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JCO PO author Dr. Dean A. Regier at the Academy of Translational Medicine, University of British Columbia (UBC), and the School of Population and Public Health, BC Cancer Research Institute shares insights into his JCO PO article, “Clinical Effectiveness and Cost-Effectiveness of Multigene Panel Sequencing in Advanced Melanoma: A Population-Level Real-World Target Trial Emulation.” Host Dr. Rafeh Naqash and Dr. Regier discuss the real-world clinical effectiveness and cost-effectiveness of multigene panels compared with single-gene BRAF testing to guide therapeutic decisions in advanced melanoma. Transcript Dr. Rafeh Naqash:Hello and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCO PO articles. I'm your host, Dr. Rafeh Naqash, Podcast Editor for JCO Precision Oncology and Assistant Professor at the OU Health Stephenson Cancer Center in the University of Oklahoma. Today, we are excited to be joined by Dr. Dean A. Regier, Director at the Academy of Translational Medicine, Associate Professor at the School of Population and Public Health, UBC Senior Scientist at the British Columbia Cancer Research Institute, and also the senior author of the JCO Precision Oncology article entitled "Clinical Effectiveness and Cost-Effectiveness of Multigene Panel Sequencing in Advanced Melanoma: A Population-Level Real-World Target Trial Emulation." At the time of this recording, our guest's disclosures will be linked in the transcript. Dean, welcome to our podcast and thank you for joining us today. Dr. Dean Regier:Thank you. I'm delighted to be here. Dr. Rafeh Naqash:So, obviously, you are from Canada, and medicine, or approvals of drugs to some extent, and in fact approvals of gene testing to some extent is slightly different, which we'll come to learn about more today, compared to what we do in the US—and in fact, similarly, Europe versus North America to a large extent as well. Most of the time, we end up talking about gene testing in lung cancer. There is a lot of data, a lot of papers around single-gene panel testing in non-small cell lung cancer versus multigene testing. In fact, a couple of those papers have been published in JCO PO, and it has shown significant cost-effectiveness and benefit and outcomes benefit in terms of multigene testing. So this is slightly, you know, on a similar approach, but in a different tumor type. So, could you tell us first why you wanted to investigate this question? What was the background to investigating this question? And given your expertise in health economics and policy, what are some of the aspects that one tends or should tend to understand in terms of cost-effectiveness before we go into the results for this very interesting manuscript? Dr. Dean Regier:Yeah, of course, delighted to. So, one of the reasons why we're deeply interested in looking at comparative outcomes with respect to single- versus multigene testing— whether that's in a public payer system like Canada or an insurer system, a private system in the United States— is that the question around does multigene versus single-gene testing work, has not typically tested in randomized controlled trials. You don't have people randomized to multigene versus single-gene testing. And what that does, it makes the resulting evidence base, whether it's efficacy, safety, or comparative cost-effectiveness, highly uncertain. So, the consequence of that has been uneven uptake around the world of next-generation sequencing panels. And so if we believe that next-gen sequencing panels are indeed effective for our patients, we really need to generate that comparative evidence around effectiveness and cost-effectiveness. So we can go to payers, whether it be single payer or a private insurer, to say, "Here are the comparative outcomes." And when I say that uptake has been uneven, uptake there's been actually plenty, as you know, publications around that uneven uptake, whether it be in Europe, in the United States, in Canada. And so we're really interested in trying to produce that evidence to create the type of deliberations that are needed to have these types of technologies accessible to patients. And part of those deliberations, of course, is the clinical, but also in some contexts, cost-effectiveness. And so, we really start from the perspective of, can we use our healthcare system data, our learning healthcare system, to generate that evidence in a way that emulates a randomized controlled trial? We won't be able to do these randomized controlled trials for various, like really important and and reasons that make sense, quite frankly. So how can we mimic or emulate randomized controlled trials in a way that allows us to make inference around those outcomes? And for my research lab, we usually think through how do we do causal inference to address some of those biases that are inherent in observational data. So in terms of advanced melanoma, we were really interested in this question because first of all, there have been no randomized controlled trials around next-gen sequencing versus single-gene testing. And secondly, these products, these ICIs, immune checkpoint inhibitors, and BRAF and MEK inhibitors, they are quite expensive. And so the question really becomes: are they effective? And if so, to what extent are