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Is mental health data more sensitive than physical health data?

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Figures from the mental health charity MQ found that only 5.8% of the UK’s total health research budget is spent on mental illness.

As a comparison, for each person affected by mental illness, approximately £8 is invested in mental health research while around £176 per sufferer is invested in cancer research – meaning that mental health research receives 22 times less funding than cancer research.

But why is this the case, what can we do to change these figures and, importantly, could our health information hold the key to democratising research and, if so, should this data be used?

It was questions such as these which catalysed myself and my colleagues from The University of Manchester’s Centre for Health Informatics to bring together experts from across research, the NHS & mental health charities to dive deeper into mental health research, publicly debating the following;

Do you agree that mental health data is no more sensitive than physical health data and that both should be used equally in data linkage research?

Arguing that both types of data are equivalent and should be treated the same were:

Whilst arguing that physical and mental health data are intrinsically different and should be treated as such were:

  • Dr Julie Morton (Senior Lecturer in social work, University of Salford)
  • Dr Michelle O’Reilly (Associate Professor with the University of Leicester and Research Consultant with Leicestershire Partnership NHS Trust)

Re-reading the figures above it’s not surprising that all our speakers unanimously agreed that we need to tackle mental health issues with the same energy and priority that we afford to physical ailments and that changes must be made in order to make this a reality.

However, the path to achieving this equality was contested. The speakers explored a range of topics including: how current legislations apply to different types of health data, how research practice might change if mental health data were actually declared more sensitive than physical, whether the data we currently have access to is sufficient to produce meaningful results in mental health research and how individuals would feel if their data were leaked.

The debate sparked poignant and thought provoking discussions between our speakers and the audience around mental health service provisions, stigma and how the use of data could improve the lives of those affected by mental illness. Leaving everyone involved with a lot to think about.

As part of the debate our audience were asked to participate in the discussion using electronic voting pads to anonymously cast their vote. Prior to hearing any of the speakers arguments, 75% of the audience either strongly agreed or agreed with our proposition (mental health data is no more sensitive than physical health data and that both should be used equally in data linkage research.) while 6% disagreed, 6% strongly disagreed and 13% were unsure.  Following the speaker’s presentations, the audience opinion began to diverge: 58% now either agreed or strongly agreed with the proposition while 38% disagreed or strongly disagreed, 4% remained unsure. The most significant shift in opinion was in the category ‘disagree’ which leaped from having only 6% of the overall vote prior to the debate to garnering a further 27% after.

Analysis from a questionnaire posed to audience members suggested that the speakers had managed to highlight the nuances within this subject but had not put audience members off sharing their data for research purposes. For example: although 10 of the 21 audience members who completed the questionnaire believed that mental health data was more sensitive than physical health data, 14 believed that it should still be treated the same as physical health data when used in research and 16 were willing to share their own data with researchers. The audience expanded on these views stating that stigma and negative societal attitudes surrounding mental health make this data more sensitive but that mental health research is in the public interest and that the rewards of this research outweigh the challenges.

You can watch the complete debate below

[vimeo 251177568 w=640 h=360]

Please let us know your thought in the comments section!

Post by: Sarah Fox

Wolves: the power of the pack

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The sound of a howling wolf is ingrained in pop culture. It adds tension to almost any scene, even if you never actually catch a glimpse of the creature creating the sound. It’s not surprising that a well-placed howl can cause anxiety, considering that wolves have a dangerous reputation. A reputation which appears well founded as there have been at least 14 wolf attacks this year alone, injuring almost 30 people.

What could be scarier than running into a wolf on a dark night? Perhaps running into a pack of wolves? Especially when we consider that your average wolf is adept at working in a group to solve tasks and cooperating to hunt down their unsuspecting victims. Not forgetting that they are also intelligent hunters, putting domestic doge to shame and making them appear positively stupid.

Recent research from the Wolf Science Centre in Vienna has shown that, when it comes to cooperation, domesticated dogs may be missing a trick while wolves take the prize. This might seem counterintuitive, especially when several domestication theories suggest that the tamer and more docile domestic dogs should possess characteristics which improve tolerance and cooperation. However, it was actually found that wolves were more tolerant than dogs raised in a similar environment, and were also more capable of completing a cooperative task.

To study cooperation these animals were given a test called the “loose-string paradigm.” This test relied on a piece of apparatus consisting of a length of rope attached to a small board with a reward on. Both ends of the rope are exposed and, in order to obtain the reward, both ends must be pulled simultaneously. If only one side is pulled, the other end becomes inaccessible, and the reward does not move. The ends are at such a distance that one animal cannot pull them both, so two animals must cooperate to get the reward. This is a widely used experimental technique, which has been carried out with a wide range of animals, from shrews to elephants. Even the handsome little quokka got in on the act.

When first presented with this task, pairs of wolves performed better than dogs. In fact, after practicing, wolves were significantly better at the task than their domestic counterparts. Wolves actually beat dogs on many elements of this test. Firstly, unlike dogs, only one wolf needed to have been exposed to the task equipment for a pair of wolves to perform better. Secondly, dogs were also less likely to interact with the task, while wolves performed a wide array of “non-functional” interactions, when first introduced to the test equipment i.e. biting, pawing or scratching. It appeared that the wolves were more curious and subsequently learned how to carry out the task more successfully.

