Dr Louise Dunford

Job: Senior Lecturer in Anatomy & Physiology

Faculty: Health and Life Sciences

School/department: School of Allied Health Sciences

Research group(s): Biomedical & Environmental Health

Address: De Montfort University, The Gateway, Leicester, LE1 9BH

T: +44 (0)116 250 6498

E: louise.dunford@dmu.ac.uk

W: http://www.dmu.ac.uk/hls

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Personal profile

I am a senior lecturer and the Programme Leader for BMedSci (Hons) Medical Science.

I am an active researcher with a special interest in obesity and weight management, including bariatric surgery. I also have some ongoing research on diet and kidney disease.

In addition, I am a DMU Teacher Fellow and have several ongoing educational research projects, including using drawing to facilitate learning of scientific concepts.

My main areas of teaching are nutrition, weight management, appetite regulation, and evidence based medicine.

Research group affiliations

Biomedical & Environmental Health

Publications and outputs

Hyperhidrosis Priority Setting Partnership: the top 10 research priorities for management and treatment of hyperhidrosis.
Hyperhidrosis Priority Setting Partnership: the top 10 research priorities for management and treatment of hyperhidrosis. McDonald, L.; Alexandroff, A.; Radley, K.; Oliver, R.; McPhee, M.; Miller, J.; Hussain, H.; Dunford, L. J. Hyperhidrosis is a common skin condition characterised by abnormal levels of sweating, and affects 1 -3 % of the population. It can cause both physical problems and psychological distress, and significantly affect quality of life. Priority setting partnerships (PSPs) enable patients and clinicians to work together on an equal footing to identify questions about treatments that cannot be answered by existing research. This study aimed to identify and prioritise the top ten most important questions relating to management and treatment of hyperhidrosis. A steering group of patients, clinicians, and researchers agreed the PSP terms of reference and methodology. Patients and clinicians were invited to complete a survey to propose questions about management and treatment of hyperhidrosis that they would like research to answer. Next the questions were reviewed to remove those out of scope of the PSP, and to form indicative questions to group duplicate and very similar submissions together. These questions were checked against existing scientific literature and removed if the question had already been answered by a systematic review. Survey participants were asked to rank the remaining questions in order of priority. A final workshop was held to prioritise the Top 10 research questions from a shortlist of 23, through a facilitated process. The first survey was completed by 268 participants, who proposed 592 research questions. Out of these, 160 were deemed to be out of scope. From the remaining 462 questions, 48 indicative questions were formed. Three of these were considered to already be answered by existing research, so 45 questions went into the second survey. After participants ranked their top ten from these 45 questions, 23 were selected for the final workshop, where the Top Ten research questions were chosen. Hyperhidrosis is currently under-researched compared with skin disorders with similar prevalence, and it is hoped that publication of the Top Ten to research funders will enable them to direct funds towards answering the questions that matter most to people with hyperhidrosis and the clinicians that treat them.
The benefits of getting involved in a Priority Setting Partnership
The benefits of getting involved in a Priority Setting Partnership Radley, Kathy; Miller, Janice; Hussain, Hana Amber; Dunford, L. J. Introduction Priority Setting Partnerships (PSPs) bring together patients, carers and healthcare professionals to have an equal say in identifying questions which cannot currently be answered by research. The aim is to create a top ten list of research priorities which are shared with funders, so that research money is directed to the areas that matter most to patients and those who treat them. A few PSPs have been carried out into dermatological conditions, but many others could benefit in the future. Methods A steering group is set up comprised of patients, carers, healthcare professionals and academics. Meetings are chaired by an adviser from the James Lind Alliance, who also supports the whole PSP process. A first survey asks respondents for questions about their condition that they would like to see answered by research, and is widely advertised on social media, patient support websites, and healthcare professional networks. Next the survey results are screened to remove any outside of the scope of the PSP, and then indicative questions are formed to group repeated or very similar questions together. The indicative questions are checked against existing literature and removed if the question has already been answered by a systematic review. A second survey asks the respondents to rank the remaining indicative questions in order to priority. A final workshop is held to reduce a shortlist of 20-30 questions down to the top ten. Results PSPs have been done for seven skin conditions, including lichen sclerosus, acne and psoriasis.1 The most recently PSP has been for hyperhidrosis, and the top ten list is currently being publicised.2 Benefits • Dermatology nurses and other healthcare professionals can have their say about research priorities • Hearing first hand from patients what their own research priorities are • Development of skills useful for other research projects • Opportunity for conference presentation and contributing to peer-reviewed articles