they cost-effective? Do they provide a good reason to have information around value for money? Dr. Rafeh Naqash:So now going to the biology of melanoma, so we know that BRAF is one of the tumor-agnostic therapies, it has approvals for melanoma as well as several other tumor types. And in fact, I do trials with different RAF-RAS kinase inhibitors. Now, one of the things that I do know is, and I'm sure some of the listeners know, is the DREAMseq trial, which was a melanoma study that was an NCI Cooperative Group trial that was led by Dr. Mike Atkins from Georgetown a couple of years back, that did show survival benefit of first-line immunotherapy sequencing. It was a sequencing study of whether to do first-line BRAF in BRAF-mutant melanoma followed by checkpoint inhibitors, or vice versa. And the immune checkpoint inhibitors followed by BRAF was actually the one that showed benefit, and the trial had to stop early, was stopped early because of the significant benefit seen. So in that context, before we approach the question of single-gene versus multigene testing in melanoma, one would imagine that it's already established that upfront nivolumab plus ipilimumab, for that matter, doublet checkpoint inhibitor therapy is better for BRAF-mutant melanoma. And then there's no significant other approvals for melanoma for NRAS or KIT, you know, mucosal melanomas tend to have KIT mutations, for example, or uveal melanomas, for that matter, have GNAQ, and there's no targeted therapies. So, what is the actual need of doing a broader testing versus just testing for BRAF? So just trying to understand when you started looking into this question, I'm sure you kind of thought about some of these concepts before you delved into that. Dr. Dean Regier:I think that is an excellent question, and it is a question that we asked ourselves: did we really expect any differences in outcomes between the testing strategies? And what did the real-world implementation, physician-guided, physician-led implementation look like? And so, that was kind of one of the other reasons that we really were interested is, why would we go to expanded multigene panel sequencing at all? We didn't really expect or I didn't expect an overall survival a priori. But what we saw in our healthcare system, what happened in our healthcare system was the implementation in 2016 of this multigene panel. And this panel covered advanced melanoma, and this panel cost quite a bit more than what they were doing in terms of the single-gene BRAF testing. And so when you're a healthcare system, you have to ask yourself those questions of what is the additional value associated with that? And indeed, I think in a healthcare system, we have to be really aware that we do not actually follow to the ideal extent randomized controlled trials or trial settings. And so that's the other thing that we have to keep in mind is when these, whether it's an ICI or a BRAF MEK inhibitor, when these are implemented, they do not look like randomized controlled trials. And so, we really wanted to emulate not just a randomized controlled trial, but a pragmatic randomized controlled trial to really answer those real-world questions around implementation that are so important to decision making. Dr. Rafeh Naqash:Sure. And just to understand this a little better: for us in the United States, when we talk about multigene testing, we generally refer to, these days, whole-exome sequencing with whole-transcriptome sequencing, which is like the nuclear option of of the testings, which is not necessarily cheap. So, when you talk about multigene testing in your healthcare system, what does that look like? Is it a 16-gene panel? Is it a 52-gene panel? What is the actual makeup of that platform? Dr. Dean Regier:Excellent question. Yeah, so at the time that this study is looking at, it was 2016, when we, as BC Cancer—so British Columbia is a population right now of 5.7 million people, and we have data on all those individuals. We are one healthcare system providing health care to 5.7 million people. In 2016, we had what I call our "home-brew" multigene panel, which was a 53-gene panel that was reimbursed as standard of care across advanced cancers, one of them being advanced melanoma. We have evolved since then. I believe in 2022, we are using one of the Illumina panels, the Focus panel. And so things have changed; it's an evolving landscape. But we're specifically focused on the 53-gene panel. It was called OncoPanel. And that was produced in British Columbia through the Genome Sciences Centre, and it was validated in a single-arm trial mostly around validity, etc. Dr. Rafeh Naqash:Thank you for explaining that. So now, onto the actual meat and the science of this project. So, what are some of the metrics from a health economy standpoint that you did look at? And then, methodology-wise, I understand, in the United States, we have a fragmented healthcare system. I have data only from my institution, for that matter. So we have to reach out to outside collaborators and email them to get the data. And that is different for you where you have access to all the data under one umbrella. So could you speak to that a little bit and how that's an advantage for this kind of research especially? Dr. Dean Regier:Yeah. In health economics, we look at the