To further test the wolves’ cooperation, a modified version of the loose-string paradigm was introduced. Two sets of test equipment were set up in the same enclosure. In order to complete the task animals had to both pull strings on the same apparatus, ignoring the other equipment. As you can imagine, the rate of success on this variant of the test relied upon compatibility between the animals. Researchers found that animals who showed more affection with each other i.e. behaviour such as grooming, body contact and even tail wagging, were better at completing the task. So, the greater the affection between the wolves, the more likely they were to succeed at the task.

It was expected that dogs would be more tolerant of each other, seeing as they are regularly kept together as pets but, repeatedly, the dogs shows more aggressive behaviour towards each other and less affection. In fact one pair of animals had to be physically split up; two dogs, Sahibu and Gombo, you guys are jerks. When the dogs weren’t fighting, they routinely exhibited a simple conflict-avoidance strategy, by not taking part. They were less likely to interact with one another or the task. This obviously led to a decreased rate of success in the dog pairs – as I’m sure you know, ignoring your problems doesn’t help. Just like pretending you can’t hear the wolves scratching outside your door won’t stop them.

Moreover, wolf packs maintain a hierarchical social dynamic. Several behaviours have been documented as dominant or submissive. Whilst these behaviours were rare between all animals, they increased after animals were previously exposed to the apparatus. Once an animal knew how the equipment worked it was more likely to act dominant, particularly if the task wasn’t being completed. As we mentioned before, it only takes one wolf to have previously used the apparatus to increase the rate of success. Does this suggest that the dominant wolves were teaching others? Despite this horrifying theory, pairs of wolves who were closer in rank were more successful at completing the task. So, maybe you can sleep a bit better.

Finally, the task was altered to delay the entry of the second animal, leaving one wolf alone with the apparatus for 10 seconds. I don’t think I need to tell you what happened. One wolf waited patiently for the other, and the rate of success was similar to that in the other conditions. The rate of success was even higher in wolves which had previously carried out the task together. Not only are the wolves learning how the task works, they are remembering which other animals understand the task.

In the wild it is crucial that wolves work together. It’s been previously suggested that “wolves cooperate but dogs submit” and that is apparent in this study. As mentioned above similar ranked wolves work best together, whereas dogs either avoid the problem, or physically clash. Once the wolves understand the task, they are able to teach the tasks to others, and then remember which pack members understand the task.

It’s also interesting to note that only one animal was removed for not caring enough. I think by now you know that it was a dog; wolves don’t give up. Wolves learn, they test things out, work as a team and solve puzzles. Like the lock on your door, slinking into your room whilst you read some nonsense on the internet…

Post by: Dr Alex Ryan

 

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Comment: Why being ‘overweight’ means you live longer: the way scientists twist the facts.

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OK, so a friend of mine recently posted a link on Facebook to an article entitled ‘Why being ‘overweight’ means you live longer: the way scientists twist the facts’. I can’t lie, just the title alone made my blood boil. My main concern was, aside from what appeared to be an oversimplification of a phenomenon that scientists know as the ‘obesity paradox’, the title also plays beautifully into the ‘us vs them’ notion that academics are somehow untrustworthy. But, after my blood pressure settled, I decided to give it the benefit of the doubt and read the whole article – I’ve heard at numerous ‘media training’ workshops that it’s not uncommon for editors to alter article titles just before print to make them more appealing and more likely to garner views, so perhaps the body of the article was a bit more nuanced?

The article overall gave the impression that the author was well versed in scientific literature, using well placed quotes from research papers to highlight important points. For example, the author quotes a study from 2005 which used medical data (collected between 1971 and 1994) to show increased mortality (risk of death) in those with BMI’s (Body Mass Index) over 30 (i.e. those classified as obese). He correctly points out that the title of this paper (‘Excess deaths associated with underweight, overweight and obesity’) is misleading and implies that being overweight (i.e. having a BMI of between 25 and 30) increases your risk of mortality, when the study actually finds lower mortality in those with BMI’s between 25 and 30 than for individuals in the ‘ideal’ BMI range (18.5-25), I.e. being moderately overweight is good for you.

These findings do actually agree with a number of similar studies. In fact, in addition to these findings, there are also a whole host of studies which suggest that being overweight can lead to better survival rates following a large range of medical conditions (for example coronary heart disease, chronic heart failure, stroke and more).

So, do I agree with this article? Well, partially.

I agree that the obesity paradox exists and these findings are not often spoken about. However, the reason that they are not often publicised is not because academics want to ‘twist the facts’ or, as the author states, that ‘no one can bring themselves to say: Sorry, we were wrong. A BMI between 25 and 29 is the healthiest weight of all. For those of you between 20 and 25, I say, eat more, become healthier’. It’s because there is much more to these findings than first meets the eye.

I don’t think many doctors or researchers would argue that obesity, especially weight carried around the stomach, is a major risk factor for type 2 diabetes, lipid disorders, hypertension, coronary heart disease and some cancers. A quick search of Google Scholar will turn up a stack of articles suggesting that increased weight is linked to a whole range of long-term conditions.

