 2018

Effect of Narrow Spectrum Versus Selective Kinase Inhibitors on the Intestinal Proinflammatory Immune Response in Ulcerative Colitis.

Inflamm Bowel Dis 2016 06;22(6):1306-15

*Centre for Immunobiology, Barts and the London School of Medicine and Dentistry, London, United Kingdom; †Topivert Pharma Ltd., London, United Kingdom; and ‡Academic Department of Medical and Surgical Gastroenterology, Homerton University Hospital, London, United Kingdom.

Background: Kinases are key mediators of inflammation, highlighting the potential of kinase inhibitors as treatments for inflammatory disorders. Selective kinase inhibitors, however, have proved disappointing, particularly in the treatment of rheumatoid arthritis and inflammatory bowel disease. Consequently, to improve efficacy, attention has turned to multikinase inhibition.

Methods: The activity of a narrow spectrum kinase inhibitor, TOP1210, has been compared with selective kinase inhibitors (BIRB-796, dasatinib and BAY-61-3606) in a range of kinase assays, inflammatory cell assays, and in inflamed biopsies from patients with ulcerative colitis (UC). Effects on recombinant P38α, Src, and Syk kinase activities were assessed using Z-lyte assays (Invitrogen, Paisley, United Kingdom). Anti-inflammatory effects were assessed by measurement of proinflammatory cytokine release from peripheral blood mononuclear cells, primary macrophages, HT29 cells, inflamed colonic UC biopsies, and myofibroblasts isolated from inflamed colonic UC mucosa.

Results: TOP1210 potently inhibits P38α, Src, and Syk kinase activities. Similarly, TOP1210 demonstrates potent inhibitory activity against proinflammatory cytokine release in each of the cellular assays and the inflamed colonic UC biopsies and myofibroblasts isolated from inflamed colonic UC mucosa. Generally, the selective kinase inhibitors showed limited and weaker activity in the cellular assays compared with the broad inhibitory profile of TOP1210. However, combination of the selective inhibitors led to improved efficacy and potency in both cellular and UC biopsy assays.

Conclusions: Targeted, multikinase inhibition with TOP1210 leads to a broad efficacy profile in both the innate and adaptive immune responses, with significant advantages over existing selective kinase approaches, and potentially offers a much improved therapeutic benefit in inflammatory bowel disease.
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http://dx.doi.org/10.1097/MIB.0000000000000759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869561PMC
June 2016

Abnormal thymic stromal lymphopoietin expression in the duodenal mucosa of patients with coeliac disease.

Gut 2016 10 4;65(10):1670-80. Epub 2015 Sep 4.

First Department of Internal Medicine, St Matteo Hospital, University of Pavia, Pavia, Italy.

Objective: The short isoform of thymic stromal lymphopoietin (TSLP), a cytokine constitutively expressed by epithelial cells, is crucial in preserving immune tolerance in the gut. TSLP deficiency has been implicated in sustaining intestinal damage in Crohn's disease. We explored mucosal TSLP expression and function in refractory and uncomplicated coeliac disease (CD), a T-cell-mediated enteropathy induced by gluten in genetically susceptible individuals.

Design: TSLP isoforms-long and short-and receptors-TSLPR and interleukin (IL)-7Rα-were assessed by immunofluorescence, immunoblotting and qRT-PCR in the duodenum of untreated, treated, potential and refractory patients with CD. The ability of the serine protease furin or CD biopsy supernatants to cleave TSLP was evaluated by immunoblotting. The production of interferon (IFN)-γ and IL-8 by untreated CD biopsies cultured ex vivo with TSLP isoforms was also assessed.

Results: Mucosal TSLP, but not TSLPR and IL-7Rα, was reduced in untreated CD and refractory CD in comparison to treated CD, potential CD and controls. Transcripts of both TSLP isoforms were decreased in active CD mucosa. Furin, which was overexpressed in active CD biopsies, was able to cleave TSLP in vitro. Accordingly, refractory and untreated CD supernatants showed higher TSLP-degrading capacity in comparison to treated CD and control supernatants. In our ex vivo model, both TSLP isoforms significantly downregulated IFN-γ and IL-8 production by untreated CD biopsies.

Conclusions: Reduced mucosal TSLP expression may contribute to intestinal damage in refractory and untreated CD. Further studies are needed to verify whether restoring TSLP might be therapeutically useful especially in refractory patients with CD.
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http://dx.doi.org/10.1136/gutjnl-2014-308876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036244PMC
October 2016

Endoscopy simulation for medical students.

Clin Teach 2014 Oct;11(6):416-20

Gastroenterology Department, Homerton University Hospital, London, UK.

Background: [Is] the endoscopy simulator a popular and effective novel approach to teaching? Medical simulation can bridge the educational gap between the classroom and the clinical environment, and is an established tool in teaching aspects of the undergraduate curriculum. We have investigated whether the endoscopy simulator is a popular and effective novel approach to teaching some of the year-3 gastroenterology learning objectives.

Methods: Feedback questionnaires were collected over two terms for tutorials on upper gastrointestinal (GI) bleeding and diarrhoea designed around the endoscopy simulator.

