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Severe Gastrooesophageal Reflux Disease Associated with Foetal Alcohol Syndrome
N. K. Sujay,Matthew Jones,Emma Whittle,Helen Murphy,Marcus K. H. Auth
Case Reports in Pediatrics , 2012, DOI: 10.1155/2012/509253

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Abstract: Prenatal alcohol exposure may have adverse effects on the developing foetus resulting in significant growth restriction, characteristic craniofacial features, and central nervous system dysfunction. The toxic effects of alcohol on the developing brain are well recognised. However, little is known about the effects of alcohol on the developing gastrointestinal tract or their mechanism. There are few case reports showing an association between foetal alcohol syndrome and gastrointestinal neuropathy. We report a rare association between foetal alcohol syndrome and severe gastrooesophageal reflux disease in an infant who ultimately required fundoplication to optimise her growth and nutrition. The child had failed to respond to maximal medical treatment (domperidone and omeprazole), high calorie feeds, PEG feeding, or total parenteral nutrition. The effect of alcohol on the developing foetus is not limited to the central nervous system but also can have varied and devastating effects on the gastrointestinal tract. 1. Case Report A 3-month-old girl was admitted to hospital for assessment and management of faltering growth. The child was born at 39 weeks’ gestation by emergency caesarean section due to foetal distress following induction of labour for intrauterine growth restriction. There were no problems in the immediate postnatal period, and she did not need admission to special care. Birth weight was 2.4？kg (0.4th–2nd centile), and head circumference was 33？cm (9th centile). She was bottle fed, consuming around 4 to 5？oz., 3 to 4 hourly with 4 or 5 bowel movements per day. She showed poor weight gain. Her mother’s previous two pregnancies had also resulted in small for gestational age babies (1.4？kg at 34 weeks and 2.3？kg at 41 weeks’ gestation). Both family and social history were fully explored during the admission. There was a history of significant alcohol consumption in the mother for which she had undergone a detoxification course during pregnancy. On admission the child weighed 3.4？kg with a length of 52.4？cm (both below 0.4th centile). She had microcephaly with a head circumference of 35？cm (less than 0.4th centile). On examination she had several distinctive features with a wide anterior fontanelle, large mouth and tongue, short anteverted nose, flat nasal bridge, long smooth philtrum, thin tented upper lip (Figure 1(a)), short neck, widely spaced nipples, mild camptodactyly of the left fifth finger and deep palmar crease on the right hand (Figure 2(a)), wide sandal gap on both feet (Figure 2(b)), and deep sacral crease. She also had a heart

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Menopause and the influence of culture: another gap for Indigenous Australian women?
Emma K Jones, Janelle R Jurgenson, Judith M Katzenellenbogen, Sandra C Thompson
BMC Women's Health , 2012, DOI: 10.1186/1472-6874-12-43

Abstract: A search of databases including Ovid Medline, Pubmed, Web of Science, AUSThealth, AMED, EMBASE, Global Health and PsychINFO was undertaken from January 2011 to April 2011 using the search terms menopause, Indigenous, Aboriginal, attitudes, and perceptions and repeated in September 2012.Considerable research shows significant variation across cultures in the menopausal experience. Biological, psychological, social and cultural factors are associated with either positive or negative attitudes, perceptions or experiences of menopause in various cultures. Comparative international literature shows that neither biological nor social factors alone are sufficient to explain the variation in experiences of the menopausal transition. However, a strong influence of culture on the menopause experience can be found. The variation in women’s experience of menopause indicates that different cultural groups of women may have different understandings and needs during the menopausal transition. While considerable literature exists for Australian women as a whole, there has been little investigation of Australian Indigenous women, with only two research studies related to Indigenous women’s experiences of menopause identified.Differences in biocultural experience of menopause around the world suggest the importance of biocultural research. For the Indigenous women of Australia, the relative contribution of culture, social disadvantage and poor general health compared with non-Indigenous women to the experience of menopause is unknown. As such, further research and understanding of the experience of Indigenous women around Australia is needed. This information could assist individuals, families, cultural groups and healthcare providers to enhance management and support for Indigenous Australian women.All women that live long enough will experience a biological decline in ovarian function leading to reproductive senescence marking the end of their fertility and capacity for reproductio

