Sara Alnasir Kassam and Wiktoria Wisniewska CO-EDITORS-IN-CHIEF
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Dearest readers, old and new, of the Bioscientist Magazine.
It has been three years and three issues since we, Sara and Wiktoria, assumed the role of Co-Editors-in-Chief of the Bioscientist.
It has been an utmost pleasure to take over from the previous editors, bring our new perspectives forward, and see the publication soar to new heights under our tenure.
Some of our highlights include the transition of the publication from a digital magazine to a Diamond Open Access Journal, which requires maintaining a high standard via peer reviewing. Our student publication was featured in the inaugural Salford Authors events, where we spoke about the publication’s journey up until that point. Our recent issue has seen the largest writer pool so far, and our issues continue to feature a plethora of internal as well as external contributors for our writers to connect with.
We have sincerely enjoyed carrying the legacy established by our legacy editors. We hope that we have done well to maintain the standards that were set all the way back in 2020.
As we continue our professional development, we have made a decision to collectively step back from our roles and pass over the roles to new and enthusiastic editors - Dilruba Boksh and Noor Ali Najam. We trust that they will continue to expand the magazine's potential and we have absolutely no doubts that the legacy will carry on.
Thank you for your continued support and we hope to see more and more of you working closely with Dilruba and Noor to take the publication to newer heights.
Sara A Kassam & Wiktoria Wisniewska Co-editors-in-chief
Bioscientist: The Salford Biomedicine Society Magazine
Pictured: Dilruba Boksh (on the left)
Noor-ul-Ain Ali Najam (on the right)
SCIENCE IN THE NEWS
Ozempic and weight loss
Food safety assurancde using bacteriophages
Mapping the infection pathways in a placenta
Neuralink and dementia
Ancient DNA - bethics with sequencing the DNA of extinct species
SPOTLIGHT
Using bioluminescence in MRI
New screening trial for prostate cancer
TOPICS IN BIOMEDICINE
AI in cardiovascular research EDITORS' NOTE
An insight into clinical trials: perpsectives and practices
Recreational drug use and it’s ethical impacts on fertility
Challenging the physiology we see in film
Ethics in Biological Sciences Explained Sustainable development goals
pg.2 pg.2
SCIENCE IN THE NEWS SCIENCE IN THE NEWS
ReadaboutOzempicandwhetheritisaweight ReadaboutOzempicandwhetheritisaweight loss drug that is truly effective, using loss drug that is truly effective, using bacteriophages to screen for disease causing bacteriophages to screen for disease causing organisms in food and the links between Elon organisms in food and the links between Elon Musk’s innovation Neuralink and Musk’s innovation Neuralink and neurodegenerative disease Dementia along neurodegenerative disease Dementia along withtheuseofplacentastoexplorepathwaysof withtheuseofplacentastoexplorepathwaysof infectionsinthehumanbody. infectionsinthehumanbody.
pg.26 pg.26
RESEARCH SPOTLIGHT RESEARCH SPOTLIGHT
A section highlighting novel research done in
A section highlighting novel research done in the last few years. Here you can discover how the last few years. Here you can discover how magnetic resonance imaging is enhanced magnetic resonance imaging is enhanced through the use of bioluminescence, what the through the use of bioluminescence, what the drug Pregabalin does and outlining the details drug Pregabalin does and outlining the details on a new and potentially promising trial for on a new and potentially promising for prostatecancer. prostatecancer.
Readers can explore topics such as United Readers can explore topics such as United NationsSustainableDevelopmentGoals,howAI NationsSustainableDevelopmentGoals,howAI isusedinthecardiovascularresearchfield,how isusedinthecardiovascularresearchfield,how physiology, portrayed in film, can be used in physiology, portrayed in film, can be used in physiology education along with the ethical physiology education along with the ethical implications of recreational drug use on male implications of recreational drug use on male fertility. fertility.
pg.58 pg.58
SALFORD SCIENCE SALFORD SCIENCE
Insights from the academics, researchers and Insights from the academics, researchers and staff based at the University of Salford. Read staff based at the University of Salford. Read about Prof Miah’s perspectives on AI in about Prof Miah’s perspectives on AI in healthcare,howscientificresearchisaffectedby healthcare,howscientificresearchisaffectedby open access journal publishing, combatting open access journal publishing, combatting childhood brain cancers with phytochemicals childhood brain cancers with phytochemicals andtheethicslinkedwithFASD. andtheethicslinkedwithFASD.
Ozempic: Revolutionary Weight Loss Drug or Too Good to Be True?
BY IRAM SHAKIL
Abstract
The drug Ozempic, also known as semaglutide, has gained popularity in recentyearsduetoitsrapidweightloss effects. It was first created as a treatment for patients with type 2 diabetes suffering with obesity. Numerous studies including metaanalyses have found that semaglutide iseffectiveinachievingweightlossbut alsohasadversegastrointestinaleffects such as nausea, diarrhoea and vomiting.
Ithasbeenseentoinfluencethebrain,as semaglutide crosses the blood-brain barrier to reduce satiety centres that in turn reduce appetite, which further supports weight loss. Although semaglutide has adverse effects, some studies have shown that it may help patientswhohavecardiovasculardisease reduce cardiovascular events such as myocardialinfarction.Ozempichasbeen proven to be effective as a weight loss treatment despite its side effects and morestudiesarebeingdonetoseehow long-termusemayaffectpatients.
What is Ozempic and how does it work?
Ozempic is the brand name for the glucagon-like peptide-1 (GLP-1) agonist semaglutidemadebythecompanyNovo Nordisk¹³. Ozempic was recently approvedforhumanconsumptionbythe US Food and Drug Association (FDA) in 2021⁴.Itsmainmedicaluseisasadrugto help patients manage type 2 diabetes⁶ . Semaglutide has gained popularity over the last few years as a weight loss treatment for those without type 2 diabetestoothroughprescriptionfroma doctor.
It was developed from a previously used GLP-1 agonist, liraglutide, made by the same company e-company¹¹. However, liraglutide must be administered through daily injections, while semaglutide can be administeredweeklyduetoitslongerhalflife.Itcanalsobeadministeredorallywhen givenwiththeabsorptionenhancersodium N-[8-(2-hydroxybenzoyl) aminocaprylate (SNAC).Semaglutideisapeptidethathasa similar structure to the human (GLP-1) receptor. GLP-1 stimulates the secretion of insulin and inhibits glucagon without causing hypoglycaemia⁹. However, GLP-1 hasashorthalf-lifeofonlyafewminutesso GLP-1 agonists like semaglutide were developed to help patients with type 2 diabetes lose weight quicker. These agonists also delay gastric emptying and reduce appetite by inducing satiety. They stimulate satiety in the brain directly, through crossing the blood-brain barrier andindirectlythroughneuralafferents¹⁵
How effective is Ozempic for weight loss?
Numerousstudieshavebeenconductedto evaluate the efficacy of semaglutide for weightloss.Ameta-analysiswascarriedout to discover the effects of semaglutide for weight loss in patients without type 2 diabetes. Four studies with 3,613 participants were analysed¹⁵. Across the studies 2,350 were given semaglutide and 1,263 were given a placebo. The metaanalysis found that there was an 11.85% mean difference in weight loss between thesemaglutideandplacebogroupsacross all four trials. This shows that semaglutide causessignificantweightlosscomparedto the placebo so is effective for people without type 2 diabetes. Another study showed that semaglutide also effects energy intake as lunch energy intake was 35% lower in the semaglutide group comparedtotheplacebogroup³.
It also showed that there was a lower intakeofenergyofhighfatfoodsmeaning semaglutidereducesappetiteandhunger. Metabolic rate did not differ between treatments showing that weight loss was not due to increased energy expenditure but rather a decrease in energy intake. However,weightwasshowntohavecome back after discontinuing the treatment, meaning patients must take semaglutide permanentlytoretaintheweightloss,this isknownas‘Ozempicrebound’althoughit can come about with any brand of semaglutide¹⁴ .
What are the advantages and disadvantagesoftakingOzempic?
The advantages and disadvantages of semaglutidewereanalysedtounderstand itssideeffectsandwhetheranysignificant harmcouldcometopatientswhotakeit. A review on the risk of developing gastrointestinal adverse effects showed that the semaglutide group were 1.59 times more likely to develop these compared to the placebo group¹⁵. Over thefourtrialsthesemaglutidegroupwere moretwiceaslikelytostoptreatmentdue to these adverse effects, 6% of the semaglutide group discontinued use compared to only 2.9% of the placebo group. Another study found that nausea wasthemostcommonsideeffectfoundin patientswhowereprescribedsemaglutide at44%¹⁰.Otheradverseeffectswerefound such as diarrhoea, vomiting and abdominal pain affecting 30%, 24% and 20%respectivelyinclinicaltrials.Areal-life study found that 49% of patients experiencedadverseeffectswhichcaused 3% of patients to discontinue treatment resultinginlessweightloss⁵.Inlaboratory mice it was found that some developed thyroidC-celltumourswhichwasbecause of higher doses of semaglutide administered¹⁰.Thismeanspeoplewitha family history of medullary thyroid carcinoma are discouraged from taking semaglutide¹².
Long-term studies show that after 1 year 24%-26% baseline weight was lost compared to only 15%-17% baseline weight after 10 years⁷. An advantage of taking semaglutide include the evidence of it reducing cardiovascular events in patients with type 2 diabetes¹. A SELECT trial suggested that semaglutide may have an impact on cardiovascular events in obese patients without type 2 diabetes, but the resultsofthistrialareyettobepublished⁸ These trials showed that major adverse cardiovasculareventswerereducedby20% in those taking semaglutide but admits moreresearchisneededtoassesstherisks of semgalutide as a treatment for this. Semaglutidealsoprovestobemoreeffective thanotherType2diabetestreatmentssuch as metformin and thiazolidinediones as it inducedmoreweightlosswithouttheriskof hypoglycaemia². Although these advantageous effects lifestyle changes should also be made such as eating healthierastheseareimportantintackling obesitytoo.
Conclusion
In conclusion, Ozempic (semaglutide) is showntobeaviableoptionforweightloss both in people with and without type 2 diabetes. Although, there are adverse side effects such as nausea, vomiting and diarrhoea there are benefits to taking Ozempic. Along with the weight loss semaglutide has been seen to reduce cardiovascular effects. However, some of these studies have been funded by Novo Nordisk so there may be some bias and hesitation with publishing any negative results. Ozempic has been proven to be effectiveinshort-termtrials,butmorelongterm studies need to be done to fully understand the effects of semaglutide on patients with and without type 2 diabetes. The SELECT trial will be the first trial to evaluate this and its results are set to be published soon⁸. As Ozempic is being approved for adolescents, more research is beingdonetoassessthepaediatricbenefits and limitations of semaglutide for the treatmentofpaediatricobesity¹⁶
References:
1. Amaro, A., Sugimoto, D., & Wharton, S. (2022). Efficacy and safetyofsemaglutideforweightmanagement:evidencefromthe STEP program. Postgrad Med, 134(sup1), 5-17. https://doi.org/10.1080/00325481.2022.2147326
2. Aroda, V. R., Ahmann, A., Cariou, B., Chow, F., Davies, M. J., Jódar, E., Mehta, R., Woo, V., & Lingvay, I. (2019). Comparative efficacy, safety, and cardiovascular outcomes with once-weekly subcutaneous semaglutide in the treatment of type 2 diabetes: Insights from the SUSTAIN 1-7 trials. Diabetes Metab, 45(5), 409418.https://doi.org/10.1016/j.diabet.2018.12.001
3. Blundell, J., Finlayson, G., Axelsen, M., Flint, A., Gibbons, C., Kvist, T., & Hjerpsted, J. B. (2017). Effects of once-weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity. Diabetes ObesMetab,19(9),1242-1251.https://doi.org/10.1111/dom.12932
5. Ghusn,W.,DelaRosa,A.,Sacoto,D.,Cifuentes,L.,Campos,A., Feris,F.,Hurtado,M.D.,&Acosta,A.(2022).WeightLossOutcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity. JAMA Network Open, 5(9), e2231982e2231982.https://doi.org/10.1001/jamanetworkopen.2022.31982
7. Kanerva,N.,Larsson,I.,Peltonen,M.,Lindroos,A.K.,&Carlsson, L. M. (2017). Changes in total energy intake and macronutrient composition after bariatric surgery predict long-term weight outcome:findingsfromtheSwedishObeseSubjects(SOS)study. AmJClinNutr,106(1),136-145.https://doi.org/10.3945/ajcn.116.149112
8. Lingvay,I.,Brown-Frandsen,K.,Colhoun,H.M.,Deanfield,J., Emerson,S.S.,Esbjerg,S.,Hardt-Lindberg,S.,Hovingh,G.K.,Kahn, S.E.,Kushner,R.F.,Lincoff,A.M.,Marso,S.P.,Fries,T.M.,Plutzky,J., Ryan,D.H.,&Group,t.S.S.(2023).Semaglutideforcardiovascular event reduction in people with overweight or obesity: SELECT study baseline characteristics. Obesity, 31(1), 111-122. https://doi.org/https://doi.org/10.1002/oby.23621
9. Monami, M., Dicembrini, I., Marchionni, N., Rotella, C. M., & Mannucci, E. (2012). Effects of glucagon-like peptide-1 receptor agonistsonbodyweight:ameta-analysis.ExpDiabetesRes,2012, 672658.https://doi.org/10.1155/2012/672658
11.Smits,M.M.,&VanRaalte,D.H.(2021).SafetyofSemaglutide. Front Endocrinol (Lausanne), 12, 645563. https://doi.org/10.3389/fendo.2021.645563
12.Smits,M.M.,&VanRaalte,D.H.(2021).SafetyofSemaglutide [Review]. Frontiers in endocrinology, 12. https://www.frontiersin.org/journals/endocrinology/articles/10.3389 /fendo.2021.645563
13.Suran,M.(2023).AsOzempic'sPopularitySoars,Here'sWhatto Know About Semaglutide and Weight Loss. Jama, 329(19), 16271629.https://doi.org/10.1001/jama.2023.2438
14.Suran,M.(2023).AsOzempic’sPopularitySoars,Here’sWhatto Know About Semaglutide and Weight Loss. JAMA, 329(19), 16271629.https://doi.org/10.1001/jama.2023.2438
15.Tan,H.C.,Dampil,O.A.,&Marquez,M.M.(2022).Efficacyand Safety of Semaglutide for Weight Loss in Obesity Without Diabetes: A Systematic Review and Meta-Analysis. J ASEAN Fed EndocrSoc,37(2),65-72.https://doi.org/10.15605/jafes.037.02.14
Wahi,G.,St-Pierre,J.,Johnston,B.C.,Fitzpatrick-Lewis,D.,Usman, A., Sherifali, D., Merdad, R., Esmaeilinezhad, Z., Birken, C. S., Hamilton,J.,Henderson,M.,Moore,S.A.,Ball,G.D.C.,&Morrison, K. M. (2024). Effectiveness of pharmacological interventions for managing obesity in children and adolescents: A systematic review and meta-analysis framed using minimal important difference estimates based on GRADE guidance to inform a clinical practice guideline. Pediatr Obes, e13169. https://doi.org/10.1111/ijpo.13169
Bacteriophages: A Natural and Effective tool for Foodborne Pathogens
BY UMMAD TARIQ
Abstract
Food safety is a major concern around the world, with millions of people suffering from foodborne illnesses each year. Traditional techniques of ensuring food safety, such as pasteurisation and chemical preservatives, have limitations, prompting the search for newsolutions.
Bacteriophages, which are viruses that particularly target and kill bacteria, represent apossiblealternative.Thisarticleinvestigates the use of bacteriophages to improve food safety by describing their mechanisms of action, uses in different food industries, benefits over old approaches, and obstacles. Bacteriophages are very selective to harmful bacteria, minimising contamination while neither hurting beneficial microbiota nor modifying food characteristics. ListShield™, a phage preparation, can efficiently decrease pathogens including Listeria, Salmonella, and E.coliinmeat,poultry,freshvegetables,dairy products,andseafood.
While bacteriophages provide a novel and natural alternative, regulatory constraints, potential bacterial resistance, and public image all pose barriers to their widespread implementation. Continued research and education are critical for overcoming these limitations and using bacteriophages to improveglobalfoodsafety.
Foodsafetyisacrucialglobalconcern,with600 million cases of people suffering from foodborne illnesses each year and 420,000 dyingfromthem¹³.Traditionaltreatments,such as pasteurisation and chemical preservatives have proven useful, although they have limitations.Whilstpasteurisationissuccessfulat killing many diseases, it can occasionally change the flavour, texture, and nutritional value of food¹⁸. Chemical preservatives, on the other hand, can cause the development of resistant bacterial strains and pose possible health hazards when consumed over time. Theseresistantbacterialstrainsaredetrimental to immunological health because they can rendernormaltherapiesineffective,resultingin more severe and persistent infections that are difficulttocure³⁰
Forexample,severalbacterialstrainsrecovered fromseafoodrevealedthatalargepercentage oftheisolatestested(75.86%)wereresistantto at least one antibiotic or biocide, which is a typeofchemicalpreservativeusedinfood,with 6.90% resistant to at least three biocides and three antibiotics¹¹. Bacteriophages, viruses that specifically target and kill bacteria, are one novel option that is becoming increasingly popular. This article investigates how bacteriophages can improve food safety, including their mechanisms, applications, and potentialproblems.
What are Bacteriophages?
Bacteriophagesarevirusesthatinfectbacteria. Discovered in the beginning of the 20th century, they are extremely specific to their bacterial hosts, making them suitable for targeting harmful bacteria while preserving beneficialmicroflora.Thesevirusesstrictlystick to the bacterial cells and introduce their own genetic material into them. The phage then hijacks the bacterial machinery and allows for viral replication, eventually leading to cell lysis anddeath².
As self-propagating antibacterial agents, when thecellruptures,additionalbacteriophagesare released,whichcaninfectotherbacterialcells. This cycle of infection and lysis enables bacteriophagestorapidlymultiplyatthesiteof infection, effectively eliminating specific bacterial populations. Their ability to selfreplicate provides a long-term antibacterial impact, as new waves of phages continue to target and eradicate remaining dangerous bacteria, potentially providing a broader and long-lasting treatment to bacterial infections than traditional antibiotics¹⁰. Furthermore, 59 clinical studies completed between 2000 and 2021 were evaluated and discovered that 79% of 1,904 patients with chronic and drugresistant infections improved after receiving phage treatment, while 87% of the target bacteriawereeradicatedin1,461cases³⁵
Mechanisms of Action
Bacteriophagesundergoalyticcycle,whichisa multi-step process that starts with the phage adhering to receptors on the bacterial cell surface³⁶.Thisattachmentisextremelyprecise, frequently requiring interactions between phagetailfibresandbacterialsurfaceproteins or polysaccharides³⁴. Once the phage has successfullyattached,itinjectsitsDNAintothe host cell, causing the bacterial machinery to copy its genetic material and make phage proteins. During this stage, the bacterial cell's usual processes are disturbed as it is reprogrammedtoformnewphageparticles⁹
Asthenumberofphageparticlesinsidethe bacteriumrises,thecell'sstructuralintegrity deteriorates.Finally,thebacterialcelllyses,or bursts,releasinganewgenerationofphages into the surrounding environment¹. These freshly generated phages can then infect neighbouring bacterial cells, repeating the cycle and effectively lowering bacterial numbers⁹
Applications in Food Safety MeatandPoultryProcessing
Phagescanbeusedonrawmeatandpoultry to minimise infections such as Salmonella and E. coli. Studies have demonstrated that using phages during processing reduces bacterial levels significantly¹². For example, a 90% reduction in Salmonella in chickens treated with a specific phage mixture was found¹⁴ .
The most prevalent phages employed in these applications are those that target Salmonella, Listeria, and E. coli. Actual phages employed include Felix O1 and SJ2 for Salmonella, P100 for Listeria monocytogenes,andT4andT7forE.coli³⁷ Furthermore,phagecocktails,whichinclude many phages, can be more effective than single-phagetherapies.Thisisbecausethey can target a wider spectrum of bacterial strainswithinaspecies,loweringtheriskof bacterial resistance and giving a more thorough strategy to bacterial eradication¹. Phage cocktails take advantage of the unique processes of many phages, increasingtheoverallefficacyofthetherapy and assuring a more powerful reduction in bacterialcontamination².
Inthecaseofcheeseproduction,phagesare added to milk or curds to eliminate unwanted bacteria that can outcompete or infectbeneficiallacticacidbacteria.Phages contribute to the microbial ecosystem balance required for optimum cheese fermentation by lowering the population of spoilage bacteria²⁹. This leads to a more uniform product with improved texture, flavour,andsafety.Furthermore,phagescan be utilised selectively to target certain spoilage organisms while preserving the beneficial bacteria required for cheese manufacturing,improvingtheoverallquality andsafetyofthefinishedproduct²⁹.
Seafood
Phages can lower infections in raw and undercookedfish,includingVibriospecies⁹.A study found that phage spraying reduced Vibriovulnificuslevelsinoystersby99%¹⁹
FreshProduce
Contaminated fresh vegetables are a common cause of foodborne illness. Phages can be sprayed on fruits and vegetablestokillsurfacegerms,increasing shelflife,andensuringsafety³³.Inastudy, the use of phages on cantaloupes and apples drastically reduced Listeria monocytogenesnumbers²⁰
DairyProducts
Phages are used in cheese production to reducespoilagebacteria,henceenhancing product quality and safety¹². Bacteriophages have been employed successfully to treat lactic acid bacterial infections in cheese, resulting in a higherqualityproduct⁵.PhageslikephiIPLA-RODI andphageP008areuniquetoLactococcus and Lactobacillus species²³. These phages target spoilage bacteria, which may negatively affect cheese texture, flavour, andoverallquality⁸ .
Contaminated fresh vegetables are a common cause of foodborne illness. Phages can be sprayed on fruits and vegetablestokillsurfacegerms,increasing shelflife,andensuringsafety³³.Inastudy, the use of phages on cantaloupes and apples drastically reduced Listeria monocytogenesnumbers²⁰
DairyProducts:
Phagesareusedincheeseproductionto reducespoilagebacteria,henceenhancing product quality and safety¹². Bacteriophages have been employed successfully to treat lactic acid bacterial infectionsincheese,resultinginahigherqualityproduct⁵.PhageslikephiIPLA-RODI and phage P008 are unique to Lactococcus and Lactobacillus species²³. These phages target spoilage bacteria, which may negatively affect cheese texture,flavour,andoverallquality⁸
Reducing Antibiotic Resistance:
Phagetherapyoffersadifferenttreatment option compared to antibiotics, helping combat the growing issue of antibiotic resistance³³. Unlike antibiotics, which frequently exert broad selected pressure that might lead to widespread antibiotic resistance, phages are very particular in their target bacteria, reducing overall selective pressure on bacterial populations²¹. This selectivity helps to sustain beneficial bacteria and decreases thepossibilityofacquiringresistantstrains.
However, it is crucial to remember that phage genomes are still not entirely known,andthetopicofphageresistance requires further investigation⁶. Some bacteriacandevelopresistancetophages, and bacteriophages can transport resistancemechanismsbetweenbacterial cellsduringinfection.Thismeansthat,like antibiotics, phages have the potential to propagate resistance if not managed effectively²².
Usingphagecocktails,whicharemixtures ofdifferentphages,canhelpmitigatethis risk. Phage cocktails target multiple bacterialstrainsandreducethelikelihood of resistance developing, as it is more difficult for bacteria to simultaneously develop resistance to several phages³⁹ Despite this, the possibility of resistance remains,andongoingresearchisnecessary to fully understand and address these concerns.
Challenges and Considerations
RegulatoryHurdles:
Regulatoryapprovalforphageusesinfood differsbyarea,withsomeneedingrigorous testing to assure safety and efficacy¹². For example, the European Food Safety Authority (EFSA) sets strict standards for innovative food additives, which might hinder the approval process. For a food additive to be authorised, the EFSA requires detailed information about its identity, manufacturing process, chemical composition, stability, and reactivity and destiny in foods. This includes specific safetydata,suchasitsgenotoxicpotential andothertoxicologicalfactsessentialtoits safety³⁸
Phagesmustmeetstrictcriteriatoprotect human health. The EFSA's Panel on Food additions and Flavourings (FAF) conducts safety evaluations, reviewing both novel additions and any new uses of existing additives. This extensive review method protectsconsumerhealthbyguaranteeing that phages and other food additives do notharmfoodsafetyorquality³⁸
BacterialResistance:
Bacteria can develop resistance to both antibioticsandbacteriophages.Ithasbeen suggested that continued research and the development of phage combinations arenecessarytopreventresistance⁹.Some researchers found that mixing numerous bacteriophagescanreducetheprobability ofresistance²⁷
This is because using a diverse cocktail of phages targets bacteria via various methods, makingitmoredifficultforthebacteriatobuild resistancetoallthephagesinthemixture.
PublicPerception:
The acceptability of bacteriophages in food productsiscrucial.Educatingthepublicabout the safety and benefits of bacteriophages is criticalforovercomingscepticism³³.Itwasfound that, while consumers are first sceptical, educationdramaticallyboostsacceptability²⁶.A varietyoffactorscontributetopublicscepticism of bacteriophages in food items, including a lack of information, safety concerns, issues about naturalness, and questions about efficacy¹⁵.
Manypeopleareunfamiliarwithbacteriophages and their significance in treating bacterial infections or improving food safety³¹. The conceptofemployingviruses,evengoodones,is frequently misinterpreted, causing doubt²⁸ . Safety issues are also prominent, with some consumers concerned about the potential side effects or long-term health consequences of eatingphage-treatedfoods¹⁵ .
However, studies showed that educating consumers addressed the knowledge gaps in consumers by significantly improving the acceptanceofphage-basedtreatments²⁵.While bacteriophages exist naturally in the environment and the human gut, many consumerspreferrawandminimallyprocessed meals⁷ .
Furthermore, there is scepticism about bacteriophages'efficacy,especiallyincompared to known techniques like as antibiotics or chemical preservatives⁷. People may be sceptical that phages can effectively replace established ways for combating bacterial contamination, which could hinder the adoptionofphage-basedtherapiesandgoods.
To address public concerns about bacteriophages, educational campaigns are essential.Providingclear,accessibleinformation onhowphagesworkandemphasizingthatthey arenaturallyoccurringinourenvironmentand bodiescanhelpreduceapprehension⁴
Sharing scientific data, such as research showing that phage intake has no harmful healthimpacts,canhelptoestablishtrust.For example, regulatory agencies like as the FDA and EFSA have previously approved phage applications as safe, which might be mentionedtocomfortcustomers².
Transparency in how corporations utilise phages, combined with labelling that emphasises their natural and tailored effect, might also appeal to health-conscious customers,encouraginggreateracceptance³³.
PhageTherapyintheUK
PhagetherapyisgainingpopularityintheUK; however, it is not yet widely available. It is generally used in clinical settings to treat antibiotic-resistantinfections,particularlywhen other therapies fail. Furthermore, phage therapy in the UK is overseen by health agenciessuchastheEFSAandmustadhereto strict regulatory criteria to ensure safety and efficacy. Clinical research and compassionate use situations are closely monitored. When it comestoresearchanddevelopment,theUKis heavilyinvolvedinphageresearch,withseveral organisations like biotechnology companies investigatingitsapplicationsinhealthandfood safety²⁴ .
Theeconomicimpactofphagetherapy in the UK is expected to keep growing as antibiotic resistance becomes a more important concern. The global phage therapy marketcouldgeneratehundredsofmillionsof pounds in revenue, driven by demand for innovative antimicrobial therapies and food safetysolutions¹⁷.
Conclusion
Bacteriophages represent a possible approach for improving food safety by addressing the limitations of previous technologies and providing a natural, effective means of combatingfoodbornediseases.Continuedresearch,regulatory support, and public education are critical to the widespread application of phage technology in the food business. These developments may make phage applications more practical andacceptable,potentiallyrevolutionisingbothfoodsafetyand medicaltreatments.
9. García, P., Martínez, B., Obeso, J. M., & Rodríguez, A. (2008). Bacteriophages and their application in food safety. Letters in Applied Microbiology, 47(6), 479-485. https://doi.org/10.1111/j.1472765X.2008.02458.x
10. García, R., Latz, S., Romero, J., Higuera, G., García, K., & Bastías, R. (2019). Bacteriophage Production Models: An Overview [Mini Review]. Frontiers in Microbiology, https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2019.01187
11.Giacometti,F.,Shirzad-Aski,H.,&Ferreira,S.(2021).AntimicrobialsandFood-RelatedStressesasSelectiveFactorsforAntibioticResistancealongtheFarmtoForkContinuum.Antibiotics,10(6). 12. Hagens, S., & Loessner, M. J. (2007). Application of bacteriophages for detection and control of foodborne pathogens. Applied Microbiology and Biotechnology, 76(3), 513-519. https://doi.org/10.1007/s00253-007-1031-8
18.Koutsoumanis,K.,Alvarez-Ordóñez,A.,Bolton,D.,Bover-Cid,S.,Chemaly,M.,Davies,R.,DeCesare,A.,Herman,L.,Hilbert,F.,Lindqvist,R.,Nauta,M.,Peixe,L.,Ru,G.,Simmons,M.,Skandamis,P., Suffredini, E., Castle, L., Crotta, M., Grob, K., . . . Efsa Panel on Biological Hazards. (2022). The efficacy and safety of high-pressure processing of food. EFSA Journal, 20(3), e07128. https://doi.org/10.2903/j.efsa.2022.7128
22. Lin, D. M., Koskella, B., & Lin, H. C. (2017). Phage therapy: An alternative to antibiotics in the age of multi-drug resistance. World J Gastrointest Pharmacol Ther, 8(3), 162-173. https://doi.org/10.4292/wjgpt.v8.i3.162
35.Uyttebroek,S.,Chen,B.,Onsea,J.,Ruythooren,F.,Debaveye,Y.,Devolder,D.,Spriet,I.,Depypere,M.,Wagemans,J.,Lavigne,R.,Pirnay,J.-P.,Merabishvili,M.,DeMunter,P.,Peetermans,W.E.,Dupont,L., Van Gerven, L., & Metsemakers, W.-J. (2022). Safety and efficacy of phage therapy in difficult-to-treat infections: a systematic review. The Lancet Infectious Diseases, 22(8), e208-e220. https://doi.org/10.1016/S1473-3099(21)00612-5
This review explores the intricate mechanisms by which pathogens breach the placental barrier, a critical interface between mother and foetus. Despite its robust defensive structures, including the syncytiotrophoblastandunderlyingtissues, various microorganisms have evolved strategiestopenetratethisbarrier,leading to severe maternal and foetal health complications. The article examines three main categories of pathogens — bacterial, viral, and parasitic — and their distinct infectionpathways.
Notable examples include Listeria monocytogenes' use of surface proteins for cellular invasion, cytomegalovirus' manipulation of trophoblasts, and Toxoplasma gondii's evasion of immune responses.Theimpactoftheseinfectionson maternal and foetal health is substantial, potentiallyresultinginpreeclampsia,preterm labour,congenitalanomalies,andlong-term developmental issues. Current research utilisesadvancedtechnologiessuchashighresolution imaging, single-cell sequencing, andorganoidmodelstoelucidatemolecular mechanismsanddeveloptargetedtherapies. The review concludes by highlighting the importance of understanding pathogenplacentainteractionsfordevelopingeffective preventive measures, early detection techniques, and safe treatment options during pregnancy. Future directions emphasisetheneedfortranslationalresearch to bridge laboratory findings with clinical practice, potentially reducing the burden of placental infections and their associated complications.
The placenta, a remarkable organ unique to pregnancy, serves as a vital interface between mother and foetus. Its primary functions include facilitating nutrient and gasexchangewhilesimultaneouslyacting asaformidablebarrieragainstpotentially harmful pathogens⁴. Despite its robust defensive mechanisms, certain microorganismshaveevolvedstrategiesto breach this barrier, leading to severe maternal and foetal health complications¹³. This article explores the intricate pathways through which infectionscanaffectthehumanplacenta, drawing on recent scientific findings and understanding.
The Placental Barrier: Structure and Function
The placenta's role in pregnancy extends far beyond its nutritional functions. It employs a sophisticated array of physical, cellular, and immunological defences to protect the developing foetus¹¹. The placentalbarriercomprisesmultiplelayers, includingthesyncytiotrophoblast,whichis directly exposed to maternal blood, and underlying cytotrophoblasts and stromal tissues¹⁶. Collectively, these layers form a formidable obstacle against invading pathogens. Additionally, the maternal immunesystemplaysacrucialroleinthis defence, maintaining a delicate balance between tolerance to foetal antigens and readinesstocombatinfections¹⁰
Pathogen Categories and Infection Mechanisms
Despitethesedefences,variouspathogens havedevelopedmechanismstopenetrate theplacentalbarrierandinfectthefoetus. Thesepathogensaretypicallycategorised intothreemaingroups:bacterial,viral,and parasitic. Each group employs distinct strategiestoevadetheimmuneresponses at the maternal-foetal interface and ensuretheirtransmissiontothefoetus.
BacterialInfections
Bacterial pathogens such as Listeria monocytogenes and Treponema pallidum (the causative agent of syphilis) have been welldocumentedintheirabilitytocrossthe placental barrier. L. monocytogenes, for instance, utilises surface proteins, primarily Internalin A (InlA), to bind E-cadherin on trophoblasts, triggering receptor-mediated endocytosis⁸. Once internalised, L. monocytogenes escapes the phagosome using listeriolysin O (LLO), replicates in the cytoplasm, and spreads cell-to-cell via ActAmediated actin polymerisation. This mechanismenablesthepathogentobreach the placental barrier, potentially reaching foetal tissues⁷. Once inside, it can evade immuneresponsesandproliferate,leadingto severe complications such as preterm birth and neonatal sepsis¹³. The disruption of the placentalbarrierbybacteriacanalsotrigger inflammatory responses that harm both mother and foetus. Prevention and management strategies for bacterial infections include antibiotic treatment, proper food hygiene, and regular prenatal check-ups.