Analysis of the final workshop for the Priority Setting Partnership for hyperhidrosis
Analysis of the final workshop for the Priority Setting Partnership for hyperhidrosis Miller, Janice; Hussain, Hana Amber; McDonald, Louise; Dunford, L. J. Introduction Hyperhidrosis is characterised by excessive sweating, and affects ~3% of the population. It can significantly affect quality of life. However, many people with hyperhidrosis don’t seek medical help due to the stigma associated with it, and those that do often struggle to find treatments that work for them. The Hyperhidrosis Priority Setting Partnership (PSP) aimed to bring together people with the condition, their friends and family, and healthcare professionals who treat them on an equal footing to have their say about the questions they want research to answer. A workshop event was the final stage of the process to identify the top ten research priorities Methods A steering group was formed including people with hyperhidrosis, patient support group representation, healthcare professionals and academics. A James Lind Alliance adviser was appointed to chair meetings and oversee the process. An initial survey asked people with hyperhidrosis, their family and friends, and healthcare professionals for the questions they would like research to answer about management and treatment of hyperhidrosis. From the initial 592 questions submitted, this was reduced to 45 by combining duplicate/similar questions, and removing those already answered by research. Survey respondents were then asked to choose their top ten from this list. The top 23 choices went through to a final workshop event, where the top ten were selected via a facilitated process. A questionnaire was carried out to analyse the success of the event itself. Results Seventy-two percent (13/18) of the final workshop participants completed the workshop questionnaire. 100% of respondents were satisfied or very satisfied that they were able to communicate their views and that they helped shape the final top ten list. 92% of respondents were very satisfied with the way the James Lind Alliance team facilitated the workshop. Conclusion PSPs are a very successful way of getting patients and healthcare professionals to have their say about research priorities. Those that took part in this PSP were very satisfied that they were helping to shape the research agenda for the treatment and management of hyperhidrosis.
Attitudes to weight management in the South Asian population
Attitudes to weight management in the South Asian population Robinson-Burke, Tamara; Tanna, Sangeeta; Hind, James; Fretwell, Laurice; Williams, Robert; Sutton, Christopher; Dunford, L. J.
Evaluating novel methods for teaching toxicology, public health and emergency response to undergraduate students.
Evaluating novel methods for teaching toxicology, public health and emergency response to undergraduate students. Pena-Fernandez, A.; Lobo-Bedmar, M. C.; Haris, P. I. (Parvez I.); Pena, M. A.; Dunford, L. J. Recent global health threats from bioterrorism and chemical attacks to the Ebola outbreak in West Africa have shown that there is a necessity for teaching toxicology, public health and emergency preparedness to future health care professionals in order to protect the public from these global threats. Thus, the public health sector is increasingly demanding health care professionals and health professionals with a knowledge and training to respond to chemical and biological events that can pose a risk to populations. Moreover, evidence base and analytical skills are necessary competences to advocate for public health interventions to protect human health. A series of specialised workshops have been created by lecturers with a public health background and experience from the field such as in the recent Ebola outbreak in West Africa or regarding human risk assessment due to metals and metalloids in urban ecosystems. These workshops have been delivered in different modules across the Medical Sciences degree at De Montfort University (2015/16) and were based on previous experience in environmental toxicology training developed by Peña-Fernández et al. (2015). Different case studies were produced in which students come with measures to protect public health. Students reported in the final module feedback through Blackboard a high engagement and interest in these workshops. The novel teaching materials produced could be effective for providing students with public health knowledge and tools to develop a response and preparedness to intervene against future chemical or biological events. This novel teaching content could be adopted to train future public health professionals.