comparative incremental costs against the incremental effectiveness. And when we think about incremental costs, we think not just about systemic therapy or whether you see a physician, but also about hospitalizations, about all the healthcare interactions related to oncology or not that a patient might experience during their time or interactions with the healthcare system. You can imagine with oncology, there are multiple interactions over a prolonged time period depending on survival. And so what we try to do is we try to—and the benefit of the single-payer healthcare system is what we do is we link all those resource utilization patterns that each patient encounters, and we know the price of that encounter. And we compare those incremental costs of, in this case, it's the multigene panel versus the single-gene panel. So it's not just the cost of the panel, not just the cost of systemic therapy, but hospitalizations, physician encounters, etc. And then similarly, we look at, in this case, we looked at overall survival - we can also look at progression-free survival - and ask the simple question, you know, what is the incremental cost per life-year gained? And in that way, we get a metric or an understanding of value for money. And how we evaluate that within a deliberative priority setting context is we look at safety and efficacy first. So a regulatory package that you might get from, in our case, Health Canada or the FDA, so we look at that package, and we deliberate on, okay, is it safe and is it effective? How many patients are affected, etc. And then separately, what is the cost-effectiveness? And at what price, if it's not cost-effective, at what price would it be cost-effective? Okay, so for example, we have this metric called the incremental cost-effectiveness ratio, which is incremental cost in the numerator, and in this case, life-years gained in the denominator. And if it is around $50,000 or $100,000 per life-year gained—so if it's in that range, this ratio—then we might say it's cost-effective. If it's above this range, which is common in oncology, especially when we talk about ICIs, etc., then you might want to negotiate a price. And indeed, when we negotiate that price, we use the economic evaluation, that incremental cost-effectiveness ratio, as a way to understand at what price should we negotiate to in order to get value for money for the healthcare system. Dr. Rafeh Naqash:Thank you for explaining those very interesting terminologies. Now, one question I have in the context of what you just mentioned is, you know, like the drug development space, you talked about efficacy and safety, but then on the safety side, we talk about all-grade adverse events or treatment-related adverse events—two different terminologies. From a healthcare utilization perspective, how do you untangle if a patient on a BRAF therapy got admitted for a hypoxic respiratory failure due to COPD, resulting in a hospitalization from the cost, overall cost utilization, or does it not matter? Dr. Dean Regier:We try to do as much digging into those questions as possible. And so, this is real-world data, right? Real-world data is not exactly as clean as you'd get from a well-conducted clinical trial. And so what we do is we look at potential adverse event, whether it's hospitalization, and the types of therapies around that hospitalization to try- and then engage with clinicians to try to understand or tease out the different grades of the adverse event. Whether it's successful or not, I think that is a real question that we grapple with in terms of are we accurate in delineating different levels of adverse events? But we try to take the data around the event to try to understand the context in which it happens. Dr. Rafeh Naqash:Thank you for explaining that, Dean. So, again to the results of this manuscript, could you go into the methodology briefly? Believe you had 147 patients, 147 patients in one arm, 147 in the other. How did you split that cohort, and what were some of the characteristics of this cohort? Dr. Dean Regier:So, the idea, of course, is that we have selection criteria, study inclusion criteria, which included in our case 364 patients. And these were patients who had advanced melanoma within our study time period. So that was 2016 to 2018. And we had one additional year follow. So we had three total years. And what we did is that we linked our data, our healthcare system data. During this time, because the policy change was in 2016, we had patients both go on the multigene panel and on the single-gene BRAF testing. So, the idea was to emulate a pragmatic randomized controlled trial where we looked at contemporaneous patients who had multigene panel testing versus single-gene BRAF testing. And then we did a matching procedure—we call it genetic matching. And that is a type of matching that allows us to balance covariates across the patient groups, across the multigene versus BRAF testing cohorts. The idea again is, as you get in a randomized controlled trial, you have these baseline characteristics that look the same. And then the hope is that you address any source selection or confounding biases that prohibit you to have a clean answer to the question: Is it effective or cost-effective? So you address all those biases that may prohibit you to find a