ViralInfections
Viralinfections,particularlythosecausedby cytomegalovirus(CMV)andZikavirus,have evolved mechanisms to breach the placenta and cause congenital infections. After maternal infection, CMV spreads through the blood to the placenta where the virus enters trophoblasts via receptor binding, endocytosis, or membrane fusion, facilitated by the viral glycoprotein B (gB), Once inside, CMV hijacks the cellular machinery for replication. Infected trophoblasts spread the virus to adjacent cells, disrupting placental barrier function
This process enables CMV to cross from infected placental cells to foetal circulation, potentially resulting in severe foetal complications such as hearing loss and developmental delays¹⁵. Similarly, Zika virus has been shown to cause significant neurological damage by crossing the placenta and infecting foetal neural tissues1. Prevention and management of viral infections often involve hygiene practices, mosquito control in endemic areas, and, whenapplicable,antiviraltreatments.
ParasiticInfections
Parasitic infections, exemplified by Toxoplasma gondii, the causative agent of toxoplasmosis, can also invade the placenta through direct cellular invasion, infected immunecelltransport,orparacellularroutes, in which the parasite employs specialised proteins, notably ROP18 (rhoptry protein 18), to form a moving junction with host cell membranes, facilitating entry. T. gondii evades both maternal and foetal immune responses, enabling replication within placental cells⁹. This invasion can lead to severe outcomes such as miscarriage, stillbirth, and congenital defects⁶. Preventive measures include avoiding undercooked meatandcatlitter,whilemanagementoften involves antiparasitic medications when infectionisdetected.
ImpactonMaternalandFatalHealth
Placental infections profoundly impact maternal and foetal health through multiplemechanisms.Maternally,infections cantriggersystemicinflammation,vascular dysfunction, and uterine contractions, potentially leading to preeclampsia, preterm labour, and in severe cases, maternal sepsis and mortality¹². Fetally, pathogenscrossingtheplacentacancause direct tissue damage, while placental dysfunction restricts nutrient and oxygen transfer, resulting in growth restriction. Infections during critical developmental periods may lead to congenital anomalies. The foetal inflammatory response can damagedevelopingorgans,particularlythe rain. Additionally, placental structural damage alters gene expression, and vascularchangeswhichfurthercompromise foetal development, and long-term consequences include developmental delays and increased susceptibility to diseases in adulthood¹⁰. This interconnected process underscores the critical need for prevention and early interventioninplacentalinfections.
Figure 1: Depicting how infections affect pregnancy outcomes and the placental defencemechanisms.
On the left, infections from sources like STDs, bacterial vaginosis, and dysbiotic microbiota activate Toll-like receptors (TLRs), leading to the release of proinflammatorycytokines(IL1β,IL6,IL8,TNFα, CCL2). This shifts the immune response fromtolerogenictoimmunogenic,resulting in foetal injuries, membrane rupture, and possibly miscarriage or preterm birth. On the right, the placenta defends against infections using exosomes, cytokines, and antimicrobial peptides. However, pathogens like Zika, Toxoplasma gondii, and Listeria monocytogenes can breach these defences, causing vertical transmissionandplacentaldamagedueto anaberrantpro-inflammatoryresponse¹⁰ .
Current Research and Challenges
Several charitable organizations, such as MarchofDimesandTommy'sintheUK,are dedicated to improving pregnancy health andreducingtheincidenceofbirthdefects, including those caused by placental infections.
These organizations play a crucial role in funding research, raising awareness, and providingsupporttoaffectedfamilies.
Current research on placental infections utilizesadvancedtechnologiestoelucidate molecular mechanisms and develop targeted therapies. High-resolution imaging, single-cell sequencing, and organoid models provide deeper insights into infection processes, in which these methods enable detailed study of pathogen-host interactions, cellular responses, and potential intervention points¹⁷
Detection methods include non-invasive prenatal testing (NIPT), amniocentesis, and chorionic villus sampling, although these methods involve ethical considerations and potential risks. Researchers are leveraging genomics, proteomics, and transcriptomics tobetterunderstandplacentalinvasionand immune evasion strategies of pathogens5. This comprehensive approach aims to enhance diagnostic accuracy and develop specifictreatmentswhilecarefullynavigating the complex ethical landscape of prenatal testingandintervention.
Conclusion and Future Directions
Understanding pathogen-placenta interactionsispivotalfordevelopingeffective strategies against placental infections. Recent advances in molecular and cellular biology have shed light on the complex maternal-foetalinterface,pavingthewayfor targeted interventions. Future research should prioritize enhancing preventive measures, refining early detection techniques, and exploring safe treatment options during pregnancy. Key focus areas include further elucidating on placental invasion mechanisms, improving placental barrierfunction,andidentifyingnon-invasive biomarkers.Advancedtechnologies,suchas organoid models and artificial intelligence (AI) offer promising avenues for drug screening and predictive diagnostics². Translationalresearchwillbevitalinbridging laboratory findings with clinical practice, leading to evidence-based guidelines for managingplacentalinfections³.
As our understanding deepens, we move closer to more effective strategies for ensuring healthy pregnancies and positive outcomes for both mothers and their children. This multi-faceted approach holds the potential to significantly reduce the burden of placental infections and their associatedcomplications.
References:
1. Bai, L., Wu, Y., Li, G., Zhang, W., Zhang, H., & Su, J. (2024). AI-enabled organoids: Construction, analysis, and application. Bioactive Materials, 31, 525-548. https://doi.org/https://doi.org/10.1016/j.bioactmat.2023.09.005
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Acosta-Reyes, J., Navarro, E., Herrera, M. J., Goenaga, E., Ospina, M. L., Parra, E., Mercado, M., Chaparro, P., Beltran, M., Gunturiz, M. L., Pardo, L., Valencia, C., Huertas, S., Rodríguez, J., Ruiz, G., Valencia, D., Haddad, L. B., Tinker, S. C., Moore, C. A., & Baquero, H. (2017). Severe Neurologic Disorders in 2 Fetuses with Zika Virus Infection, Colombia. Emerging infectious diseases, 23(6), 982-984. https://doi.org/10.3201/eid2306.161702
2. Bauman, M. D., & Van de Water, J. (2020). Translational opportunities in the prenatal immune environment: Promises and limitations of the maternal immune activation model. Neurobiol Dis, 141, 104864. https://doi.org/10.1016/j.nbd.2020.104864
Burton, G. J., & Fowden, A. L. (2015). The placenta: a multifaceted, transient organ. Philos Trans R Soc Lond B Biol Sci, 370(1663), 20140066. https://doi.org/10.1098/rstb.2014.0066
4. Choi, S., Khan, T., Roberts, R. M., & Schust, D. J. (2022). Leveraging Optimized Transcriptomic and Personalized Stem Cell Technologies to Better Understand Syncytialization Defects in Preeclampsia [Review]. Frontiers in Genetics, 13. https://doi.org/10.3389/fgene.2022.872818
5. Deganich, M., Boudreaux, C., & Benmerzouga, I. (2023). Toxoplasmosis Infection during Pregnancy. Tropical Medicine and Infectious Disease, 8(1).
6. Eallonardo, S. J., & Freitag, N. E. (2024). Crossing the Barrier: A Comparative Study of Listeria monocytogenes and Treponema pallidum in Placental Invasion. Cells, 13(1).
7. Johnson, L. J., Azari, S., Webb, A., Zhang, X., Gavrilin, M. A., Marshall, J. M., Rood, K., & Seveau, S. (2021). Human Placental Trophoblasts Infected by Listeria monocytogenes Undergo a Pro-Inflammatory Switch Associated With Poor Pregnancy Outcomes [Original Research]. Frontiers in Immunology, 12. https://doi.org/10.3389/fimmu.2021.709466
8. Kato, K. (2018). How does <i>Toxoplama gondii</i> invade host cells? Journal of Veterinary Medical Science, 80(11), 1702-1706. https://doi.org/10.1292/jvms.18-0344
9. Kumar, M., Saadaoui, M., & Al Khodor, S. (2022). Infections and Pregnancy: Effects on Maternal and Child Health [Review]. Frontiers in Cellular and Infection Microbiology, 12. https://www.frontiersin.org/journals/cellular-and-infectionmicrobiology/articles/10.3389/fcimb.2022.873253
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12. Megli, C. J., & Coyne, C. B. (2022). Infections at the maternal–fetal interface: an overview of pathogenesis and defence. Nature Reviews Microbiology, 20(2), 67-82. https://doi.org/10.1038/s41579-021-00610-y
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MacIntyre, D. A., Chandiramani, M., Lee, Y. S., Kindinger, L., Smith, A., Angelopoulos, N., Lehne, B., Arulkumaran, S., Brown, R., Teoh, T. G., Holmes, E., Nicoholson, J. K., Marchesi, J. R., & Bennett, P. R. (2015). The vaginal microbiome during pregnancy and the postpartum period in a European population. Scientific reports, 5(1), 8988. https://doi.org/10.1038/srep08988
13. Narang, K., Cheek, E. H., Enninga, E. A. L., & Theiler, R. N. (2021). Placental Immune Responses to Viruses: Molecular and HistoPathologic Perspectives. International journal of molecular sciences, 22(6).
Pontes, K. F., Nardozza, L. M., Peixoto, A. B., Werner, H., Tonni, G., Granese, R., & Araujo Júnior, E. (2024). Cytomegalovirus and Pregnancy: A Narrative Review. Journal of Clinical Medicine, 13(2).
15. Silini, A. R., Di Pietro, R., Lang-Olip, I., Alviano, F., Banerjee, A., Basile, M., Borutinskaite, V., Eissner, G., Gellhaus, A., Giebel, B., Huang, Y.-C., Janev, A., Kreft, M. E., Kupper, N., Abadía-Molina, A. C., Olivares, E. G., Pandolfi, A., Papait, A., Pozzobon, M., . . . Parolini, O. (2020). Perinatal Derivatives: Where Do We Stand? A Roadmap of the Human Placenta and Consensus for Tissue and Cell Nomenclature [Review]. Frontiers in bioengineering and biotechnology, 8. https://www.frontiersin.org/journals/bioengineering-andbiotechnology/articles/10.3389/fbioe.2020.610544
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Neuralink and Dementia
BY FAATIMA PATEL
Brain-computer interfaces (BCIs) came into development in the late 1960s and early 1970s. Over the decades, as technologyhasprogressed,humanityhas quickly reached the point where these devices that are generally seen as dangerous can now be implanted in a humanbraintobetestedandtrialled.BCIs come in many forms to aid people with debilitating conditions and disabilities to communicate, move, and perhaps even improvememory.Onesuchdeviceisthe ‘Link’producedbyNeuralink.
Currently,thedeviceisbeingtrialledontwo patientsthatarequadriplegic,tohelpthem moveandregaintheirautonomy.Eventually, itishopedthatpatientswithillnessessuch as dementia will be trialled and tested; however, there are concerns related to the invasive nature of the device. The general public are worried about what the companieswhoimplantthedevicesmaydo withthedata,aswellashowaccessibleand affordableitwillbe.
Neuralink is a piece of neurotechnology, specifically an implantable brain-computer interfaceintheformofachipthatwouldbe surgically implanted into the brain of a patient founded by Elon Musk in 2016. This technology aims to allow humans to communicatewithcomputers.Humantrials are currently ongoing with the first patient having received an implanted chip. As of August 2024, a second patient has successfully received the implant¹². The patient has been using computer-aided design (CAD) to design 3D objects, which theythen3D-print,suggestingtheimplantis working as intended, allowing patients to controldevicesastheywish.
By next year, Neuralink aims to have 11 patientsimplanted,andby2030,theaimis to have 22,000 patients receive implants⁶ . The goal of Neuralink is to enable patients with mobility problems and degenerative memory issues to regain their mobility and ability to retain information. This will be achieved by having the chip read the electrical impulses fired by the neurons, whichwillinturncreateareaction,suchas controlling prosthetics, devices, or software. Elon Musk believes it will revolutionise the treatmentofDementia,andpossiblycureit; however,thereareethicalconsiderationsand risksinvolvedwiththesurgeryitself,asitisan invasiveprocess.
There are many forms of dementia, with Alzheimer’sdiseasethoughttobethemost commonform.Manyofthediseasesthatfall undertheumbrellaofdementiaarecaused by an abnormal build-up of proteins in the brain¹⁰.Differenttypesofdementiacanalso be caused by damage to different areas of thebrain.Forexample,Alzheimer’sdiseaseis thought to be caused by high levels of the proteinbeta-amyloid,whichismadebythe breakdown of the larger protein amyloid precursor,bothinsideandoutsidebraincells, hinderingtheirabilitytocommunicate¹³.Itis thebraincellsinthehippocampusthatare responsibleforlearningandmemorythatare oftenthefirsttobedamaged².Thoughthere are treatments for the different types of dementia, due to it being caused by many diseases,suchasAlzheimer’s,frontotemporal dementia, dementia with Lewy Bodies etc, thereisnodefinitivecure³.
Musk’sBCI,named‘theLink’,chipusesthin, flexible threads that contain 1,024 electrodes⁵.Theseelectrodesarewhatrecord theneuralactivityoftheneuronsandnerve cells that send electrical signals across the body to control bodily functions. It is described as “cosmetically invisible”¹². The chip itself is around the size of a coin and worksbyrecordingtheelectricalsignalsand thendecodingthem.
After that, the decoded signals are transmitted back to the brain using electrical stimulation⁴. In essence, the chipsarecontrolledbytheusers’thoughts. The chip is surgically implanted into the cerebral cortex, which is the area of the brain responsible for memory, learning, andemotion.BCIscouldpossiblyenhance cognitivefunctionsthataredamageddue todementia;however,currentclinicaltrials with “the Link” have been focused on patients with motor neurone diseases. As humantrialsareonlybeginning,notmuch information has been released, and there hasyettobeanynewsfromNeuralinkon the use of the BCI in patients with degenerativecognitivediseases.Asaresult, itisonlyspeculationthatMusk’sBCIcould helptreatdementia¹⁴
According to Elon Musk on the 29th of January2024,aBCIhasbeenimplantedin a patient for the first time¹⁵. The patient suffers from severe paralysis, and it is hoped he will be able to control devices, such as computers and tablets, with his thoughts alone. Unfortunately, there is a lackofinformationregardingtheresearch beingconducted,aswellasthetrialitself7. This has caused some researchers to be concerned due to the communication of scientific news being relayed through social media instead of traditional peerreviewedpublications.
Furthermore, Neuralink’s lack of transparency is a violation of ethical guidelines assigned to all biomedical research⁸. There has, however, been reported success with a BSI (brain-spine implant) in a patient who suffered an incompletecervicalspinalcordinjurydue to a biking accident ten years prior. The patient, a 38-year-old male, took part in Stimulation Movement Overground (STIMO)–BSIclinicaltrial⁹
The trial included a five-month neurorehabilitation programme, where the patient would receive epidural electrical stimulation to their spinal cord. The BSI worksbyrestoringcommunicationbetween thebrainandthespinalcordbybuildinga digital bridge between them. Now, the patient can walk naturally with the aid of the BSI. Furthermore, the patient can walk assisted with crutches while the BSI is switched off, and the BSI has remained stableforoveroneyear⁹
An online cross-sectional survey, involving 326 adults between the ages of 20 and 40 wascompletedin2021,withinfivecountries intheMiddleEastandNorthAfrica.Manyof the participants believe that brain chip implants would help in processing data, treating disabilities such as epilepsy, improvecognitivefunctionmimiclostbrain functions,orevenanalternativemethodto drugdeliverysystems1.Itwasrevealed54.6% of the study participants stated they have heard about the ‘Brain Chip Implants’, and 6.1%statedtheyknewoftheimportanceof the implants. Moreover, whilst 6.1% had confirmedtheywoulduseit,only2.5%ofthe participants thought brain implants would besafe.
Concerns were shown about the possible loss of autonomy and privacy due to the invasive nature of brain chip implants as a means of gathering data¹. Society still has not caught up with the recent surge of technological development, and so many still struggle to comprehend what BCIs are and what they’re used for. In terms of legality,itwouldtaketimefortheLinktobe commercially available in most countries due to concerns of privacy and data breaches. In addition to this, ethically speaking, it should be discussed whether the virtually invasive nature of the Link feedingdatabacktoNeuralinkwarrantsthe physically invasive nature of the surgery to implantthedeviceinthefirstplace.Overall, theuseofbrainimplantsraisestheissueof numerous social, legal, and ethical questions.
References:
1. Alzheimer's Association. (2024). Alzheimer's and Dementia - What is Dementia? Retrieved 23/10/2024 from https://www.alz.org/alzheimers-dementia/what-isdementia
Abdelnaby, R., Amer, S. A., Mekky, J., Mohamed, K., Dardeer, K., Hassan, W., Alafandi, B., & Elsayed, M. (2022). Brain Chip Implant: Public’s knowledge, Attitude, and Determinants. A Multi-Country Study, 2021. Open Access Macedonian Journal of Medical Sciences, 10(B), 2489-2497. https://doi.org/10.3889/oamjms.2022.9982
2. Alzheimer's Association. (2024). What is Dementia? - Types of Dementia. Retrieved 23/10/2024 from https://www.alz.org/alzheimers-dementia/what-isdementia/types-of-dementia
3. Becher, B. (2023). What Is Neuralink? What We Know So Far. Retrieved 22/10/2024, from https://builtin.com/hardware/what-is-neuralink
4. Capitol Technology University. (2024). Neuralink's Brain Chip: How It Works and What It Means. Capitology. https://www.captechu.edu/blog/neuralinks-brain-chiphow-it-works-and-what-it-means
5. Carter, T. (2024). Elon Musk says Neuralink is looking for a 2nd participant for its brain implant. https://www.businessinsider.com/elon-musk-neuralinklooking-second-participant-brain-implant-2024-5
6. Drew, L. (2024). Elon Musk's Neuralink brain chip: what scientists think of first human trial. Nature. https://doi.org/10.1038/d41586-024-00304-4
7. Hart, R. (2024). Experts Criticize Elon Musk’s Neuralink Over Transparency After Billionaire Says First Brain Implant Works. Retrieved 23/10/2024, from https://www.forbes.com/sites/roberthart/2024/02/26/expert s-criticize-elon-musks-neuralink-over-transparency-afterbillionaire-says-first-brain-implant-works/
8. Lorach, H., Galvez, A., Spagnolo, V., Martel, F., Karakas, S., Intering, N., Vat, M., Faivre, O., Harte, C., Komi, S., Ravier, J., Collin, T., Coquoz, L., Sakr, I., Baaklini, E., HernandezCharpak, S. D., Dumont, G., Buschman, R., Buse, N., . . . Courtine, G. (2023). Walking naturally after spinal cord injury using a brain–spine interface. Nature, 618(7963), 126133. https://doi.org/10.1038/s41586-023-06094-5
9. National Health Service (NHS). (2024). Causes of dementia. Retrieved 23/10/2024 from https://www.nhs.uk/conditions/dementia/aboutdementia/causes/
10. Neuralink. (2021). Pager Plays MindPong. https://neuralink.com/blog/pager-plays-mindpong/ 11 Neuralink. (2024). Pioneering Brain Computer Interfaces. Retrieved 23/10/2024 from https://neuralink.com/ 12. NIH National Institute on Aging. (2022). What Is Dementia? Symptoms, Types, and Diagnosis. National Institutes of Health. Retrieved 22/10/2024 from https://www.nia.nih.gov/health/alzheimers-anddementia/what-dementia-symptoms-types-and-diagnosis
13. Penick, H. (2020). Will Neuralink Cure Dementia? https://getneuralnet.com/will-neuralink-cure-dementia/
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14 Reed, J., & McFadden, J. (2024). Neuralink: Can Musk's brain technology change the world? Retrieved 23/10/2024, from https://www.bbc.co.uk/news/health-68169082
Genetic Chronicles: Stories Written in Ancient DNA
Abstract
ThisarticlefocusesonthewayancientDNA research has reshaped our understanding of human history, as well as explore the ethical concerns surrounding aDNA research. As scientists uncover genetic information from long-extinct populations, ethical dilemmas related to consent, cultural sensitivity, and the potential for misuse of genetic data arise. This piece sheds light on the balance between scientificadvancementandrespectforthe communities connected to these ancient remains, as well as address the responsibilities researchers have toward descendant communities to guide ethical aDNAresearch.
This article has been reviewed by Assoc. Prof. Robin Beck, Reader in Biology, University of Salford. The Editorial Team would like to thank him for his time and contributions.
Keywords: ancient DNA, aDNA, ethical research, biological remains, genome sequencing, cultural heritage, ancestry, migrationpatterns,kinshipanalysis,human evolution,infectiousdiseases,geneticdata, consent, indigenous communities, cultural sensitivity
IntroductiontoAncientDNA
AncientDNA(aDNA)referstothegenetic materialextractedfrombiologicalremains suchasbones,hairbulbs,skinfragments, teeth, sediments, etc., dating to the last tensofthousandsofyearsorolder.Dueto itsgreatageandenvironmentalexposure, aDNA is subject to degradation, particularlyfragmentingintoshort50-100 base pairs, undergoing post-mortem mutations(e.g.,cytosinedeamination),and environmentalcontamination³.
These considerations complicate the researchandresultinadditionalmethodical approaches to avoid misleading conclusions³.InitialaDNAresearchbeganin 1984withtheextractionandsequencingof short mitochondrial fragments from the quagga (Equus quagga quagga), an extinct subspecies of zebra⁹, followed by Svante Pääbo’s paper where the first sequence of ancient human DNA from an Egyptian mummywaspublished¹¹.Pääbohasbeena pioneer in aDNA studies and has contributed greatly to the expansion and recognitionofthefieldofpaleogenomics.
ThefragilenatureofaDNAmakesitdifficult to analyse the samples by introducing variousmethodologicalassumptionliberties, difficulties in dating samples (for example, by carbon dating), and ethical considerationsrelatingtoownership.
Decoding aDNA: Methods, Limits & Applications
Whilevagueindefinition,generallytheterm aDNA encompasses DNA recovered from any postmortem material which has not been specifically preserved for later use. As describedabove,thesesamplesaresubject to degradation, meaning that it is often challengingtoestablishaprecisetimeframe ofthesamplebasedonthegeneticmaterial alone⁵. Apart from the biological material itself, the environment where the remains have been found can be associated with a particulartimeperiod,providinganindirect age for the sample. The combination of multidisciplinary DNA genotyping, radiocarbon dating, and dendrochronology assessments are often used and compared to other historical evidence to provide a narrow date range for the age of the sample⁶
When dealing with trace quantities of preserved DNA, standard methods of geneticsequencingsuchasPCRintroducea major risk of accidentally sequencing contaminants as opposed to the aDNA itself⁵ .
Nowadays, the technology used includes utilisation of sterile facilities, nextgeneration high throughput sequencing which has been shown to work most efficientlyonshortDNAsequences,aswell as novel statistical tools that can reliably estimate the sequence damage in aDNA⁵ While there have been attempts to standardise criteria in the design of aDNA research, these have often proved impractical and a ‘common-sense approach’ acknowledging the contamination issue appears to be significantly more feasible for a larger numberofstudies⁵ .
Another crucial consideration involves the awareness of taphonomic bias, which relates to burial, decay, and preservation processes, and analytical procedures bias relatingtotheextraction,amplification,and identification of the aDNA samples⁷. The mainoriginofbiasinthestudyofancient samples revolve around the source of the material,themethodologyandefficiencyof the DNA transfer, the preservation conditions of the sample, and the assumption that these have remained constantthroughouttime⁷
On a more technical scale, a controversial aspectofaDNAresearchistheassumption ofmolecularratesofchange.Theseinclude genetic diversity, the mutation rates of natural alleles, substitution rates, etc., which often assume an equilibrium between mutation and genetic drift over time5. Most of the aDNA work utilises mtDNA (mitochondrial DNA), as it is relativelyeasytoamplify.
Prior to aDNA research, studies focusing on the rates of change of mitochondrial loci sometimesresultedinconflictingvalues;,for example,estimatesforthemutationrateof the hypervariable region 1 of the mitochondrial genome have ranged between 2% to 10% per million years;, however, recent estimates over shorter timeframes for intraspecific comparisons that use aDNA methodology differ greatly from those obtained via phylogenetic methodsusingDNAfromlivingindividuals⁵ Promisingly, findings like these have the capacity to be rectified as novel bioinformaticstoolsenablethere-evaluation ofpublisheddata.TheBMCGenomicDatain particular encourages the submission of ancientDNADataNotes³.
Alongside recent advancements in nextgeneration sequencing technologies and bioinformaticresearch,theanalysesofaDNA haveachievedsignificantscholarlyattention astheyhavethecapacitytorevolutioniseour perception of human evolution, plant and animal domestication, the origins and the evolution of pathogens and microbiomes, migration patterns, and many more (see Figure1)³.Atpresent,genome-scaledatahas been obtained from thousands of palaeobiologicalsamples,andthenumberof ancientbiologicaltissuesthataresuitablefor genome sequencing is continuously increasing, hence promising realistic nearfutureadvancements³.
Research team led by the Francis Crick Institute have identified a prehistoric person withmosaicTurnersyndromewhoisassumed tohavelivedaround2500yearsago,anEarly Medieval Period individual with Jacob’s syndrome, three people with Klinefelter’s syndrome,andanIronAgeinfantwithDown’s syndrome². These individuals have been analysed as a part of the Thousand Ancient BritishGenomesprojectandhavebeenfound at sites in Oxford, Somerset, Yorkshire, and Lincoln. All have been buried within the guidelines of society’s customs at the time, butwithoutanypossessionsthatcouldinform usabouttheirlives.Thefindingssurrounding atypical autosomal and sex chromosome karyotypesaidedintheunderstandingofpast perceptions of biological sex, as well as diversebiologicaltraits².
Since polygenic risk scores are already utilisedasroutineassessmentsbytheNHS, ancient genomics data bring about the potential to reconstruct the history of human health over time, particularly the sought-afterlinkbetweengenomicdiversity and disease. The oldest nuclear genome fromtheHomogenuswasretrievedfroma 430,000-year-old-Neanderthal¹⁰
While aDNA has been obtained from variouspartsoftheworld,thereisageneral northernhemispherebiasinthedatawhich needs to be addressed. The potential of studying Neanderthal DNA arises from the introgression of Neanderthal DNA which formsasmallproportionofmodernhuman DNA,whereresearchhasrevealedgenesof major physiological relevance10. Recent paleogenomics studies have determined that 3% of people of European ancestry haveaTYK2P1104Atuberculosisriskvariant which has evolved under strong selection pressure over two millennia. This finding reflects the pressure imposed by M. tuberculosisepidemicsandwouldnothave been brought to attention with sole modern DNA studies¹⁰. Interestingly, it has been established that a Neanderthal haplotypeencompassingtheantiviralOAS1 gene is linked to protection against severe COVID-19¹². These findings have the potential to redefine our understanding of immunity and shape our strategies for tackinginfectiousdiseases.
Cultural Sensitivity: Ownership of aDNA Data
Arguably the biggest concern surrounding aDNA is lack of means to obtained informed consent from test subjects and ownershipofgenomicdata.
Thegeneralprincipleistoensurethatpaleogenomicresearchersconsidertheethicaland cultural issues before, during, and after the study has been undertaken, and they must consult with the communities the remains havebeenfoundaround⁴ .
In the past, destruction of relics, defiling of holyplaces,andmisrepresentingtheremains have discouraged ethnic communities from consenting to such studies⁴. For example, in 1996, archaeologists assembled a nearly complete skeleton consisting of more than 300 bones found along the edge of the ColumbiaRiver,anarealocaltoatleastfour Indigenous groups. The remains have been referred to as the Kennewick Man, or the AncientOne.OnearchaeologistcalledJames C. Chatters, has suggested that Kennewick ManmayhavebeenEuropeanduetocertain “Caucasoid”featureslikehisskullmorphology. When the remains have been found to be older than Chatters expected, the realised that this is not the person he suspected Kennewick Man to be. By suggesting that Kennewick Man was European, Chatters undermined the claim of Indigenous groups which stated that the skeletal remains belongedtothemundertheNativeAmerican Graves Protection and Repatriation Act (NAGPRA)⁸ .
This act clearly declares that the remains mustbereturnedtoatribeiftheywerefound tobeculturallyrelated.Courtrulingsdenied the tribes’ claims and granted scientists access to the bones, while Chatters was not partofthelawsuit,hewasabletostudythe remainsandpublishedhisbookin2002.
Jerome Rose, an osteologist, was called to analyse the remains, concluded that the skeletonbelongstoaNativeAmericanfromthe GreatPlains,whichisconsistentwiththetime and location where the remains were found⁸
Paulette Steeves, an Indigenous (Cree-Métis) archaeologist at Algoma University in Canada (and one of Rose's former students) said this when referring to Rose's work on Kennewick Man: “[the archaeologists] tried to disenfranchise Kennewick Man from the local Indigenouscommunities⁸.”
In2015,thankstomoderngenomesequencing technology using one of the individual’s hand bones, Kennewick Man has been definitively linked with, and returned to, the Indigenous Columbia Basin tribes. At his burial site, more than 200 tribal members have gathered, displayingtheimpactofthissituationontheir culture.PauletteSteeves,Rose’sformerstudent, said “Genetics . . . obviously showed later on that this person definitely was linked to those tribalcommunitiesandhewasburied,butfor how many years did [they] suffer? That’s the kind of damage that researchers and archaeologistsandgeneticistscando⁸.”
Chattersarguesthathedidnotdenythetribe ownership, instead he did not agree with the refusal to not let Kennewick Man to tell his story. The burial itself provided psychological relief to the tribal group; however, due to the unpleasant circumstances surrounding it, the stigmaprohibitedscientistsfromreviewingthe burial site and answering important historical questions⁸
Furthermore, literature reports that genetic findings may result in repression of such communities through communal or personal convictions,orperpetratingfalsifyingnarratives through the misuse of genetic data for determininggroupbelonging¹.
Someexpertsbelievethatitisnotappropriate for these data to be used as an “arbiter of identity”andtoavoidexercisingextremeand misguideddeterminationofclaimtoancient heritage¹. In addition, when conducting culturallysensitivestudies,researchersshould inform the communities that the genetic findings may be inconsistent with the communities’ beliefs. While the scientific analyses are reported as scholarly outputs, a study highlights that “they do not discredit, diminish, or decrease the importance of traditionalexpertiseanddeeplyheldbeliefs”, and other lines of evidence should be reportedalongsidegeneticanalysestoreflect thecomplexityoffactorsthatplayedarolein shapingthosetraditions¹.
To address these ethical concerns, protective guidelines like NAGPRA ensure an alliance between scientists and Indigenous communities, where ethical and cultural implications are considered to develop strategies regarding communication and handling of the sensitive data, Indigenous community engagement, making sure they are fully aware of the process to maximise informedconsent,andalsotacklinglong-term responsibilities that arise from the genetic findings⁴. In these studies, the main priority lies with community engagement that involves Indigenous scholars and stakeholders⁴
Morespecifically,thewidespreadargumentis that “(1) researchers must ensure that all regulationswerefollowedintheplaceswhere they work and from which the human remainsderived;(2)researchersmustprepare adetailedplanpriortobeginninganystudy; (3) researchers must minimize damage to human remains; (4) researchers must ensure that data are made available following publicationtoallowcriticalre-examinationof scientific findings; and (5) researchers must engage with other stakeholders from the beginningofastudyandensurerespectand sensitivitytostakeholderperspectives¹.”
Every aDNA researcher must commit to adheringtotheseandisexpectedtopromote ahighethicalstandardinaDNAresearchon humanremains¹.
In conclusion, the field of ancient DNA has changed enormously since its beginnings, both in aspects of technological advancements and in ethical considerations. Eversincethefieldgainedhistoricrecognition throughSvantePääbo’spaleogeneticresearch on Neanderthals, it has consistently reached new milestones in terms of increased technical accuracy and sparking curiosity for insights into human migration patterns, cultural heritage, and even the impact of genetic diversity on infectious diseases. The field continues to expand, and with that, scientists learn to develop initiatives to establish and strengthen the dialogues betweenresearchers,Indigenouspeoples,and interdisciplinary specialists, ultimately elevating the domain of knowledge while ensuring a respectful and considerate approach.
References:
1.
Alpaslan-Roodenberg, S., Anthony, D., Babiker, H., Bánffy, E., Booth, T., Capone, P., Deshpande-Mukherjee, A., Eisenmann, S., Fehren-Schmitz, L., Frachetti, M., Fujita, R., Frieman, C. J., Fu, Q., Gibbon, V., Haak, W., Hajdinjak, M., Hofmann,K.P.,Holguin,B.,Inomata,T.,...Zahir,M.(2021). Ethics of DNA research on human remains: five globally applicable guidelines. Nature, 599(7883), 41-46. https://doi.org/10.1038/s41586-021-04008-x
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Anastasiadou,K.,Silva,M.,Booth,T.,Speidel,L.,Audsley,T., Barrington,C.,Buckberry,J.,Fernandes,D.,Ford,B.,Gibson, M., Gilardet, A., Glocke, I., Keefe, K., Kelly, M., Masters, M., McCabe, J., McIntyre, L., Ponce, P., Rowland, S., . . . Skoglund,P.(2024).Detectionofchromosomalaneuploidy in ancient genomes. Communications Biology, 7(1), 14. https://doi.org/10.1038/s42003-023-05642-z
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Chen, N., & Nedoluzhko, A. (2023). Ancient DNA: the past for the future. BMC Genomics, 24(1), 309. https://doi.org/10.1186/s12864-023-09396-0
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4. deBruyn,M.,Hoelzel,A.R.,Carvalho,G.R.,&Hofreiter,M. (2011).FaunalhistoriesfromHoloceneancientDNA.Trends in Ecology & Evolution, 26(8), 405-413. https://doi.org/https://doi.org/10.1016/j.tree.2011.03.021
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Dalal, V., Pasupuleti, N., Chaubey, G., Rai, N., & Shinde, V. (2023). Advancements and Challenges in Ancient DNA Research:BridgingtheGlobalNorth–SouthDivide.Genes, 14(2).
