Taking part in a research study: a different perspective

Jenny Cook
Dr Jenny Cook

Dr Jenny Cook is a Research Associate at King’s College London studying the impact of engaging publics with health research.

I am a researcher in Public Engagement for King’ College London and the National Institute for Health Research Biomedical Research Centre, part of my job role is to promote taking part in clinical research to the general population.

So last month I decided to practice what I preach and took part in a research study at the Division of Imaging Sciences and Biomedical Imaging based over at St Thomas Hospital. The study is called the iFind project which stands for intelligent Fetal Imaging and Diagnosis.

The study, funded jointly by the Wellcome Trust and EPSRC aims to improve the accuracy of routine 18-20 week screening in pregnancy, by bringing together advanced ultrasound and magnetic resonance imaging (MRI) techniques, robotics and computer aided diagnostics.

So when I realised I was eligible to take part, for a couple of extra hospital visits, I thought it would be for a good cause!

I had worked previously with the iFind team to engage different audiences with the project as educational and interactive sessions using a pregnant tummy mannequin and the ultrasound machines for the King’s Health Partners Summer School and International Clinical Trials day.

I emailed them for more details and was put in touch with a very friendly Research Midwife who sent me over a patient information pack and some available dates.

I arrived at the Clinical Research Facility on a grey drizzly morning and was met by Josie, a friendly researcher who ran through some final consent and information forms with me. She reassured me about the practical details of the study, like who would be present and how long each part would last.

I went into the Ultrasound room and was met by three people; a research sonographer, one fetal cardiac clinician researcher and another working on the imaging robotics part of the project.

They talked me through the images they were collecting and explained what they meant and why they were important to the study. They also showed me how they can create the 3D images using the new software and at the end printed me out five pictures for me to take home.

Since taking part in iFind, I was also contacted to take part in another study, this time using Magnetic Resonance Imaging (MRI) to look at fetal brain development in the Developing Human Connectome Project. The aim of this study is to map the baby’s brain development before and after birth to understand better how the brain grows and how problems may arise.

This involved coming into St Thomas’s post-natal scanning department and spending about 60 minutes inside a big MRI machine. I have to admit, it was quite noisy and cramped in there, but the imaging team were fantastic and reassuring. I had music in my headphones, plenty of pillows and came out a couple of times for a quick break. After the scan, Laura from the team went through my images with me and showed me a video of my baby moving in my stomach and the different parts of her brain. They also sent me links to the images, so I can keep them.

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A saggital view of Jenny’s baby’s brain

The results of these images and scans in the future will contribute to a database of images that will help research. By understanding the potential benefits of using imaging and detecting more problems before birth, they hope to provide better information to parents and their doctors, and allow babies to get access to the treatments they need as soon as possible after they are born.


If you are interested in participating in the iFind project or any other fetal studies please contact: gst-tr.fetalbookings@nhs.net.
For further information on the iFIND study please contact: iFIND@gstt.nhs.uk

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Making reproducible research as natural as breathing

Peter CharltonPeter Charlton is a PhD student at King’s College London working as part of the Hospital of the Future (HotF) project. The overall aim of the HotF project is to provide early identification of hospital patients who are deteriorating. Peter’s work focuses on using wearable sensors to continuously assess patients’ health.

One of the key aims of the HotF project is to develop a technique to continuously monitor a patient’s “respiratory rate”: how often they breathe. Respiratory rate often changes early in the progression of a deterioration, giving advanced warning of a severe event such as a heart attack. However, it is currently measured by hand by counting the number of times a patient breathes in a set period of time. This approach is time-consuming, inaccurate, and only provides intermittent measurements. The alternative approach which I’m working on is to estimate respiratory rate from a small, unobtrusive, wearable sensor.

Wearable sensors are currently routinely used to monitor heart rate and blood oxygenation levels. It turns out that the signals which provide these measurements are subtly influenced by respiration, as demonstrated below. If these subtle changes can be extracted reliably, then we could monitor respiratory rate “for free”, without the need for any additional sensors. This may provide all-important information on changes in a patient’s health, allowing clinicians to identify deteriorating patients earlier.

PeterCharlton_heartratesignal

The heart rate is clearly visible in this signal since each spike corresponds to a heart beat. The spikes also vary in height with each of the four breaths. These subtle changes can be used to estimate respiratory rate.