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Delphi study to identify key features of community-based child and adolescent mental health services in the East of England
Ainul Nadhirah Hanafiah,Ayla Humphrey,Chiara Lombardo,Emma Howarth,Joanna K Anderson,Maris Vainre,Peter B Jones
- , 2019, DOI: 10.1136/bmjopen-2018-022936

Abstract: Objective To identify priorities for the delivery of community-based Child and Adolescent Mental health Services (CAMHS). Design (1) Qualitative methods to gather public and professional opinions regarding the key principles and components of effective service delivery. (2) Two-round, two-panel adapted Delphi study. The Delphi method was adapted so professionals received additional feedback about the public panel scores. Descriptive statistics were computed. Items rated 8–10 on a scale of importance by ≥80% of both panels were identified as shared priorities. Setting Eastern region of England. Participants (1) 53 members of the public; 95 professionals from the children’s workforce. (2) Two panels. Public panel: round 1,n=23; round 2,n=16. Professional panel: round 1,n=44; round 2,n=33. Results 51 items met the criterion for between group consensus. Thematic grouping of these items revealed three key findings: the perceived importance of schools in mental health promotion and prevention of mental illness; an emphasis on how specialist mental health services are delivered rather than what is delivered (ie, specific treatments/programmes), and the need to monitor and evaluate service impact against shared outcomes that reflect well-being and function, in addition to the mere absence of mental health symptoms or disorders. Conclusions Areas of consensus represent shared priorities for service provision in the East of England. These findings help to operationalise high level plans for service transformation in line with the goals and needs of those using and working in the local system and may be particularly useful for identifying gaps in ongoing transformation efforts. More broadly, the method used here offers a blueprint that could be replicated by other areas to support the ongoing transformation of CAMHS

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Design, Dignity and Due Process: The Construction of the Coffs Harbour Courthouse
Diane Jones,Emma Rowden
- , 2018, DOI: 10.1177/1743872115612954

Abstract: The discourse around the merit of public architecture often depicts the architect as having complete autonomy over its design. This belies the constraints placed upon creative solutions by design briefs or the intense negotiations between the State, the architect and the various stakeholders involved in the construction process. Through a case study examining the construction of a courthouse, we demonstrate the difficulties in pursuing improvements to the phenomenological experience of justice within these constraints. It reveals the need for architectural knowledge to be shared for the common good in order to resist practices that replicate existing conditions and inhibit innovation

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Development of a core outcome set for studies involving patients undergoing major lower limb amputation for peripheral arterial disease: study protocol for a systematic review and identification of a core outcome set using a Delphi survey
Adrian G. K. Edwards,Cherry-Ann Waldron,Christopher P. Twine,David C. Bosanquet,Emma Thomas-Jones,Graeme K. Ambler,Lucy Brookes-Howell
- , 2017, DOI: 10.1186/s13063-017-2358-9

Abstract:

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GAM: a web-service for integrated transcriptional and metabolic network analysis
Abhishek K. Jha,Alexander A. Loboda,Alexey A. Sergushichev,Edward J. Pearce,Edward M. Driggers,Emma E. Vincent,Maxim N. Artyomov,Russell G. Jones
- , 2016, DOI: 10.1093/nar/gkw266