Domínguez-Delmás, M., Schroeder, H., Kuitems, M., Haneca,K.,Archangel,S.,vanDuin,P.,&Piena,H.(2023).A stepwise multidisciplinary approach to determine the dateandprovenanceofhistoricalwoodenobjects.Journal of Cultural Heritage, 62, 430-440. https://doi.org/https://doi.org/10.1016/j.culher.2023.06.023 6. Giguet-Covex, C., Ficetola, G. F., Walsh, K., Poulenard, J., Bajard, M., Fouinat, L., Sabatier, P., Gielly, L., Messager, E., Develle, A. L., David, F., Taberlet, P., Brisset, E., Guiter, F., Sinet, R., & Arnaud, F. (2019). New insights on lake sediment DNA from the catchment: importance of taphonomic and analytical issues on the record quality. Scientificreports,9(1),14676.https://doi.org/10.1038/s41598019-50339-1
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Higuchi, R., Bowman, B., Freiberger, M., Ryder, O. A., & Wilson, A. C. (1984). DNA sequences from the quagga, an extinctmemberofthehorsefamily.Nature,312(5991),282284.https://doi.org/10.1038/312282a0
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Kerner, G., Choin, J., & Quintana-Murci, L. (2023). Ancient DNAasatoolformedicalresearch.Naturemedicine,29(5), 1048-1051.https://doi.org/10.1038/s41591-023-02244-4
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Pääbo, S. (1985). Molecular cloning of Ancient Egyptian mummy DNA. Nature, 314(6012), 644-645. https://doi.org/10.1038/314644a0
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Zeberg,H.,&Pääbo,S.(2021).Agenomicregionassociated withprotectionagainstsevereCOVID-19isinheritedfrom Neandertals. Proceedings of the National Academy of Sciences, 118(9), e2026309118. https://doi.org/10.1073/pnas.2026309118
USING BIOLUMINESCENCE IN MAGNETIC RESONANCE IMAGING
BY NASHAF AZIZ
Abstract
Magnetic resonance imaging (MRI) is a powerful medical diagnostic tool that provides detailed images of tissues and organs. However, conventional MRI has limitations in sensitivity and specificity that can be overcome by integrating bioluminescence. This article explores the innovative application of bioluminescence in MRI, discusses its mechanisms, advantages, and potential clinical applications. Bioluminescence can be particularly beneficial for cancer patients, in preclinical studies, In neurological research and diagnostics. Individuals with genetic disorders, Patients with certain implanted medical devices such as pacemakers or cochlear implants, may not be able to undergo MRI due to the strong magnetic fields involved. Bioluminescence-based MR can revolutionize non-invasive diagnostics and personalized medicine by improving contrastandenablingmolecularimaging.
Magnetic resonance imaging (MRI) has become a cornerstone of modern medical diagnosis, known for its ability to produce high-resolution images of internal structures and to visualise detailed internal structures withouttheuseofionizingradiation⁶.Despite its advantages, MRI has problems with sensitivity and specificity, especially in differentiating between different tissue types and detecting small or early-stage abnormalities.
Bioluminescence, the emission of light from living organisms, offers a new approach to overcometheselimitations.
By adding bioluminescent molecules such as luciferin and luciferase, which emit the light through the biochemical reactions to MRI, researchers aim to improve contrast and provide more accurate imaging capabilities. These molecules could significantly advance medical imaging, offering deeper insights into health and disease. Utilizing strong magnetic fields and radiofrequency waves, MRI produces high-resolutionimagesofsofttissues,makingit particularly effective for examining the brain, spinalcord,muscles,andjoints.Thisisdoneby aligning hydrogen nuclei in the body and detectingthesignalstheyemit¹⁰
Figure 1:
Standard MRI Scan showing high-resolution images of internal structures, commonly used in medical diagnostics to visualise tissues and organs¹⁵ .
Bioluminescence enables molecular imaging, which allows specialists to visualise and monitor molecular processes over time. This capabilityisimportantinoncologyasitcanbe used to track tumour growth, metastasis, and response to treatment. Bioluminescence MRI focusesonspecificbiomarkersthatcanprovide information about the molecular basis of disease¹².
Specialists are generally required to use bioluminescence-based molecular imaging effectively, given the complexity of the technology and the depth of understanding neededtointerprettheresultsaccurately.
Bioluminescence magnetic resonance is very promisingforcancerdiagnosis.Bioluminescent studies focus on tumour-specific markers that can show malignant cells with high accuracy, allowingearlydetectionandaccuratediagnosis ofcancer.Thistechnologymakesitpossibleto assess the effectiveness of cancer treatment in real time to create a personalized treatment plan.
One of the main advantages of incorporating bioluminescence into MRI is the significantly improved contrast. Traditional MRI relies on differences in fluid content and tissue density toproducecontrast.Bioluminescenceprovides a different layer of information on molecular and cellular activity, which can accurately distinguishbetweenhealthyanddeadtissue
Non-invasiveandsafe
The biomolecules used in MRI are non-toxic and do not require ionizing radiation, so this procedureissafeforpatients.Thenon-invasive natureofbioluminescenceMRImeansitcanbe used for repeated imaging over time, which is important for monitoring disease progress and treatmenteffectiveness
ClinicalApplications:
MusculoskeletalDisorders
JointDisorders
MRIisfrequentlyusedtoassessjointproblems, includingligamenttears,meniscusinjuries,and cartilage damage, particularly in the knee, shoulder,andspine⁵
SpinalConditions
MRI is crucial in diagnosing herniated discs, spinal stenosis, and other spinal cord abnormalities, aiding in both conservative and surgical treatment planning.
NeurologicalDisorders
Inneurologicalstudies,bioluminescenceMRIcanbe used to study brain function and monitor neurological diseases. By focusing on neurotransmitteractivityorspecificneuralpathways, researchers can understand conditions such as Alzheimer's disease, Parkinson's disease, and epilepsy. This approach can aid in development of targeted treatments and provide insights into the progressionofthesediseases¹⁴
BrainFunctionMapping
MRI is used to map brain activity by detecting changes in blood flow, particularly useful in presurgical planning for epilepsy or brain tumour surgeries².
PsychiatricResearch
MRI is increasingly used in research to study brain function in psychiatric disorders such as depression, schizophrenia,andanxiety¹⁹
This non-invasive technique is critical for evaluating conditions like cardiomyopathies, coronary artery disease, and congenital heart defects. Additionally, MRI can detect inflammatory cytokines like interleukin-1β (IL-1β) and tumour necrosis factoralpha(TNF-α),whicharecentraltotheprogressionof atherosclerosis, enabling early detection of plaque formation. MRI can visualise apoptotic processes in heart tissue after myocardial infarction and detect oxidative stress, both of which are critical for understanding the progression of heart failure. This approach provides a non-invasive, sensitive method to detect molecular and structural changes in cardiovasculardiseases,aidinginearlydiagnosisand treatmentmonitoring⁷
BiodynamicsisimportantinMRI,buttherearealsochallengesthat need to be addressed. These includes developing better bioluminescence probes, ensuring the stability and biocompatibility of these probes, and integrating bioluminescence detection with current MRI techniques. Bioluminescence probes can degrade over time due to chemical reactions with the biological environment or imaging equipment, leading to diminished luminescence Probes may also undergo photobleaching when exposed to light, which reduces their luminescence Probes must remain stable in the complex physiological environment, including varying pH levels, ionic strength,andtemperatures³.Toensurebiocompatibilityprobesare coatedwithbiocompatiblematerialslikepolyethyleneglycol(PEG) to minimize immune reactions. Employing non-toxic luciferins and luciferases reduces potential harm¹⁶. Adhering to regulatory guidelines ensures probes are safe for clinical use. Future research will focus on overcoming these obstacles and expanding the clinicaluseofbioluminescenceMRI.
Conclusion
The introduction of bioluminescence in magnetic resonance imaging represents a major advance in medical imaging. By enhancing contrast and enabling molecular imaging, bioluminescence MRI can improve the accuracy and effectiveness of diagnosis and treatment monitoring. Current research and development in bioluminescence MRI include advancements in probes, integration with MRI, and biocompatibility and stability. Major UK universities and research centres are advancing bioluminescence MRI technology, funded by UK Research and Innovation (UKRI) and through collaborative efforts among academicandhealthcareinstitutions.Fundingforbioluminescence MRI research in the UK comes primarily from UKRI, including grants from the Medical Research Council (MRC). Major UK universities, research centres, and healthcare institutions are also involved, with collaborative efforts supported by both public and private sector funding. This financial backing is crucial for advancing bioluminescence MRI technology, particularly in developing better probes, improving MRI integration, and ensuring biocompatibility,ultimatelypushingthetechnologytowardclinical application. As research progresses, this innovative approach could revolutionise non-invasive diagnostics and personalised medicine, bringingnewhopeforpatientsanddoctors.
Figure
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3.Brodl, E., Winkler, A., & Macheroux, P. (2018). Molecular Mechanisms of Bacterial Bioluminescence. Comput Struct Biotechnol J, 16, 551-564. https://doi.org/10.1016/j.csbj.2018.11.003
4.Busse, A., Rajagopal, R., Yücel, S., Beller, E., Öner, A., Streckenbach, F., Cantré, D., Ince, H., Weber, M.-A., & Meinel, F. G. (2020). Cardiac MRI—Update 2020. Der Radiologe,60(1),33-40.https://doi.org/10.1007/s00117-020-00687-1
5.Cejvanovic, S., Sheikh, Z., Hamann, S., & Subramanian, P. S. (2024). Imaging the brain: diagnosis aided by structural features on neuroimaging studies. Eye (Lond), 38(12),2380-2391.https://doi.org/10.1038/s41433-024-03142-w
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RESEARCH SPOTLIGHT
BY AREEBA KHALID
Prostate cancer is the most diagnosed cancer in men, mainly those over 50. In the UK, an average of 52,000 men are diagnosed with prostate cancer each year, and about 12,000 men die from it⁹. Prostate cancer often shows little to no symptoms in its early stages. The TRANSFORM Trial is a research project worth £42 million, launched by Prostate Cancer UK, with the sole purpose of finding the best way to screenmenthroughaneasyandlessstressfuldiagnosis¹⁰
ProstatecancerbeginswhensomecellsdevelopmutationsintheirDNAandstartgrowinganddividing uncontrollably, causing normal healthy cells to die. Cancer cells will continue to grow and divide creating a tumour that can spread over time, to other tissues and organs such as the bladder, bones, lymphnodes,pelvicwall,lungs,andrectum.
Prostate cancer metastasis can rarely occur in the kidneys and spleen³. Some of the symptoms of prostate cancer include blood in semen and urine, weak flow, bladder not fully emptied, and prolonged duration of urination. Some advanced symptoms, indicating the cancer has spread, include involuntary weight loss, reduced appetite, and pain in the testicles, back and bone⁵. It can also become metastatic,meaningitspreadstootherorgans, such as the bladder or, in some cases, to the bloodstream⁸
On average, it takes two to four weeks to be diagnosed with prostate cancer following different tests and biopsies. Generally, a positive biopsy indicates the presence of cancer cells. The cancer is graded by factors suchashowquicklythecellsarelikelytogrow and how aggressive the cells are. These scores areknownastheGradeGroup².
Currently, there is no definitive test or screening for prostate cancer. However, it is possible to determine the risks by simple factors that include PSA Levels and results of prostate examinations. Depending on the results of the previous tests, Multiparametric Magnetic Resonance Imaging (mpMRI) is performed.
The mpMRI scan is preferred as it gives a more detailed image of the prostate gland, and it helps the doctor check for abnormalities,decidewhetherabiopsyis needed and if needed from which area is best to take it, if the cancer has spread². One of the limitations is that it cannot surely confirm if there is cancer, which is why a transperineal or transrectal biopsy isneededaccordingly⁴ .
The TRANSFORM Trial’s main purpose is to find an effective screening method which will improve diagnostic rates, without making the patient undergo unnecessary procedures that can also leadtomentaldistress².
Other risk factors include ethnic groups. Black men are more likely to get prostate cancer than anyotherethnicgroup;currently,intheUK,1in4 black men are more likely to get prostate cancer in their lives, with reasons not yet determined. The reasons are not fully known but as age increases, the risk of getting prostate cancer increases too. Most men get diagnosed between the age of 70 and 74 years. Family history and genetics are also key risk factors. The genes determine the growth, functions, and developmentofthebody;ifgenevariationoccurs, it often leads to cancer. In the case of prostate cancer, a BRCA1 or BRCA2 gene variation leads to the disease⁸. BRCA genes work by preventing cancer cell growth, and make sure healthy cells are growing normally. People with the BRCA2 gene variant are more likely to develop prostate cancer than those with the BRCA1 variation. Although there is no clear evidence, some researchers suggest that the BRCA1 or BRCA2 gene variation can also increase the possibility of developing this disease at a young age as well as the disease becoming aggressive and spreading more
A large number of men are expected to take part in the TRANSFORM Trial. The trial will comparethemosteffectivetestsandprovide definitiveevidenceindicatingthebestwayto screen for prostate cancer; the trial will try to reducepatientdeathbyupto40%⁷ .
This trial consists of two stages:
Stage one – this stage will consist of researching different screening options that include PSA blood tests, faster MRI scans (also known as ‘Prostagram’) as well as genetic testing to identify men that are at higher risk. The effectiveness of these new techniques will be evaluated through comparison with the NHS's existing diagnostic procedure to choose who should progress to the trial's next phase. Approximately 12,500 men will be requited, and this stage itself may take three years to completebyprovidinginitialresults¹ ⁷
Stage two – this stage will consist of utilising the most effective methods found in stage one. 300,000 men are projected to participate. The trial is estimated to run for a minimum of 15 years to determine if the screening can lower prostate cancer related deathsaswellasimprovequalityoflife;itwill also unveil whether patients will suffer consequences from unnecessary procedures (biopsies and invasive treatment). Most importantly, it will help identify the least harmfultestsandproceduresthatenablethe diagnosis of major cancers such as prostate cancer¹-⁷ .
The TRANSFORM Trial will contribute to the largest prostate cancer biomarkers in the world by collecting various samples, such as images and data, from over 250,000 men. This will help researchers make major discoveries that will guide the diagnosis and treatmentofprostatecancer¹-⁷ .
Pregabalin, a GABA analog originally developed as an anticonvulsant, has recently gained widespread use in managing neuropathic pain and fibromyalgia. Despite its therapeutic evidence, recent studies suggest that pregabalin hasabusepotentialespeciallyamongindividuals with prior history of drug abuse and those using opioids. While pregabalin is a controlled substance in the UK and USA, its misuse continues to rise. Case reports show that even patients without a history of substance abuse can experience withdrawal symptoms, including agitation and insomnia, upon discontinuation, suggestingthepotentialfordependenceevenat therapeutic doses. This article examines the pharmacological action of pregabalin, the patternofabuseandhowtheissueofpregabalin abuse and misuse can be addressed by prescribersandhealthcarepolicymakers.
Pregabalin, popularly marketed as Lyrica, is a lipophilicanalogofGABA(gammaamino-butyric acid) and is structurally similar to Gabapentin. It is currently indicated in the management of neuropathic pain, fibromyalgia, partial seizures, and epilepsy⁴. Pregabalin is believed to exert its pharmacological effects by acting on voltage gated calcium channels in the central nervous systeminhibitingtheinfluxofCalciumions(Ca²⁺) into the nerves leading to a decrease in the releaseofexcitatoryneurotransmitters¹.
Inrecenttimes,pregabalinhasbeenclassifiedas a Class C Schedule drug in the UK and a Schedule V drug in the United States⁵. This classificationindicatesthatpregabalincannotbe purchased over the counter, and possession or sharing of the drug is only legal with a valid prescription.
Although pregabalin is currently not listed as a substance of abuse, recent studies have revealed that pregabalin has abuse potential, which is exacerbated in patients with a history of substance abuse disorder, as well as patients administeredpregabalinalongwithopioids².
However, a recent case study demonstrated that at normal therapeutic doses of pregabalin for the management of neuropathic pain, patients developed symptoms such as shortness of breath, agitation, insomnia, and psychotic-like symptoms upon abrupt discontinuance⁷. This indicates that at normal therapeutic dose of pregabalin, patients with no history of substance abuse tend to develop dependence and withdrawal symptoms upon abruptwithdrawal.
This is particularly significant, as most studies and reports of pregabalin abuse misuse the reason of substance abuse as a risk factor⁶. It should however be stated that while the sample size for the study was limited and no follow-up study has been conducted on it, it raises concern and points to a neglected area ofresearch.
The reasons for the growing trend of pregabalin dependence and misuse are not clearly defined but contributing factors to the rising incidence includes ease of obtaining large quantities without a prescription with pregabalin prescriptions increasing by 5% between 2021 and 2022 in the UK³. Additionally, off-label use and lack of thorough understanding about the abuse potential of pregabalin by both prescribers and patients alike⁵
This places a clear responsibility on prescribers and healthcare professionals when prescribing pregabalin as patients may be unaware of the dependency potentialofthemedication.Additionally, since pregabalin has a soothing and calmingeffect,patientsmaybeoblivious to the starting point of dependence, as mostpatientsonpregabalintendtotake themdaily.
Prescribers and pharmacists should exercise more caution when prescribing pregabalin to patients already taking opioids as this exponentially increases the abuse potential of pregabalin5. Prescribers would need to take into cognizance history of substance abuse before prescribing pregabalin and necessitate routine monitoring of patientstakingpregabalintoadequately monitortheonsetofdependenceaswell as consider alternatives to pregabalin. This routine monitoring should involve constant medication review, preferably monthly for patients on long-term therapyandeducatingthemonthesigns of dependence. Furthermore, more intentionalstepsshouldbeemployedin tapering off patients on already high dosesofpregabalinasopposedtoabrupt discontinuation to prevent the developmentofwithdrawalsymptoms.
For patients without any history of substanceabusewhoneedtobestarted on pregabalin therapy for management of chronic neuropathic pain, prescribers can start therapy by prescribing low doses of the medication with adequate patientcounsellingtoensurepatientsdo notdevelopdependence.
Policymakersalsohavearoletoplayby establishing a patient registry solely for trackinguseandoutcomeofpregabalin.
More epidemiological surveys that monitor the prevalence rate of pregabalin abuse and dependence shouldbecarriedouttomakeinformed decisionsonpoliciestoguidepregabalin prescriptionamongprescribers.
INSIGHTS INTO CLINICAL TRIALS: PERSPECTIVES AND PRACTICES
BY WIKTORIA WISNIEWSKA AND SARA ALNASIR KASSAM
TRANSCRIBED BY DILRUBA BOKSH
Issue6Co-Editors-in-ChiefWiktoriaWisniewskaandSaraAlnasirKassamhadthepleasureofhavinga conversationwithDrJonathanBannard-SmithandProfessorMaheshNirmalanregardingClinicalTrials andtheirimportanceindevelopinglifesavingtreatmentsandansweringclinicalquestions.DrJonathan Bannard-Smith is a Critical Care & Anaesthesia Consultant at Manchester University NHS Foundation Trust.ProfessorMaheshNirmalanisamedicaleducationprofessor,anHonoraryCriticalCareMedicine Consultant at Manchester Royal Infirmary, and Former Vice Dean for social responsibility at the UniversityofManchester.
Sara: Can you explain what clinical trials areandwhattheyentail?
Jonathan: Clinical trials aim to test various methodsofdiagnosingandtreatingpatients and their influence on patient outcomes. Classically, you can think of it as a comparison between two methods. In a clinical setting, these methods are applied to patients, and their progress is monitored to determine if the different approaches lead to different results. It's a structured experiment to identify the most effective treatmentsforspecificconditions.
Wiktoria: What was your involvement in clinicaltrials?
Jonathan: My first exposure to clinical trials was at international meetings where the results of trials were presented, and I found them fascinating. While many early critical care trials revealed no difference between treatment groups, they have allowed us to refine our practice toward efficient and effectivecare.
I was fascinated by how these experiments were organised and conducted across multiple countries, involving large communities of clinical professionals and thousandsofpatients.
After completing my training, I decided to work with a prominent trialist in Australiaknownforconductingextensive trials in our field. Upon returning to Manchester about ten years ago, I decided to focus on conducting clinical trials here and becoming part of the UK community dedicated to addressing these bedside questions. I believe this is whereallclinicaltrialsshouldbegin.
In the ICU, we often treat patients with critical and life-threatening conditions. However,itmaysurprisemanythatmuch of what we do lacks solid evidence in improving patient outcomes. Many treatments are empirical, based on scientific rationale and physiological principles to support patients until they recover.
However, there remains uncertainty about whether these treatments genuinely benefit patients and if the benefits of treatment outweigh potential harm due to side effects. Countless questions arise at the bedside— when to administer a treatment, whether to wait or act immediately—that could easily become clinical trials. Therefore, the starting point for clinical trials is often the questions thatarisedirectlyfrompatientcare.
Mahesh: Medical practices were often based solely on scientific theories for several decades. For example, if a treatment was found to lower blood pressure, it was frequently implemented without considering potential side effects. However, every treatmentcarriesrisksalongwithitsbenefits, and the overall balance is crucial. Thus, there was a growing consensus that real evidence from large cohorts of people was necessary beforeadoptingnewpractices.Thisapproach is known as evidence-based medicine, emphasising the importance of empirical evidence over theoretical assumptions. This context laid the foundation for introducing clinical trials, which have since played a dominantroleinmedicaldecision-making.
Jonathan: Ethical and legal regulatory standards govern all our research, whether it involves enrolling patients on ventilators in the ICU or testing cell cultures in the lab. Everything must be conducted ethically. This is somewhat different from how you design a trial.It'sessentialtostartwithaclearresearch question and be thoroughly knowledgeable about the current evidence base surrounding thatquestion.Supposeaquestionhasalready been answered through previous research it maynotbenecessarytorepeatthiswork.
It's beneficial because we can change practice or apply that answer without wasting time and resources on unnecessary trials. Understanding the context of your research question is essential before embarkingonanewtrial.
Mahesh: The term 'ethics' can be defined narrowly or broadly as necessary. For example,whenconductingaclinicaltrial,the obvious question is whether it will harm people. Therefore, an independent panel needs to evaluate the balance of risk versus benefit, as the person conducting the trial is likely to emphasise its benefits. Another aspect is whether people feel coerced into participating, maybe via financial incentives or fear. The doctor-patient or healthcare professional-patient relationship creates a power hierarchy, and patients might feel obliged to participate, fearing that refusal could affect the care they receive. This indirect pressure can make individuals feel obliged to participate even if it goes against theirbeliefs.
Large clinical trial companies or pharmaceutical firms might offer financial inducements to participants, which can also prove problematic. Individuals who typically wouldn't have access to personal data will review patient notes, raising concerns about confidentiality. This potential for breach of confidentialityunderscorestheimportanceof ethicalreviewprocesses,which,thoughtimeconsuming, are essential to protect the integrityofthepatient-doctorrelationship.In clinical trials, stringent protocols are implementedtosafeguardpatientdatafrom unauthorised access or breaches. Only the clinicalteamresponsibleforpatientcarecan access identifiable patient information. Research teams, integrated within the clinical setting, undergo training identical to thatofclinicalstaff.
Identifiable data is only accessed when necessary. After uploading, the data undergoes meticulous de-identification (encryption), ensuringcompleteanonymityandsecurityinthestudydatabase.This processcomplieswithUKlaws,includingtheDataProtectionAct
Sara: Does the standardisation of legislation and uniform guidance by ethics committees aid in risk mitigation? How do you handle toughconversationswithpatientsandtheirfamilies?
Jonathan: The process undergoes rigorous scrutiny. For example, when seeking regulatory approval for a Phase I clinical trial involving a new drug'sfirstdoseinacriticallyillpatientonaventilator,Iexpectextensive questioning about safety and preclinical data. The project will be reviewed by specific ethics committees and regulatory approval panels, such as those focused on paediatric patients, individuals with mental illness,andcriticalcareresearch.
Incritical care, weoftenenrol participants whocannot consent, suchas sedated patients on life support. We adhere to an ethical protocol to enrolthesepatientsandseektheirconsentafterrecovering.TheUKhas robust guidelines and a strong track record for ethical conduct of researchinvolvingsuchvulnerablepatientgroups.
Engagingwithpatientsisessential.Oncearesearchquestionisidentified andexistingevidenceisreviewed,thenextstepispatientinvolvement.In theUK,weexcelinpatientandpublicengagementandinvolvement.We collaborate with patient groups who have undergone similar care pathways to co-design clinical trials and apply for funding with their input. This partnership helps us understand patients' questions if approached to join a clinical trial. This engagement is crucial to designing a clinical trial. It is carried out in tandem with consultations withstatisticiansandhealtheconomists.
Mahesh:Anessentialcomponentofourapprovalprocessistheprovision of a detailed information leaflet that outlines all potential risks, regardless of their severity or frequency. This leaflet must be given to participants well in advance, allowing ample time for them to read, understand, and consider the information. They should also have the chance to ask questions before agreeing to participate and signing the consent form. This is known as the informed consent process, a cornerstoneofethicalconductofresearch.
In our projects, dedicated teams are trained to assist participants throughtheinformedconsentprocess.It'sunacceptabletoasksomeone to join a study on short notice, as this could exert undue pressure. Participants must receive the information leaflet at least 24 to 72 hours beforehand. The leaflet includes contact details for any questions they may have. Only after a thorough review and consideration should participants sign the consent form. This ensures they are fully informed andwillingtoconsent.
Sara: In the context of the UK, what additional safeguards should be implemented to protect vulnerable individuals, such as those with cognitiveimpairments,duringtheirparticipationinclinicaltrials?
Jonathan: In the ethics application process, researchers must articulate precisely how their experimental design deviates from standard care for patientswithaspecificillnesswithinthehealthcaresystem.Thisinvolves specifying every alteration, such as additional blood pressure management, new questionnaires, blood sampling, or extra diagnostics like X-rays. Each deviation must be justified with a solid evidence-based rationale, weighing its benefits against any potential burdens for the patient. Ethics committees are crucial in evaluating these justifications, ensuring that proposed changes are proportionate to the study's objectives and do not unnecessarily burden participants. This approach aims to streamline clinical trials by gathering essential data while minimising unnecessary data collection, thereby optimising efficiency in researchpractices.
Wiktoria: When an established drug is proven effective for a disease under study, would it be ethically justified to incorporate a placebo into the trial design?
Jonathan: When evaluating a new drug, the ethical consideration for using a placebo arises. Typically, comparing the latest treatment with the established one or in other words, comparing the added benefits of using the new drug against standard care only would be the standard approach under these circumstances. Placebostraditionallycomeintoplaywhen noexistingtreatmentexistsforthestudied condition. However, there is a shifting perspective on the necessity of placebos, especially given their high costs and the logistical challenges of blinding participantsandassessorsintrials.Theycan be costly and might not always be essential, especially when blinding is feasible among patients, assessors, and statisticians.
Wiktoria: Do the participants have any entitlement to access this proven treatmentoncethetrialhasconcluded?
Mahesh: When conducting a clinical trial, ourgoalistodemonstratetheeffectiveness of a drug in achieving specific outcomes. However, even if the trial shows promising results, we cannot immediately implement widespreadchangesinmedicalpractice.In the United Kingdom, a structured process followstoensurethatanynewtreatmentis notonlyeffectivebutalsosocially/culturally viable, and economically viable or cost effective. This decision-making process is overseen by the National Institute for Health and Care Excellence (NICE). This additional rigorous evaluation ensures that broaderconsiderationsofeffectivenessand acceptability in the healthcare landscape and inform decisions regarding new treatments.
Jonathan: In academic research, particularlyinclinicaltrials,evaluatingcosteffectiveness often involves considerations beyond the trial's immediate objectives. As researchers, our primary focus is designing and conducting trials to evaluate treatments and report outcomes. Whether a treatment merits public funding falls under the purview of external bodies such asNICE.
JIn commercially funded research, especially in critical fields such as cancer or rare degenerative diseases, contractual agreements often govern interactions between participants and drug providers. For instance, in double-blind randomised controlled trials (RCTs), participantsmayreceiveeitherthetreatmentoraplacebo.Supposethe treatment proves effective and is approved. In that case, participants whoreceivedtheplacebomightbeabletoreceivetheactivetreatment first. These potential benefits must be agreed before-hand and are carefully regulated under ethical and contractual guidelines, including participants consenting to receive trial updates and treatment alternatives.
However, providing treatments post-trial raises ethical and scientific complexities, potentially compromising the trial's blinding. Despite these complexities, such practices aim to balance scientific integrity with providing potential benefits to participants engaged in pivotal researchefforts.
Sara: When the vaccine was developed in high-stakes situations like the global COVID-19 pandemic, would it typically undergo a clinical trial under normal circumstances? How do we uphold efficacyandethicalstandardsduringsuchcriticaltimes?
Jonathan: During the COVID-19 pandemic in the UK, all trials on vaccines and new treatments strictly followed standard practices and regulatoryprotocols.Despitetheurgencyofthepandemic,allnecessary stepswerefollowedwithoutcuttingcorners.Thisfocusedapproachand a surge in eligible participants facilitated rapid advancements in our research. Despite the urgency of the situation to our knowledge, all regulatory approvals from bodies like the MHRA (Medicines and Healthcare Products Regulatory Agency) and HRA (Health Research Authority)wererigorouslyadheredto,ensuringtheintegrityandsafety ofthetrials.
The Medicines and Healthcare Products Regulatory Agency (MHRA) scrutinisesclinicaldrugtrials.Otherbodiesmaybeinvolvedinchanges in care pathways. Overall, the Health Research Authority (HRA) is the umbrella organisation for health research in the UK, integrated within NHS infrastructure. This structure supports a unified network of ethics committees,ensuringtheyadheretothesameguidelinesandlawswith similarcompositionsandoperatingpractices.
Mahesh:Infact,therewasconsiderablepressure,especiallywithcertain medications other than vaccines, to bypass the trials and proceed directly because of the urgency and fatal nature of the disease. A notable example is hydroxychloroquine. However, the UK generally resisted such pressures and adhered to the established processes and goodpractice.
Jonathan:Afteradministeringanewtrial,oneofourprimaryconcerns is monitoring adverse events to determine if any short- or long-term harmmayberelatedtotheirresearchparticipationortheirunderlying illness. We swiftly identified adverse events during the COVID-19 trials due to the extensive recruitment efforts and rapid vaccine administration. This resulted in rapid changes to the vaccine formulationtopreventrecurrence.Thisprocesswouldhavebeenmuch slower in traditional vaccine trials due to longer intervals between adverseevents.Despitecriticisms,particularlyregardingnow-withdrawn vaccines using older technology, our approach enabled us to establish thesafetyprofilemuchquickerduetothehighvolumeofparticipants involvedsimultaneously.Ithighlightsthatourresearchisn'tsolelyabout efficacybutalsofocusesonlong-termsafetyconsiderations.
Wiktoria:Howareparticipantsscreened to ensure their eligibility, mainly when testing a drug for multifactorial conditions?
Jonathan: We generally use a mnemonic called PICO (Population, Intervention, Comparison, Outcome) to guide the screening process for clinical trials. It's crucialtodescribethepopulationsampled foraclinicaltrialclearlyandtoensurethat itcloselymatchestheendpopulationthat might be prescribed the new diabetic drug.
For instance, in sepsis trials, there is no definitive diagnostic test. Instead, we rely on a set of inclusion criteria that patients must meet and exclusion criteria that would exclude them. Creating these criteria involves balancing broad and narrow definitions. A broad inclusion criterion might yield a diverse study population with high external validity, meaning the results widely apply to realworldsettings.Conversely,narrowinclusion criteria focus on a specific patient population, offering high internal validity (strength of the study results) but may be lessapplicableineverydayclinicalpractice.
Sara: How can researchers ensure that the selection of participants for clinical trials is fair and unbiased, representing thediversityofthepopulation?
Jonathan: From an NHS perspective, ensuring fair and unbiased participant selection in clinical trials is crucial. Our policy is that every patient who enters our facilities is given the opportunity to be included in appropriate trials. We conduct comprehensive screenings daily, from MondaytoFriday,particularlyintheICU,to identify eligible participants without discrimination.Wemakeaconcertedeffort toavoiddiscriminationofanykind.
For instance, if participant information sheets are only available in English, are lengthy, and require a high reading level, individuals who are non-native English speakers or have lower literacy levels may be excluded. Similarly, suppose follow-up procedures require participants to return tothehospital.
However, they cannot do so due to distance or lack of transportation. In that case, these participants are effectively excludedfromthestudy.
Mahesh: Moreover, when the study is written up as a report or formal paper, the results section typically includes a detailed description of the study population. This description typically includes details such as the mean or medianage,theagerange,andvarious demographic characteristics. Comparing the study population's demographics to the general population. This practice helps control for demographic variables and ensures that the study's findings are accurately contextualised.
Sara: Could you explain how the integration of machine learning and deep learning might improve the success rate of clinical trials if implementedsuccessfully?
Jonathan: AI has immediate potential to enhance the efficiency and costeffectivenessofclinicaltrials.Forinstance, electronic patient records (EPRs) already streamlinepatientscreening,automatically identifying eligible candidates based on specificcriterialikeantibioticprescriptions for infections. This automation saves time andlabour.Additionally,AIcouldfacilitate faster data transfer and transcription, furtheroptimisingtrialprocesses. Moreover, AI could facilitate data management and transfer improvements, further optimising trial operations. However,challengesremain,particularlyin integrating and harmonising data across different healthcare settings and regions. Current data systems are not yet fully interconnected at the level required for comprehensive analysis and personalised decision-making.