Results: Both tutorials received uniformly positive feedback from the students who attended: 26/26 (100%) and 14/14 (100%) students stated that the upper GI bleeding and diarrhoea tutorials, respectively, had been enjoyable, improved their knowledge of the causes of the condition and had been useful in meeting the learning objectives; 26/26 (100%) and 13/14 (93%) students found the tutorials useful in improving knowledge on clinical management. Popular aspects of the sessions included the relevance to the curriculum and interactive nature of the teaching. Small class sizes were preferred.

Discussion: Endoscopy simulators can be a novel and effective teaching tool for undergraduates. Hospitals with this resource should consider broadening its application to include teaching students.
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http://dx.doi.org/10.1111/tct.12172DOI Listing
October 2014

The dangers of living in a tent in London.

BMJ Case Rep 2014 May 20;2014. Epub 2014 May 20.

Department of Gastroenterology, Homerton University Hospital, London, UK.

A middle-aged patient was admitted severely unwell with acute liver and renal failure of unknown cause. After extensive investigation the patient was found to have leptospirosis. We examine the investigations and management and discuss the disease itself.
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http://dx.doi.org/10.1136/bcr-2013-201654DOI Listing
May 2014

The virtual continuity in learning programme: results.

Clin Teach 2012 Aug;9(4):216-21

Academic Department of Medical and Surgical Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK.

Background: The implementation of the European Working Time Directive and specialty-driven care has resulted in the loss of continuity of patient care, and thus a loss of continuity in learning. We proposed a potential solution to this fragmentation of junior doctor workplace learning in the Virtual Continuity in Learning Programme (VCLP). The VCLP enables the doctor to follow the virtual patient journey (of an actual patient who is no longer under their care) using the Virtual Consulting Room (VcR), and to understand the rationale behind clinical decision making prior to completing their case-based discussion (CbD) work-based assessments.

Method: Fifty-seven out of 62 (92%) of foundation doctors (Homerton University Hospital, London, UK) consented to participate in the study. Web-tracking software was used. Fifty-three out of 57 (93%) doctors completed an initial questionnaire. Twenty-nine out of 57 (51%) doctors returned a follow-up questionnaire 6 months later. Eleven doctors were interviewed in three focus groups: the VcR user group; the VcR non-user group; and a mixed group. The data was analysed qualitatively.

Results: Tracking showed 33.3 per cent (19/57) of doctors used the VcR over a 6-month period. Interestingly doctors used the VcR in a range of situations, not solely as instructed. Results enabled us to understand how doctors learn and their perception of using the VCLP to support their learning and completion of work-based assessments.

Discussion: Foundation doctors use the educational resources available, including the VcR, to help structure their workplace learning. The majority of VcR users found it particularly useful for just-in-time learning. The VCLP offers support to junior doctors learning during their preparation for case-based discussion.
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http://dx.doi.org/10.1111/j.1743-498X.2012.00551.xDOI Listing
August 2012

Shadowing a foundation-year doctor: a third-year medical student's perspective.

Clin Teach 2011 Sep;8(3):156-9

Barts and the London Medical School, London, UK.

Context: This paper considers the advantages of shadowing foundation-year doctors (FY1) in the third year of medical school, an opportunity the UK's General Medical Council (UKGMC) recommends to be given to final-year students only.

Method: Eighteen students spent 1 day each shadowing an FY1, holding their pager and carrying out their duties under direct supervision. Questionnaires, based on UKGMC expectations of an FY1, were completed assessing students' confidence and experience before and after the shifts. The doctors were interviewed.

Results: The questionnaire response rate was 72 per cent (13/18). The overall increase in student experiences in good clinical care (p<0.001), maintaining good medical practice--teaching and learning (p=0.002), and recognition and management of the acutely ill (p<0.001), were statistically significant. The increase in student confidence in answering the pager (p<0.001), prioritising jobs (p=0.002), venepuncture (p=0.008), writing drug charts (p=0.031), writing in patient notes (p=0.002) and developing management plans (p=0.002) were statistically significant. Qualitative results yielded an overwhelming opinion from students and doctors that it should be made a compulsory part of the third-year curriculum. The doctors found it increased their knowledge and teaching skills.

Conclusion: This study has implications for the future of medical training. If incorporated into the third-year curriculum, compulsory shadowing would give students a structured one-to-one learning experience during which to learn clinically relevant skills. By shadowing a doctor so closely, they will also learn first-hand how to interact professionally with patients and other health care workers, a skill difficult to teach at medical school.
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http://dx.doi.org/10.1111/j.1743-498X.2011.00449.xDOI Listing
September 2011

Oesophageal tuberculosis.

BMJ Case Rep 2011 Dec 8;2011. Epub 2011 Dec 8.

Barts and The London SMD, London, UK.

The case discussed is that of a previously healthy 48-year-old female who presented with a week long history of epigastric pain and continuing weight loss. A series of investigations and supporting literature alluded to a diagnosis of oesophageal tuberculosis (TB), and antituberculous medication was commenced accordingly. An accompanying discussion considers the incidence, differential diagnoses, pathogenesis, clinical features, investigations and aspects of management of oesophageal TB.
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http://dx.doi.org/10.1136/bcr.09.2011.4883DOI Listing
December 2011

Thrombophlebitis migrans in a man with pancreatic adenocarcinoma: a case report.