signal if indeed a signal is there. And so, what we did is we created—we did this genetic matching to balance covariates across the two cohorts, and we matched them one-to-one. And so what we were able to do is we were able to find, of those 364 patients in our pool, 147 in the multigene versus 147 in the single-gene BRAF testing that were very, very similar. In fact, we created what's called a directed acyclic graph or a DAG, together with clinicians to say, “Hey, what biases would you expect to have in these two cohorts that might limit our ability to find a signal of effectiveness?” And so we worked with clinicians, with health economists, with epidemiologists to really understand those different biases at play. And the genetic matching was able to match the cohorts on the covariates of interest. Dr. Rafeh Naqash:And then could you speak on some of the highlights from the results? I know you did survival analysis, cost-effectiveness, could you explain that in terms of what you found? Dr. Dean Regier:We did two analyses. The intention-to-treat analysis is meant to emulate the pragmatic randomized controlled trial. And what that does is it answers the question, for all those eligible for multigene or single-gene testing: What is the cost-effectiveness in terms of incremental life-years gained and incremental cost per life-years gained? And the second one was around a protocol analysis, which really answered the question of: For those patients who were actually treated, what was the incremental effectiveness and cost-effectiveness? Now, they're different in two very important ways. For the intention-to-treat, it's around population questions. If we gave single-gene or multigene to the entire population of advanced melanoma patients, what is the cost-effectiveness? The per-protocol is really around that clinical question of those who actually received treatment, what was the incremental cost and effectiveness? So very different questions in terms of population versus clinical cost and effectiveness. So, for the intention-to-treat, what we found is that in terms of life-years gained is around 0.22, which is around 2.5 months of additional life that is afforded to patients who went through the multigene panel testing versus the single-gene testing. That was non-statistically significant from zero at the 5% level. But on average, you would expect this additional 2.5 months of life. The incremental costs were again non-statistically significant, but they're around $20,000. And so when we look at incremental cost-effectiveness, we can also look at the uncertainty around that question, meaning what percentage of incremental cost-effectiveness estimates are likely to be cost-effective at different willingness-to-pay thresholds? Okay? So if you are willing to pay $100,000 to get one gain of life-years, around 52.8% of our estimates, in terms of when we looked at the entire uncertainty, would be cost-effective. So actually that meets the threshold of implementation in our healthcare system. So it's quite uncertain, just over 50%. But what we see is that decision-makers actually have a high tolerance for uncertainty around cost-effectiveness. And so, while it is uncertain, we would say that, well, the cost-effectiveness is finely balanced. Now, when we looked at the population, the per-protocol population, those folks who just got treatment, we actually have a different story. We have all of a sudden around 4.5 or just under 5 months of life gained that is statistically significantly different from zero, meaning that this is a strong signal of benefit in terms of life-years gained. In terms of the changes in costs or the incremental costs, they are larger again, but statistically insignificant. So the question now is, to what extent is it cost-effective? What is the probability of it being cost-effective? And at the $100,000 per life-year gained willingness-to-pay, there was a 73% chance that multigene panel testing versus single-gene testing is cost-effective. Dr. Rafeh Naqash:So one of the questions I have here, this is a clarification both for myself and maybe the listeners also. So protocol treatment is basically if you had gene testing and you have a BRAF in the multigene panel, then the patient went on a BRAF treatment. Is that correct? Dr. Dean Regier:It's still physician choice. And I think that's important to say that. So typically what we saw in both in our pre- and post-matching data is that we saw around 50% of patients, irrespective of BRAF status, get an ICI, which is appropriate, right? And so the idea here is that you get physician-guided care, but if the patient no longer performs on the ICI, then it gives them a little bit more information on what to do next. Even during that time when we thought it wasn't going to be common to do an ICI, but it was actually quite common. Dr. Rafeh Naqash:Now, did you have any patients in this study who had the multigene testing done and had an NRAS or a KIT mutation and then went on to those therapies, which were not captured obviously in the single-gene testing, which would have just tried to look at BRAF? Dr. Dean Regier:So I did look at the data this morning because I thought that might come up in terms of my own questions that I had. I couldn't find it, but what we did see is that some patients went on