Looking ahead, younger generations of healthcare professionals may increasingly relyonAIatthebedsidetoinformclinical decisions.Yet,AIisunlikelytoreplacethe human element of patient care, which involves nuanced decision-making and compassionate communication with patients and families. As such, while AI offerspromisingadvancements,itsrolewill complement rather than replace healthcare professionals in delivering patient-centredcare.
Mahesh: Throughout history, every technological advancement has sparked fear and anxiety about potential disruptions and consequences. Artificial intelligence (AI) is no different. The consensus is that AI holds immense potential benefits but also risks causing harm. Like any technology, its outcomes depend on how humanity chooses toutiliseit,andtheregulatoryframeworksput inplace
Sara: How can we ensure patient data protection amidst concerns about AI's susceptibility to cyberattacks and other securityrisks?
Jonathan: Within the UK healthcare infrastructure, NHS digital plays a crucial role. Suppose we can effectively harmonise data acrossdifferentplatforms.Inthatcase,wecan achieve labour-saving efficiencies in the short term, with long-term benefits expected from harmonising data across different NHS platforms. However, as you have pointed out data security is important and is an absolute priority for the NHS. Several systems are in place in our own Trusts, Universities and the wider NHS to ensure data security. Specialist unitsandexpertsareemployedtoensurethat all precautions are in place to protect the integrity of data, and these systems are subject to regular audits and checks by internalandexternalauthorities.
The Editorial Team and the writers would like to thank Professor Niroshini Nirmalan for her assistance with establishing a connection with the featured collaborators forthisarticle.
TOPICS IN BIOMEDICINE
BY EGHOSA ENORIOMWANIHA
Abstract
Recreationaldrugsaremainlyusedbyyoungpeopleandtheyarelegalandillegalsubstancestaken byindividualsforpleasureratherthanmedicalpurposes.InEngland,themostusedrecreationaldrug is cannabis among other drugs including cocaine, codeine, ecstasy, alcohol, and nicotine. Recreationaldrugscanhaveanegativeinfluenceonmen’sspermbyreducingitsqualityandhaving an impact on male hormones like testosterone which is necessary for the regulation of the male reproductive system. There are limited studies on the effects of recreational drugs on sperm but there is evidence that demonstrates the negative influence of these drugs on sperm and the male reproductive system. It also relates to health ethics and parental responsibility as it can have a negativeimpactontheirfuturechildrenleadingtotheimportanceofinformingthepublicaboutthe consequencesofrecreationaldrugsonthemalereproductivesystem.
WhatareRecreationalDrugs?
Recreational drugs are legal and illegal substances taken by individuals for pleasure rather than medical purposes⁸. They are mainlyusedbyyoungadultsforreasonssuch as curiosity on the drug’s effect on their wellbeing by making them feel happy or relaxed,ortohelpthemtoforgetabouttheir personal problems or circumstances⁹. One study reported that 9.5% of the population aged16to59(around3.1millionpeople)and 17.6% of individuals aged 16 to 24 (about 1 million individuals) disclosed using drugs at some point in the year that ended in March 2023¹⁵ .
Therearemanydifferenttypesofrecreational drugs, but the most common drug used in Englandiscannabis.Researchshows15.4%of those in the 16–24 age group and 7.6% of those in the 16–59 age group confirmed that they consumed the drug at some point in theirlife¹⁵.Someotherexamplesofcommon recreational drugs include cocaine, codeine, ecstasy,alcohol,andnicotine.
Theeffectsonrecreationaldrugsonsperm
Many people are not aware that apart from the negative effects previously mentioned, recreational drugs can also influence men’s sperm by reducing its quality which could leadtofertilityissuesinthefuture.
Recreationaldrugshaveanegativeimpact on hormones such as testosterone, luteinizing hormone (LH), gonadotropin releasinghormone,andfolliclestimulating hormone(FSH)whicharenecessaryforthe effective regulation of the male reproductivesystem,leadingtochangesin thespermatozoaandmalefertility¹².
Cannabis
Studieshavedemonstratedthattheuseof cannabis, which is also known as marijuana,islinkedtotheinhibitionofLH, FSH and testosterone levels in the bloodstream⁷. Researchers observed that men who smoked cannabis more than once a week suffered from lower sperm concentrations, total sperm counts, motile sperm percentages, and morphologically averagespermpercentages⁶.Regularuseof cannabis, more than once per week was associated with a 28% decrease in sperm concentrationanda29%decreaseintotal sperm count, according to a Danish study²⁰. However, research found that gradually stopping cannabis use can reduce these effects, so this is possibly reversible. Based on the study's findings, men who quit smoking cannabis for 77 days produced sperm that lacked most of the known alterations that were evident duringtheiractivecannabisusage¹³.
Cocaine
Frequent cocaine use has been associated with lower sperm mobility and concentration as well as a rise in the percentage of sperm with abnormal morphology⁷. Both short-term and long-term cocaine usage damages the ultrastructure of the testes and reduces spermatogenesis. Cocaine triggers cell death, vacuoles, and lipid droplets, which instantly interrupt spermatogenesis and tubule formation⁷.Menwhohadusedcocaineforfive years or longer were twice as likely to have poor sperm motility, according to research conducted on male patients at a Yale infertility clinic⁴. The limited information available on how cocaine affects spermatogenesis is obtained from research conducted on animals found that rats that weregivenlargedosesofcocainehadreduced seminiferous tubule dimensions and a lower likelihoodofpregnancy¹⁸
Although some effects, primarily decreased motility, are still observed, research indicates that relatively low dosages of cocaine are unlikelytohaveanenormouseffectonsperm quality²¹. Additionally, some evidence indicates that the alterations are temporary, restoring to normal sperm quality once the useofcocaineisstopped²¹.
Codeine
While codeine has been demonstrated to increase male libido and sexual activity, It may also significantly lower copulatory efficiency and reproductive indices¹. Longterm codeine usage has been demonstrated to result in testicular degeneration, reduced sperm quality, and the development of oxidative sperm DNA damage and apoptosis⁷ Itwasdiscoveredthatat4mg/kgb.w.,codeine caused a 25% and 30% reduction in sperm plasma membrane integrity in 30 and 60 minutes, compared at 10 mg/kg b.w., which caused a 35% and 42% decline in 30 and 60 minutes². These findings indicated that the poor membrane integrity observed with codeineusewasdose-dependent².
Ecstasy
The effects of ecstasy were investigated in animal research, which revealed an increased incidenceoftubulardegeneration,damageto sperm DNA and interstitial oedema in the testes, although sperm motility and morphology were unaffected on all tested levels⁴
Alcohol
Alcohol use has been associated with sexual dysfunction, which has been linked to male infertility. This includes issues with arousal anddesireaswellaserectileandejaculatory impotence.Ithasbeenshownthatpersistent and excessive alcohol use decreases the levels of gonadotropin and testosterone in the blood, shrinks the testicles, reduces sperm production, and causes low sperm quality⁷. When compared to males who consumed 1-4 units per week, it was found that men who usually consumed more than 40unitsperweekhada33%declineinsperm concentration¹⁰
Alcohol consumption has been linked to impairment of the majority of semen parameters, despite no consistent doseresponse pattern¹⁷. Infertile patients in the "daily drinkers" group had poorer semen quality and hormonal characteristics in comparison to all other groups, according to the same study's results. Also, couples where the male drank over 20 units of alcohol a week had a noticeably longer time frame beforegettingpregnant¹⁷.Evidencesuggests that alcohol abstinence can facilitate rapid changes in sperm quality, shown by the return of normal semen parameters within threemonthsoftheabsenceofalcohol¹⁹
Nicotine
One of the most harmful components in cigarette smoke is nicotine. There have been concerns about its impact on the male reproductive system as it was found that nicotine reduced the number of spermatocytes and spermatids³. Because the testes are affected by cigarette smoke, continuousexposuretoitchangestheshape of spermatogenic cells and interferes with spermatogenesisandspermproduction,allof which directly contribute to male infertility³. In addition, testosterone, pituitary gonadotropins, and the antioxidant status of the testicles are all altered by nicotine. Research revealed that the density of sperm in smokers was 13%–17% lower compared to nonsmokers¹¹.
Testicular damage was also demonstrated in another study involving male rats, where the higherlevelsofreactiveoxygenspecies(ROS) produced by nicotine targeted the polyunsaturated fatty acids (PUFA) in the testes membrane, eventually resulting in the impairment of testicular function and structure³.
Thismeanslowspermqualitycausedbynicotineinduced oxidative damage could be the cause of the structural damage to the testicles and an impairmentofthetestes'normalfunction.
Any male who stops smoking at least three months prior conception will have better sperm withahigherpossibilityoffertilisinganegg.This means that quitting smoking can reverse its effectsonsperm²².
How do recreational drugs and its effects on spermrelatetoethics?
Individuals who take recreational drugs often believe that there are no negative effects from regular use or that the effects do not have any major consequences¹⁴. Although it is known that there are limited studies on the effects of recreationaldrugsonspermandfertilitybecause of ethical concerns and insufficient reporting of the problem, there is still strong evidence that demonstrates that using recreational drugs can haveanegativeinfluenceonspermandthemale reproductivesystemingeneral¹⁸ .
From an ethical standpoint, recreational drugs have an impact on sperm quality which influences the chances of conceiving and giving birth to healthy children apart from causing issues in men’s reproductive health¹⁸. Equally, in terms of parental responsibility, future fathers should responsibly prevent unhealthy behaviours like recreational drugs that could cause their future children to face developmental or overall healthissuesduetothespermquality¹⁶
Recreational drug usage can cause problems in the future because the parent might not be able to give their child a safe and healthy environment. The reason behind this is that drug usage may eventually make it difficult for a parent to provide for their child's necessities and could cause doubt on their ability to keep their childsafe⁵
Everyone should be informed and aware about the risks and consequences of these and its impact on fertility and child health. This demonstrates that it is ethically necessary to inform the public about the harmful consequences of recreational drugs on the reproductivesystembyputtinginplaceinitiatives and raising awareness to reduce its incidence. This also leads to ethical issues concerning informedconsentduetothelackofpublichealth education as individuals cannot make the right decisionduetonotbeingappropriatelyinformed about the risk of recreational drugs on their own healthandthehealthoftheirunbornchild⁴
References
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Ajayi, A. F., & Akhigbe, R. E. (2020). Codeine-induced sperm DNA damage is mediated predominantly by oxidative stress rather than apoptosis. Redox Report 25(1), 33-40. https://doi.org/10.1080/13510002.2020.1752003
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Budin, S. B., Kho, J. H., Lee, J. H., Ramalingam, A., Jubaidi, F. F., Latif, E. S., Zainalabidin, S., Taib, I. S., & Mohamed, J. (2017). Low-dose nicotine exposure induced the oxidative damage of reproductive organs and altered the sperm characteristics of adolescent male rats. The Malaysian journal of medical sciences, 24(6), 50-57. https://doi.org/10.21315/mjms2017.24.6.6
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17. Schifano, N., Chiappini, S., Mosca, A., Miuli, A., Santovito, M. C., Pettorruso, M., Capogrosso, P., Dehò, F., Martinotti, G., & Schifano, F. (2022). Recreational Drug Misuse and Its Potential Contribution to Male Fertility Levels’ Decline: A Narrative Review. Brain Sciences, 12(11).
Sansone, A., Di Dato, C., de Angelis, C., Menafra, D., Pozza, C., Pivonello, R., Isidori, A., & Gianfrilli, D. (2018). Smoke, alcohol and drug addiction and male fertility. Reproductive Biology and Endocrinology, 16(1), 3. https://doi.org/10.1186/s12958-018-0320-7
18. Sermondade, N., Elloumi, H., Berthaut, I., Mathieu, E., Delarouzière, V., Ravel, C., & Mandelbaum, J. (2010). Progressive alcohol-induced sperm alterations leading to spermatogenic arrest, which was reversed after alcohol withdrawal. Reproductive BioMedicine Online, 20(3), 324-327. https://doi.org/https://doi.org/10.1016/j.rbmo.2009.12.003
19. Srinivasan, M., Hamouda, R. K., Ambedkar, B., Arzoun, H. I., Sahib, I., Fondeur, J., Escudero Mendez, L., & Mohammed, L. (2021). The Effect of Marijuana on the Incidence and Evolution of Male Infertility: A Systematic Review. Curēus, 13(12), e20119. https://doi.org/10.7759/cureus.20119
22.
20. Testhim. Cocaine and Male Fertility. https://testhim.com/news/lifestyle/cocaine-and-male-fertility 21 YourFertility. (2018). Smoking. Retrieved 11/09/2024 from https://www.yourfertility.org.au/everyone/drugs-chemicals/smoking
TOPICS IN BIOMEDICINE
Challenging the Physiology We See in Film
BY SARA ALNASIR KASSAM
Sara:First,wheredidyougettheinspirationfor this module? As in, why teach Physiology throughfilm?
Áine: I've been teaching a module in integrative physiology for about 20 years. I developed this module because students often tend to think about different physiological systems in isolation, andcanstrugglewithbringingdifferentaspectsof physiology together and thinking about how the bodyworksasawholeintegratedorganism,which is the key to Physiology. I put a module together where students would look at broad questions or case studies that would challenge them to integrate their entire knowledge of physiology. In recent years, I started bringing questions about filmintothemodule.
I was inspired by Professor Mike Tipton, a brilliant physiologist who works on the Physiology of extreme environments. He mentioned to me that he was the physiology consultant on the film ‘Everest’. He's got a brilliant lab in Portsmouth where researchers can model extreme environments, different atmospheric pressures, temperatures, etc. And he actually had the actors fromthefilmintheretosimulatetheexperienceof being at altitude to help their performance. And first of all, I thought, what a cool thing to do. And second, I thought that would be a fascinating integrative-typequestion.
Through this approach, the students watch films that I assign to them and think about what would actually happen physiologically in those situations and also whether the portrayal makes sense to themasphysiologists.
Idevelopeditsothatthefilmquestions are done by the students at the last stage of the module, and they present their findings via individual oral presentations. It's getting them to think about integrating physiology in a differentandfunway.
Sara: What was your students' consensuswhenyouaskedthemhow they found this particular way of learning physiology? What was their responsetoit?
Áine: Yeah,theyloveit.Isurveyedthem and made a word cloud of their responses; the word that came up most often was "fun". The students prepare really good PowerPoint presentations and often put in little clips and diagrams.Ithelpedthemtothinkabout Physiology from a different angle. Some of them did believe that it was a lot of fun, but maybe they didn't learn as muchastheydidfromsomeoftheother sessionsthatwerealotmorestructured. But generally, they like it as a way of finishingoffthemodulewithsomething abitdifferent.
Sara: Let's talk about your talk at the Physiological Society meeting at Salford. It was titled 'What Volume Is Ryan Reynolds?'. I read that title in the programme book and asked, "Hang on a minute, why are we talking about Ryan Reynolds?" Can you tell our readers the storybehindyourtalk?
Áine: Yeah. I have great fun when trying to think of new films every year. Physiology encompasseseverything,andtherearealotof movies that concentrate on particular diseases, for example, while some focus on extreme events. Buried is one of them. Buried is about an American in Iraq who gets kidnapped for ransom, and he gets buried aliveinacoffin.Hewakesupinthecoffinand only has a phone that he can use to communicate with people. But the film is doneinreal-time,over90minutes-youspend 90 minutes with him in the coffin. So, the challenge for the students is to ask if the portrayal of what's happening to him is accuratephysiologically.
Figure 1: Photograph of Professor Kelly’s student, presenting her talk titled “What Volume Is Ryan Reynolds?”, duly inspiring Prof Kelly’s talk at The Physiological Society meeting at the University of Salford in May 2024. Photo Credit: Professor Áine Kelly.
Sara: Do you think Physiology is depicted accuratelyinfilms?
The title for the talk came from the title of a slide that the student who studied that film last year included in her presentation (Figure 1). It was, "What volume is Ryan Reynolds?" becausesheneededthatinformationtofigure out how long his oxygen would last, when he would get hypoxic and when is would be hyperventilating and so on. So she calculated, the volume of the coffin and how much air would be in that? But it's not just air because Ryan Reynolds displaces some of the air. So, whatvolumeisRyanReynolds?Whenyoutake him into account, how much air is there and howmuchoxygenisthere?
Spoiler alert: in the film, Ryan Reynold’s character dies because the coffin collapses, and sand comes inside and suffocates him. But according to her calculations, he should have been unconscious within an hour and therefore the film couldn't have been 90 minutes long. But that's just according to her calculations - the class then had a discussion to determine whether we thought her conclusionwascorrect.
Áine: I think it depends. Some films do it better than others. Everest did it very well because they gotMikeonboardasanexperttodiscussthings. Sometimes, some aspects of Physiology are depictedwell,butnotothers.So,forexamplethe reactions to changing temperatures, activation of the sympathetic nervous system, etc. Sometimes, thesethingsareplotdevicesifyoulike,andother times the film is trying to depict something real. Some of the films I chose are based on real-life events,andagain,theextremePhysiologyonesare usuallythecoolest.Wecancompare127Hoursand Titanic, for example. In some films, they try to depictthePhysiologywell,becausethattellspartof the story or helps to tell the story. Sometimes it's justsortofanincidentallittleplotpoint.
Sara: If we were to look at general public education of physiology using films, would these depictions be ethical, with the potential oftheassumptionthatthephysiologydepicted iswhollyaccurate?
Áine:Themodulehasthrownupafewsurprising ethicalquestionsintheyearsI'vebeendoingthis.I thinkifthefilmmakersareportrayingadiseaseora real-life situation that people can find themselves in, an attempt really should be made to be accurate. If it's something like the HIV AIDS as depicted in Dallas Buyers Club or dementia or Parkinson’s Disease, that really does impact on people'slives,Ithinkthefilmmakersshouldtryto be as accurate as they possibly can in terms of depicting diagnosis and symptoms and drug treatmentsetc.
Áine:Ididn'taskthatthatquestiondirectly,but I would hope so. Hopefully they already have a lotofskillsandalotofknowledgebythatstage as the students who take this module are final year students. They can draw on a lot of knowledge in these discussions. I think it's important to think about things like ethics because science doesn't exist in a vacuum - it hastoapplytosociety.SoIthinkit'simportant that we think about these issues and how we usesciencetobettersociety.
I'vetriedtokeepthefilmsIchooserealistic.SoI haven't gone into zombie Physiology or superhero Physiology. You could go down that road in terms of what might be physiologically possible for humans above and beyond what's possibleforusnow.ButI'vesortofstayedaway fromthat.Imean,I'vetriedtokeepitwithinthe realms of realistic physiology, but that's not augmentedinanyway.
Sara: Do you think using films with augmented physiology could be something youwouldbewillingtoexperimentwith?
Áine: Definitely. I'd be interested to see what the students come up with because of course, inthis,thestudentsaretheoneswhodoallthe work! I just assign the films and then can sit back to see all the brilliant work they've done andhaveaninterestingdiscussionafterwards.
Sara: would you like to leave our readers with any final thoughts? Which films would you recommend, to help people learn about physiology? And what approach would you recommendtheytake?
Áine:IlikesomeoftheextremePhysiologyones like ‘127 Hours' or 'Buried'. That might not be everyone’scupoftea.Buteverywhereyoulook, there's Physiology. You can probably find some physiologyinanyfilm,aslongasthey'renotjust animations or something like that. If there are livingbeingsonthescreenandmovingaround intheworld,thenPhysiologyisthere.
Sara: Thank you so much, Áine. I loved learning about the inspiration behind your useoffilmtoteachphysiology.Thankyouso muchforjoiningmetoday.Iappreciateyour time.
TOPICS IN BIOMEDICINE
Uncovering Ethics In Bioscience
BY ANISE YOUNIS
Ethicsisarecurrentconversationinscience,withtheadvancementofnewtechnologies,cellularresearch and clinical trials, we find ourselves asking how well the population of service users are really protected. Nowadays, concerns arise about how well our privacy is being protected and how our consent and safeguardingisbeingprioritised.Whiletheadditionsofnewlawsandregulationsaimtoprotecthuman rights,theyraisetheall-importantquestionintheworldofbioethicsabouttheresponsibilityofscientists and institutions: How well can these organisations ensure the protection of service users while keeping pacewithnovelscientificinventions?
ThisarticlehadacontributionfromandhasbeenreviewedbyProfessorHarryWitchel,arenownedDoctor ofPhysiologyandNeuroscience,currentlyteachingatBrightonandSussexMedicalSchool.Bysharinghis expertise, he has provided a better understanding of ethics and decision making of scientists over time. TheEditorialTeamwouldliketothankProfWitchelforhistimeandexpertisethathehasshared.
Ethics through time
To understand the fundamentals of ethics and theevolutionoflawovertime,itisimportantto discuss prior civilisations where legal systems andmoralcodesnaturallydiffered.
Early descriptors of ethics
The birth of ethics comes from an era where humans began to reflect on what behaviours were in the best interest of life. According to the World History Encyclopaedia, the oldest known code of law was written by King UrNammu in 2100-2050 BCE a Sumerian king whopresented57lawstohispeople⁵.KingUrNammupresentedtheideathatthiscodewas written by the gods sharing ideas that all subjects are equal disregarding social status. Another early surviving document from the Egyptianssupportedideasofidealconductand societal behaviour for boys⁹. Arguably, this document only focused on how to achieve social favour and did not delve into ethics but conveyed ideas about not passing judgement andhowothersshouldbetreated.
Later on, around 350 BCE, Aristotle wrote describingthetheoryofNicomacheanEthicsas the nature of human actions derived from the concept of happiness³. The preface of the discussion highlights the difference in opinion surroundingthebestinterestformankindand how disagreement may be resolved. Ideally all of humankind would have the same ideals whereby the same morals and values are shared, in this way there would never be a difference in opinions and conflict would consistentlybeavoided.
Thishowever,isimpossible,thedifferencein culture, religious belief and social etiquette paired with the ability of man to have free will ensures there will always be differences in values. For instance, female genital mutilation (FGM) is considered the social norm in some regions of Africa, the Middle east and Asia¹¹. Most contemporary Western societies consider this practice highly unethicalpractice,asthisisaclearviolation ofhumanrightsforgirlsandwomen.Itgoes without saying that societies have their reasons for such practices, traditional patriarchal societies have associated the practice with coming of age in preparation formarriagetopreventfornicationandfoster fidelity¹¹. There are no religious scripts that advocate for the practice, but it is believed thatthereisreligioussupport.
The 13th century philosopher, Thomas Aquinas discussed that there exists two forms of law: an eternal law, which is an omnipotentGod'slawgoverningtheuniverse and a natural law which humans acknowledge through reason⁶. The idea that God ordains humans to ultimate happiness may, for certain groups of people, result in theadditionofpracticesthatarethoughtto please the God in which they follow¹. One canargue,FGMisanexampleofthis.
Many other ethically questionable practices learnt about in history result in the addition of new laws to prevent such disasters from recurring.
Past unethical disasters and their implications
It is apparent that rules are added to prevent the recurrence of historical mishaps and ethical disasters, mishaps that question the idea that decisions are made in the best interest of humankind- eugenics was the prime example. In the year 1883 Sir Francis Galton invented the term "eugenics", which was defined as the selection of desirable characteristics to better equip latter generations¹⁰. This term, which was initially accepted by scientists and political leaders, rapidly degenerated as a fundamental science after the Nazis used eugenics in an attempt to eradicate many groups of people (Jews, Roma, the disabled, homosexuals) who they viewed as undesirable for the human gene-pool². The publication by Kevles highlightsthepracticeofeugenicsfromthe1930s1970s in Sweden, where 60,000 people were sterilised in an attempt to prevent the number of infants born with genetic disorders. In many societiesthesepracticesweredrivenbyasuperiority complex of particular races over others. This gave lifetonegativeeugenics,thebeliefthatthequality ofthehuman-racemaybeimprovedbyeliminating ‘inferior’ people. That poses the question, who is allowed to decide which group of people are inferior?
In recent times there has been the abolishment of deep-rootedsocietalideas,thisisalltosaythatwe ashumansacknowledgeourbeliefisalteredbythe development and discoveries of new theories and ideas.
The Impact of ethical theories on novel science Variations of regulations and laws exist to protect patients in multiple ways with new regulations being implemented the moment a practice goes wrong – to prevent recurrence. The Centres for DiseaseControlandPrevention(CDC)alongsidethe FederationofStatemedicalboards(US),TheHealth and Care Professions council (UK) and even the United Nations are examples of organisations that work in the best interest to protect human rights and regulate the use of certain technology in scientific practice. Even with these heavy regulations what is currently deemed as unethical practicesstilloccurunnoticeduntilitisuncovered.
A 2018 report of the first gene-edited infants shocked the world of science and bioethics as we know it. Scientist He Jiankui was responsible for using clustered regularly interspaced short palindromic repeats (CRISPR) to alter the lives of twin girls. By disabling the C-C Motif Chemokine Receptor 5 (CCR5) which is a HIV co-receptor enablingtheentryofHIVintohostcells,Jiankuiwas abletomakethesechildrenimmunetoHIV4.Inthe UK, The Human Fertilisation and Embryology (HFE) Actprohibitstheinsertionofanembryoniccellwith an altered germline DNA into a woman. Similarly, the Chinese Ethics Guiding Principles for Research on Embryonic Stem Cells banned research of embryos in vitro 14 days after conception, and its implantationintoauterus⁸
Thisresearchfacedmuchglobalbacklashwithmanyscientistsinagreementthatthisactionwasnot morallyorethicallysound;frombirth,thelivesofthesechildrenaretheresultofascienceexperiment; however,theirlivesareatestamenttothefunctionalabilityofscientifictechnology.Finally,onecould argue that not intervening when it is known that quality of life could be greatly improved is not ethicallycorrect.
The new generation of scientists alongside established governing bodies are now responsible for decidinghownoveltechnologiesshouldbeimplementedinmodernmedicaltreatments.Asascientist or someone who can understand the gravity of some of these new advancements there are a few things to consider: Is it ethical to prevent the use of new technologies when it is certain they could considerably alter patient diagnosis and treatment for the better? Is it ethical to prevent the use of geneeditingincasesliketheoneabove,removingtheneedfortreatmentbypreventingthedisease? Orhassciencegonetoofar,andshouldthispracticebeprevented?
AquotefromEdwardOsborneWilson,Americansociobiologist,stated“Wehavepalaeolithicemotions, medieval institutions and godlike technology. It is terrifically dangerous and now it is approaching a point of crisis overall⁷.” How can we utilise new technology in a way that is not harmful to prevent unethicalmishaps?
References
1. Kevles, D. J. (1999). Eugenics and human rights. BMJ, 319(7207), 435. https://doi.org/10.1136/bmj.319.7207.435
Floyd, S. (n.d.). Thomas Aquinas: Moral Philosophy. Retrieved 30/10/2024, from https://iep.utm.edu/thomasaquinasmoral-philosophy/#H4
2. Kraut, R. (2022). Aristotle's Ethics. https://plato.stanford.edu/archives/fall2022/entries/aristotle-ethics
3. Lopalco, L. (2010). CCR5: From Natural Resistance to a New Anti-HIV Strategy. Viruses, 2(2), 574-600.
4. Mark, J. J. (2021). Code of Ur-Nammu. Retrieved 30/10/2024 from https://www.worldhistory.org/Code_of_Ur-Nammu/
5. New Advent. (1920, 2017). Question 94. The natural law. New Advent LLC. https://www.newadvent.org/summa/2094.htm
6. Oxford Reference. (2016). Edward O. Wilson 1929 - American sociobiologist. In S. Ratcliffe (Ed.), Oxford Essential Quotations (Vol. 4). Oxford University Press. https://www.oxfordreference.com/display/10.1093/acref/9780191826719.001.0001/q-oro-ed4-00016553
7. Raposo, V. L. (2019). The First Chinese Edited Babies: A Leap of Faith in Science. JBRA Assist Reprod, 23(3), 197-199. https://doi.org/10.5935/1518-0557.20190042
8. Singer, P. (2024). The history of Western ethics. Britannica. Retrieved 30/10/2024 from https://www.britannica.com/topic/ethics-philosophy/The-history-of-Western-ethics
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9. Wilson, P. K. (2024). Eugenics. Britannica. Retrieved 30/10/2024 from https://www.britannica.com/science/eugenicsgenetics
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World Health Organization. (2024). Female genital mutilation. Retrieved 30/10/2024 from https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation
Sustainable Development Goals - Sustainable Development Goals - Sustainable Development GoalsHumanising Science Beyond the Lab Humanising Science Beyond the Lab Humanising Science Beyond the Lab
BY JULIA CASSEROTI
The United Nations (UN) has developed 17 objectives to improve education, health and sanitation, poverty, hunger, etc. These objectives are called Sustainable Development Goals (SDGs). This article mainly focused on SDG 3, which promotes ideal health and well-being, where scientific contribution has been essential to its development. Nevertheless, barriers to poverty seen in Sub-Saharan regions have limited further advancements, requiring social protection programme investment through the government. Expansion of HIV treatments, such as Cabenuva, has reduced AIDS-related deaths by 50%, although eradication of social discrimination is essential to surpass the AIDS-related stigma present since the 1980s. An estimated 80% of women will be content with their reproductive health by 2030, for instance, due to the development of the HPV vaccine, which prevents cervical cancer. A drastic decline in vaccination is still observed, which calls for more efficient vaccination incentives. Lastly, the article focused on goal 12, highlighting the importance of replacing medical plastic with biodegradable materials such as starch to ensure a more sustainable and eco-friendly environment. In the next six years, economic and socio-protective regulations will be needed asastartingpointfortheSDGtargetstobepossibletoreachby2030.
Alothasbeendiscussedrecentlyabouta more sustainable future and its vital importance within society. Nevertheless, what is sustainability, and how can we achieve it? Sustainability is a broad term encompassing social, political, environmental, and economic interconnectionsandintegrationstocome to fruition⁷. It is the knowledge of sustainability’s promise and capacity for transformationtowardsanidealqualityof life that confronts and tackles current globalchallengessuchaspoverty.Thishas becomeofinteresttoUnitedNations(UN) members, who want to explore and establish sustainable development goals (SDGs) to achieve this. The 17 sustainable development goals and 169 targets were created in September 2015 at a sustainable development conference held in Rio de Janeiro, with aims to improve factors such as education, health and sanitation to ensure the same standard quality globally, eradicate poverty and hunger and promote world peace by 2030⁴.Withjustsixyearsto2030,howfar areweachievingthesegoals?Whatarethe scientific research contributions towards theattainmentofthesegoals?
Asithasemergedinbiomedicalscience,it is our core interest and need to keep abreast of goal three of the SDGs, which refers to promoting good health and wellbeing¹¹. According to the 2023 SDGs progress report by the United Nations, we canobserveconsiderableprogresstowards goalthree.Forinstance,itisreportedthat among members of the UN, 73% have fought or are working to reduce the mortality rate among children under five, fulfillingobjective3.2.However,amongthe remaining 27%, approximately 4/5 of the countries are concentrated in the subSaharanregion,whichstandsoutasoneof the regions of extreme poverty globally. Perhaps the possible progress towards improvement would be correlated to goal one, which aims to eradicate poverty and raise the economy of such societies, thus promoting and ensuring improvement in health. Nevertheless, this reality seems distant when looking at the data reports from the UN, which estimate that 575 million people live in precarious situations and that this number will not improve unless governments invest more in social protection programmes for further progress¹².
Science has revolutionised the world and brought unimaginable benefits to society; its healthbenefitsarenoexception.Asmentioned, there are still changes that need to occur to ensure the promotion of ideal health and wellbeing globally. Even so, the substantial assistancescientistscanprovideinameliorating healthcare cannot go unnoticed. This can be evidenced, for example, through advances in HIV treatment, which, according to statistics from the United Nations, have reduced approximatelyhalfofthedeathsrelatedtoAIDS (advanced state of HIV) between 2010 and 2021¹². New HIV treatment, such as retroviral injections,madethisreductionpossible
TakeCabenuvaasanexample,whichinvolvesa combination of ART therapy drugs, Integrase inhibitors and NNRTIs that prevent viral replication⁵. The New England Journal of Medicinehasshownthistomaintainvirallevels at undetectable levels. This is beneficial in the prevention of HIV progression and transmission⁹-¹⁰. Despite such benefits, social discrimination and AIDS-related stigma have created barriers to access to treatment. The “badlabel”thatthenameAIDScarriesoriginate fromitsdiscoveryinthe80swhenitwascalled “gay-related immune disease”, which imposed shameoninfectedpeopleandhaslimitedtheir search for treatment, even to this day⁶. To seek progressinendingtheAIDSepidemicreported byobjective3.3oftheUN,itwillbenecessaryto impose stricter laws against discrimination, especially within the healthcare sector, and to implement cautious monitoring measures. This will be an arduous and laborious task, considering insufficient and unreliable data on discriminationacrosscountries².
Moreover, access to women's reproductive healthcare has positively increased, which will make it possible for approximately 80% of womentofeelsatisfiedby2030.Theinventionof the HPV vaccine is considered one of the revolutionary milestones in advancing female reproductive health. This vaccine helps prevent cervicalcancer,whichhasbeencommonamong women and is administered during early adolescence (ages 12-13) as a preventative measure. However,recentdatafromtheUnited Nations highlights the decline in childhood vaccination, estimating that 21 million children willnotreceiveessentialhealthvaccinesin2022. Despite the HPV vaccine being introduced in 67% of UN member countries as part of their immunisation campaigns, it covers only 15% of the population. Implementing health informationsystemsthroughtechnologycanbe crucial in increasing vaccination coverage13. Implementing health information systems through technology can play a pivotal role in increasing vaccination coverage. An article published in 2021 in the British Journal of Medicine has shown the effectiveness of SMS reminder messages in improving vaccination ratesinlowertomiddle-incomecountries.These quick,directmessagesenhancecommunication between patients and healthcare providers, making access to vaccination information more efficient³.