But, how can both these findings be correct? How can it be possible that being overweight can mean you live longer but you are also more likely to suffer from a chronic illness (i.e. diabetes or heart disease)?

I believe that this is the question we are yet to find a satisfactory answer to, and therefore the reason it’s best to be cautious about making statements such as “being “overweight” is the healthiest and most “normal” weight of all”.

A paper entitled ‘The Obesity Paradox Does Exist’ expressed this problem very well, stating: “the discussion over the existence of the obesity paradox cannot lead to an underestimation of obesity as a crucial risk factor for the development of cardiovascular and metabolic diseases that requires comprehensive prevention and management strategies”.

But what’s my overall impression of this article?

I believe that it does raise awareness of a medical phenomenon which needs to be discussed but, that it does so in a dangerous and inflammatory way. Blaming scientists and accusing them of manipulating/twisting results is not helpful. Neither is writing a biased article which does not acknowledge the breadth and depth of understanding around a topic – i.e. it’s just as dangerous to tell individuals that it’s entirely healthy to be overweight (in the case of this article to even go as far as to suggest that the dangers of obesity are greatly overrated) as it is to ignore this obesity paradox entirely and blame everything on excessive weight. We need to be smart and realise that any reference to things being ‘black or white’ is probably dangerously misleading.

So, what can we take from this article and the related research?

Well, certainly not that it’s always going to be OK to be overweight. But, perhaps that we put too much stock in BMI calculations? Especially when this calculation (weight in kilograms divided by the square of your height in meters) does not take into account the extra weight carried in muscles, an individual’s body shape, fat distribution across the whole body or overall fitness level – all of which are important indicators of whether or not the weight we carry could be harmful. In fact, many of the academics studying this paradox suggest that it may actually be caused by problems related to the BMI measurement rather than any actual protection afforded by excess weight. That means that if you eat well and exercise regularly, even If your BMI is high, you are probably going to be healthier than someone who eats badly, smokes, and rarely gets off the sofa (whatever their BMI). At the end of the day it’s just a number, we all know how healthy our lifestyles are so we shouldn’t believe that such measurements can 100% predict our health outcomes. Hopefully, in the future, researchers can plan studies which allow them to look beyond BMI and work out how different types of fat, where it’s stored on the body and our overall fitness level affect our health – this might give us a better picture of what is really good for us.

Post by: Sarah Fox

References:

Excess deaths associated with underweight, overweight and obesity

The Obesity Paradox: Perception vs Knowledge

Obesity Paradox Does Exist

 

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Citizens across the North invited to get moving and help heart research in UK digital health first

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The University of Manchester’s Connected Health Cities and Nokia partner to organise an 8 week step challenge across the North

Nokia and the Connected Health Cities (CHC) programme have launched CityMoves, an eight-week step challenge taking place from 23rd October to 21st December 2017.

I’ve already downloaded the app and am having a bit of fun logging my weekly activity. It seems I’m all systems go during the week but make up for it by lazing around over the weekend!

The challenge promotes healthy living and the positive use of data and technology in health and research. It’s also an opportunity for citizens across Greater Manchester to help advance science’s understanding of how low-intensity exercise improves heart health. Scientists know that intense exercise, like marathon running, will reduce your resting heart rate. But, they know less about how well moderate exercise such as walking can cause this reduction. Hopefully data from this app could provide an answer.

Participants will be able to track their steps through the Nokia Health Mate app, which also allows users to measure their pulse rate using their smartphones camera. Although this does take a bit of practice… Actually I was a bit worried by how my pulse spiked from simply climbing the stairs to my office, I’m blaming my technique but perhaps I just need a bit more gym time?

The project will be delivered across Connected Health Cities four city regions including Greater Manchester, Yorkshire, Liverpool and the North West Coast and Newcastle and the North East. Each region will be able to see how the amount of steps they have taken over the period compares to the others’.

As well as daily updates on the dedicated website, each week users get personalised feedback with information about their progress and how they compare to others from across the North – A bit of healthy northern competition! Throughout the eight weeks of the challenge CHC and Nokia will keep people motivated with motivational content, seasonal tips to get moving more, hundreds of fitness tracker give-aways and awareness messages on how to keep your heart healthy.

After the 8-week period de-personalised data will be sent to The University of Manchester’s Connected Health Cities programme where data scientists will look for changes in heart rate across the study period.

Prof John Ainsworth, Director of Connected Health Cities said:

“More effective use of data and technology has great potential to deliver health benefits for all of us. The CityMoves study is a great example for people to see the positive impact that their data can have.

“In CityMoves study we aim to develop a better understanding of the relationship between increased physical exercise and resting heart rate, a key indicator of health.”