to clinical trials. So, meaning that this multigene panel testing allowed, as you would hope in a learning healthcare system, patients to move on to clinical trials to have a better chance at more appropriate care if a target therapy was available. Dr. Rafeh Naqash:And the other question in that context, which is not necessarily related to the gene platform, but more on the variant allele frequency, so if you had a multigene panel that captured something that was present at a high VAF, with suspicion that this could be germline, did you have any of those patients? I'm guessing if you did, probably very low number, but I'm just thinking from a cost-effective standpoint, if you identify somebody with germline, their, you know, first-degree relative gets tested, that ends up, you know, prevention, etc. rather than somebody actually developing cancer subsequently. That's a lot of financial gains to the system if you capture something early. So did you look at that or maybe you're planning to look at that? Dr. Dean Regier:We did not look at that, but that is a really important question that typically goes unanswered in economic evaluations. And so, the short answer is yes, that result, if there was a germline finding, would be returned to the patient, and then the family would be able to be eligible for screening in the appropriate context. What we have found in economic evaluations, and we've recently published this research, is that that scope of analysis is rarely incorporated into the economic evaluation. So those downstream costs and those downstream benefits are ignored. And when you- especially also when you think about things like secondary or incidental findings, right? So it could be a germline finding for cancer, but what about all those other findings that we might have if you go with an exome or if you go with a genome, which by the way, we do have in British Columbia—we do whole-genome and transcriptome sequencing through something called the Personalized OncoGenomics program. That scope of evaluation, because it's very hard to get the right types of data, because it requires a decision model over the lifetime of both the patients and potentially their family, it becomes very complicated or complex to model over patients' and families' lifetime. That doesn't mean that we should not do it, however. Dr. Rafeh Naqash:So, in summary Dean, could you summarize some of the known and unknowns of what you learned and what you're planning in subsequent steps to this project? Dr. Dean Regier:Our North Star, if you will, is to really understand the entire system effect of next-generation sequencing panels, exome sequencing, whole genomes, or whole genomes and transcriptome analysis, which we think should be the future of precision oncology. The next steps in our research is to provide a nice base around multigene panels in terms of multigene versus single-gene testing, whether that be colorectal cancer, lung cancer, melanoma, etc., and to map out the entire system implications of implementing next-generation sequencing panels. And then we want to answer the questions around, “Well, what if we do exomes for all patients? What if we do whole genomes and transcriptomes for all patients? What are the comparative outcomes for a true tumor-agnostic precision oncology approach, accounting for, as you say, things like return of results with respect to hereditary cancers?” I think the challenge that's going to be encountered is really around the persistent high costs of something like a whole-genome and transcriptome sequencing approach. Although we do see the technology prices going down—the "$1,000 genome" or “$6,000 genome" on whatever Illumina machine you might have—that bioinformatics is continuing to be expensive. And so, there are pipelines that are automated, of course, and you can create a targeted gene report really rapidly within a reasonable turnaround time. But of course, for secondary or what I call level two analysis, that bioinformatics is going to continue to be expensive. And so, we're just continually asking that question is: In our healthcare system and in other healthcare systems, if you want to take a precision oncology approach, how do you create the pipelines? And what types of technologies really lend themselves to benefits over and above next-generation sequencing or multigene panels, allowing for access to off-label therapies? What does that look like? Does that actually improve patients? I think some of the challenges, of course, is because of heterogeneity, small benefiting populations, finding a signal if a signal is indeed there is really challenging. And so, what we are thinking through is, with respect to real-world evidence methods and emulating randomized controlled trials, what types of evidence methods actually allow us to find those signals if indeed those signals are there in the context of small benefiting populations? Dr. Rafeh Naqash:Thank you so much, Dean. Sounds like a very exciting field, especially in the current day and age where cost-effectiveness, financial toxicity is an important aspect of how we improve upon what is existing in oncology. And then lots more to be explored, as you mentioned. The last minute and a half I want to ask about you as an individual, as a researcher. There's very few people who have