Sustainability is often linked to ecological sustainability, which seeks to guarantee the performance of human activities that respect the limits of the environment. Goal 12 of the Sustainable Development Goals (SDGs) considers the importance of sustainable material production, minimising waste, and usingeco-friendly,renewableresources¹².
In the daily operations of biomedical scientists, laboratories frequently use disposable materials, particularly plastics. Research shows that plastic accounts for approximately 30% of medical waste worldwide, with the UK producing 133,000 tonnes annually. This plastic waste in syringes, blood samplingtubes,andglovessignificantlycontributes to global warming by releasing greenhouse gases. Furthermore,exposuretocertainplasticshasbeen linked to cancers such as leukaemia and lymphoma¹.Giventheseenvironmentalandhealth concerns, it is crucial to implement measures to reduce plastic use in alignment with Goal 12. This can be done by utilising the three Rs of waste management: reduce, reuse, and recycle. For example, reducing plastic consumption can be achievedbyconvertingitsusagetoothermaterial sources. In the UK, plastic waste bins have been replaced by paper-based bins. Additionally, biodegradable plastics made from corn are a potential solution, though they may disrupt food supplies⁸ .
What can be concluded is that over the next six years,extensiveandarduousworkwillbeneededto achieve the SDGs, most of which will come from the government through economic and socioprotective measures. Significant advances have beenseeninthehealthcaresector,corresponding toSDG3,wheregradualimprovementisexpected. However, when observing global poverty indices related to SDG 1 and its tendency for nonimprovement, this raises concerns about the possibilityofitbeinganunachievablegoalforthe United Nations by 2030. It requires more difficult measurestoimplementandchangethanthosefor SDG12.
Cardiovascular research encompasses a vast array of challenges such as including the development of effective therapeutics and access to them, education about cardiovascular pathologies,andtheimplicationsofcost.Butwhatiftheproblemswearetryingtosolvecould beaddressedwiththeuseofartificialintelligence(AI)?ThisarticleexploreshowAIiscurrently beingutilisedinsomemedicalfieldsandiscontinuouslybeingimprovedforgreaterprecisionto aidinadvancementsinbiologicalunderstanding⁴ .
AI is technology that is used to solve problems by simulating human intelligence, allowing us to perform data handling in a morerapidbutaccuratemanner.Thiscanbe beneficial in diagnostics, therapeutics, and management of existing healthcare data, whichiswhatAIiscurrentlybeingusedfor.AI is an umbrella term which encompasses many subcategories. These include machine learning, natural language processing and rulebasedexpertsystems.
Machine learning uses data and algorithm analysis which allows learning without the need to explicitly program technology, fundamentally ascertaining new outcomes and performing complex tasks. Machine learningmodelsaretrainedtouselargedata sets including ECG data via techniques like parallelisation6. This involves integrating a variety of methods such as specialised algorithms, workload split across generators andutilisinggraphicsprocessingunits(GPUs), effectively, combining these techniques together improve the efficiency, speed and accuracy of large datasets and provide high sensitivity and specificity. The specialised algorithms used are specifically designed to carryoutthoroughanalysisandthesoftware trainsthemachines.
For example, within a study using unsupervised learning, the machine was trained without ECG recordings and is trained in annotations performed by cardiologists that would be used in recordings and identifying cardiovascular conditions like arrythmias. Unsupervised learning utilises clustered input which effectively groups similar datapoints togetherandcanthenlearnbasedonthe annotations for when scanning through ECG datasets. AI is also trained through deepconvolutionalneuralnetworkswhich scan through data and predict clinical outcomes,andthiscanbeappliedtoECG datasets to predict conditions such as left ventriculardysfunction¹-².
Natural language processing is when technology is used to generate language and uses data for computers to comprehend linguistics and interpret this information. Rule- based expert systems exploit data using a set of rules to determine decision-making and employ logicalreasoningtoexecuteoutcomes.
CurrentlyongoingstudiesusingAIinareas of cardiovascular research, diagnosis and therapeuticsarebeingdeveloped.
Onemajorstudyhasinvolvedthediagnosisof an asymptomatic left ventricular dysfunction (ALVD).ALVDisatypeofheartfailureresulting inreducedbloodflowthroughtheleftventricle leading to loss of contractility, ultimately progressingtochronicheartfailure.AIwasused withinthestudyviaanelectrocardiogram(ECG) to determine patient risk of developing the diseasewithinasymptomaticpatientsandhad high levels of accuracy, thus delivering beneficial outcomes within cardiovascular diagnosis.
AI can however pose algorithmic bias and unintentionally propagate health disparities duetobiasedtrainingindatasets.Forexample, racial bias was observed in the US when additional healthcare needs wrongly underestimated over 50% of black patients were not in need⁹. This bias presented major biasduetohealthcareinequalityandprioritised healthcarecostsratherthanhealthcareneeds. Using AI across various demographics could open the possibility of data collection bias whetherthisbesamplingormeasurements,for example⁸. This may occur in countries with lower socio-economic status as access to healthcarefacilitiesmayalreadybescarceand the patient data used may not be representativeoftheentirepopulation,creating disproportion in how the algorithms generate outcomes. Meanwhile, measurement bias is another potential risk that may arise and has been observed in a study where men were given more lipid lowering medications than womenduetocardiovasculardiseaseriskbeing higher statistically in men⁵. Many examples of biasfromAIdatacanariseandtherefore,itis advantageous for a global effort amongst clinicians, governments, and healthcare institutions to work collaboratively to harness thebenefitsthatAImodelscanachieve.
Another study where AI has been used in cardiovascular research has been in atrial fibrillation (AF) diagnosis where the sensitivity ratewas82.3%andspecificityratewas83.4%². AFanirregularityandrapidheartrhythmthat canleadtoothercomplicationssuchasstroke, heartfailure,andothercardiopathies.
AF is a common cardiopathy, often asymptomatic and underdiagnosed. The study used machine learning to shed a light on identifying patients in ECG recordings. Moreover, other studies have shown AI modelling to be highly feasible in cardiovascular magnetic resonance imaging with predication of cardiovascular function in acutemyocardialinfarctionpatients³.Thestudy performedaclinicaltrialwhichhadshownthat with multivariable modelling, outcomes for diagnosisandassessmentwithp-values<0.0010.0048. Therefore, AI enhances the diagnostic accuracy,andthesestudiesareamongstmany othercardiovascularstudiesusingAImodelling which have obtained significantly higher sensitivityandspecificityratesthanwithclinical only input⁷-¹⁰. AI clearly shows increased accuracy and can identify cardiovascular abnormalities that may be unnoticed by humanjudgementandintelligence,butithas itslimitations.WhenusingAIwithinhealthcare systems, informed consent tends to be compromised due to the complexity of platformsharing.Thereisnotalwaysawayto mitigate lack of informed consent in some scenarios. For example, a patient may be entirelyunawareofwhatAIisandmayreceive proposed treatment for preventing embolic stroke by utilising AI to analyse patient data. This also raises ethical considerations around theclinicalefficacyofAIalgorithms.Howlikely it is that the situation be misjudged, and will patientsbegivenunnecessarytreatments?
When contemplating the use of AI, legal and regulatory requirements are standard in validating the models for healthcare use. Regulatory bodies such as the Food and Drug Administration (FDA) have provided additional guidance for AI to be used within medical deviceswhichincludeshavingapremarketing reviewtoreflectonanymodificationsthatmay needtobemadeandtoriskassesstheimpact onthepublic¹².Theadditionalguidanceistobe utilised alongside with the traditional framework for regulation of medical devices. The legal implications of AI include privacy of data,intellectualpropertyrights,accountability, transparency,andalgorithmdisgorgement.
Attia,Z.I.,Kapa,S.,Lopez-Jimenez,F.,McKie,P.M.,Ladewig,D.J.,Satam,G.,Pellikka,P.A.,EnriquezSarano,M.,Noseworthy,P.A.,Munger,T.M.,Asirvatham,S.J.,Scott,C.G.,Carter,R.E.,&Friedman,P. A. (2019). Screening for cardiac contractile dysfunction using an artificial intelligence–enabled electrocardiogram.Naturemedicine,25(1),70-74.https://doi.org/10.1038/s41591-018-0240-2
2. Backhaus, S. J., Aldehayat, H., Kowallick, J. T., Evertz, R., Lange, T., Kutty, S., Bigalke, B., Gutberlet, M., Hasenfuß, G., Thiele, H., Stiermaier, T., Eitel, I., & Schuster, A. (2022). Artificial intelligence fully automated myocardial strain quantification for risk stratification following acute myocardial infarction.Scientificreports,12(1),12220.https://doi.org/10.1038/s41598-022-16228-w
Attia,Z.I.,Noseworthy,P.A.,Lopez-Jimenez,F.,Asirvatham,S.J.,Deshmukh,A.J.,Gersh,B.J.,Carter, R. E., Yao, X., Rabinstein, A. A., Erickson, B. J., Kapa, S., & Friedman, P. A. (2019). An artificial intelligence-enabled ECG algorithm for the identification of patients with atrial fibrillation during sinus rhythm: a retrospective analysis of outcome prediction. The Lancet, 394(10201), 861-867. https://doi.org/10.1016/S0140-6736(19)31721-0
3. Gaetani,M.,Mazwi,M.,Balaci,H.,Greer,R.,&Maratta,C.(2024).Artificialintelligenceinmedicineand the pursuit of environmentally responsible science. The Lancet Digital Health, 6(7), e438-e440. https://doi.org/10.1016/S2589-7500(24)00090-6
4. Li, S., Fonarow, G. C., Mukamal, K. J., Liang, L., Schulte, P. J., Smith, E. E., DeVore, A., Hernandez, A. F., Peterson, E. D., & Bhatt, D. L. (2016). Sex and Race/Ethnicity–Related Disparities in Care and Outcomes After Hospitalization for Coronary Artery Disease Among Older Adults. Circulation: Cardiovascular Quality and Outcomes, 9(2_suppl_1), S36-S44. https://doi.org/10.1161/CIRCOUTCOMES.115.002621
5. Martínez-Sellés, M., & Marina-Breysse, M. (2023). Current and Future Use of Artificial Intelligence in Electrocardiography.JournalofCardiovascularDevelopmentandDisease,10(4).
6. Mohsen, F., Al-Saadi, B., Abdi, N., Khan, S., & Shah, Z. (2023). Artificial Intelligence-Based Methods for PrecisionCardiovascularMedicine.JournalofPersonalizedMedicine,13(8).
7. Nazer, L. H., Zatarah, R., Waldrip, S., Ke, J. X. C., Moukheiber, M., Khanna, A. K., Hicklen, R. S., Moukheiber, L., Moukheiber, D., Ma, H., & Mathur, P. (2023). Bias in artificial intelligence algorithms and recommendations for mitigation. PLOS Digital Health, 2(6), e0000278. https://doi.org/10.1371/journal.pdig.0000278
8. Obermeyer, Z., Powers, B., Vogeli, C., & Mullainathan, S. (2019). Dissecting racial bias in an algorithm used to manage the health of populations. Science, 366(6464), 447-453. https://doi.org/10.1126/science.aax2342
9. Singh, M., Kumar, A., Khanna, N. N., Laird, J. R., Nicolaides, A., Faa, G., Johri, A. M., Mantella, L. E., Fernandes,J.F.E.,Teji,J.S.,Singh,N.,Fouda,M.M.,Singh,R.,Sharma,A.,Kitas,G.,Rathore,V.,Singh,I. M.,Tadepalli,K.,Al-Maini,M.,...Suri,J.S.(2024).Artificialintelligenceforcardiovasculardiseaserisk assessment in personalised framework: a scoping review. eClinicalMedicine, 73. https://doi.org/10.1016/j.eclinm.2024.102660
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US Food and Drug Administration. (2024). Artificial Intelligence and Machine Learning in Software as a Medical Device. Retrieved 13/10/2024 from https://www.fda.gov/medical-devices/softwaremedical-device-samd/artificial-intelligence-and-machine-learning-software-medicaldevice#regulation
SALFORD SCIENCE
Ethical Implications of AI in Healthcare: An Introductory Piece
PROFESSOR ANDY
MIAH IN
CONVERSATION WITH ROBIN MEKVAN
The ethical implications of integrating Artificial Intelligence (AI) into healthcare have raised significant concerns. With the advancement of AI technology and its increasing integration into medicalprocedures,thereisapressingworryabout thepotentialforAIsystemstoperpetuateexisting biasesandinequalities.Thisconcernisrootedinthe possibility of unfair treatment of specific patient demographics,whichcouldworsenexistinghealth disparities.
In this interview, Robin Mekvan spoke with Professor Andy Miah, the Chair of Science CommunicationandFutureMediaattheUniversity ofSalford.ProfessorMiahalsodirectstheSciComm Space and leads the Metaverse Special Interest Group, along with overseeing the ENGAGEMENT FORUM that focuses on Community and Public Engagement. As the university's AI Ethics lead, he actively promotes responsible AI integration while advising global organisations on the ethical considerationsofemergingtechnologies.
Can you start by telling us a bit about your backgroundandbriefknowledgeintheethical implicationsofAIinhealthcare?
My background is in the ethics of emerging technologies. I have written about genetics, biotechnologyand,ofcourse,artificialintelligence. Recently, my focus has been on the gains associatedwithfurtherintegratingbiotechnology withdigitaltechnologiesandthisiswhereAIhas becomeamajorinfluence,butattheheartof everythingIdoarequestionsabouttheethical implication of recent technology. Some of my recentworkhasexaminedtheethicalimplications ofbrainimplants,forexample.Ihavealwaysbeen interestedintheboundarybetweentherapyand enhancement - when does technology take us beyond just repair into an entire range of capabilities? My research investigates the implicationsofthatethicallyanditispartofmy wider interest in how we think about our relationshipwithtechnologymoregenerally,how shouldhumanityusetechnology?Whatarethe limitsofthatuse?Whataretheconcernswehave aboutit?Additionally,howcanitallowustoalso evolve?Fundamentally,thesearequestionsabout how humanity can flourish and what makes a goodlife.
How do you think AI is transforming the healthcare industry? What are some of the most significant benefits and challenges that comewiththistransformation?
Wemustrecognizethatthehealthcaresector,to serve an increasingly aging population with increasing numbers of medical challenges, is entirely reliant on the technological efficiencies of artificial intelligence. If we want a healthcare servicethatisavailabletoeverybodyatthepoint of need, rather than dependent on private healthcare,thentheonlywaywecanservicethis need is by achieving greater efficiencies within the system. And those efficiencies operate on threedistinctlevels.
One is a human resource efficiency; how can we ensure that we have a workforce that is able to function effectively? Another is a technological efficiency; how can we make sure that the infrastructure that underpins healthcare is optimal for delivery? But the third one, and this for me, is the more critical one: how can we ensure there are data efficiencies within the system? And what we have seen over the last 15 years, with the rise of data driven economies, is thatcompaniesthathavethedataaremostable toprovidethebestservice.
However, if we progressively use third party companies to drive healthcare innovation as an infrastructure, then the risk to public health care is huge, as it has progressively diminishing capability, as more of that data is owned by a third party to whom we are now increasingly beholdentomakeanykindofefficienciesatall.
So, with all of this in mind, the role of artificial intelligence-whichstillisverymuchtreatedasa panacea for society – is huge and we need to ensure that public health provision can take a leading role in those developments. The impact of this technology is something that is already having dramatic consequences for healthcare andcreatingalotofoptimismforitsfuture.
What are some of the most pressing ethical concerns surrounding the use of AI in healthcare?Howdoyouthinktheseconcerns canbeaddressed?
Some of the more prominent conversations are about the disruption to the workforce. for example,in2020,theWorldHealthOrganization launched its first digital healthcare worker, an AI chat bot driven through a semi realistic avatar with which you could have a conversation about your condition. And it was quite a limited trial, but they wanted to see if it could supplement or even replace some of the existing healthcare provision.
You could argue that such examples potentially reducing the important nuances of good healthcare practice and risks losing some crucial elements, like the human touch. But you could also argue that, in fact, for many people, the current system of healthcare provision is not working very effectively. So, they wanted to explorewhetheritcouldbeamoreeffectiveway ofdoingthat.
A notable example is obesity. So, many parts of the world are experiencing an obesity crisis, and countries are reverting to drugs to address this problem, which is a model that many clinicians are concerned about. The general predisposition towards finding a drug to treat a problem is something that people are quite anxious about as a behavioural expectation. Yet, we have spent half a century driving treatments through pharmaceutical solutions, because of their efficiencies and we are now seeing this potential foraddressingobesity.Andwhilstthereisalotof complexity this subject, an appetite supressing drug seems like an innovative idea. However, we might also apply AI to understand the complex behavioural characteristic of problematic eating, and this could be helpful to many people to assist in their weight loss, without needing to resorttodrugs.
More generally, the ethical implications associated with AI derive in healthcare relate to the impact on the healthcare sector. AI will undoubtedly transform the workforce in a huge way, but that does not necessarily mean a reduction. If you look at the World Economic Forum,itpublishedareportacoupleofyearsago which argued that eighty-seven million jobs are in jeopardy because of AI, but ninety-five million jobsarelikelytobecreatedbyAI.So,onbalance, itislikelythatwewillhavemorejobsratherthan lessjobs.
But what you need to do is make sure that you can transitionpeoplefromtheirexistingworkintoanAI based work experience. And that is often the hard part when you look at the economics of the labour force, as transitioning people into new skills is a really challenging task and the fair treatment of employees is paramount in that process. So, these are critical risks that are fundamental to how governments must start to think about the implications of AI, because if your AI crashes your economy, you have got lots of other problems as well.
Goingbacktothepointaboutlookingatthisfroma macro perspective, you must address that first; the primary responsibility is to ensure the stability of an economy which is intimately tied to the stability of prospects of healthcare. People that have no jobs and have no income have extremely limited health prospects. Once you have thought about that, you then must look at the specific applications of AI, whether they are undermining a range of health or ethical concerns. We have a reasonable proposition for that in Europe now with the EU AI Safety Act, which has demarcated various levels of ethical concern. So, it has a graded system for assessing what level of ethical concern is appropriate to whateverapplicationandputinplacesomespecific recommendationsforthingsthatwedonotdo.
For example, an AI system should not discriminate between people based on their demographic circumstances. If an AI is unmonitored and unmanaged, where you cannot see clearly what impacts it is having on the people whose lives are affected by its use, then that is something that would fail the test of meeting the ethical standards oftheEUSafetyAct.Thatiscrucial.
One of the things that is critical, but which is often overlookedishowweconsiderinformalexperiences of healthcare provision. We look at that the health profession as if it represents the whole problem, whenalotofwhatistakingplaceishappeningwell outside of that sphere. Many people are using health related digital systems that have an entire range of implications for their own health and wellbeing,butalsoallowcompaniestodeterminea full range of health insights by looking at the data. Examples like Spotify are platforms where health relatedinformationisbeinggatheredbynon-health related applications that, in my mind, is potentially the biggest part of the health data that we both need, but also is being exploited by commercial companieswithoutanyrealinsightfromtheuser.
There are very few clinicians within the NHS that are interacting with AI patient data. So, we have not even begun the process of working out what should be the nature of the clinician’s interaction with AI data when it comes to patient care. The NHS is also still quite primitive in its use of digital technology and this needs to change. If you go into most hospitals, the IT infrastructure is far less effectivethanthelatesttechnologyanditisnotall excessive cost either. For example, there has been various interesting articles in the BMJ recently which talk about whether doctors should be allowed to use WhatsApp during their clinical observations and that sort of tells you the level of conversation that we are at. It is incredibly early stage and extremely far behind where we should be as a digital conversation in healthcare. I would say that the immediate risks, in fact, are less to do with deployment and more to do with not being able to critically and rapidly engaged with the pace of change of technology in this sector. It has been quite well recognized that, not only has the NHS been far behind digitally, but it is also at risk of becoming further behind if it does not utilize theAIeffectively.
Who should be held accountable when AI systems make mistakes or cause harm to patients, and how can we ensure that accountabilityinthesesituations?
I would urge that we look at accountability from the perspective of formal governance of healthcare and all other health related data together, because not only can we gain greater insights into how best to develop healthcare by lookingat thosetwoelements, but it alsoexplains thecomplexityofthisproblem.Ifyoulookatwhat healthcare tries to do and what it is tried to do, especially over the last 30 years, we have had a strong focus on preventive medicine. We want to makesurethatpeopledonotestablishhabitsthat lead to health care burdens, but the only way you can do that is by accessing them in aspects of theirlifethatareoutsideofhealthcare.
Where is the NHS finding opportunities to talk to patients about healthcare, health risk prevention or reduction? It must look elsewhere, when interaction is very minimal with patients, which meansitmustgrapplewithallthathealth-related data that exists within social media to maximize thoseopportunities.
WhenitcomestohowtheNHSdeploysspecificAI based applications, the emphasis will have to be specific,andtheexampleofgeneticcounsellingis agreatcomparisonhere.
When the prospect of harnessing insights from genetic information became a reality twenty or soyearsago,itwasneverthecasethatyoucould simply give someone a genetic test and expect that to be beneficial without further support in understanding what to do with that information. In many cases, the information created new burdens that required support to think through. We now have quite established and rigorous systems of genetic counselling to help people cometotermswiththeimplicationsofwhatthat datameansaboutthemandwemayakindofAI counselling to help people work through the implications of health insights that arise through asimilarprocess.Andthat'stheconversationthat still hasn't begun, and perhaps is something that is a service that should be delivered in combination with healthcare professionals, both to diminish the burden on the NHS, but also to recognize that there's distinct consequences to people interacting with AI that will have an impactonthehealthcaresystemaswell.
How do you think we can ensure that the benefits of AI in healthcare are equitably distributed and accessible to all patients, regardless of their background or socioeconomicstatus?
I think the first thing to recognize is that we do not have that already, in a pre-AI world. Often, theimmediateresponsethatpeoplehavetoAIis that it could create greater inequalities, which is often the same case with concerns about technology. I believe that AI will deliver greater equality, greater justice in healthcare, but this requires vigilance and monitoring, but also understanding the complexities of injustice. The current healthcare system cannot deliver healthcare justice presently and we need to look atthiscritically-atwhatisnotworkingpresently - and appreciate where that can be improved by technology. There is more research that is illuminatingthedegreeofbiasesthatexistwithin the profession, not just at the clinical level, but alsoattheatthebureaucraticlevelaswell.
There is a good chance that AI improves those situations, because it will help us identify those injustices, based on being able to more adequately analyse data and examine those injustices.
Now, a lot of our data is determined by quite a limited human resource that has capacity to do that research and generate those insights. I think again, the optimist in me thinks that we can design an awareness of that into the system so the AI can be informed by those potential risks, andbothmonitorforit,butalsoadjustforit.
If you think about AI and what it could do, AI designedwiththesesortsofquestionsinmind,these sorts of concerns, would be able to reveal that distinction and that difference and flag it up as a potential bias. Following through from the methodology that this research has developed, it would be able to more effectively test whether the questions are working. I am optimistic that, with our awareness of those ethical concerns about injustice in mind, it has the capacity to deliver a far more efficient and effective way of monitoring for them, becausenow,wearenotparticularlygoodatthat.
In conclusion, is there anything else you would liketoaddabouttheethicalimplicationsofAIin healthcare, or any concluding thoughts you wouldliketosharewithourreaders?
Well, I think the first thing I would say is that everybody needs to be part of this journey. A lot of work is needed to make sure that people are part of the transformation to society that is happening throughAI.
I speak to many people about their use of ChatGPT, which, of course, is the most common application that is out there. Most people are still using it like Google, but the best way to use it, is not like Google atall.Thereisahugeamountofworktohelppeople understand what is possible with even that application. That application is one of 1000s of applicationsthatareouttherenow.Sothatisahuge chunkofworkforsocietytodotomakesurethatthe population understands what can be done to improvepeople'slivesbecauseofthesetechnologies.
Myadvicewouldbetomakesureyoucompleteyour training with a degree of AI literacy that will allow you to bring that innovation into your sector. If you are going into biotechnology, make sure you graduate with biotechnology skills around AI integrations that will both allow you to make more useful contributions to your sector, but it will also allowyoutobereadyforthefutureofyoursectortoo. Artificial intelligence will not replace your job, but peoplewhoknowhowtousartificialintelligencewill replacethosewhodonot.
ThefinalthingIwouldaddtothatis,donotjustlook to your narrow sector for guidance, look at what is happening around your entire industry and beyond. More generally, discover the companies that are doing the best work ethically, but more importantly, the companies that are developing AI for the right reasons and have the best values to underpin that work.
SALFORD SCIENCE
Influencing Parliament to See the Importance of Genetics
INTERVIEW
WITH
PROF ARIJIT MUKHOPADHAYAY BY SANARIA FATHULLA
Genetic sequencing, especially whole genome sequencing, has become a groundbreaking method for improving publichealth.Whilestillindevelopment,ithaslimitationsandchallengesthatallstakeholdersneedtoovercome andadaptingto.Forintegrationofthesedevelopmentsintocurrentandfuturehealthcarepolicies,itiscrucialthat scientists keep the parliament informed and involved. This is done through the British Society of Genomic Medicine (BSGM) to ensure informed decisions are being made with the public’s interest at the forefront. This interview with Dr Arijit Mukhopadhyay will shed light on the current development of genetics, its integration into publichealthcareandpotentialchallengesthatarisefromit.
Sanaria Fathulla: How do you think 100,000 Genome Project will be implemented? Do you thinktherewillbeanyrestrictions?
Arijit Mukhopadhyay: The implementation will happenoveralongperiodoftime.Iamnotawareof the exact specifics since I am not involved in the project. If you find a variant from the sequence data, thatisusuallynotenough.Ifyoufindavariantwitha known mutation for a particular disease, you will be able to predict, with high accuracy, that the individual will have the disease in the future. However,youwillnotbeabletotellhowthatperson has inherited the disease unless you sequence the parents. Even if the disease is dominant or recessive, the parents (one or both) maybe completely unaffected. That is why when the 100,000-genome project has recruited individuals, they must take unaffected family members as well, because the ability of anybody to assign a variant with a pathology is crucially dependent on the relative comparison with the absence of the variant in unaffected members. Eventually, the goal is to be able to make genotype-to-phenotype correlation. Now to answer your question, is it fully integrated, I do not think so. It is a slow ongoing process, but it is happeningaswespeak.Itisafive-yearprojectwhere the sequencing project was completed but done at various times. Some genomes were sequenced in year one, and some in year five so discoveries form yearonewouldhaveprogressedfurther.
When a genetic counsellor counsels one of these patients, they will have the backstory and they will know the clinical diagnosis, they know the sample, they know the genome sequencing results so that is thewayitisintegrated.
Further integration that goes beyond the NHS, which I hope will happen, is when the findings are published, and new mutations are included in the public databases, meaning that anyone will be able to query a particular gene on NCBI and check which other variants are disease-causing. This has not happened yet. However, not every genome from the 100,000 Genome project will have a conclusive answer, as they might have variants of unknown significance (VUS). Many variants will be catalogued as VUS, some of whichwillhavefunctionsassignedasmoresequences aredepositedinthepublicdomain.
SF: What made you decide to contribute to the BSGMandwhyisitimportant?
AM: The official society that is tasked with making these understandings available to the public and the ministry,andtotheadministrators,iscalledtheBritish Society of Genomic Medicine (BSGM). I am a member of that society; it relates to what I do. They put out a calltoallmembersmorethanfiveyearsagowhenthe UK had decided to be out of the European Union. At the same time, the new GDPR (General Data Protection Regulation) law was introduced by the EU, whichUKhaddecidedtofollow.Thisunderstandingof that legal/political scenario is important because a question came from this. If the 100,000 Genomes Project is happening today and tomorrow, the longtime result is that everyone might have their genome sequenced at some point in time, what about the privacy of that data? The previous policy was not fit for purpose.
Thatiswhythedocumentwasmade.Iwasinterested because of how society changes with technological developmentandnowyouarehearingaboutAI,Chat GPT. Because this was right in my domain of expertise,Iwantedtobepartofthatnarrative.Having saidthatIwaspartofthesubcommitteesoifyousee the document, you will see my name in the acknowledgements. My contribution was looking at the technical accuracy of the genetic sequencing bit ofthatdocumentationandcorrectingafewthingsin that draft. It was quite humbling going through this process of everybody’s contribution. My contribution wasimportant,butsmall.
Updating such documents is important because Parliament is representative of the public. The NHS has faced multiple legal cases and litigations from members of the public, suing for not having the information they think they deserved due to lack of understanding. Parliament is final policy makers or approvers of new guidelines but lacks technical knowledge in the areas that are everchanging and needupdating.Thatiswhyifitisasignificantchange that is happening in any area that is going to impact a larger portion of the public life, informing parliamentisvital.
AM: Currently, the parliament should have a say but that is not specific to genetics. As I was saying, they arethepolicyapproverssotheyalsohaveasayinany change in broader policies so GDPR, change in healthcare, how much of genomics will come into theforefrontofhealthcareallthatwillbegovernedby the parliamentarians so yes, they should have a say. We, as domain experts, through societies such as BSGM must be responsible for giving the right informationtotheparliamentarians.
SF:Whoshouldhaveaccesstothatdata?
AM: The basic principle is that any personal information,youshouldbethedeciderofwhoshould be able to get it. Having said that, it is actually a can of worms. In a sense, let us say, you are getting your genome sequencing done and there is a variant that puts you at a high risk of a certain disease when you are 50 years old. You chose not to reveal that to anyone, then when you are 50 years old, and if you havethatdiseaseandareunabletodoyourjob.Your employerswouldneedtosupportyourwellbeing,but the work is suffering. So, what is the right answer? Especially if it is a private health insurance, or if it is your employers, should they have known before they employedyou?
SF: What are the main problems in terms of consent and confidentiality hindering progress in making genetics a wide stream concept in healthcare/public?
AM: A General understanding and awareness about the pros and cons. What genetic info can tell and what it cannot tell. That’s the biggest thing lacking which you asked me earlier why I’m interested in engaging in such conversations, whether it’s part of my role in the subcommittee or in conversations like this, it’s part of that process I feel responsible that I should be engaging in any way to increase understandingandawarenessofthis.Untilwehavea general understanding of genetic data and what it means, we cannot have this public debate of who shouldhaveaccess.
SF: Do you think the public mindset on consent/confidentialitywillchangeinthefuture?
AM: Although they are public documents, members ofthepublicwillneverfindthedocumentduetolack of publicity. They do not feature in the front page of the newspaper; it is not the mainstream public information. The world has changed forever postpandemic, people have become more aware of biomedical research and its potential. The 100,000 Genome Project is a very visible project so in that respect, people are now familiar with the technologiesofgenetics,butitstopsthere.
It is difficult to say, it will depend on the individual. People who are more aware will be able to make an informed choice. People who are less aware will simply say no or yes without understanding or they will depend on somebody to make the choice. People are not sure or do not feel comfortable sharinganyprivateinformation,notjustgeneticdata, worried about it getting misused or abused. As the technological risk is increasing, the technological protection is also improving. It will be a lengthy process, but it largely depends on the individual’s abilitytounderstandtheriskandbenefitsandgivean informedchoice.
SF: In the future, how do you think genetics will beused?
AM: The NHS published a document in 2016, proposing that genomics will be the first layer of healthcare. If you think of the current healthcare process, when you have a problem, you contact your GP, and the GP prescribes tests and medicine. At the very end, they can prescribe a genetic test as a last resort because it is expensive and complicated, it is not something you can buy a medicine with prescriptionandthenfeelbetter.
Thenewgenomegenerationisafuturelookingdocumentproposingthatanewbornbabywillhavetheir genome sequenced and any health condition that arises in their life will be seen as the first layer of information.The100,000Genomewebsitetodayhas100,000newborngenomesequencingprogrammes.It isalreadyintheprocess,andIthinkgenomicswillbecomethefirststepinpublichealthsoon.
AM: It boils down to whoever pays to generate the data and receives the custody of the data. It does not meantheyarefreetoshare,buttheyhaveaccesstothedata.Becausethe100,000Genomeprojectisfunded by the NHS, they are the custodian of the data but that does not mean NHS will be able to hold onto it forever. How it should be monitored depends on the funders, but a larger dialogue surrounds human genomesequence,becauseitisanaturallyoccurringphenomenonanditcannotbepatented.NHScannot monetiseitthereforeNHSwillnotbeabletosellittoathirdpartyoraskforsomethinginreturnbecauseit cannotbepatentedormonetised.EverybigpharmacompanylikeGSKandJohnson&Johnsonholdonto thousands of genome sequencing data of their own. They cannot monetise the data, but they can make profitoffmakingdrugsbecausetheyareaprivatecompany.TheNHScannotdothesame,theindirectprofit willbethatpublichealthwillbeimproved.Howitwillbemonitoredisacomplicatedquestiontoanswer.I thinklargebodiessuchastheNHS,NIH,US,EUhealthcareservices,keyrepresentationsfromothernations must come together and form data policies so that most of this data is used for the greater good. Policy makingisnotmyexpertise,soIcannotsay,Icanonlysayitshouldbeusedforgreatergood.
SALFORD SCIENCE
Access Granted: Discovering the Significance of Open Publishing
INTERVIEW
WITH WENDY TAYLOR & TRACY BREHENY BY WIKTORIA WISNIEWSKA
The ‘Bioscientist’ magazine is a fully open access journal available on the Salford Open Journals platform, led for students, by students. Our CoEditor-in-Chief Wiktoria Wisniewska had the pleasure to interview Wendy Taylor, an Open Research Coordinator at the University of Salford, and Tracy Breheny, Academic Support Librarian, about open access publishing and its benefits for scientificcommunicationandstudentlearning.