To join the programme participants can register at nokia.ly/citymoves, choose their team and begin measuring their steps and watch as they rise up their team’s leader board.

www.connectedhealthcities.org @CHCNorth #DataSavesLives

 

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Achieving Zero Carbon – A visit to the Centre for Alternative Technology (CAT)

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A Cretan windmill in CAT’s early days with R. James and G. Collier (Photo: The CAT Archive)

Throughout my degree in marine biology, we were always encouraged to attend as many career and interest-related events as possible. One of my passions is climate change mitigation. Therefore, when I saw that Zero Carbon Liverpool (ZCL) had managed to secure a few fully funded places to the ‘Zero Carbon Britain: Making it happen’ short course at the Centre for Alternative Technology (CAT), I had to do some research. CAT was founded in 1973 by businessman turned environmental activist Gerard Morgan-Grenville in an abandoned slate quarry site near Machynlleth, Wales. Originally established as a small community experimenting with alternative methods of construction and food production, CAT is now an award-winning facility that promotes low-energy technologies and sustainable living.

I remember thinking to myself ‘what better place to learn about the clean energy revolution than in a hippy-ville turned research institute!’ I was so excited by the prospect of visiting CAT, I immediately applied for one of the funded spots on the course. A few days later, I found out that I would be off to visit the beautiful region of Mid-Wales, to engage with CAT’s vision of a modern, zero-emission society.

Centre for Alternative Technology

CAT reception and ticket office (Photo: Lindsay Melia)

I managed to get a lift to CAT from Jo (one of the co-founders of ZCL) and her fiancé Adam. We were also joined by Lindsay, a fellow zero carbon enthusiast. We set off from Liverpool on an overcast afternoon and reached our destination a little over two hours later. Upon arriving at CAT we were soon surrounded by lush greenery, which had recolonized the disused quarry. The novice terrestrial naturalist within me instinctively started looking out for various flowering plants in bloom and instantly regretted not bringing my vegetation ID guide.

We arrived slightly before tea time, so Lindsay and I decided to wander around and check out the facilities on site. I found out that we would be staying in the Wales Institute for Sustainable Education (WISE) building for the entire duration of the course and that our course activities would also be based in and around WISE. The building has numerous environmentally friendly additions, for example the adoption of the rammed earth technology, a construction technique that uses natural aggregates such as clay, gravel, sand and silt; as well as incorporating reed beds for waste water treatment. We also found, scattered on the CAT trail, various environmentally friendly innovations all of which were labeled explaining why and how they were more sustainable then other, more common, alternatives. One can easily spend hours on the trail but the dinner bell rang and we headed back to the CAT café to enjoy a delicious vegetarian curry. Afterwards, we went to the bar for a couple of drinks. Coincidentally, a local folk group were having their weekly practice, which provided us with some much-appreciated musical entertainment.

WISE eco-friendly features. (Photo: CAT Information Service)

Zero Carbon Britain: Rethinking the future

Footpath and the exterior of the Sheppard Lecture theatre. (Photo: Lindsay Melia)
Interior of the greenhouse (Photo: Fiona Chong)

The next day was the start of the ZCB course which focused on the possibility of an alternative future. We were introduced to the many contributing factors to climate change. These include but are not limited to industrialization, population growth, capitalism and diet. As of June 2017, the atmospheric carbon dioxide (CO2) level has reached 408.84 parts per million (ppm) (Mauna Loa Observatory), well over the pre-industrial 280 ppm in the mid-1700s. This unprecedented amount of CO2 is much more than can be absorbed by natural processes. The excess CO2 traps more heat in the atmosphere, which leads to global warming and a cascade of negative effects, such as regional flooding and droughts. If the world’s population continues its dependence on fossil fuels to support our ‘modern’ lifestyle, these negative effects will continue to accelerate. These are the reasons that climate change is often deemed as the biggest humanitarian crisis of our generation. Even though world leaders are aware of how pressing the matter is, this is a battle against time. Knowing this, I couldn’t help but feel deflated about the future of our climate.

Energy mix in the ZCB scenario. (Photo: ZCB Graphics)

However, my pessimism was quickly dissipated by Alice Hooker-Stroud, the former ZCB research coordinator, when she explained that CAT’s research has shown that current technology is sufficient for the UK to achieve a net zero greenhouse gas emission now, without having to wait for the ‘silver bullet’ of future technologies or potentially dangerous nuclear power. She reiterated that we need to: 1) ‘power up’ renewable energy, with a concentration on wind power; and 2) ‘power down’ our current energy demand, by improving home heating efficiency, supporting the electrification of vehicles less air travel. This all sounds very familiar but I was both doubtful and curious as to whether we could ‘keep the lights on’ – even when there’s no wind and the sun isn’t shining.

Energy demand in 2010 and in the ZCB scenario. (Photo: ZCB Graphics)
Estimation of land use today and land use in the ZCB scenario in million hectares. (Photo: ZCB Graphics)

The answer, apparently, is a resounding ‘yes’ – CAT’s modelling has shown that a ZCB future would produce a surplus of energy 82% of the time – by using ‘smart’ appliances, storing excess electricity and using carbon neutral synthetic fuels, any shortfall could be overcome. Last but not least, through diet changes (mainly by reducing meat consumption), 75% of the land currently used for grazing livestock can be repurposed to grow more biomass required to support the ZCB energy system; or be restored back to forest or peatlands to capture carbon.

Zero Carbon Britain: Making it happen

The Paris Climate Agreement states that globally we must reach net zero greenhouse gas emissions by 2050, therefore there really is no option but to embrace the zero-carbon future. We spent the second day exploring the big question – What’s stopping us?