expertise in oncology, biomarkers, and health economics. So could you tell us for the sake of our trainees and early career physicians who might be listening, what was your trajectory briefly? How did you end up doing what you're doing? And maybe some advice for people who are interested in the cost of care, the cost of oncology drugs - what would your advice be for them very briefly? Dr. Dean Regier:Sure. So I'm an economist by training, and indeed I knew very little about the healthcare system and how it works. But I was recruited at one point to BC Cancer, to British Columbia, to really try to understand some of those questions around costs, and then I learned also around cost-effectiveness. And so, I did training in Scotland to understand patient preferences and patient values around quality of care, not just quantity of life, but also their quality of life and how that care was provided to them. And then after that, I was at Oxford University at the Nuffield Department of Population Health to understand how that can be incorporated into randomized control trials in children. And so, I did a little bit of learning about RCTs. Of course, during the way I picked up some epidemiology with deep understanding of what I call econometrics, what others might call biostatistics or just statistics. And from there, it was about working with clinicians, working with epidemiologists, working with clinical trialists, working with economists to understand the different approaches or ways of thinking of how to estimate efficacy, effectiveness, safety, and cost-effectiveness. I think this is really important to think through is that we have clinical trialists, we have people with deep understanding of biostatistics, we have genome scientists, we have clinicians, and then you add economists into the mix. What I've really benefited from is that interdisciplinary experience, meaning that when I talk to some of the world's leading genome scientists, I understand where they're coming from, what their hope and vision is. And they start to understand where I'm coming from and some of the tools that I use to understand comparative effectiveness and cost-effectiveness. And then we work together to actually change our methods in order to answer those questions that we're passionate about and curious about better for the benefit of patients. So, the short answer is it's been actually quite a trajectory between Canada, the UK. I spent some time at the University of Washington looking at the Fred Hutch Cancer Research Center, looking at precision oncology. And along the way, it's been an experience about interdisciplinary research approaches to evaluating comparative outcomes. And also really thinking through not just at one point in time on-off decisions—is this effective? Is it safe? Is it cost-effective?—not those on-off decisions, but those decisions across the lifecycle of a health product. What do those look like at each point in time? Because we gain new evidence, new information at each point in time as patients have more and more experience around it. And so what really is kind of driving our research is really thinking about interdisciplinary approaches to lifecycle evaluation of promising new drugs with the goal of having these promising technologies to patients sooner in a way that is sustainable for the healthcare system. Dr. Rafeh Naqash:Awesome. Thank you so much for those insights and also giving us a sneak peek of your very successful career. Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review, and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcast. Thank you. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.      

In today's episode, we spoke with Shubham Pant, MD, MBBS, and Professor Timothy Elliott, about ongoing research with cancer vaccines. Dr Pant is a professor in the Department of Gastrointestinal Medical Oncology in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center in Houston. Dr Elliott is the Kidani Professor of Immuno-oncology in the Nuffield Department of Medicine at the University of Oxford in the United Kingdom. In our exclusive interview, Pant and Elliott discussed the current landscape of vaccines for cancer treatment, ongoing research seeking to extend the benefits of vaccines as cancer management and prevention strategies, and what the future may hold.

Two wide open cases from the latest issue of the journal. Starting with a case from Italy (1:18), of a 63-yo man having a history of behavioural and cognitive problems since retiring. His many changes included low mood, significant weight loss, and problems with sleep and temperature regulation. He had a background of type 2 diabetes. Initial treatment was on a suspicion of Alzheimer's, but there was no clinical improvement. https://pn.bmj.com/content/25/2/159  A case from the United States is next (17:36), featuring a 66-yo lady experiencing 10 days of generalised weakness, with episodes of forgetfulness and a series of falls. She had previously been treated for left-sided ophthalmic herpes zoster. Neurological examination showed mild right arm and leg weakness. https://pn.bmj.com/content/25/2/164    The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the February 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Brian O'Toole. Thank you for listening. 