Wendy: My name is Wendy, and I am an Open ResearchCoordinatorpublishingattheUniversityof Salford. I support postgraduate students and academic staff in publishing their research open access,disseminateit,andshareitwiththeworld.I am part of the library’s open research team, which assists researchers, not only with open access and publishing but also with making their data open andmanagingtheirresearchdata.
Tracy: My name is Tracy, and I am an Academic SupportLibrariansupportingtheSchoolofScience, Engineering & Environment. I help students, academic staff, and researchers develop their information literacy and research skills. I offer guidance and support in finding academic information,referencing,andmaintainingacademic integrity. I also manage the Science, Engineering & Environment collections. I am part of the Library, Careers&EnterpriseTeam.
Wiktoria: In your own words, what would you say Open Access is and how is it different from traditionalsubscription-basedmodel?
Wendy: Open Access enables anyone, anywhere in theworld,toreadresearchmaterialaslongasthey haveaccesstotheInternet.Theydonotneedtobe partofalibraryoranacademicinstitutionthatpays foralibrarysubscriptiontoaccessthatcontent.
This reduces international barriers and allows charitablegroups,membersofthepublic,andothers to view this material, not just the academic community. If the research is published with a CreativeCommonslicense,itcanbereusedandbuilt upon, leading to further innovation. Studies show that Open Access content is cited more than subscription content, which makes sense because it is freely available and, therefore, more likely to be pickedupandcited.Thebenefitsextendnotonlyto the researchers themselves but also to society as a whole.
Wiktoria: What are the challenges behind using OpenAccessandhowaretheybeingaddressed?
Wendy: There are different routes to Open Access. One option is Gold Open Access, where the publishermakesthecontentopenlyaccessible.This usually requires a fee called an article processing charge(APC),whichaveragesaround£2,000–£3,000 but can cost up to £10,000. Depending on the author’s funding to pay this Open Access charge, they may or may not be able to publish with that journal.Wehaveanumberofdealswithpublishers thatenableourcorrespondingauthorsfromSalford topublishGoldOpenAccessforfree,andtheseare alllistedonourwebsite.Thesedealsareintendedto move journals away from being subscription-based to becoming fully Open Access journals. Over time, morecontentwillbepublishedasOpenAccess,and eventually,thejournalwillflip,nolongerdepending onthesubscriptionmodel.Theaimwasforjournals tobecomefullyOpenAccess,butstudiesshowthat thisistakingmuchlongerthanpreviouslyhoped,so asasector,weareexploringothermodelstoenable OpenAccesspublishing.
For example, another model is Diamond Open Access,where,likeGoldOpenAccess,thepublisher makestheworkOpenAccess,butthereisn’tafeefor theauthor,allowingthemtopublishinthatjournal without worrying about funding. These Diamond journals are funded through different business models that are more sustainable and equitable thanthetraditionalGoldOpenAccessmodel.
The final model is Green Open Access. In this model, the accepted version of the paper—the finalpeer-reviewedversionbeforeanyformatting by the publisher—can be made Open Access in our repository, USIR, at no cost to the author. Whenauthorssignacontractwithajournal,they usually transfer their copyright to the publisher, who then decides whether there is an embargo on open access and determines the license terms. There is a strong push at the moment to have Open Access available immediately upon publication, with a clear Creative Commons license to enable maximum reuse of the research.Weaimtoenableallofourresearchers to make their work Open Access in this way, whichiswhywepreferequitableandsustainable openaccessmodels.
Wiktoria: What rights do the authors have to theircontent?
Wendy: When you sign a contract with a publisher, you are signing over the copyright of that work to them. The publisher then becomes the copyright owner and determines how the workisused.Ifanauthorwantstoreuseitinany way, they have to contact the publisher and ask for permission because they’ve lost control of their rights. There is a significant movement called Plan S, started by a group of funders, including UKRI and the Wellcome Trust. Plan S enables authors to retain their rights so that works can be made immediately Open Access with a CC BY license.Plan S funder policies state thatwhenanauthorsubmitsapaper,theymust include a statement within the paper indicating that any accepted papers resulting from the submission can be made immediately Open Access with a CC BY license in a repository. Starting with Edinburgh, many institutions have developed institutional rights retention policies toenabletheirauthorstoretaintheirrights,and Salford is in the process of working towards implementingitsownpolicy.
Wiktoria: Could you tell us more about the licensing that our ‘Bioscientist’ magazine currentlyoperatesunder?
Wendy: The ‘Bioscientist’ runs on Salford Open Journals, an open-source platform. This means that Salford maintains and manages it without relyingonacommercialorganizationforanypart of the publishing process. The journals on the platform operate as Diamond Open Access publications, providing immediate Open Access without any charges to authors for either access orpublishing.
The system includes publishing workflows that simplify the process from article submission to fullpublication.Theseworkflowsincorporatethe allocation of a digital object identifier (DOI), a persistent identifier for each article, and allow editorstoassignvarioustypesoflicenses.Forthis material, the Creative Commons license is most appropriate, which is why it is used for the magazine. This license is the most permissive, requiring that anyone reusing the content attributes the author to ensure they receive creditfortheirwork.
The journal titles are assigned an ISSN, a unique identifier that is considered best practice in article publishing. Additionally, the system connects with ORCID, a unique identifier for researchers.
These features enable authors to adhere to best practices from the start. By including these identifiers, the article metadata is harvested by Google Scholar and the university library cataloguesearch,whichincreasesthereachand engagement of the articles and provides analytics on views and downloads displayed on thearticlepages.Eacharticlealsohastheoption to generate citations in different styles, allowing your work to be recognized and referred to. This setup allows our students to publish using best practices in a straightforward and accessible manner.
Tracy: Asanauthor,youbenefitfromhavingyour work widely accessible. Not only do you gain visibility and reach through Google Scholar and the library catalogue (Library Search), but you also have the opportunity to develop your skills by using a publishing platform like this. As an editor, you engage in various publishing processes, such as peer review and article management, which will strengthen your researchskillsovertime.Ifyou’reanEarlyCareer Researcher, you might not be fully aware of all the Open Access options Wendy mentioned earlier.Itisimportantforustomakeyouawareof and inform you about the options that best fit your research. We are here to support you in makingthesechoices.
Wiktoria: Can our students count on library support with starting their own journal publications?
Tracy: Yes, of course. It is a university wide platform, so if any ideas come forward to the library,we'llbeabletolookatthoseindividually.
Wiktoria: Thank you, that was very informative. Lastly, if a student wanted to access a journal locked behind the paywall, could the library gain access to this specific material?
Tracy: We have systems in place to obtain resourcesforstudents.Ifthereisaspecificjournal article you need from a subscription-based journal that we do not have access to, we can request it for you. We offer a service called ‘You Want It,’ where you can place resource requests. Thisservicetypicallyhandlesindividualarticlesor book chapters, rather than whole journal access. Itisfreeforstudents,researchers,andstafftouse, thoughthereisacosttotheuniversity.
If a journal or resource subscription is deemed beneficial for the university's teaching, learning, and research purposes, we have a separate process for evaluating these requests. This involves a series of checks to assess content coverage, accessibility, cost, and other factors. Thisprocessislonger,whereasifyouencountera paywall when trying to access a single journal article or book chapter, we can facilitate that throughthe‘YouWantIt’service.
There are also other ways that our students can accessresources,sofeelfreetochecktheseout:
YouWantIt’service
Our ‘You Want It’ service enables you to request articles from subscription-based journals and books/chapters that the university doesn't have access to. This is free to use for students, researchers,andstaff.Youcanaccesstheservice here: https://www.salford.ac.uk/library/findresources/you-want-it-service
LeanLibrary
LeanLibraryisabrowserextensionthatsimplifies accessing articles, journals, and databases, making research easier, especially off-campus. Lean Library can be accessed here: https://www.salford.ac.uk/library/findresources/lean-library
Unpaywall
Unpaywall is an open database giving access to freescholarlyarticles.Ithasabrowserpluginthat allows users to access full-text PDFs of resources easily and quickly, for free, when available. You canaccessthishere:https://unpaywall.org/
University of Salford Institutional Repository (USIR)
USIR is an Open Access showcase for the published research output of the university. Our collection contains a wide range of research across multiple formats and subject areas and can be accessed here https://salfordrepository.worktribe.com/
OpenAccessSupport
We have lots of support with Open Access available for PGRs and academic staff. You can find out more here: https://www.salford.ac.uk/library/openresearch/open-access/support-for-open-accessfunding
What is Foetal Alcohol Spectrum Disorder and its ethical impacts
on society?
ELAINE COATES IN CONVERSATION WITH DR DAVID JUNIOR GILBERT
Foetal Alcohol Spectrum Disorder (FASD) is a range of neurological and physical conditions caused by prenatal exposuretoalcohol.Alcoholcandamagedevelopingcellsinvariousways,andtheimpactwillvarydependingon theamount,durationandtimingofthealcoholexposure.Thereisnosafelimit,butwomenmaybeunawareof therisksormaydrinkbeforetheyrealisetheyarepregnant.
Dr David Junior Gilbert is part of the multi-disciplinary FASD research group at the University of Salford, which investigates various aspects of FASD. Dr Gilbert’s research is specifically focuses on the behavioural impacts. This articledescribeshiscurrentresearchintosuggestibilityandconfabulationinadolescentswithFASD,andhowthis affects their vulnerability, particularly in interactions with the criminal justice system. Greater awareness of FASD amongsocialworkers,medicalprofessionalsandwithinthejusticesystemwillhelptofacilitateearlierintervention andenableaffectedindividualsmoreappropriatelysupported.
Foetal Alcohol Spectrum Disorder (FASD) is a range of conditions caused by exposure to alcohol in the womb, impacting neurological and physical development. It is estimated to affect 2-3% of children in the UK⁷, and these children are far more likely to encounter the criminal justice system (CJS) thanchildrenwithoutFASD³.ElaineCoatesspoketo SalfordresearchfellowDrDavidJuniorGilbertabout theresearchbeingdoneatSalfordonFASD.
WhatisFASD?
FASD encompasses a range of closely related brain and body disorders caused by prenatal alcohol exposure (PAE). Alcohol is known to be a teratogen, meaning that it can cause defects in developing cells. If a baby is exposed to alcohol in the womb, irrespectiveofthetrimesterwhenthathappens,they maybebornwiththecondition.Itcanaffectanypart of the body but particularly affects the brain, with reduced brain volumes and white matter abnormalities in the hippocampus and corpus callosum⁸. Individuals with FASD often have executive function disorder, so they struggle to regulatetheirownbehaviour.Theymaybeimpulsive andhavedifficultyunderstandingtheconsequences oftheiractions.AtthefarendoftheFASDspectrum, children with Fetal Alcohol Syndrome (FES) often have characteristic malformed facial features including small eyes, a thin upper lip and smooth philtrum and may also have damage to visual, auditoryandotherorgansystems⁹
There is currently no treatment for FASD, but early diagnosis and intervention can help parents access appropriate support. There is some evidence that nutritional supplements during pregnancy can reduce the damage caused by PAE⁸. A recent small study found that FAS impacted children who received choline supplements during early childhoodhadimprovedcognitivedevelopmentand executivefunctioncomparedtoacontrolgroup⁴
Mechanismsofalcoholdamage
Alcohol increases free radicals, highly reactive molecules which can react with biological macromolecules, affecting their function. When the balance of free radicals compared to antioxidants is disrupted, this is referred to as oxidative stress. Developing cells can be affected in many different ways and there may be different impacts depending on the amount, duration and timing of the alcohol exposure
Freeradicaldamagetoproteinsandlipidscandisrupt membrane functions and cell signalling. Critical cell cycle control proteins may be compromised, which can result in cells maturing early or in the cell cycle stalling,orininappropriatecelldifferentiation.Alcohol can also affect DNA methylation and histone methylation,resultinginchangesingeneexpression¹.
Alcoholdirectlydamagesmitochondria,disruptingthe electron transport chain and leading to increased cellular apoptosis. In the developing brain, increased apoptosis of glial cells may be the cause of the reduced brain density associated with FASD. Neurotransmitter systems may also be affected, resultinginbehaviouralimpactsthroughoutlife¹.
HowdidDrGilbertbecomeinterestedinFASD?
DrGilbertinitiallytrainedasabiochemistinNigeria. He worked for a few years for a pharma company, whereheworkedwithphysiciansandclinicianswith adrugportfoliomainlyaimedatimprovingqualityof lifeforpeoplewithseriousorterminalconditions.He decided to pursue a Masters and obtained a scholarshiptotheUniversityofSalfordtocompletea Master’s in Public Health supervised by Professor Penny Cook who leads the Salford FASD research group. The Salford research group is a multidisciplinary team with expertise on different aspects of FASD research, ranging from prevalence and epidemiology, genetics, trauma, interventions to support those with FASD, to social workers and criminaljusticeresearch.Thegroupisregardedasthe largest and most expert research group on FASD in Europe.
When Dr Gilbert decided to specialise in FASD, he sayshewasinspiredbythreewords:
Misdiagnosis – Individuals with FASD are often misdiagnosed with autism, ADHD or personality disorders,becauseoflackofawarenessofFASD.
Missed diagnosis – individuals may not be diagnosed with any condition, and so receive no support
Under diagnosis –duetolackofresources.Thereis only one specialist clinic in the UK, in Surrey. There hasbeenverylittleresearchtoestablishtheextentof FASD.
ForhisPhD,DrGilbertinterviewedparentsofchildren with FASD, and the children themselves, about their experiences. Dr Gilbert work provided the first experimental evidence of interrogative suggestibility in adolescents with FASD . Individuals with FASD demonstrated a significantly higher level of suggestibility compared to the control group². Dr Gilbert has now been awarded a 5-year research fellowshiptoexpandonthiswork,recruitingsubjects fromtheUS,Canada,Australia,NewZealandandthe Republic of Ireland, to investigate the vulnerabilities of individuals with FASD to and within the justice system.
FASDandtheCriminalJusticeSystem
In New Zealand, a teenager with FASD falsely confessed to having been involved in the rape and murder of a woman because he wanted to claim a $20,000 reward and thought he would be immune from prosecution. Over 20 years later the conviction wasquashed⁶
PeoplewithFASDaremorelikelytohavehighrates of adverse childhood experience, and FASD adds another layer of adversity compounding their vulnerability. Problems with impulse-control and executive function mean these individuals are more likelytoencountertheCJS.
They are then vulnerable because their higher suggestibilitymeanstheyaremorelikelytoagreeto suggestions put to them, or to say what they think interviewerswanttohear.Someparentsinterviewed byDrGilbertreportedthantheirchildwould“sayYes to anything”. They may struggle to understand complexquestionsandmaybeeasilymanipulated.
In research not yet published, Dr Gilbert has also looked at confabulation. Confabulation is when peoplemakethingsuptofillingapsintheirmemory, anddon’trealisetheyaredoingso.PeoplewithFASD have poor memory recall and have a higher rate of confabulation.
There is a need for increased awareness of FASD within the CJS, and an understanding of the increased vulnerability of impacted individuals whetherassuspects,witnesses,ofvictimsofcrimes,in order to avoid false confessions or miscarriages of justice. Dr Gilbert emphatically says that individuals withFASDarenotcriminals,itistheirdiagnosisthat provides a context to behaviours relevant to the justice system. Also, these individuals have strengths whichshouldbeleveragedupontocreatecustodial, sentencingandrehabilitationplans.
HowisSalfordmakingadifference?
Dr Gilbert hopes his research will lead to better understanding of FASD, and for professionals within the justice system to be more aware of the vulnerabilities of FASD impacted individuals and not takethingsatfacevalue.Itisimportantforexample to avoid leading questions in interviews, and for sentencing and rehabilitation plans to provide appropriatesupport.
Salford researchers have also been working with the Greater Manchester Combined Authority on a major intervention called the Alcohol Exposed Pregnancy programme. No woman wants to harm their baby –they either do not know they are pregnant, are not awareoftheharmalcoholcando,ortheyneedhelp and support to control their alcohol intake. The programme has already trained hundreds of social care staff to equip them to have conversations around the harms of alcohol during pregnancy, and has provided screening, support and early interventions⁵ .
FurtherInformation
This short video by the FASD Salford group gives an overviewoftheirresearch.
More on Dr Gilbert’s research: https://www.salford.ac.uk/our-staff/david-junior-gilbert
1. Gilbert, D. J., Allely, C. S., Gudjonsson, G., Mukherjee, R. A. S., & Cook, P. A. (2024). Immediate and repeat interrogative suggestibility in a sample of adolescents with fetal alcohol spectrum disorder. Diversity & Inclusion Research, 1(1), e12007.
3.
Abdul-Rahman, O. A., & Petrenko, C. L. M. (2023). Fetal alcohol spectrum disorders : a multidisciplinary approach (1st 2023. ed.). Springer International Publishing.
2. Gilbert, D. J., Allely, C. S., Mukherjee, R. A. S., & Cook, P. A. (2022). Foetal alcohol spectrum disorder and Investigative interviewing: A systematic review highlighting clinical and legal implications and recommendations. Behavioral Sciences & the Law, 40(1), 170-185.
Gimbel, B. A., Anthony, M. E., Ernst, A. M., Roediger, D. J., de Water, E., Eckerle, J. K., Boys, C. J., Radke, J. P., Mueller, B. A., Fuglestad, A. J., Zeisel, S. H., Georgieff, M. K., & Wozniak, J. R. (2022). Long-term follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder: corpus callosum white matter microstructure and neurocognitive outcomes. Journal of Neurodevelopmental Disorders, 14(1), 59.
4. Greater Manchester Integrated Care Partnership. (2022). “A very positive and rapid influence on change” – reflecting on work to reduce alcohol exposed pregnancies in Greater Manchester. Retrieved 11/09/2024 from
Hansen, R. (2016). Report for Minister of Justice on Compensation Claim by Teina Anthony Pora.
McCarthy, R., Mukherjee, R. A. S., Fleming, K. M., Green, J., Clayton-Smith, J., Price, A. D., Allely, C. S., & Cook, P. A. (2021). Prevalence of fetal alcohol spectrum disorder in Greater Manchester, UK: An active case ascertainment study. Alcoholism: Clinical and Experimental Research, 45(11), 2271-2281. 7. Popova, S., Dozet, D., Shield, K., Rehm, J., & Burd, L. (2021). Alcohol’s impact on the fetus. Nutrients, 13(10), 3452.
Riley, E. P., Infante, M. A., & Warren, K. R. (2011). Fetal Alcohol Spectrum Disorders: An Overview. Neuropsychology Review, 21(2), 73-80.
SALFORD SCIENCE
Celastrol as a Potential Phytopharmaceutical for Medulloblastoma Therapy: Assessing Efficacy and Cardiotoxicity
BY ALVINA IMRAN
Cancerremainsapervasiveglobalhealthchallenge associated with substantial mortality. While current chemotherapy treatments are efficacious, they frequentlyentailsignificantoff-targeteffects,notably hepatotoxicity, neurotoxicity, and cardiotoxicity, impacting long-term patient survival. Childhood cancers, including medulloblastoma, present additional complexities due to the heightened susceptibilityoftheseindividualstotheseoff-target effects³. Thus, a compelling need exists to evaluate novel therapeutics with heightened efficacy and diminishedoff-targeteffects.
ThisarticlehasbeenreviewedbyDrMatthewJones, Lecturer in Biomedicine (Physiology), University of Salford.TheEditorialTeamwouldliketothankhim forhistimeandcontributions.
Phytopharmaceuticals, biologically active compoundsderivedfromplantorigins,providea diverse array of potential therapeutic agents¹. Celastrol,apentacyclictriterpeneextractedfrom the species Tripterygium wilfordii, has demonstratedanti-inflammatoryandantioxidant properties in vitro and exhibited anti-cancer properties against diverse cancer types². This collaborative study with KidsCan Children’s Cancer Research and funded by a Biochemical Society Summer Research Studentship focuses onevaluatingcelastrolagainstmedulloblastoma, emphasizingitsefficacyagainstvarioussubtypes anditspotentialforinducingcardiotoxicity.
The research unveils celastrol's potent cytotoxicity against medulloblastoma cells, particularly the group 3 medulloblastoma cell line HD-MB03. Celastrol demonstrates effectiveness with EC50 values (The concentration required to decrease viability by 50%) below 0.5μM (Figure 1A), through the induction of apoptotic cell death. Subsequent investigations extended to the Sonic Hedgehog medulloblastoma subtype, DAOY (Figure 1B), with similar findings observed validating celastrol's efficacy across different medulloblastomasubtypes.
Theobservedirreversiblecytotoxicityafter24hours of treatment with concentrations exceeding 500nM(Figures1C-D),andfluorescentmicroscopy visualising the activation of Caspases 3 and 7, provide supporting evidence of irreversible caspase-mediatedapoptoticcelldeathinducedby celastrol in numerous medulloblastoma subtypes (Figure 2). These data position celastrol as a promising chemotherapeutic agent for medulloblastomatreatment.
As a part of this project, we also sought to preliminarilyinvestigatethepotentialsideeffects of celastrol by evaluating its toxicity towards cardiac cells. This analysis explored the cardiotoxicpotentialofcelastrolusinganinvitro model of cardiotoxicity utilising H9c2 cardiac myoblasts. Results of these investigations indicate that concentrations greater than 2μM inducecardiotoxicityafter72hoursoftreatment (Figure 3) highlighting some selectivity towards medulloblastoma cells but also highlighting potentialcardiotoxicityathigherconcentrations. This underscores the need for meticulous assessment of potential side effects of novel compounds early in the drug development pipeline.
Beyonditspotentialclinicalapplication,theproject encouraged scientific exploration of compounds derived from traditional medicine for therapeutic potential, an underexploited source of novel therapeuticcompounds,andbegantodevelopan understanding of their molecular mechanisms of action. The development of an in vitro model of cardiotoxicity for simultaneous screening of therapeuticandcardiotoxicpotentialholdspromise for revolutionizing drug development, especially considering the relatively fewer off-target effects associated with phytochemicals compared to syntheticcompounds.
The project has equipped me with a diverse set of practical and transferable skills crucial for embarkingonaresearchcareer.
From fundamental laboratory techniques to advancedmethodologiesliketime-lapselive-cell microscopy and flow cytometry, I have gained proficiency and resilience in problem-solving. Workshops and presentations have further contributedtothedevelopmentofmyanalytical and communication skills, priming me for postgraduateresearchopportunitiesorindustrial researchpositions.
In conclusion, celastrol emerges as a promising and comparatively safe phytopharmaceutical candidate for medulloblastoma treatment. Ongoing research aims to delve into the molecular mechanisms of action and explore nano-encapsulation strategies to enhance potency and minimize off-target effects. The findings underscore the broader applicability of in vitro models for simultaneous screening of therapeuticandcardiotoxicpotential,pavingthe wayforthedevelopmentofnovelcompoundsin therealmofcancertherapeutics.
The author would like to thank the Biochemical Society for awarding her with the Biochemical Society Summer Studentship which enabled this researchtobeconductedandforexposuretobe gained in academic research. Additionally, the authorextendsappreciationtoDr.MatthewJones forendorsingherapplicationforthestudentship. Throughhissupport,theauthordeliveredanoral presentation summarizing the findings and conclusionstotheresearchlaboratoryteamanda broader academic audience. His guidance providedtheauthorwithvaluableinsightsintothe daily responsibilities of a research scientist involved in interdisciplinary research, an experience made possible by this studentship opportunity.
1 Shi, J., Li, J., Xu, Z., Chen, L., Luo, R., Zhang, C., . . . Fu, C. (2020, November 18). Celastrol: A Review of Useful Strategies Overcoming its Limitation in Anticancer Application . Frontiers inpharmacology,11,558741.
3.
Lim, C. L., Raju, C. S., Mahboob, T., Kayesth, S., Gupta, K. K., Jain, G. K., . . . Nissapa. (2022, January 12). Precision and Advanced Nano-Phytopharmaceuticals for Therapeutic Applications. Nanomaterials(Basel,Switzerland),12(2),238.
2. Zahnreich, S., & Schmidberger, H. (2021, May 26). Childhood Cancer: Occurrence, Treatment and Risk of = Primary Malignancies.Cancers,13(11),2607.
CAREER STORIES CAREER STORIES
VIRTUAL BLOOD GROUPING TRAINING VIRTUAL BLOOD GROUPING TRAINING pg.75pg.75
Let’s explore a novel tool developed by NHS Blood and Transport through a conversation with Alison Hines, a clinical training and education mentor based in NHSBT Bristol.
CAREER ADVICE CAREER ADVICE
THE SKILLS OF A BIOMEDICAL SCIENTIST THE SKILLS OF A BIOMEDICAL SCIENTIST pg.77pg.77
ReadaboutaconversationbetweenDrVictoriaChalker and biomedical science apprentice Lloyd exploring the skills that are required for all biomedical scientists to haveinatechnologicallyadvancingworld.
Paula, a Careers Consultant, shares 4 ways that can be used to develop employability skills that will be crucial intheworldofworkaftergraduation.
CAREER INSIGHTS CAREER INSIGHTS
TEACHING SCIENCE IN HIGH SCHOOL
TEACHING SCIENCE IN HIGH SCHOOL pg.81pg.81
We hear from a high school teacher who qualified to teach science in a local secondary school. She talks about her journey so far and shares some advice for aspiringteachers.
CAREER INSIGHTS CAREER INSIGHTS
MILITARY HEALTHCARE ETHICS
MILITARY HEALTHCARE ETHICS pg.83pg.83
Ethics in the military is explored, which is governed by several regulations. A comparison is established between medical practice in a civilian setting and in a militarysetting.
CAREER STORIES
ALISON HINES IN CONVERSATION WITH AYESHA NAEEM
AlisonHinesisaclinicaltrainingandeducationalmanagerwhoiscurrentlyworkingwiththeNHSBlood& TransplantdepartmentinFilton(Bristol).NHSBloodTransplanthasrecentlyintroducedaVR(Virtualreality) training programme that enhances knowledge on blood transfusion education². This program can be accessedontheMetaQuestAPPLabstore.TheNHSBTbloodidentificationappgiveslearnersaninsightinto the processes of correct blood group and educates them on the consequences of administering a transfusionfollowingincorrectbloodgroupidentification.Inadditiontorealisticsimulationsthathighlight thegraveconsequencesofmistakes,italsoprovidesquickfeedback.Thisappaimstoprovideanimmersive hands-onlearningexperienceaswellasraisesawarenessoftransfusionscienceencouragingrecruitmentin thisfieldtohelpovercomestaffingshortagesintransfusionlaboratories.
Tell us about your educational background what made you join blood transfusion and whataspectsofbloodgroupingamazeyou?
I have been a biomedical scientist for 15 years now. My interest in haematology and transfusion stemmed from having a relative diagnosed with a haematological condition, which sparked my passion for this field. As I progressed in my career, I became more focused on the blood transfusion side, which led me to work for NHS Blood and Transplant in one of the specialist labs here in Bristol. Eventually,Itransitionedintotrainingothersin this area instead. What amazes me about blood grouping is the sheer number of blood groupsthatexist.Mostpeoplearefamiliarwith ABO and antigen D (when referring to being Rh-positive or negative), but there are hundreds of different antigens on red blood cells.Infact,thereareoverfortydifferentblood group systems. New discoveries are constantly being made in blood transfusion, and that is whatmakesitsuchanexcitingareatoworkin.
Explain the main purpose of using virtual reality in the blood grouping programme introducedbyNHS?
We brought in the virtual reality training programmeasaproofofconcepttoshowthat it is possible to train people in specialist techniquesusingvirtualreality. Wehavefound that this package that we developed is useful for various audiences, from people who have no experience of blood grouping to experienced scientists because it introduces the techniques to someone who has not been trained. For experienced scientist, it provides the patient aspect where they are interacting with a patient in the package, and it is taking them back to our core purpose of saving lives and improving patients' lives. Thus, it is beneficialforavarietyofreasons.
Why was the Meta Quest app lab store chosen asaVRtrainingplatform?
It was exceedingly difficult to find a suitable platform, particularly in health in healthcare, to host your apps, there is not a national NHS platform available to host things that we could easilyaccess,soweneededtomakeitavailableto people nationally and internationally. It was suggested that the Meta Quest app lab store was the only option for us. This makes it an easy, accessible platform. For the future, we are hoping that as we continue to work with Institute of BiomedicalScience,therewillbeaplacewherewe canhostallappstodowithbiomedicalsciencein oneplace.
Can you walk us through the experience of using VR training app and what does a training sessionlooklike?
The training session is designed to take around 10 to 15 minutes to complete, and it walks you through meeting your patients at the beginning and performing ABO grouping by the tile technique.First,yougetallyourreagentsoutofthe fridge and prepare them. You can then interpret your test results and compare these to a table. In case you are not sure about what is how to interpret those results, then you go on to select bloodfortransfusingtoyourpatientsandthenyou take that blood to the patient's bedside and start that transfusion. You see the process from beginning to end, performing the testing through to the transfusion of the units that you selected. Depending on the blood that you chose to get fromthefridge,youmaysaveyourpatient'slife,or you may have What we call a negative outcome where you are told that there have been some complications, and you are walked through what happens when there is an incompatible transfusion. What makes this package good for trainingisthatitallowspeopletofailinasafeway because they can select an incorrect unit for transfusionandnopatientwillbeharmedbythat. It is particularly good for helping people to try a processmultipletimesandlearnfromit.
How does the app enhance the experience of handlinglabequipment?
In the experience, we introduce each piece of lab equipment and explained to people what each piece of equipment was and how it is used. For example, they use pipettes in this exercise, and we have managed to use haptic feedback so that people can tell if they are perpetuating too hard and potentially overdispensing their reagents and when they're mixing their reagents, they are given feedback through the handsets as to whether they are doing it correctly. Users feel as if they are truly performingthetestwhilstwearingtheheadsets andusingthehandsets.
What kind of issues does the VR training software aim to resolve within the field of transfusion?
In the field of transfusion, there is a lot of pressureonthehospitaltransfusionlabsandon our reference labs where there is a shortage of highly qualified biomedical scientists. This is putting a huge training burden on hospitals to train their staff up to an experienced level. The virtual reality packages that we have been working on are trying to address that training gap so that people can enter the blood transfusion laboratory; after completing some virtual reality training They will be much more prepared to learn those individual laboratory processes because they have already been introduced to them over and over in virtual reality. We also hope to develop transfusion laboratory hub where people can have training, canmeetinthevirtualworld.
References
1.
2.
How did the app help you reduce the risk of associated with mismatched transfusion?
We do not expect the app to fully replace the actual training within the transfusion laboratories, but we hope that the app provides a better understanding of the ABO blood grouping process and the need to select compatible units. Though the app, user experience negative outcome at the endofanincompatibleunitistransduced.In a hospital transfusion lab, there are lots of processes in place to prevent an incompatible unit from being issued for a patient. The app reinforces this knowledge, making people aware of the safety repercussions. By practicing frequently in the app, it becomes difficult to make mistakes,particularlyinthelabsetting.
Have you observed any improvements sincetheapphaslaunched?
Atthemoment,wearedoingsomeresearch into the benefits of virtual reality training and what we found is that it is relieving some of the pressure on laboratories. We have two projects on the go, one that involves the blood identification app and onethatinvolvesacross-matchingpackage. Both have found that people who have completed the virtual reality training were ready and confident when they went into the lab to perform the real test. Those who completed the training came in with prior experience and required less instruction on the technique and procedure, reducing the need for extensive explanations in the laboratory. This frees up time for specialists tofocusmoreonpatientwork,aswellason training in laboratory processes, rather than having to explain all the foundational knowledgeassociatedwiththeprocedure.
Evans, R., & NHS Blood and Transport. (2024). Virtual Reality training - Blood typing. Retrieved 29/08/2024 from https://hospital.blood.co.uk/the-update/virtual-reality-training/
NHS Blood and Transport. (2024). NHS Blood and Transplant now using virtual reality training for blood transfusion matching. Retrieved 29/08/2024, from https://www.nhsbt.nhs.uk/news/nhs-blood-and-transplant-now-using-virtualreality-training-for-blood-transfusion-matching/
Figure 1:
Performing ABO grouping by the tile technique¹
The Need For Biomedical Scientists To Have The Right Skills
DR VICTORIA CHALKER, DEPUTY CHIEF SCIENTIFIC OFFICER
CONVERSATION WITH LLOYD MCLEGGON-WATKINSON
FOR NHS
ENGLAND
IN
Biomedical scientists play a pivotal role in the care and management of patients that is rarely seen in the public eye; it is also a specialist area that is constantly evolving. The nature of this evolution requires that registered Biomedical Scientists continually work towards achieving a skillset suitable for a continually developing speciality. These skills may begin to be acquired early in education and firmly established into a career and beyond. The dynamic nature of the sector often requires the integration of innovative technology, methodology and evidence-based practice to be implemented which requires Biomedical Scientists to continuously work to obtain updated knowledge in an ever-changing environment. Lloyd Mcleggon-Watkinson, a Biomedical Science Apprentice at the University of Salford, spoke with Dr Victoria Chalker, the Deputy Chief Scientific Officer for NHS England, to get to know how healthcare science has evolved over time but also about the importance of Biomedical Scientists updating their skills and practices for a modern laboratory setting.
The Editors would like to thank Professor Richard Birtles (The University of Salford) for connecting us with Dr Victoria Chalker. Additional thanks go to Kim Allen, Alex Wilson and the NHS Communications Team, David Wells (Chief Executive of the Institute of Biomedical Science) and Sue Jones (Executive Head of Education –Institute of Biomedical Science) for reviewing this article and providing their insights.
Lloyd: Please introduce yourself to our readersandtellusalittlebitaboutyourrole.