Abstract: Novel techniques for high-throughput steady-state metabolomic profiling yield information about changes of nearly thousands of metabolites. Such metabolomic profiles, when analyzed together with transcriptional profiles, can reveal novel insights about underlying biological processes. While a number of conceptual approaches have been developed for data integration, easily accessible tools for integrated analysis of mammalian steady-state metabolomic and transcriptional data are lacking. Here we present GAM (‘genes and metabolites’): a web-service for integrated network analysis of transcriptional and steady-state metabolomic data focused on identification of the most changing metabolic subnetworks between two conditions of interest. In the web-service, we have pre-assembled metabolic networks for humans, mice, Arabidopsis and yeast and adapted exact solvers for an optimal subgraph search to work in the context of these metabolic networks. The output is the most regulated metabolic subnetwork of size controlled by false discovery rate parameters. The subnetworks are then visualized online and also can be downloaded in Cytoscape format for subsequent processing. The web-service is available at: https://artyomovlab.wustl.edu/shiny/gam

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The Patient Deficit Model Overturned: a qualitative study of patients' perceptions of invitation to participate in a randomized controlled trial comparing selective bladder preservation against surgery in muscle invasive bladder cancer (SPARE, CRUK/07/011)
Moynihan Clare,Lewis Rebecca,Hall Emma,Jones Emma
Trials , 2012, DOI: 10.1186/1745-6215-13-228

Abstract: Background Evidence suggests that poor recruitment into clinical trials rests on a patient ‘deficit’ model – an inability to comprehend trial processes. Poor communication has also been cited as a possible barrier to recruitment. A qualitative patient interview study was included within the feasibility stage of a phase III non-inferiority Randomized Controlled Trial (RCT) (SPARE, CRUK/07/011) in muscle invasive bladder cancer. The aim was to illuminate problems in the context of randomization. Methods The qualitative study used a ‘Framework Analysis’ that included ‘constant comparison’ in which semi-structured interviews are transcribed, analyzed, compared and contrasted both between and within transcripts. Three researchers coded and interpreted data. Results Twenty-four patients agreed to enter the interview study; 10 decliners of randomization and 14 accepters, of whom 2 subsequently declined their allocated treatment. The main theme applying to the majority of the sample was confusion and ambiguity. There was little indication that confusion directly impacted on decisions to enter the SPARE trial. However, confusion did appear to impact on ethical considerations surrounding ‘informed consent’, as well as cause a sense of alienation between patients and health personnel. Sub-optimal communication in many guises accounted for the confusion, together with the logistical elements of a trial that involved treatment options delivered in a number of geographical locations. Conclusions These data highlight the difficulty of providing balanced and clear trial information within the UK health system, despite best intentions. Involvement of multiple professionals can impact on communication processes with patients who are considering participation in RCTs. Our results led us to question the ‘deficit’ model of patient behavior. It is suggested that health professionals might consider facilitating a context in which patients feel fully included in the trial enterprise and potentially consider alternatives to randomization where complex interventions are being tested. Trial Registration ISRCTN61126465

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Astrocyte-Secreted Matricellular Proteins in CNS Remodelling during Development and Disease
Emma V. Jones,David S. Bouvier
Neural Plasticity , 2014, DOI: 10.1155/2014/321209