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Monserrat Conde from the University of Oxford. Associate Professor Jamie Hartmann-Boyce and Associate Professor Nicola Lindson discuss the new evidence in e-cigarette research and interview Dr Monserrat Conde from the Nuffield Department of Primary Care Health Sciences, University of Oxford. In the March podcast Monserrat Conde discusses the findings of the recent systematic review of electronic cigarettes and subsequent smoking in young people and an evidence and gap map. The systematic review aims to assess the evidence for a relationship between the use of e-cigarettes /vapes and subsequent smoking in young people under 30, and whether this differs by demographic characteristics. There is very low certainty evidence suggesting that e-cigarette use and availability are inversely associated with smoking in young people (i.e. as e-cigarettes become more available and/or are used more widely, youth smoking rates go down or, conversely, as e-cigarettes are restricted, youth smoking rates go up). At an individual level, people who vape appear to be more likely to go on to smoke than people who do not vape; however, it is unclear if these behaviours are causally linked. Monserrat discusses the differences in the information coming from the population studies compared to the individual level studies and notes that most studies are from high income countries, in particular from the US. To see the full review: https://doi.org/10.1111/add.16773 This podcast is a companion to the electronic cigarettes Cochrane living systematic review and Interventions for quitting vaping review and shares the evidence from the monthly searches. Our literature searches for the EC for smoking cessation review carried out on 1st March 2025 found 1 new study (DOI: 10.1016/j.drugalcdep.2024.112271), one new ongoing study (ACTRN12625000179437) and two records linked to studies included in the review. Our literature searches for the interventions for quitting vaping review carried out on 1st March 2025 found 2 new ongoing studies (NCT06832098, ACTRN12625000143426) and four records linked to studies included in the review. For further details see our webpage under 'Monthly search findings': https://www.cebm.ox.ac.uk/research/electronic-cigarettes-for-smoking-cessation-cochrane-living-systematic-review-1 For more information on the full Cochrane review of E-cigarettes for smoking cessation updated in January 2025 see: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub9/full For more information on the full Cochrane review of Interventions for quitting vaping published in January 2025 see: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD016058.pub2/full This podcast is supported by Cancer Research UK.

A puzzling pair of Case Reports from the most recent issue of the journal. First up (1:35) is a man in his mid-fifties, presenting with lumbar spine fractures, which then developed into confusion, vomiting, and abdominal pain. An x-ray showed  dilated intestinal loops and his blood sodium levels were low. https://pn.bmj.com/content/25/1/87 The second case (23:06) involves a 21-yo woman, who presented  at 18 weeks pregnant with  multiple episodes of right upper limb tonic extension, and subsequently developed new-onset refractory status epilepticus (NORSE). https://pn.bmj.com/content/25/1/56    The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Xin You Tai³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the February 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Letícia Amorim and Brian O'Toole. Thank you for listening. 