Victoria: My name is Dr Victoria Chalker; I am the current Deputy Chief Scientific Officer in NHS England. I am not a Biomedical Scientist, but I am a Clinical Scientist, and I have spent several decades of my life working very closely with Biomedical Scientists. I have worked in various areas, such as the UK Health Security Agency, NHS Blood and Transplant, and NHS England. In all of those, I have worked with Biomedical Scientists who are delivering high qualityhealthcareforpatients.
Lloyd: Your current role as the Deputy Chief Scientific Officer, how is that linked to the workofbiomedicalscientists?
Victoria: We have quite a lot of interactions with Biomedical Scientists because Biomedical Scientists are part of the healthcare science family. In healthcare science, we have more than fifty types of scientists operating. Our personnel range from bioinformaticians, clinical engineers, medical physicists, epidemiologists, to Biomedical Scientists who form one of our largeststaffgroups;theHCPCreportedinMarch 2023thatthereare27,067BiomedicalScientists registered with them. Biomedical Scientists work in hospital laboratories, providing services such as infectious disease testing, blood typing and other testing, immunology, and biochemistry,whichareimportantforpeoplein hospital, informing clinicians on the required treatmentsofpatients.
AdditionalareasthatBiomedicalScientistswork in include histology, cytology, transfusion, and genomics. Tests are needed by the public, 24 hours a day, 365 days of the year. Information that is used nationally for our surveillance of infectious diseases relies on Biomedical Scientistsundertakingthetestsinahigh-quality way and reporting those tests through to the epidemiologists undertaking analysis. Biomedical Scientists also provide emergency out-of-hours tests for services and patients on theweekendsandlateatnightaswell.
Lloyd: There has been an increase in awarenessoftheprofession,especiallysince COVID. However, there is still work to do. Whatdoyouthinkcouldhelp?
Victoria: BiomedicalScienceisaprofessionthat is more than one hundred years old, and we have the Institute of Biomedical Science as one ofthelongeststandingprofessionalbodieswith a strong history of tradition, skilled and proud members. The profession can provide an amazingly rewarding career. If you look at the history of Biomedical Science, many biomedical scientists have contributed the development of steriletechnique,vaccinesandmuchmore.Over manyyearsBiomedicalScientistshavetakenthe country through the creation of techniques and processes that ensure high laboratory quality, whichwestillusetoday.
Lloyd: How can we improve the understanding of biomedical science for youngpeopleandthepublic?
Victoria: We can do it in a number of ways: we need to talk to teachers. We need to talk to universities as well. Not all biomedical science degreesareaccredited;62%ofallBScBiomedical Science(s)coursesareaccredited,soaroundsixtyfourareofficiallyIBMS-accredited.Ithinkitwould be helpful if that was better articulated to young peoplewhentheyarechoosingtheiroptions,with more information now being circulated on sites suchasUCAStomakeprospectivestudentsaware ofwhatisrequired.Iftheywanttobeaccredited as a Biomedical Scientist, or if universities could increase the extension of Biomedical Science degreessothattheyareallaccredited,wewould then be able to help students not start studying beforerealisingthatthedegreeisnotaccredited. Also, we need to be better at articulating the rewarding careers that people can have, to teachers, and focusing on showcasing the great workthatourBiomedicalScientistsdo.
I think we need flexible entry for Biomedical Science, and we need for people to be able to entertheprofessionandbesupportedduringthe work to gain accredited status; this is done throughthefourroutestoregistration.Wedothat in the NHS and other organisations; we take peoplewithnon-accrediteddegreesandearlierin their careers and help support them through the process.Irecentlymetabiomedicalscientistwho has been supporting the NHS for forty years and did his A levels and biomedical science degree andothertrainingqualificationsallsupportedon the job. We have a strong tradition of training peopleonthejob.
BiomedicalscientistsdonotjustworkintheNHS, they also support other organisations and academia. Having both accredited and nonaccrediteddegreesishelpfulforpeopletostudya breadthofscience,whichweneedasasociety.
Lloyd: The NHS Long Term Workforce Plan gives enough description of the future of developing and retaining its staff to better protect and improve the health service. Point #18 of the plan relates to the continuation of science, research and technology, digital and data development. Will there be a greater initiative and support for CPD to ensure skill developmentandretention?
Victoria: CPD is essential for all our scientists to ensure that they are actively learning on the job, butalsoworkingwiththemostup-to-datequality and safety standards and procedures to translate ourresearchintothecarethatthepatientsneed. There should be an ongoing focus on CPD for all our staff to make sure everyone is performing as wellastheycan.
All the organisations that I have worked in, support staff in many ways. For example, the apprentice route for training is open to staff members in the NHS. I undertook an apprenticeship as part of my role when I was in UKHSA, and they are not necessarily purely science focused. There are degree apprenticeships that are science-focused, and they can help you on your route to become a Biomedical Scientist. There is a breadth of apprenticeships that are available in the system now to support the development of staff; we needtohelpthem,helpourpatients.Oneperson in my team is undertaking a data analytics apprenticeship.
Lloyd: On the topic of equality, diversity, and inclusion, which are key principles that form thefoundationoftheNHS?Whatisinplaceto ensuregroupsobtainandretaintheirskillsas biomedicalscientists?
Victoria: All staff should be supported to be competent in their practises that they are undertaking, and continuous professional development is part of that process. The retention of skills is something that if you are a biomedical scientist is iterative; we are all constantly learning, and science is constantly changing. It is important that we have a diverse and broad community of scientists to bring a breadthofthoughtthatwewouldnotnecessarily haveotherwise.Everybodywhowantstobecome a biomedical scientist should be supported to consider if it is the right role for them and be supported to obtain the qualifications. We need biomedical scientists across the country. It is important we help people aspire to be biomedicalscientists.
It is about role modelling and communicating and there are things we can do to help do that. For example, last year, I went to a school in Bradford where I used to play sport when I was younger.There,Italkedtothestudentsaboutmy career to help them aspire to work in science. When I speak to young people and teachers about the breadth of science, not many of them are aware of the whole variety of scientists that we employ in government and in the NHS. We reallyneedtogetbetteratcommunicatingwhat wedoandthescientistsweneed.Wedohavea truly diverse community in the workforce, but it canalwaysbeimproved.
Lloyd: My next question now, as an apprentice,Idohaveanappreciationofbeing able to work in the NHS trained laboratories whilst undertaking the Biomedical science degree. Do you think that post graduate apprenticeshipswilltakeagreaterrolegoing forward in enhancing the knowledge and skillsetsofregisteredbiomedicalscientists?
Victoria: Absolutely. There are already available postgraduate qualifications for biomedical scientists supported by the IBMS such as the specialist portfolios. Our biomedical scientists, can undertake many advanced clinical qualifications with the IBMS. An additional optionistoundertaketheSTP(scientisttraining pathway) programme and then progress to become consultant level scientists. There is also an equivalence route for clinical scientists, and this is the Certificate of Attainment by Equivalence for Clinical Scientist (CEP). A CEP can be done in the field of laboratory management as well. Postgraduate training is also open for biomedical scientists to apply for, but there are also other forms of postgraduate education,suchasundertakingresearchorPhD qualificationsifthatissomethingthattheyreally wanttodo.
We have people who work in things like communication of science, or the regulation of science, safety and quality regulation or accreditationservices.Weevenhavepeoplewho gooniftheyareinterestedtotaketheirscience degree, whatever that may be, and then undertakelawtoadviseonintellectualproperty. Myadvicetoaspirantbiomedicalscientistswho wanttobroadentheirportfolioisthatthereare many different careers in science that your biomedical science provides a solid foundation for.Wehavealsogotareasofemergingscience where we need biomedical scientists going forward, which are interesting and innovative areasthatwillhelppatientsforthefuture.
Lloyd: Speaking of emerging sectors, how is artificial intelligence being introduced into the NHS laboratory settings and how does the NHS support recent graduates to make thebestuseofAI?
Victoria: We can certainly use improved machine learning and digital capabilities in the science that we undertake. The scope for AI to influence practise is potentially quite large. However, it is going to take time to make sure thattheseprocessesaredoneinaregulatedand qualityassuredmanner,thatpeoplearetrained to understand how they work, as well as make sure they are working as expected with safety andqualitybeingbuiltintoanysystems.
The NHS is investing a lot in digital transformation, including training staff in AI, as wellasdigitalpathology Infact,IwassentanAI framework just yesterday, with learning opportunities for staff, not just those in science to understand how AI could really transform whatwearedoing.Youcanfindoutmoreabout the NHS viewpoint on AI and machine learning on the NHS England website. AI and Machine Learningissomethingthatmighthelptransform someoftheareasthatweworkon,butweneed
to make sure that with everything we do, patient safetyandpatientcareisattheheartofit.
It is important to note that not all biomedical science will be or can be replaced by AI. We still need subject matter experts; not all techniques are undertaken digitally. There are a lot of physiological basedsciencesthatareneededtosupportpatients.I donotwantscientiststobeputofffromundertaking biomedical science because they are not as excited or interested in AI. We need we need a whole breadth of expertise and specialists, including those withdigitalandAIcapability,whichiswhythereare manydifferentpathwaystofollow.
Lloyd: Do you have any advice for biomedical science students, including myself, who are working to gain skills and experience to prepare formedicallaboratoryorresearchwork?
Victoria: Reading scientific papers and abstracts is an effective way to get a broad understanding of different sort of research techniques and methodologies, and the structure of how different protocols, studies and clinical trials have been established and set up. If there is one area you are interested in, you can always read around that, contact the lead researcher or researchers on the team and ask them to talk to you about it. Most scientists are quite willing to talk about their own researchtoothers.Itisgoodtobeawareofwhothe expertsareinthefieldandwherearetheylocatedin the world. Research skills and a final year research project are embedded in all BSc (Hons) degrees for studentsandapprenticestoallowasmanystudents as possible to gain valuable experience in the laboratoryspace.
Often, it is about increasing your own knowledge, and that is really through learning from others through attending conferences etc. Scientific conferences are important, such as the IBMS Congress. There are local, regional, or national level conferencesthatpeoplecanattend,toincreasetheir scientific knowledge and build a network. If you are early in your career, it will hold you in good stead over a number of years. I am still in contact with peopleIstartedworkingwithdecadesago.
Peopleshouldnotbeafraidtofail;youshouldnotbe afraid to ask questions. No question is a stupid question.Youcanalsoapplyforgrants.Iappliedfor and received my first grant when I was a junior scientisttohelpmewithadiscretepieceofresearch. The lessons I learned in going through that applicationprocessheldmeingoodsteadbecauseit helped me look at how to structure research applications,howtocommunicate,andhowtoplan and undertake the study, considering its financial, ethical and governance requirements. For young scientists,therearegrantsavailabletosupportthem with undertaking basic level of research to start. If youdonothaveexperiencewritinggrants,therewill besomeoneinyourorganisationwhoisexperienced atit,whocanhelpyouandadviseyouonthat.
Employability Skills – What are they
and how can you develop them as a student?
BYPAULACOURCHENE
Paula Courchene, who is a Careers Consultant in the University of Salford’s School of Science, Engineering and Environment, shares her tips on how to become more employable. She emphasises the current competitive nature of the job market and suggests ways to develop skills needed in the worldofwork.Sheworkscloselywiththecareersteamwhoprovidecareerandemployabilitysupport toallstudentsattheUniversity.Youmaycontactthemviacareersandenterprise@salford.ac.uk
Employers value your degree and the range of transferable or ‘employability’ skills you gain throughout your course. During your degree, you will develop a number of technical and job-specific skills, such as lab techniques and report writing. Alongside this, you will use soft skills, for example, time management to manage deadlines and critical analysis to complete assignments. Combined, all of these are important and can demonstrate to an employer your potential to be effective in the workplace.
We know that the graduate job market is competitive,sowhileyouarestudyingforyour degree and picking up this broad set of employabilityskills,considerwhatelseyoucan do to enhance your employability and make yourself stand out from the crowd. There are many activities you can get involved with outsideofyourstudies.Belowyouwillfindfour suggestions of activities that can develop your employability:
1.Gainworkexperience.
Workexperiencecomesinmanyforms,suchas an integrated placement, like the IBMS or a research placement, an internship, volunteering, or part-time employment. It could involve applying for positions of responsibilitywithintheuniversity,likeacourse or student representative role. Any experience yougaincanbeaddedtoyourCVandusedin applicationsandinterviews.
2. Engage with the support offered throughyourdepartmentanduniversity.
Throughout the year, many academic departments organise lab visits, industry speakers,andcareerfestivals.Speaktoyour academic team to see what is on offer, as these are great CPD opportunities where youcanenhanceyourknowledgeaboutthe sector and start to network with professionals. As well as departmentalspecific support, seek out your Careers Service, as they usually offer workshops, events,andone-to-oneadviceandguidance appointments to help you explore your career options and develop job-seeking skills.
3. Become a student member of a professionalbody.
Manycoursesareaccreditedbytheleading professionalbodyinthatsector.TheIBMSis a great example of this, and if you are studying an eligible degree, you can apply for student membership. This will give you access to industry updates, CPD webinars, and career resources. Membership shows your interest and commitment to keeping up to date with the sector and is a great additiontoyourCV.
4.Takeupextra-curricularactivities.
Universities offer many different societies, sports, and clubs; there is something for everyone. What’s more, if you can’t find exactly what you want, you can use your initiative and entrepreneurial skills to start yourown!Extra-curricularactivitiescanbea great way to collaborate with peers, learn new skills, and show employers what interests you outside of your studies. UniversityofSalfordstudentsandgraduates can get in touch with the Careers & Enterprise Team for further information by visitingtheir website.
Diving Deep – Qualifying as a Science Teacher
BY DILRUBA BOKSH
MeetThasmiahKhanom,adedicatedscienceteachermakingarealdifferenceinsecondaryeducation. WithaBScinBiologicalSciencesfromQueenMaryUniversityandaPGCEfromGreenwichUniversity, Thasmiah has risen through the ranks to become the Head of Biology at a secondary school. Additionally,sheplaysacrucialroleasanAQAexaminerforGCSEandA-Levelbiology.Inaninterview with second-year BSc Biomedical Science student Dilruba Boksh, Thasmiah shares her journey into teaching,thechallengesshehasovercome,andwhatkeepshermotivatedintheclassroom.Shealso offers valuable advice for those considering a career in teaching, drawing on her journey and the insightsshehasgainedalongtheway.
Could you share a bit about your educational background and explain what inspiredyoutopursueacareerinteaching science?
IcompletedaBScinBiologicalSciencefrom Queen Mary University of London. I then decidedtotakesometimeouttoexploremy interests. As I have always had an interest in the education sector, I decided to see if I would enjoy being in the classroom, so I completedayearofunqualifiedteachingand academic mentoring. Throughout this year, I realized that I really enjoyed being in the classroomandsharingmypassionforscience, especially biology, with future generations. I then decided to complete my PGCE (Postgraduate Certificate in Education) the followingyear.
Can you describe your PGCE journey and what it took for you, as a recent graduate, toapplyandsucceed?
During my time working in a school, I encountered teachers who had pursued various routes into teaching, such as Teach First, School Direct, and the more traditional PGCE. This exposure allowed me to evaluate the advantages and disadvantages of each pathwayandselecttheonethatbestaligned with my goals. Ultimately, I chose the PGCE route, as it offered extensive opportunities to experience different school environments throughplacements.ThePGCEisayear-long program featuring placements in two different schools, each with distinct educational settings. This setup offers handson classroom experience, allowing you to teach several hours weekly with the support ofadedicatedmentor.Theongoingfeedback on my lessons proved crucial, significantly advancing my development, and refining my teaching abilities. The PGCE also involves university-level coursework, requiring critical writing and assignments for different modules, which further develops your academicandprofessionalskills.
What is the best part of your job, and what challenges have you overcome in your teachingcareer?
Ienjoybuildingrapportwithstudentsandtheir families,witnessingtheirsuccessandsharingin that achievement. If you stay at a school for a long period, you start to see siblings of your formerstudents,anditisreallyrewardingtosee their success and hear about what the older studentsaredoinginlife.Asateacher,spending significant time with students allows me to impact not only their academic achievements butalsotheirpersonaldevelopment.Ilovethat aspect of the job. The most challenging aspect ofthejobismanagingvarioustasksthroughout the day, such as marking, providing feedback, and handling other administrative duties. However, the time spent teaching in the classroom is perhaps the easiest and most enjoyablepartofthejob,makingtherestofthe responsibilitiesworthwhile.
How excited are you about your new role as Head of Biology? Also, could you share how longittakesandwhatitinvolvestoprogress intheteachingfield?
I always love a good challenge, so I am looking forward to it. I have always enjoyed planning curricula and observing how they are delivered andtheirimpactonstudents.Whilecompleting myPGCE,Iwasrecruitedasascienceteacherto undergo my NQT (Newly Qualified Teacher) training (now known as ECT, Early Career Teacher). During my NQT induction year, I was promotedtoKS3CoordinatorforScience.Iheld thisroleforthreeyearsbecauseitwasimportant to support a cohort throughout KS3 (Year 7 to Year9).Now,Iamexcitedtotakeontheroleof Head of Biology for a new challenge. On career progression there is no fixed timeline. Typically, you start with two years as an ECT. After this period, you can apply for middle leadership positions. Once you demonstrate success as a middle leader, you can then progress to senior leadership roles. The progression to each level depends on individual achievements and readiness,ratherthanapredefinedtimeframe.
HowhasyourexperienceasanAQAexaminer shaped your teaching approach, and what is thepathwaytobecomingone?
IhavejustbecomeanAQAexaminer,andthisis my first set of marking. To become an AQA examiner,youtypicallyneedtohaveoneortwo years of classroom experience. You can express your interest on the AQA website, and if there are any job openings, they will contact you. You thensendyourCVandapplication,selectingthe subjectyouwanttomark.ThereasonIwantedto become an examiner is to learn from expert examiners, specifically, to understand what they look for in mark schemes and see the types of answersstudentsacrossthecountryarewriting. This experience allows me to bring valuable insights into my teaching, ultimately benefiting mystudents.
Do you think there are any drawbacks to a careerinteaching?
Like in any other career, there are some drawbacks.Especiallyatthebeginning,teaching canbeverytime-consuming,andfindingagood work-lifebalancemaybechallenging.Thisiswhy many new teachers experience burnout quickly. Initially, you want to give it your all, but by the end of the two years, you might feel like you cannot continue. This challenge contributes to thehighturnoverrateamongteachers.However, with time, experience, and an excellent team, it doesgetbetter.
Besides academic learning, what other qualitiesorexperiencesfromyourschooland university life have you integrated into your teachingcareer?
TherearealotoftransferableskillsthatIpicked upalongtheway.Forexample,Istillremember how my biology teacher in secondary school taughtcertaintopics,andItrytointegratethose methodsintomyownteaching.
One of the most important skills I picked up from university is working collaboratively as partofateam.Itiscrucialtoworkasateamto achieve the best outcomes for students, and the group presentations from university really helped me understand how to effectively collaborate in large teams and consider everyone'sideas.
Howcanundergraduatestudentsdetermine if teaching is the right career for them, and what advice do you have for aspiring teachers?
Beforecommittingtobecomingateacher,itis crucial to experience a classroom from a teacher's perspective. That is why I did not go straight to a PGCE, even though it was one of my options. I wanted to see if teaching is something I could do for the rest of my life. I hadvolunteeredinschoolsandtutoredfroma young age, but that experience is different from standing in front of a classroom of 30 studentsallday.Teachingisademandingrole, soshadowingateacherforatleastaweekcan provide insight into its requirements. My best recommendation would be to work as a teaching assistant (TA) for a year before entering teacher training. While it might be challenging to find a job as an unqualified teacher, TA positions are more accessible. This roleexposesyoutovariousteachingstylesand often involve supporting our most vulnerable students, including those with special educationalneedsanddisabilities(SEND).This experiencehelpsyoulearnadaptiveteaching,a crucialstandardintheprofession.
IhavealwaysnoticedthatPGCEstudentswith TA experience perform better than those who go straight into the program. They are more prepared and have a better understanding of classroomdynamics.
Military Healthcare Ethics - Practicing Healthcare Ethically in a Military Setting
BY BLESSING AKPEJI
Military healthcare operates differently from medical healthcare. Even though they provide the same services, treating sick and wounded patients, military healthcare is governed by different ethics.TopracticeasaMilitaryhealthcareprofessional,crucialskillsareneeded.Militaryhealthcare professionalsareboundbymedicalethicsofsavinglivesfirstandbeingloyaltotheircountryonthe war front. Even though they are not involved in fighting on the war front, they make equally essentialdecisionsregardingwhogetstobetreatedandevensavetheenemy.Thisarticleexpands on some of the crucial needs and requirements necessary to practice as a military healthcare professionalandhowdifferentthisisfromcivilianmedicalpractice.
Beingahealthcareprofessionalhasbeensaidto beoneofthemostrewardingandfulfillingroles as you save the lives of others. Being in the military has a different twist to the picture. As military personnel, you lay your life on the frontline to fight for your people, and as medical personnel, you are there to save every life you can, often under extreme and challengingconditions.
Military healthcare professionals, including doctors, nurses, or biomedical scientists, must adapt to the tenets of a military environment. They may operate in various work settings, ranging from well-equipped military hospitals, remote relief areas with limited resources, and field hospitals in conflict zones or war fronts. Medical ethics is governed based on certifications of qualifications and competence done by relevant professional bodies, such as theGeneralMedicalCouncilforMedicalDoctors and the Health Professional Council for BiomedicalScientists.
TheGenevaConventionsandotherinternational humanitarian laws mainly govern military healthcareprofessionals.Thisisthebasisofthe term “Dual Loyalty” associated with Military medical healthcare professionals because they areinbetweentwoprinciplesinpractice,which may become conflicting as they must uphold national security supporting the military objectives and the responsibility to cater to patientsandtreateverypatient⁵ .
Military healthcare professionals are usually specially trained by their medical body and Army officers to be resilient, empathic, and physicallyfittoprovidecareundersuchdiverse andsometimesharshconditions.
Theymustalsohaveastrongethicalcompassto guide them in their duties as a military healthcare professional; you can get deployed anywhere, on the battlefield, on naval bases, or even in remote areas, which is why one of the critical skills is adaptability³. Requirements for joiningthearmyincludeabasicphysicalfitness assessment, an age requirement of 17 to 35 years, basic military training and a bachelor's degree in your field; for example, for a Biomedicalscientist,youwouldrequireadegree in Biomedical science and be registered with relevantbodies.
This rigorous training prepares them for the psychological and physical challenges of treatingbothciviliansandsoldiers.Someofthe training includes emergency medical procedures, trauma care, and the use of other medical technologies. Also, military healthcare professionals must be adaptable to different cultures, traditions, customs, beliefs, and medical needs of the population they are deployedtoserve;thisispartofmilitarytraining and is designed to maintain the integrity and coreelementsofmedicalmilitaryprofessionals².
Medicalpersonnelmustfollowadifferentsetof rulesandethics.Thisisverydifferentfrombeing acivilianhealthcareprofessionalbecauseofthe different circumstances and modes of operationsinthemilitary.
The ethics of doctors and healthcare professionals are summed in the dictum, “First do no harm, so they do their best to save every sickandinjuredpersonthatcomestheirway.In military ethics, the soldier is loyal only to his country and must fight the war to protect national security. The role combines both the military physician and the healthcare professional.
Themilitaryphysicianisexpectedtobeboth apatrioticsoldierandahumanphysician.A military physician is expected to bridge these professions and blend into one. Military medical personnel are faced with diversechallenges,especiallyonthefield¹.
Their roles as military healthcare professionalsmaybetermedcomplicatedas they may face different challenges. For example, confidentiality cannot be breached; they must keep every patient's information confidential. These healthcare professionals find themselves in a dilemma whethertokeeptheinformationofasoldier struggling with alcohol dependency from themilitarycommanders⁷ .
Also, in a war situation, the healthcare professional may face challenges making difficult decisions urgently, deciding who receivestreatmentontheseverityofinjuries andsurvivallikelihood.Thismaybeaheartbreaking decision to make for the healthcareprofessionalandothers⁴ .
The Geneva Convention states, "Each belligerent must treat his fallen adversaries ashewouldthewoundedofhisownarmy.It meansthatmedicalhealthcareprofessionals must treat all injured and sick soldiers regardlessofwhethertheyaretheenemyor not.Thiswouldmeantwothings:upholding themissionofwinningthewarandkeeping the Hippocratic oath⁶. Assaults and injuries are a standard part of the war, so medical aid must be provided solely for medical needs regardless of sex, race, nationality, religion or political opinions. The wounded and sick must not be left without medical assistance, and treatment should be based onurgency.Itisalsoimportanttonotethat following the Geneva Conventions, Military medical healthcare professionals are to be regarded as non-combatants and are forbidden to engage in war, so they have a special status, and they are not to be captured and they are immune from attacks⁸ .
Being a military healthcare professional is beyond duty; it is more of a calling because youareresponsibleformanylives,including your own. You can decide who gets urgent attention and who can wait with limited resources. These tough choices are part of what moulds the military healthcare professional¹.
If eligible and fit to be a military healthcare professional, you will undergo several training sessionstoprepareforyourrolesandguideyouin yourethicaldutiesandresponsibilities.Asidefrom the generic training that would need to be undertaken by every personnel in the military, some other institutions have developed training, such as the ICMM Centre of Reference for EducationonInternationalHumanitarianLawand Ethics, the U.S. DoD Medical Ethics Centre (DMEC),andtheKing’sCollegeLondonCentrefor Military Ethics (KCME). These trainings and workshops are usually done annually on Military Medical ethics and are solely to support military healthcareprofessionalstomakelegalandethical decisionsinthemilitarycontext⁵
Navigating the ethical challenges of a military healthcare professional requires a solid ethical and moral compass. Military healthcare professionals are primarily responsible for their patientsandmustensuretheygivetheirbestcare to their patients, whether civilians or soldiers. They are also responsible for the resources allocated to them, whether limited or abundant, ensuring the most crucial needs are met. They must find the balance between their military obligations and medical duty. It is, however, the most rewarding position, and their commitment and resilience help to save lives and uphold the core values of both the medical and military professions.
References
1. Bricknell, M., & Story, R. (2022). An Overview to Military Medical Ethics. Journal of Military and Veterans' Health, 30. https://jmvh.org/article/an-overview-to-military-medical-ethics/
2. Brintz, C. E., Miller, S., Olmsted, K. R., Bartoszek, M., Cartwright, J., Kizakevich, P. N., Butler, M., Asefnia, N., Buben, A., & Gaylord, S. A. (2020). Adapting Mindfulness Training for Military Service Members With Chronic Pain. Mil Med, 185(3-4), 385-393.https://doi.org/10.1093/milmed/usz312
3. Finnegan, A., Finnegan, S., McKenna, H., McGhee, S., Ricketts, L., McCourt, K., Warren, J., & Thomas, M. (2016). Characteristics and values of a British military nurse. International implications of War Zone qualitative research. Nurse Education Today, 36, 86-95. https://doi.org/https://doi.org/10.1016/j.nedt.2015.07.030
4. Hines, L. A., Gribble, R., Wessely, S., Dandeker, C., & Fear, N. T. (2014). Are the Armed Forces Understood and Supported by the Public? A View from the United Kingdom. Armed Forces & Society,41(4),688-713.https://doi.org/10.1177/0095327X14559975
5. Lin, C.-Y., Bricknell, M. C. M., Brockie, A. F., & Kelly, J. C. (2022). Military Healthcare Ethics: Making It Relevant to the Whole Military Care Team. Military Medicine, 188(1-2), 21-24. https://doi.org/10.1093/milmed/usac321
6. Meyer, H. S., Bader-Larsen, K. S., Artino, A., & Varpio, L. (2021). Ethical Bearing Is About Our Conduct: Ethics as an Essential Component of Military Interprofessional Healthcare Teams. Military Medicine, 186(Supplement_3), 23-28. https://doi.org/10.1093/milmed/usab197
7. Noroozi, M., Zahedi, L., Bathaei, F. S., & Salari, P. (2018). Challenges of Confidentiality in Clinical Settings: Compilation ofanEthicalGuideline.IranJPublicHealth,47(6),875-883. 8. Vaidya,R.,&Bobdey,S.(2021).Medicalethicsduringarmed conflicts:Dilemmasofaphysiciansoldier.MedJArmedForces India,77(4),377-381.https://doi.org/10.1016/j.mjafi.2021.08.013
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You may read our newly released and previous issues at issuu.com/bioscientistmagazine
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PROGRAMME LEADS ADDRESS PROGRAMME LEADS ADDRESS
TheBiomedicineProgrammeLeadTeamreflect on the academic year 2023-2024, highlighting the key achievements and events. They also welcome new and returning students to the Universityforanewyearoflearning.
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COFFEE WITH CAROLINE
DrCarolineTophamdiscussestheneurobiology behind resilience and shares tips on how to bounce-back in tough times, whilst conversing withAshleighBowskill.
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MY PLACEMENT EXPERIENCE
Biomedical Science placement student Heba talks about her placement at Wythenshawe Hospital and her experience working towards building her portfolio to achieve her IBMS CertificateofCompetence.
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BIOMEDICAL SCIENCE DAY 2024
BiomedicalScienceDayisanannualcelebration oftheworkofBiomedicalScientists.Theevents that the University of Salford’s students got involvedinareoutlinedinthispiece,writtenby SalfordBiomedicineambassador,Sara.
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MY JOURNEY TO SALFORD AS A DEGREE APPRENTICE
Louisetalksaboutherreturntoeducationasa biomedicalscienceapprenticeattheUniversity of Salford. She mentions her work in Spire HealthcareasanAssociatePractitionerandher transition toeducation.
We would like to begin by welcoming all of our new and returning students to the University of Salford, for the 2024/2025 academic year. For returningstudents,wehopethatyouareenjoying thenewtopicsthatyouarestudyingandcontinue toengagewellwithyourstudies.Forallofournew students and degree apprentices, we hope that youareadaptingwelltouniversitystudiesandare enjoyingthetransitionfromlearningincollegeto themuchlargerscaleofuniversity.Wealsohope thatyouaremanagingtointeractwithyourfellow studentsandlearnersthroughoutyourstudies,to hopefullyallowyoutodeveloplifelongfriendships and collaborations which last much longer than the time of your degree programme. We hope thatyoualltakeeveryopportunitytheUniversity of Salford can offer you, both timetabled and extracurricular to make you the best possible graduates,allowingyoutoachieveyourdreams.
This previous year has been a busy year, with a series of major achievements and milestones for the Biomedicine suite of programmes. The Biomedical Science programmes were successfully reaccredited by the Institute of Biomedical Science (IBMS), confirming our accredited degree status until 2029. This was a monumental task led by Dr Sara Namvar but required significant input from the whole programme team to complete the submission and ensure it met the high standards the IBMS requires. Our Biomedical Science degree apprenticeship provision was also inspected by OFSTED lastyearasapartoftheirwideruniversity inspection, with us being awarded a good outcome. This is a great achievement with the inspectors highlighting numerous positives and areasofexcellencewithintheprogrammeandthe team which deliver it. We would like to thank everyone involved in the inspection and the key members of the team who spent their evenings coordinatingthissuccessfulinspection.
“Congratulations on being recognised as ‘EducationalInstitutionoftheYear’atthe2024 IBMS Awards. Your commitment to excellence and innovation in biomedical science is truly exemplary. Your degree apprenticeship program’s high pass rates and the successful transition of your graduates into biomedical scientist roles reflect the effectiveness of your educational strategies and robust support provided by your programme team. The curriculum innovations you’ve implemented suchasthepathologyspecimenreceptionand blood transfusion simulations provide students with practical, real-world experiences that enhancetheirprofessionalcompetencies.
Furthermore, the growth of your extracurricular career mentorship groups and the success of yourportfolioclubinaligninguniversitystudies with HCPC standards demonstrate your proactiveapproachtostudentdevelopmentand career readiness. Your institution’s efforts to adapt to the needs of the workplace and continuously improve the educational experience have set a high benchmark in the field. This award is a testament to your dedication to developing skilled professionals who are well-prepared to contribute to the biomedical science profession. Congratulations once again on your outstanding achievements andcontributionstothefield”.
This is a fantastic achievement, with the UniversityofSalford nownationallyrecognised asoneofthebestuniversitiesinthecountry to study Biomedical Science. But this is only thebeginning.Wearecontinuingtoinvestinour department with the appointment of four new academic staff, to support and expand our Biomedical Science teaching team. We would like to welcome Dr Amy Morgan (Lecturer in Biomedical Science), Dr Samantha Borland (LecturerinBiomedicalScience)andDrWillian A. da Silveira (Lecturer in Medical Genomics), with a fourth new lecturer to arrive in the comingmonths.
Further to this, we are continuing to develop our teaching and learning provision to ensure our students have the best possible student experience, with the development and expansion of numerous initiatives including the development of collaborative online international learning (COIL) opportunities, based on the successful COIL event developed by Dr Matthew Jones and Dr Pika Miklavc with Wayne State University in Detroit. We are also designing and implementing digital escape rooms into selected modules to offer students a “playful” way to better understand key academic content related to numerous areas of biomedicine using the UoScape platform (https://uoscape.co.uk/) developed by Dr Nicky Morgan. We will also continue to deliver key events alongside our extracurricular societies including the nationally recognised IBMS portfolio club led by Tahmina Hussain, as well as journal clubs, lab tours, book clubs, plus the return of Bioart and PassionFlash. You will hear a lot more about these events in the coming months, so keep your eyes peeled for the advertisements on how to sign up soon.
We would like to end by taking the time to say thank you to all of our staff and students who have made these positive outcomes possible, and we look forward to welcoming our new students into the Salford Biomedicine family. We wish you luck with your upcoming academic year of studies.
Coffee With Caroline
Resilience STUDENTS
DR CAROLINE TOPHAM GIVES ADVICE TO STUDENTS ON RESILIENCE WHILST DISCUSSING THETHEMEWITHASHLEIGHBOWSKILL.