Harmonising the training of students within the EU to implement intervention programmes to protect the public in the aftermath of a HazMat incident
Harmonising the training of students within the EU to implement intervention programmes to protect the public in the aftermath of a HazMat incident Pena-Fernandez, A.; Dunford, L. J.; Haris, P. I. (Parvez I.); Lobo-Bedmar, M. C.; Pena, M. A.
Remote effects of acute kidney injury in a porcine model.
Remote effects of acute kidney injury in a porcine model. Gardner, D. S.; De Brot, S.; Dunford, L. J.; Roma, L. G.; Welham, S. J. M.; Fallman, R.; O'Sullivan, S. E.; Oh, W.; Devonald, M. A. J. Background: Acute Kidney Injury (AKI) is a common and serious with no specific treatment. An episode of AKI may affect organs distant to the kidney, further increasing the morbidity associated with AKI. The mechanism of organ cross-talk after AKI is unclear. The renal and immune systems of pigs and humans are alike. Using a preclinical animal (porcine) model, we test the hypothesis that early effects of AKI on distant organs is by immune cell infiltration leading to inflammatory cytokine production, extravasation and edema. Study Design: In 29 pigs exposed to either sham-surgery or renal ischemia-reperfusion (control, n=12; AKI, n=17) we assessed remote organ (liver, lung, brain) effects in the short-(from 2 to 48h reperfusion) and longer-term (5 weeks later) using immunofluorescence (for leucocyte infiltration, apoptosis), a cytokine array, tissue elemental analysis (electrolytes), blood hematology and chemistry (e.g. liver enzymes) and PCR (for inflammatory markers). Results: AKI elicited significant, short-term (~24h) increments in enzymes indicative of acute liver damage (e.g. AST:ALT ratio; P=0.02) and influenced tissue biochemistry in some remote organs (e.g. lung tissue [Ca++] increased; P=0.04). These effects largely resolved after 48h and no further histopathology, edema, apoptosis or immune cell infiltration was noted in liver, lung or hippocampus in the short- and longer-term. Conclusions: AKI has subtle biochemical effects on remote organs in the short-term including a transient increment in markers of acute liver damage. These effects resolved by 48h and no further remote organ histopathology, apoptosis, edema or immune cell infiltration was noted.
Remote conditioning or erythropoietin before surgery primes kidneys to clear ischemia-reperfusion-damaged cells: a renoprotective mechanism?
Remote conditioning or erythropoietin before surgery primes kidneys to clear ischemia-reperfusion-damaged cells: a renoprotective mechanism? Gardner, D. S.; Welham, S. J. M.; Dunford, L. J.; McCulloch, T. A.; Hodi, Z.; Sleeman, P.; O'Sullivan, S.; Devonald, M. A. J. Acute kidney injury is common, serious with no specific treatment. Ischemia-reperfusion is a common cause of acute kidney injury (AKI). Clinical trials suggest that preoperative erythropoietin (EPO) or remote ischemic preconditioning may have a renoprotective effect. Using a porcine model of warm ischemia-reperfusion-induced AKI (40-min bilateral cross-clamping of renal arteries, 48-h reperfusion), we examined the renoprotective efficacy of EPO (1,000 iu/kg iv.) or remote ischemic preconditioning (3 cycles, 5-min inflation/deflation to 200 mmHg of a hindlimb sphygmomanometer cuff). Ischemia-reperfusion induced significant kidney injury at 24 and 48 h (χ2, 1 degree of freedom, >10 for 6/7 histopathological features). At 2 h, a panel of biomarkers including plasma creatinine, neutrophil gelatinase-associated lipocalin, and IL-1β, and urinary albumin:creatinine could be used to predict histopathological injury. Ischemia-reperfusion increased cell proliferation and apoptosis in the renal cortex but, for pretreated groups, the apoptotic cells were predominantly intratubular rather than interstitial. At 48-h reperfusion, plasma IL-1β and the number of subcapsular cells in G2-M arrest were reduced after preoperative EPO, but not after remote ischemic preconditioning. These data suggest an intrarenal mechanism acting within cortical cells that may underpin a renoprotective function for preoperative EPO and, to a limited extent, remote ischemic preconditioning. Despite equivocal longer-term outcomes in clinical studies investigating EPO as a renoprotective agent in AKI, optimal clinical dosing and administration have not been established. Our data suggest further clinical studies on the potential renoprotective effect of EPO and remote ischemic preconditioning are justified. In collaboration with colleagues at University of Nottingham & Nottingham University Hospitals NHS Trust.
Maternal protein-energy malnutrition during early pregnancy in sheep impacts the fetal ornithine cycle to reduce fetal kidney microvascular development.
Maternal protein-energy malnutrition during early pregnancy in sheep impacts the fetal ornithine cycle to reduce fetal kidney microvascular development. Dunford, L. J.; Sinclair, K. D.; Kwong, W. Y.; Sturrock, C.; Clifford, B. L.; Giles, T. C.; Gardner, D. S. This is an Open Access article