Researchers have shown that we are not limited by technology but rather a combination of economic, cultural and psychological barriers. They believe that climate change in the modern world is not a root problem but a symptom of consumerism and a disconnection from nature and from other human beings. Changing how millions of people live is a unique challenge in itself and can only be overcome if actions are carried out at global, national, local and individual levels. There is no act too small and no act too bold. However, some things

A visual representation of our zero-carbon Britain brainstorm. (Photo: Lindsay Melia)

that are beneficial include lobbying climate legislation, divestment from the fossil fuel industry, investing in zero carbon projects and community energy, challenging climate skepticism in the media, improving carbon literacy, promoting communications…the list goes on. There are countless solutions to this wicked problem but collective action is the key.

I left CAT with a new-found sense of optimism for our zero-emission future. It is often easy to assume that others care less about climate change (amongst other things) than you do. This blog is my contribution to spreading climate positivity. What will yours be?

I would like to thank Zero Carbon Liverpool for giving me this invaluable experience. If you would like to get involved with Zero Carbon Liverpool’s work locally, get in touch with them on Twitter and Facebook.

The Zero Carbon Britain reports can be accessed here.

Post by: Fiona Chong

 

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‘Hangry’ humans – why an empty stomach can make us mean

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There’s no point denying it, at one point or another, we’ve all been guilty of being ‘hangry’. Whether you’re a frequent culprit or just an occasional offender, getting angry when hungry is a common crime in many households, and one that can result in arguments, ‘fallings out’ and even a night spent sleeping on the couch. But is it really our fault or is there a more biological reason to blame? An increasing body of research suggests our blood glucose may be the real culprit.

The glucose we obtain from our diet is a key source of energy, required for our bodies to function and delivered to all of our cells via our blood. Out of all the organs of the body, our brain is the most energy-consuming, using around 20% of the energy our bodies produce. It also relies almost completely on glucose as its energy source, making an efficient supply of this sugar essential to maintaining proper brain function. This is particularly true for higher-order brain processes such as self-control, which require relatively high levels of energy to carry out, even for the brain. Since self-control allows us to resist such impulsive urges as out-of-control eating or aggressive outbursts, if our brain does not have sufficient energy to perform this process, our ability to stem these unwanted impulses can suffer.

Low levels of glucose in our blood can also result in an increase in certain chemicals in our body, believed to be linked to aggression and stress. Cortisol, for instance, colloquially named the ‘stress hormone’, has been shown to increase in individuals when they restrict their caloric (and therefore glucose) intake. Neuropeptide Y concentrations have also been shown to be higher in individuals with conditions associated with impulsive aggression when compared to healthy volunteers.

Given such evidence, it therefore makes sense that low levels of blood glucose, like those experienced when we are hungry, could plausibly lead us to become more aggressive. The association between blood glucose and level of aggression has been observed in multiple studies, including Ralph Bolton’s 1970s research of the Quolla Indians. These Peruvian highlanders are well-known for their high rates of unpremeditated murder and seemingly irrational acts of violence. Having observed both this behaviour and a strong sugar craving among the Quolla Indians, Bolton decided to investigate the possible link between hunger and aggression. In agreement with his hypothesis, Bolton found that the Quolla Indians commonly experienced low blood glucose levels, and that those with the lowest levels tended to be the most aggressive.

In another, more recent study, similar findings were observed in college students who took part in a competitive task. Participants were randomly assigned to consume either a glucose beverage or placebo drink containing a sugar substitute. Following this, participants then competed against an opponent in a reaction time task, which has been shown previously to provide a measure of aggression. Before beginning the task, the students could set the intensity of noise their partner would be blasted with if they lost. As predicted, participants who drank the glucose drink behaved less aggressively towards their partner, choosing lower noise intensities, compared with those who had consumed a sugar substitute. This suggested that hunger-related aggression, or ‘hangriness’, could be ameliorated by boosting one’s glucose levels.

One notable (though some may argue rather dark) study into the ‘hangry’ condition investigated the relationship between blood glucose and aggressiveness in married couples. As well as pitting spouses against each other in a similar reaction time task to the one described above, participants were also given a voodoo doll of their partner and told to stick pins in the doll each evening, depending on how angry they were at their partner. (Warning, do not try this at home). As with previous studies, lower levels of blood glucose resulted in participants blasting their spouses with higher noise intensities and sticking more pins in the voodoo dolls, suggesting greater levels of anger and aggression.

While these studies do not necessarily ascertain causality, the relationship between low blood glucose and the tendency to become aggressive makes biological sense, since glucose is the main energy source our brains need to control such negative impulses. As observed in studies and experienced by many of us, ‘hangry’-related crimes can also be easily avoided by supplying the potential offender with food, further supporting the role of glucose in hunger-related anger. So next time ‘hangriness’ threatens to ruin the harmony in your household, fill your mouth with food rather than foul language, and save yourself a night banished to the couch.

Post by: Megan Freeman

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How your smartphone could improve your health

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Lamiece Hassan on why unlocking the potential of smartphone data could be the next frontier for health research.