Whatisresilience,andwhyisitimportant?
TheAmericanPsychologicalAssociationdefines resilienceas“theprocessofadaptingwellinthe face of adversity, trauma, tragedy, threats, or significant sources of stress”¹. The physiological capacity to adjust behaviourally, emotionally andmentallyisacorefeatureofbeingresilient, as challenges present themselves throughout our lives, some bigger than others. How we respondtothesechallengesiscrucial.Adapting is a fundamental aspect of resilience, as obstacles arise continuously throughout our lives, and our ability to adapt increases our likelihoodofsurvival.Ourabilitytothriveinthe world is directly influenced by how we react to these challenges, given that our very existence depends on our reactions. Reflection upon our ancestors shows the increasingly evident link betweenresilienceandsurvival,astheircapacity to obtain sustenance, maintain warmth, and protectthemselvesagainstharmdailywasvital for continuing to live their lives in the face of tragedyandadversity.Iftheywereincapableof this, they would not have survived. In contrast, the majority of modern-day individuals in the UK enjoy a higher level of security in terms of access to necessities such as food, water and shelter. This increased security reduces the immediateneedforresilienceformeresurvival. However, resilience remains essential for individuals to thrive and reach their maximum potential.
Howdoesresilienceworkneurologically?
Aspects of our personalities are linked to our neurobiology,suchasmyhabitofcreatingto-do listsandcheckingofftasksasIcompletethem. Over the years, I have noticed that this action triggers a sense of satisfaction and a release of dopamine, which reinforces the behaviour. Our brains form and strengthen neural pathways through repetitive behaviours, making certain actions feel more natural to us. When we consider the reinforcement of neural pathways in terms of resilience, individuals may experience various positive or negative outcomes based on the choices they make in eachsituation.Theseoutcomescanberandom, and/orbeinfluencedbyspecificcircumstances,
leading to the development of habits (reinforced neural pathways) based on the success of their decisions. This might explain why some people remain calm in difficult situations while others quickly become overwhelmed. It seems that we develop certain reactions and coping strategies that becomeautomatichabitswhenweareunder stress.
For example, individuals who have experienced trauma may feel anxious and fearful in situations that remind them of the traumatic event, even when there's no logical reasonforthesefeelingsinthepresent.Thisis known as Post-Traumatic Stress Disorder (PTSD), which occurs when neural pathways associated with fight/flight/freeze responses are reinforced by past traumatic experiences. These pathways can be quickly activated in responsetominorstressors,causingsignificant distress and impacting daily functioning. Thankfully, psychotherapist or psychiatrist consultations can effectively treat this condition.
Are humans naturally resilient, and what makes some people more resilient than others?
Thewayeachpersonrespondstostressvaries and can be influenced by factors such as the environment in which they were raised. Additionally,thereisevidenceasstatedearlier, that we differ phenotypically in terms of our neurobiology, regardless of environmental factors.
Roughly20%ofthepopulationisbornwitha “highly sensitive” nervous system, and these individuals are referred to as Highly Sensitive People(HSPs)bypsychologists.HSPshavealso been termed “orchids” by psychologists in comparison to individuals with lower sensitivity, who are called “dandelions”². Orchids generally thrive in a specific environment,whiledandelionscanadaptand thrive anywhere. Although HSPS can absolutely be resilient, they may require differentformsofsupporttocope effectively. If you are curious if you may be HSP,youcantrythistestout!
How does genetics play a role in resilience?
Researchers who have focused on the genetics of resilience concur that there is a genetic element to our stress-managing abilities. It is not surprising that genes associated with neurotransmitter systems are among the potential candidates, and developing a deeper understanding of these genetic connections could aid in the prevention of mental illnesses and the development of various pharmacological interventions. A 2019 review by Maul S, et. al. providesacomprehensivesummaryofseveral studies examining PTSD and depression, making it an excellent starting point for reading³.
Does technology and social media impact a person’s resiliency, and are these impactsbeneficialordetrimental?
Technology and social media use can potentially influence an individual's resiliency in both positive and negative ways. On the positive side, social media platforms allow opportunities for individuals to make connections, obtain valuable resources, and seek support that may aid a person through adversity. These also allow means of selfexpression, creativity, and personal development, all of which contribute to enhancingresilience.
However, the use of technology and social media can also have adverse effects on an individual’s resilience. Excessive reliance on social media platforms can trigger feelings such as envy, loneliness, and the stress of trying to create a perfect and unrealistic image of themselves. These outcomes can significantly consume an individual’s selfconfidence,aswellastheirphysiologicaland physicalwell-being,overallunderminingtheir abilitycapacitytocopewithlife’schallenges.
The impact of technology and social media on a person’s resilience is multi-faceted and complex,ultimatelydependingontheuseof these tools and the underlying factors that influence their relationship with technology andsocialmedia⁵⁻⁶.Beingmindfuloftheuse of technology is important. Healthy habits and boundaries to ensure these tools contributepositivelytoresilience.
What are some of the most common factors for strengthening and maintaining resilience?
Thisisahottopicinthementalhealthworld, and there are hundreds of resources and numerousbookstochoosefrombasedonthis subject! Having an effective stress and emotionmanagementmethodisessentialfor building resilience, however, these attributes and skills can work differently among individuals.
TogetstartedIrecommendcheckingoutthehelpful tipsontheMindwebsite,whichisanexcellentguide forthoseembarkingonthejourneytoenhancetheir resilience. One key aspect highlighted in their recommendations is the importance of self-care and buildingagoodrelationshipwithyourselfandothers inyourlifeandcommunity.Associalbeings,humans tend to fare better in managing stress when surrounded by supporting networks. Seeking assistance from a counsellor or psychotherapist can alsoaidintheprocessofstrengtheningresilience⁴
Are there any misconceptions and downsides to resilience?
Resilienceisoftenseenasapositivetraittoacquire, butitisimportanttoconsiderthepotentialdownside of becoming overly dependent as a coping mechanism. This hyper-independence can develop from childhood as a coping mechanism, from childhoodexperienceswheretrustinpeopleandthe world around you was shattered and could not be reliedupontokeepyousafeandsecure.
Those of us who have experienced abuse or neglect, including emotional neglect, may decide at an early agethatonlywecantakecareofourselves,andfind ithardtotrustpeopleandformconnectionslaterin life. While self-reliance can be a survival strategy, it mayalsoresultindepression,anxiety,andloneliness if we do not learn to trust others again. As stated earlier, animals are social beings who thrive on community and connections. Denying ourselves this due to hyper-independency, and not sharing our feelings and needs, can be very isolating. If you recognisethisyourself,
I encourage you to reflect on how you can start building trust in your relationships, perhaps with a friend,counsellor,mentor,ortherapistwhocanhelp youtostartrebuildingthoseconnections.Remember, aproblemsharedisaproblemhalved!
Heba Toumeh, a Biomedical Science student on placement, is currently working towards her IBMS Certificate of Competence by building her portfolio. She talks about her time at Wythenshawe Hospital, a part of Manchester University NHS Foundation Trust. She provides an insight into what life is like as a placement student, looking at the day to day running of a BiochemistrylabaswellasthechallengesfacedbyBiomedicalScientists.
Hi, I am Heba Toumeh. I want to share my incredible experience as a Biomedical Scientist (BMS) trainee at Wythenshawe Hospital’s Biochemistry Department. This year has been a stimulating journey of growth, learning, and discovery.
Asabeginner,Idoveintobiochemistry,workingon various tests from osmolality to diabetes diagnosticswithHbA1csamples.Eachday,westart with a team huddle, setting the stage for collaborationandproblem-solving.Thesemeetings havebeeninvaluableinsharpeningmyprofessional and communication skills (HCPC SoP 7.1, 7.7 and 7.9).
A crucial part of my training involved mastering pipetting techniques and ensuring our lab results are accurate with strict quality controls (QCs). Pipetting is fundamental in a biochemical lab, crucial for precise measurement and transfer of liquids,anditdirectlyimpactstestreliability.
Ibecameproficientwithvariouspipettes,including positive displacement pipettes, which prevent air from entering and are ideal for viscous or volatile samples; multi-channel pipettes for efficient handlingofmultiplesamples;andairdisplacement pipettes,whicharetypicalforgeneraluse.
Quality controls (QCs) are integral to this process. They involve using different control levels to validate testing accuracy and precision and identifying errors early to ensure reliable results (HCPC SoP 12.6). Adhering to the Westgard rules, which provide guidelines for detecting errors and ensuring consistent results, is essential. Regular calibration and maintenance of pipettes are also vital.Thesepracticesarecrucialformaintainingthe credibility of diagnostic processes and impacting patientcare.
Corporate mandatory training, especially on Equality, Diversity, and Inclusion (EDI), has broadenedmyperspectiveoncreatinganinclusive workplace. This training was not just a checkbox but a transformative experience that underscored theimportanceofrespectandinclusivitywithinthe workplace(HCPCSoP5.2).
Ofcourse,thejourneywasnotwithoutitsobstacles. Managing my energy involved developing a consistent routine, prioritising self-care, and taking enoughresttomaintainfocusandproductivity.
To overcome language barriers, I actively communicated with colleagues, sought help, and utilisedscientificlanguageresourcestoimprovemy vocabulary. Enhancing my time management skills required planning and the use of organisational tools, like schedules and to-do lists, to ensure all duties were completed efficiently. Each challenge mademestrongerandmoreresilient,equippingme withvaluableskillsformyfuturecareer.
Reflecting on my year, I am deeply grateful for the support from my supervisors Susan Poni and Hetalika Banka, colleagues, and the University of Salford. Their guidance has been crucial to my development. This placement has increased my passion for biochemistry and prepared me for an interestingfuture.
Thankyouforjoiningmeonthisjourney!
References: Health & Care Professions Council. (2023). The Standards of Proficiency for Biomedical Scientists. Retrieved 28/01/2024 from https://www.hcpcuk.org/standards/standards-ofproficiency/biomedical-scientists/
BIOMEDICAL SCIENCE DAY 2024 AT THE UNIVERSITY OF SALFORD
SARA ALNASIR KASSAM
Biomedicine Student Ambassador, Sara A Kassam, recounts the events that she helped organiseandexecuteaspartofBiomedicalScienceDay2024.WorkingcloselywithTahmina Hussain,MatthewJonesandseveralotherambassadors,eventswererunintandemacrosstwo sixth form colleges and at NHSBT Manchester. Ambassadors and organisers share their thoughtsonhowtheeventswentandwhattheygainedfromtheexperience.
Biomedical Science Day, an annual day of celebration highlighting the incredible contributions of Biomedical Scientists nationwide to the healthcare system, occurred this year on Thursday, 6th of June 2024. First established by the Institute of BiomedicalSciencein2017,
Biomedical Science Day is celebrated in severalwaysbyallinvolvedintheBiomedical Sciencefield,whetherworkingasBiomedical Scientists or students. Competitions are held tounleashthecreativityofthosewhoworkat the heart of healthcare. This year, students from the University of Salford immersed themselves in the celebrations of this incredible day through three events that ran simultaneously. Level 4 and apprentice Biomedical Science students visited Manchester's NHS Blood and Transport Centre.
Additionally,agroupofstudentambassadors visited Connell Co-Op College, East Manchester,whilstanothergroupvisitedHoly Cross College, Bury. Both groups delivered similar talks to students promoting BiomedicalScienceasapotentialdegreeand career.Volunteersdistributedmerchandiseto attendees who had the opportunity to ask questionsabouttheBiomedicalSciencefield andstudentlifeattheuniversity.
The ambassadorial team that went to Holy Cross College was joined by practising biomedical scientist Waqas Hussain, from Manchester University NHS Foundation Trust. Hespokeoftheroleofabiomedicalscientist on a daily and some of the equipment and tests they conduct within Biochemistry, sharing his professional experience with the collegestudents.
In an event running simultaneously, a visit to NHS BT Manchester was organised, based in SouthManchester.
The event was organised by Tahmina Hussain, with Manisha Mort being critical to its success. Lloyd Mcleggon-Watkinson, a Biomedical Science Degree apprentice, accompanied Tahmina and a groupofLevel4studentswhotriedtheirhandat virtual reality blood grouping, a groundbreaking training resource recently launched by NHSBT throughtheircollaborationwithMeta.
The organisers received positive feedback from attendees,participants,andSalfordambassadors. Iqra, who was a Salford ambassador during the ConnellCo-OpCollegeVisit,stated:
"I absolutely loved today's event. I would consider it a sudden breakthrough in my career and academic life as it demolished my ideaofunderestimatingmyconfidence.Iwent from being a caterpillar to a butterfly spreading the beautiful colours of Biomedical Sciencetoyoungerpeople."
Attendee Lloyd, who attended the NHSBT event, said:
"My current work in Immunology doesn't expose me to all of the disciplines within healthcarescience,soIseizedtheopportunity toviewtheNHSBTlaboratorywhenitbecame available. And it was, coincidentally, on Biomedical Science Day… Without valuable donations, there would be no service to maintain blood products for patients in need. What I have seen is a highly organised and complex service where laboratory staff, including biomedical scientists, can create products that contribute to maintaining the quality of life for patients with haemoglobinopathies (e.g., thalassaemia, sickle cell) or life-saving interventions in the eventofahaemorrhage."
STUDENTS
Dr Matthew Jones, who led the Holy Cross Event, reported that the event was highly commended by Holy Cross College & University Centre staff, with the staff invited back to attend an upcoming careers event and repeat this event again next year. The eventwasalsoverywellreceivedbystudents, with 98.4% of participants stating that they had a positive experience, and 96.8% of attendees said that they found the delivered activities fun and exciting. College students participating in the event found that it increased their knowledge of Biomedical Science.Theday'seventsposedfantasticskill development opportunities for our ambassadors, some of whom took the brave step out of their comfort zones and volunteered to represent the University of Salford.Sanariasaid:
"Ihadagreattimebeingabletoeducateand highlightthediversityofdoingabiomedical sciencedegreeandthecareerpaths.Itwasa great opportunity for me to network and help students with their future careerprospects."
The events were all featured on the IBMS website. You may see the article by following https://www.ibms.org/resources/news/biomedic al-science-day-2024--ibms-manchester-branch/.
My Journey to Salford as a Degree Apprentice
LOUISE
ANNESLEY
Louise is a Biomedical Science Degree Apprentice. Louise explains her journey involving her return to education, from unexpected opportunities to building confidence and competence to practice as a future biomedical scientist. She describes what her journey as a student has been like thus far.
My return to education at the University of Salford was really quite unexpected, as the COVID pandemic changed my life in a different way than itdidformost.Foradecadepriorto2020,Iworked inthetravelindustry;however,ithadstartedtofeel increasinglymonotonous,andIknewIwasn’tbeing challenged to my potential. The decade prior to that, I had worked in hospitality within the UK and overseas,gainingplentyoflifeexperiencealongthe waytoo.
When the first lockdown hit and I was furloughed indefinitely, I, along with millions of others across the world, was thrown into the unknown. I joined the admin team at a local hospital during my furloughtoassistwiththeirofficearchivingbacklog on a temporary basis, and while I was there, the opportunity to apply for a full-time Medical Laboratory Assistant role in histology presented itself.
Having not considered a career in healthcare prior to starting there, I jumped at the chance to learn something completely new. Starting this new role introduced me to the fast-paced world of histology, where I received first-hand training on the job, learning basic laboratory skills from my peers. This experience ignited a spark in me that had been lying dormant. As my confidence grew, I began taking on new tasks, and with each new skill-based competency signed off, I reached the limit of my practice as an Associate Practitioner without a science degree. We then entered a discussion about what to do next for me to continue progressing.
Several avenues were explored to continue my progression, including online distance learning or potentially changing my role within the workplace; however, these options just didn’t feel like the right fit for me. When the discussion around doing an apprenticeshipdegreeatSalfordarose,itreallypiqued my interest because it was the perfect combination: I could continue doing the job I was really enjoying while completing the degree program on my study day(onedayoncampusperweek)andintegratingthe registration portfolio into the apprenticeship. Getting that study day is such a vital tool to allow me to focus my time and energy to get the most out of all aspects of my working life. The combination of work-life, university-life, and life-life has so far turned out to be an intricate juggling act of prioritization, something which, thankfully, I excel at due to my experience in previousroles.
I never thought I would be going back into education at 36 years old, and some weeks are certainly more challenging than others, especially when life gets busy and the fear of falling behind strikes. However, I have found this first year to be incredibly rewarding, and the support received from both my tutors and my fellow apprentices has been beyond what I could have everexpected.Thatsupportnetworkissuchablessing to have; knowing you can reach out to others who have gone through the challenges or are right in them with you has turned it into an incredible shared experience. Healthcare science is a fascinating, everdeveloping discipline, and I continue to be excited to learn more within this field on my personal journey to becominganHCPC-registeredBiomedicalScientist.
PRESIDENT’S ROUND UP PRESIDENT’S ROUND UP PRESIDENT’S ROUND UP
BY TASFIA HAZARI
Tasfia Hazari was the President of the Biomedicine Society during 2023-2024. She reflects upon the past year, recounting the events that were organised by the committee. Several achievements are also highlighted, some of which include the Biomedically Speaking Podcast as well as Biobites and the Passionflash and BioArt Competition Finals.
The sixth year of the Biomedicine Society has been a challenging year. I am Tasfia Hazari, the President of the Biomedicine Society for 2023-2024, and this is a reflection on the incredible journey we have had over the past year. We kicked off the year with Freshers Week, where we met each other for the first time and introduced ourselves and the society to the new cohort of Level 4 HBID and Biomedical Science students. The following day, at the Freshers Fair, we attracted prospective members and welcomedbackexistingonesforanotheryear.Tocreatea more diverse cohort, we reached out to students from courses outside of Biomedicine and HBID. Our first social began that evening with a screening of Dr Arijit's documentaryaboutglaucomaandhisassociatedwork.
Our initial events included weekly sports sessions and CV workshops delivered by our secretary, Mariam Yaqoob. Alongsidethese,weorganisedavarietyofactivitiessuchas charity stalls to raise money for aid in suffering countries, bookclubcatchups,andabowlingevent.
This year, we introduced three new initiatives: the Debate of Science, the Biomedically Speaking Podcast, and BioBitessectorofthesociety.Thescavengerhuntwasalot offun,wherethecommitteegottoact,andmembersgot to enjoy the creativity and solve clues like detectives. A memorable experience was the 12-hour live stream which helpedourmembers,whojoinedin,tobecomecloser;this wasthemostuniqueandengagingeventweplanned.We raised money for KidsCan through a boxing event where oneofourBioSportsLeads,KaylaKezaMillane,participated andgracefullywon.AnotherhighlightwastheBiomedSoc WinterDinner,whereouracademicsjoinedustorelaxand enjoytheendofthefirsttrimester.
Additionally, we participated in the Morson Group’s Go Beyond Women in STEM Celebration, speaking about our society to many phenomenal women in STEM and recruitingnewmembers.Wealsointroducedoursocietyin a GEMSPA event by inviting attendees to various events andpromotingoursociety.
Our primary objective of this year was to help students in such a demanding course relax and enjoy university life whileprovidingopportunitiestobuildtheirportfolios,gain volunteeringexperience,andnetworkwithfellowstudents. Weachievedthisbysupportingandinvolvingvolunteersin every event possible, providing networking opportunities by collaborating with other societies and their members, andstartingBioBitestocreatemoreopportunities.
The year culminated on a high note with a grand masquerade gala, “The Final Show,” at the stunning Gorton Monastery. The event was an exquisite blend of classic elegance and modern flair.Thesoft,melodictunesofaharpistwelcomedus,settinga serene and elegant tone. The service from the Monastery team was impeccable, ensuring everything ran smoothly and adding to the evening's enjoyment. The food was delicious, offering a variety of dishes that pleased every palate. As the night progressed, the atmosphere became livelier and more vibrant. Wehadthepleasureofmeetingstudentsfromotheruniversities who joined us, making the event even more special. The night culminated in dancing, with everyone hitting the dance floor andcelebratingtheendofanunforgettableyeartogether.
This year, we introduced a delightful new mascot for the Biomedicine Society, created at the last minute but quickly becomingabelovedsymbolofourcommunity.Theideaforthe mascot emerged spontaneously during a fun and memorable momentinoneofourgroupchats.Atonepoint,everyonewas trying to get my attention, and they started calling me a "host cell." Overwhelmed by the bombardment of messages, I humorously responded by addressing everyone as my viruses. This playful exchange turned into a tiny inside joke within our group,whichwefeltperfectlycapturedthespiritofoursociety.
After a final voting for this new one of a kind member, the members of the Society decided to name it “Host Cell”. This mascot is a leaving memory from my committee and shall be embracedbythecommitteestocome.
Reflecting on this journey as the President of the society, I am immenselyproudofourstridesandthepositiveimpactwehave had on our members. Leading such a vibrant and dedicated communityhasbeenanhonourandajoy.Whileitisbittersweet to step down, I am filled with excitement and confidence as I handoverthereinstoadeservingnewcommittee.
BioDebate.
SHOULD GENOMIC SEQUENCING BE MADE THE NORM?
BY AWEIYE OMUSI
Students of the University of Salford came together on the afternoon of the23rdofApril2024toengageina bold debate on the topic: “Everyone shouldgettheirgenomesequenced”. The discussion involved three students on each side, all from the University’s Biomedicine programme, with one group arguing for the motion and the other against. The spirited debate was judged and assessed by Dr Arijit Mukhopadhyay along with members of the BiomedicineSocietyCommittee.
Thedebateraisedthought-provoking questions about the ethics and regulations around genome sequencing. The debate centred on thetopicofgenomesequencingand comes at a time when the topic has garneredtheinterestofmanypeople who are interested in learning more about this rapidly developing scientificfield.
The debate kicked off with the team in favour of the motion, who gave their opening statement and stated how genome sequencing would transform healthcare systems as we know it, especially for those with genetic diseases. They argued that it could improve health outcomes and enhance the quality of life of people globally by offering personalised treatments.
Following this argument, the team against the motion opened up their arguments for the debate by raising various concerns around practicality, safety, and morality of genome sequencing. They noted that sequencing costs £6,625 per individual, making it impractical for widespread use. They also highlighted consent and privacy issues, questioning who exactly would have access to information of individuals who took part in genome sequencing.
It was now the turn of the for side to give their response. One of the opposition’skeyargumentswasabout data safety and who would have access to the data that is procured through the genetic screening. They argued that if personal information is removed and the data is encrypted, genomesequencingcouldactuallybe safeforeveryone.
Additionally, by implementing the already existing regulations such as the Genetic International Data Guidelines this would make genome sequencing safe for everyone even on agloballevel.
Thepropositionrebuttedthatthecost of genome sequencing has dropped dramatically from $100 million to about $1,000 which contradicted the statement made by the opposition thatthecostperpersonis£6,625.They stated that it makes it much more affordableandaccessibletothewider community. The advocates pointed outthatsequencingcannotonlysave time but also money by reducing the need for countless consultations and endlessbloodteststodiagnosehealth conditions.Theyalsohighlightedhow genome sequencing can help with more accurate medical care for each individual. Understanding an individual’s genetic makeup can lead tomoreaccurateprescriptionsaswell as dosages as a person need can vary basedontheirgeneticmakeup.
One student of the proposition noted that even though the cost has dropped significantly over time for genomic sequencing, the reason sequencing is still $1,000 which while stillbeingoutofbudgetformany,asit becomesmorewidespread,priceswill likelydecreaseevenfurther.Asforthe issue of data usage and consent for minors, they argued that receiving consent from a parent/guardian will suffice.
The debate continued with both the opposition and the proposition arguing valid and well researched points to make their arguments and articulated them in a cohesive manner. The cross-examination portionofthedebatehadbothsides firequickfirequestionsateachother and gave them a chance to find cracksintheotherteam'sarguments and also develop their arguments. The judges asked questions to prompt further discussion between theteams.
After over an hour of lively debating from both the proposition and the opposition and more discussion of points from both parties, the judges took time to discuss and determine their winner. They determined that theirwinnerwastheproposition!The judges determined that their argumentswerethemostconvincing inagreeingwiththemotion.
Thisconcludedtheexcitingeventsof the first debate of the Salford Biomedicine Society brought to light the exciting yet controversial topic of genome sequencing. The proposition argued that it could revolutionise healthcare with personalised treatments. Meanwhile, the opposition raised prominent issues about privacy, costs, and ethical concerns, questioning who would have access to the personal genetic data collected. This debate did not onlyinformstudentsandpeersabout this interesting aspect of scientific research but also highlighted the need to balance new ideas and innovationwithgoodethicalpractice in the healthcare industry. The debate left everyone pondering how genomic medicine could influence the field of medicine and revolutionise modern treatment of disorders.
Looking back on our rolethisyear
BY ALI AL TAIE
For the past year, our work as events managers was mainly focused on preparing the events, starting with brainstorming different ideas with the rest of the committee during our regular meetings.ForthefirsteventatPrintworks, we were responsible for contacting Printworks management and arranging a timeanddatefortheevent.
We discussed the pricing and potential number of attendees. Post confirmation, we had our social media manager create an advertising post for the event, and we published it on all platforms, allowing memberstobooktheirticketsinadvance.
At the event, we were responsible for regulatingtheeventbyensuringeveryone arrived safely and was satisfied with the atmosphere surrounding them. Post the event, we usually ask the members who attended to provide us with feedback so wecanimproveourupcomingevents.We also allow the members to dictate the locations and activities of our potential events, ensuring they are tailored to our members' interests. These essential roles apply to most of our work, from educational and informative to fun and entertainingevents.
By Alvina Imran By Alvina Imran
On the 16th of April, we successfully hosted our highly anticipated BioArt Competition, and it was an event to remember! As the BioArt leader, I was incredibly proud to see how science and art came together, creating a beautiful fusion of creativity and biology, all centred around the theme of "Sustainability”.
Participants truly embraced the theme, showcasing an incredible array of artworks that ranged from detailed depictions of microscopic organisms to breath-taking representationsofentireecosystems.Itwas inspiring to witness how artists interpreted sustainability,usingtheirpiecestohighlight thebeauty,resilience,andcomplexityofthe natural world. The diversity of ideas and styles made the competition a vibrant celebrationoflifeandourconnectiontothe environment.
The Event Atmosphere
In keeping with the sustainability theme, theeventfeaturedavarietyofgoodiesand refreshments that were thoughtfully selectedtoalignwitheco-friendlypractices. Weprovidedorganic,locallysourcedsnacks and sustainable packaging, ensuring that even the smallest details reflected our commitment to environmental consciousness. The atmosphere was buzzing with excitement as participants and attendees mingled, exchanged ideas, and appreciated the artistic masterpieces ondisplay.
Winners and Prizes
We awarded prizes of up to £150 to those whose artwork stood out for their creativity, originality,andabilitytoconveytheessenceof sustainability. The winners demonstrated an exceptionalunderstandingofthetheme,and their works left a lasting impression on everyonewhoattended.
Collaboration and Decision-Making
This event wouldn't have been the success it was without the collective efforts of the decision-making team. Alongside me, Harriet Burrow,Dr.SaraNamvar,Dr.Matthew Jones, and Dr.Niroshini Nirmalan played a pivotal role in planning and organising the competition. From selecting the theme to coordinating the logistics, their dedication ensuredthattheeventransmoothlyandthat we were able to create an unforgettable experienceforallinvolved.
TheBioArtCompetitionwasmorethanjustan event—it was a celebration of how art and science can come together to inspire conversations about sustainability. We’re grateful to everyone who participated and contributed to making it such a memorable occasion. Thank you for joining us on this journey,andwelookforwardtoevenmore creativityandinnovationinthefuture!
BY KAYLA KEZA MILLANE
Before the first training session, I was filled with pureadrenalineanddetermination;betweenus,I thought this experience would be a walk in the park; little did I know that I was in for a rude awakening.ThemomentIsteppedintothegym, theatmospherewasthickwiththesmellofsweat and a sense of tenacity. As I watched seasoned fighters spar in the ring, a shiver shot down my spine;Icouldn'tbelieveIwasdoingthis.
The first week, aptly called Hell Week, was a wake-up call. The first session involved sweating and panting through countless drills. After what feltlikeathousanddrills,Ilayonthesoakingwet mat, looking up at the cloud of steam my peers andIhadmade,onlytofindthatwewereonly10 minutesin.Iperseveredthroughthesessionand somehowmadeittotheend,stillalive.Thepride Ifeltfrommakingitthroughthatfirstsessionwas the fuel that powered me through every subsequentsession.
I felt like I was becoming stronger and more skilled with each practice until I sparred for the first(andonly)time.Initially,Iwasexcitedtospar, andhonestly,IthoughtIwoulddominateuntilI saw the intense, fiery determination in my opponent'seyes.Asthecoachsignalledforusto start, she swiftly moved towards me and hit me with a jab square in my face. The sparring was finally over after what felt like an eternity and a hellofalefthook.IknewIhadmyworkcutout for me. I continued to work hard during the remainingtrainingsessionsandworkedoutinmy sparetime.Duringthisperiod,IconsideredwhyI had decided to commit to this. After some contemplation, I realized that one of the main reasonsIwascompetingwasforthecharityIwas fightingfor.
Kidscan is a charity that helps children with cancer and their families. These children are thrust into a battle that is a matter of life and death,andinallhonesty,they'retherealfighters. So, when I needed that extra push, I thought of them and the responsibility to raise awareness about such a fantastic charity that offers muchneededresourcesandcaretothosewhoneedit.
After eight weeks of training, it was finally the day I was looking forward to Fight Night. As I entered the venue, a nervous energy permeated the atmosphere. At this point, only the fighters had arrived, as we needed medical clearancebeforetheeventbegan.Thecrowdstartedfilling the venue, with over 1000 people cheering on their loved ones. I felt a cacophony of fear, excitement and a hint of pride.
HadImadeitthisfar?
WouldIbeabletoholdmyowninfrontofthecrowd?
Soon, it was my turn to fight. I boldly strolled from centre stagetotheringwhileKanye's"AlloftheLights"playedin the background. The moment I stepped into the ring, everything else faded. My heartbeat was deafening as my focus narrowed down on my opponent. She looked as intenseasshedidduringthatfirstsparringsession,withthe same fiery determination. This time, I was ready. I raced towardsherwhenthebellrang,eagertoprovemyself.The three rounds were a blur of punches and a constant remindertokeepmyguardup.Ihadtrainedhard,butthe realityofbeingintheringwasmoredemandingthanany of my previous training. I felt fatigue set in early on, but somehow, I pushed through to the final bell. As the final bell rang, I felt relief wash over me. I had done it – I had foughtmyfirstboxingmatch.Aswewaitedforthejudge's decision, I held my head up because I had made myself proudregardlessoftheresult.
I'mgladtosayIwon.However,thatexperiencewasabout morethanjustaboxingmatch.Itwasaboutperseverance, disciplineandself-belief.AnAlexHormoziquotesays,"You don't become confident by shouting affirmations in the mirror,butbyhavingastackofundeniableproofthatyou arewhoyouare.Outworkyourself-doubt".
So, if you've read this far, I encourage you to have experiences that push you beyond your comfort zone and revealtheincrediblepersonyouare.
Hey guys, Keelan here!
As one of the two Sports Bees for the 23/24 Biomedicine Committee, I could not be prouder of the events we have achieved this year.
At the start of the year, we had badminton sessions. which were well attended and enjoyedbyall!Asabadmintonplayermyself,it was great to see so many members getting involved regardless of ability, and even seeing some really good progression among members.
Following this, we had dodgeball sessions which were a blast. We could not have done it without Nafisa, our wonderful Sports Support Bee, who really brought energy and enthusiasmtothesessionsandwaslethalwith a dodgeball! We managed to get male and female sessions running for the comfort of any student who wished to join in, and attendees reallyappreciatedthisconsideration.
Finally, we had our basketball sessions toward theendoftheacademicyear,wherewesawa bigincreaseintheactivityofourmembersand even some interest in the Sports Bee position forthenewcommittee.
Kayla, Nafisa and I are beyond grateful for the opportunitytoworkwiththecommittee,andI wish the new committee well with the 24/25 year!
BIO-BOOK CLUB BIO-BOOK CLUB BIO-BOOK CLUB
12HR STREAM 12HR STREAM 12HR STREAM
BY NAFISA ALI
Nafisa Ali, our Sports Support Bee, reflects on the Biomedicine Society event called the ‘12-Hour Book Club Challenge’andhowitenrichedthestudentexperienceby facilitating collaborative reading and bringing the memberscloser.
One of the highlights of my year with the Biomedicine Society was participating in the 12- Hour Book Club Challengeonbehalfofthesociety'sbookclub.Thisunique event involved all participants joining a Microsoft Teams call for 12 hours to study or read books, with a prize for whoeverstayedonthecallthelongest.
Initially, we were all focused on being productive, diving intoourstudiesorreading.Wetookbreakseveryhalfhour, relaxingfortenminutesbeforegettingbacktoourtasks. Astimepassed,however,ourfocusshifted,andwebegan tochatandrelaxtogether.Ourconversationsrangedfrom worldly matters, morals, and principles to fun topics like moviesandchildhoodmemories.Thesediscussionswerea fantastic way to get to know each other and understand differentperspectives.
Imetsomeincrediblepeopleduringthischallenge,many of whom are still my friends today. It was a great way to warm up to university life and connect with others, especially after the isolation of lockdown. The challenge started around 9 PM and ended at 10 AM the next day. Initially, we thought it would be easy, but by 4 AM, the difficultybecameapparent.
We started with about twelve participants, but by 5 AM, onlyfourofusremained.Theremainingparticipantswere particularly engaged in discussions about politics and historical events. Given our diverse backgrounds, it was fascinating to learn about different cultures and beliefs. I truly enjoyed these conversations, even though I couldn't stay until the end of the challenge. The experience was enriching and a wonderful way to bond with fellow students, blending productivity with meaningful connections.