Click here to view a full listing of Louise Dunford's publications and outputs.

Key research outputs

Dunford L.J., Sinclair K.D., Kwong K.W., Sturrock C., Clifford B.L., Giles T.C., Gardner D.S. (2014) Maternal protein-energy malnutrition during early pregnancy in sheep impacts the fetal ornithine cycle to reduce fetal kidney microvascular development. FASEB 28 (11), 4880-4892

Gardner D.S., Welham S.J.M., Dunford L.J., McCulloch T.A., Hodi Z., Sleeman P.,O’Sullivan S., Devonald M.A.J. (2014) Remote conditioning or erythropoietin before surgery primes kidneys to clear ischemia-reperfusion-damaged cells: a renoprotective mechanism? American Journal of Physiology-Renal Physiology 306 (8), F873-F884

Lloyd L.J., Foster T, Rhodes P, Rhind S, Gardner DS. (2012) Protein energy malnutrition during early gestation blunts fetal renal vascular and nephron development and negatively impacts renal function in the adult. Journal of Physiology: 590, 377-393.

Lloyd L.J., Langley-Evans SC, McMullen S. (2012) Childhood obesity and risk of the adult metabolic syndrome: a systematic review. International Journal of Obesity: 36, 1-

Lloyd L.J., Langley-Evans SC, McMullen S. (2010) Childhood obesity and adult cardiovascular disease risk: a systematic review. International Journal of Obesity; 34(1),18-28.

*note, my previous surname was Lloyd*

Research interests/expertise

Kidney disease
Obesity
Nutrition
Education

Areas of teaching

Nutrition
Weight Management
Appetite regulation
Geriatric medicine
Evidence based medicine
Presentation skills

Qualifications

PhD (University of Nottingham)
BSc (Hons) Nutrition First Class (University of Nottingham)
Fellow of the Higher Education Academy (FHEA)
Postgraduate Certificate in Higher Educations (Distinction; De Montfort University)

Courses taught

Medical Science (BMedSci)

Honours and awards

DMU Teacher Fellow

Membership of professional associations and societies

The Physiological Society (member)
The Society for Endocrinology (member)

Professional licences and certificates

Conference attendance

‘The remote effects of acute kidney injury after renal ischaemia in a porcine model’, British Endocrine Societies Conference, March 2014, Liverpool, Poster presentation & invited Chair, attendance funded by the Society for Endocrinology.

Current research students

Naima Ali, MRes student, Second Supervisor

Case studies

A newspaper article about my research on childhood obesity (note my previous surname of Lloyd is used in the article):

http://www.thejournal.co.uk/news/north-east-news/dr-sarah-mcmullen-gives-views-4420188