I have an addiction to my smartphone. It helps me to navigate not only the streets of my adopted home city of Manchester, but life in general; everything from banking to shopping, scheduling, videoing, networking, dating and, on occasion, making phone calls.  And it helps me to monitor things, like my patterns in exercise, diet and sleep. I’m the type who posts annoying screenshots of their step count on Instagram after a big night (#danceallnight). To some this could seem a somewhat unhealthy, yet common, obsession. However, I’m keen to learn how our increasing attachment to technology can actually help to generate new insights into health and disease and benefit others.

You see, your smartphone is a sort of digital Swiss Army knife, jam-packed with vital sensors and tools that collect, process and transmit all manner of data. Furthermore, it’s a constant companion, always on and always with you, effortlessly tracking your everyday routines. To researchers like me, who would otherwise have to dedicate significant time and effort to collecting these data themselves, smartphone apps are appealing, inexpensive tools for generating a wealth of high quality data on everyday life on a mass-scale.  Moreover, this type of ‘big data’ could hold the key to better understanding and treatments for many health conditions – like seasonal allergies, dementia and Parkinson’s.

One area where patient data is currently lacking is seasonal allergies.  Allergies are basically the result of the body’s immune system ‘misfiring’ and incorrectly responding to harmless substances or ‘allergens’, such as pollen. These allergies are very common in the Western world. One in four people will experience an allergy at some point in their lives and this number is increasing.  However, the causes are unclear.  Dr Sheena Cruickshank, an immunologist at The University of Manchester, explains the situation: “The rise in seasonal allergies like hay fever could be down to all sorts of things – such as changes in pollen exposure, pollution or maybe a lack of childhood exposure to germs. We have good quality data on many of the suspected causes but we don’t know how people are actually being affected. Gathering real-time data on a mass-scale about when and where symptoms occur could really help to change all of that.”

A nationwide study is currently underway to fill in these blanks and try to better understand seasonal allergies, all using a smartphone app called #BritainBreathing*. Allergy sufferers act as ‘citizen sensors’, using the app to keep a daily log of their symptoms (or lack thereof) like sneezing, itchy eyes and wheezing and track them over time. The app automatically does the rest, automatically sharing anonymised reports with the research team, with a time-stamp and approximate location.

Whilst sometimes trivialised, hay fever symptoms can be severe for some people and it is often associated with other conditions, such as asthma and eczema. Caroline, now 32, has had all three since childhood: ” I’ve had eczema since I was a baby, then I got hay fever and asthma later on around primary school age. At one point I was constantly on antihistamines.” Could a smartphone app help people like Caroline get a better handle on what their triggers might be? “When you’re young everyone else manages it for you, but when you get older you need to build up a picture in your own head to start to think about triggers: what is it, where was I, what was I doing at the time? Everyone carries their phone around now so that would be a good place to start.”

Indeed, decoding data has been key to other recent breakthroughs in the world of allergy research.  Whilst big is often beautiful, advances in statistical methods have arguably been just as important to unlock the insights hidden within the data. For example, combining data from several long-term studies (which collectively tracked almost 10,000 children from birth) helped researchers to question the stereotype of the so-called “allergic march”; a supposedly classic progression of symptoms starting in childhood, beginning with eczema, then progressing to wheeze and finally hay fever.  Using sophisticated analysis techniques, researchers showed that individuals fall into one of several ‘profiles’ and that this classic sequence is much less common than once thought (less than 7% followed this pattern). Findings like these appear to strengthen the case for acknowledging how variable patterns of allergic conditions can be, with slightly different symptoms and trajectories.

Teaming smartphone data with data from research studies like these has, to date, been an area with largely untapped potential. However, researchers are increasingly recognising the opportunities in bringing together different sources of data – including smartphones, wearable fitness gadgets and medical records – to shed light on diseases like dementia and Parkinson’s. For example, the 100 for Parkinson’s project invited people to use a smartphone app to track aspects of their health (including sleep quality, mood, exercise, diet and stress) for 100 days and donate their data to research.

Of course, it’s not all plain sailing. Some have expressed concerns about the quality of data, the ability to produce meaningful analyses and safeguarding personal information. However, the ability to work with the public to build large datasets to allow us to gain insights into both health and disease states mean that it’s an option increasingly being considered by a large array of scientific and medical fields. Is the smartphone the future of health research or is the challenge of disentangling the complex data generated by constant tracking more trouble than it’s worth?  We’ll just have to wait and see. I, for one, think it’s an opportunity too big to pass up.

*The free Britain Breathing app is available on the App Store and Google Play now.

Post by: Lamiece Hassan

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Seasons and Sefton

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In temperate regions such as the UK, our ecosystems experience seasonal dynamic fluctuations, as our moderate climate slowly fluctuates throughout the year. These fluctuations follow an annual trend, with many species of tree blossoming in spring before shedding their leaves in an impressive colourful autumn display leaving just bare branches through the winter days. In sync with this, animals appear to breed as temperatures increase yet hibernate through cooler days.