Abstract: Matricellular proteins are secreted, nonstructural proteins that regulate the extracellular matrix (ECM) and interactions between cells through modulation of growth factor signaling, cell adhesion, migration, and proliferation. Despite being well described in the context of nonneuronal tissues, recent studies have revealed that these molecules may also play instrumental roles in central nervous system (CNS) development and diseases. In this minireview, we discuss the matricellular protein families SPARC (secreted protein acidic and rich in cysteine), Hevin/SC1 (SPARC-like 1), TN-C (Tenascin C), TSP (Thrombospondin), and CCN (CYR61/CTGF/NOV), which are secreted by astrocytes during development. These proteins exhibit a reduced expression in adult CNS but are upregulated in reactive astrocytes following injury or disease, where they are well placed to modulate the repair processes such as tissue remodeling, axon regeneration, glial scar formation, angiogenesis, and rewiring of neural circuitry. Conversely, their reexpression in reactive astrocytes may also lead to detrimental effects and promote the progression of neurodegenerative diseases. 1. Introduction Astrocytes secrete numerous factors and active molecules [1–4], which modulate synapse development, neuronal activity, and plasticity during development and in the mature brain [5–10]. In particular, immature astrocytes produce and secrete many types of proteins that allow them to remodel the extracellular matrix (ECM) surrounding neurons and synapses [11]. In addition, astrocytes have the ability to react to any kind of insult or change in their environment, physical, viral, or chronic disease, and work side by side with microglia, the immune cells of the brain, in order to contain and to repair the brain from injuries [12, 13]. Astrocyte reactivity is associated with striking changes in gene expression and morphology [14, 15]. It has been demonstrated that reactive astrocytes revert to a partially immature molecular profile [16], which allow them to reexpress a variety of factors/proteins required for tissue remodelling around injury sites [13]. Some of these proteins have direct roles on modulation of ECM and cell to cell interactions. One mechanism used by reactive astrocytes to reshape their microenvironment is through the secretion of matricellular proteins. Matricellular proteins are a family of structurally unrelated proteins that are secreted into the extracellular space. They act as nonstructural regulators of the ECM and cell-matrix interactions through modulation of growth factor signaling,

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Optimised Anaesthesia to Reduce Post Operative Cognitive Decline (POCD) in Older Patients Undergoing Elective Surgery, a Randomised Controlled Trial
Clive Ballard, Emma Jones, Nathan Gauge, Dag Aarsland, Odd Bjarte Nilsen, Brian K. Saxby, David Lowery, Anne Corbett, Keith Wesnes, Eirini Katsaiti, James Arden, Derek Amaoko, Nicholas Prophet, Balaji Purushothaman, David Green
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0037410

Abstract: Background The study determined the one year incidence of post operative cognitive decline (POCD) and evaluated the effectiveness of an intra-operative anaesthetic intervention in reducing post-operative cognitive impairment in older adults (over 60 years of age) undergoing elective orthopaedic or abdominal surgery. Methods and Trial Design The design was a prospective cohort study with a nested randomised, controlled intervention trial, using intra-operative BiSpectral index and cerebral oxygen saturation monitoring to enable optimisation of anaesthesia depth and cerebral oxygen saturation in older adults undergoing surgery. Results In the 52 week prospective cohort study (192 surgical patients and 138 controls), mild (χ2 = 17.9 p<0.0001), moderate (χ2 = 7.8 p = 0.005) and severe (χ2 = 5.1 p = 0.02) POCD were all significantly higher after 52 weeks in the surgical patients than among the age matched controls. In the nested RCT, 81 patients were randomized, 73 contributing to the data analysis (34 intervention, 39 control). In the intervention group mild POCD was significantly reduced at 1, 12 and 52 weeks (Fisher’s Exact Test p = 0.018, χ2 = 5.1 p = 0.02 and χ2 = 5.9 p = 0.015), and moderate POCD was reduced at 1 and 52 weeks (χ2 = 4.4 p = 0·037 and χ2 = 5.4 p = 0.02). In addition there was significant improvement in reaction time at all time-points (Vigilance Reaction Time MWU Z = ？2.1 p = 0.03, MWU Z = ？2.7 p = 0.004, MWU Z = ？3.0 p = 0.005), in MMSE at one and 52 weeks (MWU Z = ？2.9 p = 0.003, MWU Z = ？3.3 p = 0.001), and in executive function at 12 and 52 weeks (Trail Making MWU Z = ？2.4 p = .0.018, MWU Z = ？2.4 p = 0.019). Conclusion POCD is common and persistent in older adults following surgery. The results of the nested RCT indicate the potential benefits of intra-operative monitoring of anaesthetic depth and cerebral oxygenation as a pragmatic intervention to reduce post-operative cognitive impairment. Trial Registration Controlled-Trials.com ISRCTN39503939

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