So what’s all this got to do with reproducible research? Well, over the past few decades over 100 papers have been written describing methods for estimating respiratory rate electronically from signals that are already monitored by wearable sensors. If you read them (it takes a long time) then you find that hundreds of methods have been described. The key questions are: which method is the best, and is it good enough to use in clinical practice? Answering these questions can be a daunting task given how many different methods there are. Very few of the methods are publicly available, so to answer these questions you’d have to implement each of the methods yourself. Even once you have done this, you’d need to try them out on some data. Collecting this data is no easy task. Altogether, reproducing scientist’s previous work on this problem is quite difficult.

I’m hoping that this won’t be such a problem in the future. We have recently implemented many of the methods, collected a benchmark dataset on which to test the methods, and reported the results. All of this is publicly available. What’s more, you can download it all for free, from the methods, to the data, to the article describing the results. So in a few clicks you can catch up, reproduce our research, and start making progress yourself, even producing methods like this:

PeterCharlton_resp_video_gif_red

Well, nearly … I’ve written a tutorial on the methods, which is due to be published in a textbook soon. This work can be reproduced exactly. Since then we have extended the range of publicly available resources by adding more methods, and the new benchmark dataset. This most recent work can’t be reproduced exactly since we had to make a few changes before making it publicly available. I intend to make future work on this topic fully reproducible so that researchers can build on our work. Who knows, perhaps this will contribute towards earlier identification of deteriorating patients in the future.

Raising my head above the (lab) parapet

Last week was British Science Week and the Division took part in an exhibition in the corridors of St Thomas’ Hospital to highlight the research that we do here. Claire Thornton, Lecturer in KCL Perinatal Brain Injury Group talks about her experience.

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Science Week stickers

One of the great things about being a cell biologist is that no two days are the same. At a fundamental level, there are new discoveries to be made and problems to be solved; nothing ever beats that rare moment when you know your experiment has worked unequivocally, your cells actually behaved in the way you predicted and your hypothesis really is true! As you climb the science career ladder further, the lab work becomes balanced by writing papers and grants, giving talks, teaching and supervision, all of which bring more variety (not to mention their own peculiar challenges). But one thing I rarely get a chance to do is present what we do directly to the public. I was able to change that last week, by taking part in a British Science Week exhibition at St Thomas’ Hospital. The exhibition was also a chance for healthcare scientists to showcase their various and diverse fields so we would be in good company.

The research in my lab aims to discover the molecular mechanisms behind brain injury in preterm and term babies. Currently there are no treatments available for preterm brain injury and only one, therapeutic hypothermia, for term brain injury. We believe that understanding these disease mechanisms will enable us to identify targets for which new therapies can be designed. This is obviously a very emotive area so it was with a little trepidation that we planned our exhibition.

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Ana getting ready for pipetting

We set up a variety of microscopes to show people the differences in post-mortem brain tissue from babies with no brain injury compared with babies who experienced term brain injury. We also brought with us a fluorescence microscope to look inside live neurons at structures such as nuclei and mitochondria, and the changes that occur in them when a cell death mechanism is triggered. Finally, as we work with such small volumes, we challenged our visitors to have a go at using our pipettes to measure out anything from 1ml down to 1μl (a millionth of a litre)!

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Veena explaining what visitors are seeing through the microscope

What a positive experience! Ana, Veena, Ginger and I had lots of interest in our work and some very searching questions about our research. Initially I was concerned that visitors might be put off by the idea of talking about injured babies, but it was exactly the opposite. We seemed to be explaining and answering questions solidly for 4 hours! The overriding opinion we heard was that it was a pity these exhibitions didn’t happen more often, and that there should be some kind of schools roadshow. The adults were as enthusiastic as the children and were very good at getting stuck in! Of the children and young adults I talked to, the majority were considering a career in science, engineering or medicine, and were very keen to interact with all of the exhibits, both on our stand and the others. There were teams from Medical Physics, Cardiovascular and Biomedical Resources showing everything from cardiac ultrasound and 3D printed hearts to wireless robots directed by arm movements and making strawberry DNA.

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Me pointing out the coloured neurons

For me, not only was it a reminder about why we do this work, it was also a chance to reconnect with my fundamental awe at the elegance of brain cells and their interconnections.  How these complex cells sense their environment and communicate with each other and how trauma alters their behaviour and triggers their death is something I am happy to work on for a very long time.