For those of you living in Liverpool, student or otherwise, it is well known that Sefton park is one of the most popular places to visit for its aesthetic beauty. I have lived in Liverpool for 4 years and have always been intrigued by the ecosystems it has to offer. Here I have documented how the park changes throughout the year by capturing photos at four different occasions between September 2016 and May 2017:

September 2016
November 2016
March 2017
May 2017

The science behind these changes is fascinating. One of the most noticeable differences observed in the park can be seen in the trees, specifically in how their leaves reflect the fluctuating seasons. Throughout the winter months, trees enter a period of dormancy in order to survive the low temperatures. However, despite their stark dormant appearance, deep within their branches they are actually busy maintaining themselves through respiration and enzyme synthesis and preparing for the coming spring.

As spring approaches, these trees begin to bud leaves and flowers, a change brought about in response to an increase in temperature and light availability. Throughout the summer months, different shades of green dominate the park. It is the photosynthetic pigment chlorophyll which gives leaves their vibrant green colour. This pigment enables plants to absorb energy from sunlight, specifically, it absorbs light in the blue and red portions of the electromagnetic spectrum while reflecting the near-green portion, therefore producing the vivid shades of green we see throughout the summer.

The breakdown of chlorophyll in the autumn reveals carotenoids in the leaves causing them to change from green to yellow/orange and creating a variety of colour throughout the park. Eventually, leaf abscission occurs.
Leaf abscission refers to the controlled process by which trees shed their leaves. This occurs from the Abscission zone (at the base of the leaf’s stem). Abscission zone cells differentiate in early plant growth and are able to respond to a number of environmental stressors and plant hormones. When light levels start to reduce and chlorophyll is degraded, levels of the plant hormone auxin decrease which in turn increases sensitivity in the abscission zone to another hormone ethylene. When the plant is exposed to ethylene cell wall-degrading enzymes such as cellulase and polygalacturonase are activated and abscission occurs.The trees then enter dormancy and the process repeats itself. There is a clear seasonal regulation of growth. And, it’s not only trees which follow this cycle, other flowering plants also respond to changes in seasons and sunlight which, in turn, allows many insects and mammals to thrive building a complex and beautiful ecosystem around these plants.

The images included in this article provide a visual representation of how our planet constantly changes. Sefton provides city dwellers with the ability to witness these changes first hand throughout the year – and we can guarantee you a mystical view on whatever day you decide to visit.

Take home message: Next time you take a trip to Sefton, have a look at the forever changing ecosystems and think about the biological processes occurring beneath the visual changes.

Post by: Alice Brown:

References
http://www.journals.uchicago.edu/doi/abs/10.1086/283724?journalCode=an
https://link.springer.com/chapter/10.1007%2F978-94-011-4453-7_45#page-1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1087143/pdf/plntphys00512-0027.pdf
http://postharvest.tfrec.wsu.edu/pages/PC2000F
http://scienceline.ucsb.edu/getkey.php?key=1110
https://www.ncbi.nlm.nih.gov/pubmed/17737985

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The Nuclear (Waste) War

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Article by Rose Linihan, student of Xaverian College (Manchester) and winner of the British Science Association’s  2017 Science Journalism contest.

The United Kingdom currently faces nuclear threat. And no, not that kind. There is in fact a potential energy crisis on its way, involving huge energy shortages and 100,000 tonnes of nScreen Shot 2017-05-26 at 14.33.25uclear waste, to be precise.

There are currently nine nuclear power stations here in the UK, providing 22% of our total electricity. The Government have decided they want nuclear power to continue to provide a portion of our energy, alongside other low-carbon options. The general public conception of nuclear power is notoriously bad, and yet nuclear power is very effective. It’s a low-carbon way of producing the energy needed to power everything in the UK, from our toasters to TVs, and radioactivity is all around us – there’s even radioactivity in bananas!

Nuclear energy itself is produced by a process called fission, whereby a very unstable isotope of an element called uranium is split into two smaller radioactive nuclei and 2 or 3 neutrons are released and lots of energy. In a nuclear reactor, uranium fuel is surrounded by graphite (material that used to be in pencils) moderators and keep the reaction under control by slowing the neutrons down so they’re at the optimum speed for a further reaction to occur. After it has done its job inside the nuclear reactor, this graphite is known as nuclear waste.

However, our current reactors are now old and so require decommissioning and replacing with new and more advanced models, or else there will be a national energy shortage. Which leaves the us with the problem of the 100,000 tonnes of radioactive nuclear waste. Not to mention 300,000 tonnes worldwide. The NDA (Nuclear Decommissioning Authority) is responsible for decommissioning nuclear waste and their present plan of how to do this is to wait 100 years and then bury the waste in a geological disposal facility. Another option is to go down a similar route to US whereby waste is shipped in containers and the stored in underground tunnels by machines. These options are both very expensive, costing a whopping £20 billion, not to mention being very time consuming and the fact that suitable geological sites are rare. So what do we do? Dump it at the bottom of the ocean? Bury it somewhere? Launch it into space? Or something else…

Alex Theodosiou is a post-doctoral research associate at Manchester University, working in the field of nuclear decommissioning as part of the Nuclear Graphite Research Group. They work as part of a consortium to come up with novel methods of tackling the nuclear waste crisis. Alex is currently researching the thermal treatment of nuclear graphite by reacting it with oxygen at high tempuratures to produce carbon dioxide. This carbon dioxide can then be managed using carbon capture techniques such as liquefication. Alex says ‘This will lead to a massive volume reduction in the graphite inventory and should help reduce overall costs involved with decommissioning, as well as reduce the lengthy timescales currently predicted.’ It could also have wider applications such as nuclear weapon disposal.