Cases J 2009 Apr 29;2:6610. Epub 2009 Apr 29.

Broomfield Hospital, Court Road, Broomfield, Chelmsford CM1 7ET.

Introduction: Thrombophlebitis migrans is characterised by the development of recurrent (i.e. migratory) superficial thrombophlebitis. It is an acquired coagulopathy that is strongly associated with malignancy, especially solid tumours of the adenocarcinoma type.

Case Presentation: A 62 year old male presented with jaundice, abdominal pain, anorexia, steatorrhoea and dark urine. Ultrasound demonstrated a mass in the head of the pancreas causing common bile duct obstruction. Histology confirmed pancreatic adenocarcinoma. He was subsequently noted to have a migratory, tender and erythematous rash consistent with thrombophlebitis migrans.

Conclusion: Thrombophlebitis migrans is more easily recognised in patients with an established diagnosis of malignancy than in situations where the thrombophlebitis is first diagnosed. In the latter situation, investigations for an occult malignancy should be sought.
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http://dx.doi.org/10.1186/1757-1626-2-6610DOI Listing
April 2009

Rhabdomere biogenesis in Drosophila photoreceptors is acutely sensitive to phosphatidic acid levels.

J Cell Biol 2009 Apr;185(1):129-45

Inositide Laboratory, Babraham Institute, Babraham Research Campus, Cambridge, England, UK.

Phosphatidic acid (PA) is postulated to have both structural and signaling functions during membrane dynamics in animal cells. In this study, we show that before a critical time period during rhabdomere biogenesis in Drosophila melanogaster photoreceptors, elevated levels of PA disrupt membrane transport to the apical domain. Lipidomic analysis shows that this effect is associated with an increase in the abundance of a single, relatively minor molecular species of PA. These transport defects are dependent on the activation state of Arf1. Transport defects via PA generated by phospholipase D require the activity of type I phosphatidylinositol (PI) 4 phosphate 5 kinase, are phenocopied by knockdown of PI 4 kinase, and are associated with normal endoplasmic reticulum to Golgi transport. We propose that PA levels are critical for apical membrane transport events required for rhabdomere biogenesis.
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http://dx.doi.org/10.1083/jcb.200807027DOI Listing
April 2009

The accident and emergency department virtual consulting room.

Telemed J E Health 2006 Oct;12(5):521-7

The Virtual Consulting Room Project, The Royal Free & University College Medical School (Hampstead Campus), University College London, London, UK.

The goal was to describe the development of the Virtual Consulting Room (VcR), a unique intranet-based guidance application providing direct access to local specialist knowledge, and to evaluate its usability and whether it has the potential to educate staff while working in the Accident and Emergency (A&E) department. Duty staff of the A&E Department, The Royal Free Hospital, London, participated in a prospective observational study. Two hundred and twenty consecutive patients were identified from the triage section of their casualty card as having a presenting complaint that featured in the VcR. These casualty cards were highlighted with a red sticker alert and a short questionnaire attached. Members of staff were invited to consult with the VcR after assessing each patient by clicking on an icon located on the department's computer desktops. No prior training was provided. The questionnaire was completed in 103 of 220 (46.8%) patients. The VcR was used in the management of 38 of 220 (17.3%) patients. In 21 of 38 (55.3%), users reported the VcR supported clinical decision making, in 20 of 38 (52.6%) the VcR improved knowledge and in 11 of 38 (28.9%) the VcR helped directly influence the decision to discharge the patient. In 2 of 38 (5.3%) users changed their decision to refer and in 1 of 38 (2.6%) investigations were altered. This evaluation indicates that A&E clinicians accessing the VcR found it easy to use and educational in the workplace.
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http://dx.doi.org/10.1089/tmj.2006.12.521DOI Listing
October 2006

Sphingosine kinase 1 is an intracellular effector of phosphatidic acid.

J Biol Chem 2004 Oct 13;279(43):44763-74. Epub 2004 Aug 13.

Department of Signalling, Babraham Institute, Cambridge CB2 4AT, United Kingdom.

Sphingosine kinase 1 (SK1) phosphorylates sphingosine to generate sphingosine 1-phosphate (S1P). Because both substrate and product of the enzyme are potentially important signaling molecules, the regulation of SK1 is of considerable interest. We report that SK1, which is ordinarily a cytosolic enzyme, translocates in vivo and in vitro to membrane compartments enriched in phosphatidic acid (PA), the lipid product of phospholipase D. This translocation depends on direct interaction of SK1 with PA, because recombinant purified enzyme shows strong affinity for pure PA coupled to Affi-Gel. The SK1-PA interaction maps to the C terminus of SK1 and is independent of catalytic activity or of the diacylglycerol kinase-like domain of the enzyme. Thus SK1 constitutes a novel, physiologically relevant PA effector.
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http://dx.doi.org/10.1074/jbc.M405771200DOI Listing
October 2004
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