Alex’s laboratory work is small scale and involves using a few grams of nuclear grade graphite and heating it with a tube furnace under various conditions, before using a gas analyser to monitor the species formed. This lab data can then be transferred to an industrial scale by partner companies who use a plasma furnace and greater volumes of graphite, to produce results on 1000x the scale.

Alex and his colleages hope that together they can develop a commericially viable decommissioning strategy for the nuclear sector, to propose to the NDA to hopefully win the war against nuclear waste!

Informatics for health – an interdisciplinary extravaganza.

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A few weeks ago I attended the European Federation for Medical Informatics and the Farr Institute of Health Informatics Research’s Manchester-based conference – Informatics for Health 2017. The conference was a vibrant mix of academic thought topped off with a generous helping of public collaboration, showing that the field of health and medical informatics takes collaboration and public involvement very seriously.

Since health informatics covers all aspects of health-data collection, storage and processing it would be impossible to do justice to the sheer breadth of research presented at this conference in a single article. Therefore, here I will focus on a couple of my personal highlights.

On Tuesday the 25th, Susan Michie from University College London gave a keynote talk about the Human Behavioural Change Project:

With environmental, social and health concerns appearing endemic in our society, Suzan noted that one of the best ways to address these issues would be through targeted behavioural change interventions. These take a huge array of forms from subtle nudges implemented by many governments and large organisations (encouraging everything from litter reduction to targeted urinal use – see here for examples), to less than subtle public health campaigns. These interventions are widely documented across academic literature and show a range of outcomes and successes. Susan outlined a vision where this literature could be used to answer the big question:

‘What behaviour change interventions work, how well, for whom, in what setting, for what behaviours and why’

This is undoubtedly a pretty ambitious question to answer and it is made harder by the fact that the literature on this subject, although vast, is often fragmented, inconsistent and sometimes incomplete. So how do Susan’s team propose to tackle this big data problem?

The Human Behaviour-Change Project, funded by the Wellcome Trust, draws together some of the best minds in behavioural, computer and information science. Their output will depend on the close working relationships and interplay between all disciplines involved.

Behaviour scientists have been tasked with developing an ‘ontology’, basically a standardised method of categorising different behavioural change interventions. It is then hoped that this standardised ontology can be used to both sort existing literature and as a template on which new studies can be based. It is hoped that this will add some much needed order to the current fragmented literature and pave the way for further analysis. Specifically, computer scientists on this team will use Natural Language Processing (a branch of computer science which employs artificial intelligence and computational linguistics to sort and process large bodies of text) to extract and organise information from these studies, whilst also learning as they process this information.

Finally information scientists, the big data miners, will develop effective user interfaces which allow researchers to delve into this data and to untangle it in a way that reveals answers to many important research questions.

This is undoubtedly a huge task but with the combined input of so many specialists it certainly seems tractable.

On Wednesday the 26th the conference was drawn to a close with a compelling talk from Sally Okun, Vice President for Advocacy, Policy and Patient Safety at PatientsLikeMe, an online patient powered research network. The PatientsLikeMe network partners with 500,000+ patients living with 2700+ conditions and offers a platform for patients to share experiences and where researchers can learn more about treatments directly from those undergoing them. Indeed, more than 90 peer reviewed papers have already stemmed from data collected through the PatientsLikeMe network.

The theory behind this work is compelling and almost begs the question as to why such networks are not yet commonplace. Indeed, it’s no secret that online marketers spend billions analysing our search histories and purchase data in an attempt to feed us highly personalised targeted marketing, so why shouldn’t patient experiences be used to tailor personalised medicine? Although there are undoubtedly greater complications linked to the use of patient data, not to mention the perils of misinformation, this is no excuse not to try and work towards a digital ideal.

Sally also discussed the launch of their new platform, the Digital Me. This platform will combine a plethora of personal health data including genetic data, medical histories, activity tracking – basically if you can collect it you can include it. Their hope is that this data can be used to personalise medical treatments, tailoring them to your own individual requirements. Indeed, advances in statistical methods could take us beyond blanket prescribing and into a world where your digital profile can be compared to those similar to you (similarity being based on a large number of patient characteristics) and recommendations made based on successes and failure of treatments for you nearest digital neighbours (those sharing most of your traits).

As my first experience of an informatics-based conference, I was struck by both the breadth and depth of knowledge in the field and the ethos of working together to optimise our outputs – a skill which is often found lacking in other fields. It was also plain that researchers in this area value patient input and many elements of this conference were tailored to be accessible and engaging for a lay audience. Indeed, representatives from HeRC’s own patient public forum who attended the event enjoyed the opportunity to engage further with researchers and learn about engagement and involvement work being conducted across the field.

Post by: Sarah Fox

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