In this episode, our guests discuss the potential of large-scale health datasets to transform research and improve patient outcomes and healthcare systems. Our guests also delve into the ethical, logistical, and technical challenges that come with these programmes. We hear how organisations such as UK Biobank, Our Future Health, and All of Us are collecting rich, diverse datasets, collaborating and actively working to ensure that these resources are accessible to researchers worldwide. Hosting this episode is Dr Natalie Banner, Director of Ethics at Genomics England. She is joined by Dr Raghib Ali, Chief Medical Officer and Chief Investigator at Our Future Health, Professor Naomi Allen, Professor of Epidemiology at the Nuffield Department of Population Health, University of Oxford, and Chief Scientist for UK Biobank, and Dr Andrea Ramírez, Chief Data Officer at the All of Us Research Program in the United States. "There are areas where academia and the NHS are very strong, and areas where industry is very strong, and by working together as we saw very good examples during the pandemic with the vaccine and diagnostic tests etc, that collaboration between the NHS and academia industry leads to much more rapid and wider benefits for our patients and hopefully in the future for the population as a whole in terms of early detection and prevention of disease." You can download the transcript or read it below.  Natalie: Welcome to Behind the Genes   Naomi: So, we talked to each other quite regularly. We have tried to learn from each other about the efficiencies of what to do and what not to do in how to run these large-scale studies efficiently. When you are trying to recruit and engage hundreds of thousands of participants, you need to do things very cost effectively. How to send out web-based questionnaires to individuals, how to collect biological samples, how the make the data easily accessible to researchers so they know exactly what data they are using.   All of that we are learning from each other. You know, it is a work in progress all the time. In particular you know, how can we standardise our data so that researchers who are using all of us can then try and replicate their findings in a different population in the UK by using UK Biobank or Our Future Health.    Natalie: My name is Natalie Banner, and I am Director of Ethics at Genomics England. On today's episode we will be discussing how we can unlock the potential of large health datasets. By that I mean bringing together data on a massive scale, including for example genomic, clinical, biometric, imaging, and other health information from hundreds and thousands of participants, and making it available in a secure way for a wide range of research purposes over a long time period.   Through collaboration and industry partnerships, these programmes have the potential to transform research and deliver real world benefits for patients and health systems. But they also come with challenges ranging from issues in equity and ethics through to logistics, funding, and considerable technical complexities. If you enjoy today's episode, we would love your support. Please like, share, and rate us on wherever you listen to your podcasts.     I'm delighted to be joined today by 3 fantastic experts to explore this topic. Dr Raghib Ali, Chief Medical Officer and Chief Investigator at Our Future Health. Professor Naomi Allen, Professor of Epidemiology at the Nuffield Department of Population Health, University of Oxford, and Chief Scientist for UK Biobank, and Dr Andrea Ramírez, Chief Data Officer at the All of Us Research Program in the United States.   Andrea, if I could start with you. It would be really great to hear about All of Us, an incredibly ambitious programme in the US, and maybe some of the successes it has achieved so far.   Andrea: Absolutely. Wonderful to be here with you and thank for you for the invitation. The All of Us Research Program started in 2016 from the Precision Medicine Initiative and was funded with the goal of recruiting 1 million or more participants into a health database. That includes information not only from things like biospecimens including their whole genome sequence, but also surveys that participants provide, and importantly linking electronic health record information and other public data that is available, to create a large database that researchers that access and use to study precision health.   We have recruited over 830,000 participants to date and are currently sharing available data on over 600,000. So, we're excited to be with your audience, and I hope we can learn more and contribute to educating people listening about precision medicine.   Natalie: Thank you, Andrea. And not that this is competitive at all, but Raghib, as we are recording this, I understand the Our Future Health programme is marking quite a phenomenal milestone of 1 million participants. Would you mind telling us a little bit about the programme and something that you see as the benefits of working at scale for health research.   Raghib: Thank you very much. So, Our Future Health is a relatively new project. It was launched in 2020 with the aim of understanding better ways to detect disease as early as possible, predict disease, and intervene early to prevent common chronic diseases. Similar to All of Us, we are creating a very large database of participants who contribute their questionnaire data, physical data, genetic data, and linkage to healthcare records, with the aim as I said, to really improve our understanding of how best to prevent common chronic diseases.   So, we launched recruitment in October 2022. Our aim is to recruit 5 million participants altogether, and in the last 2 years about 1.85 million people have now consented to join the project. But you are right, as of last week we have what we call 1 million full participants, so people that have donated a blood sample, completed the questionnaire, and consented to link to their healthcare records. In our trusted research environment, we now have data on over 1million people available for researchers to use.   Of course, we have learnt a lot from the approach of UK Biobank, which we are going to hear about shortly, but the resource is open to researchers across the world, from academia, from the NHS, from industry, so that will hopefully maximise the benefits of that data to researchers, but as I say with a particular focus on early detection, early intervention, and prevention research.   Natalie: Thank you Raghib. Great to have you with us. Naomi, Raghib mentioned that UK Biobank has been running for a long time, since 2006.  It is a real success story in terms of driving a huge range of valuable research efforts.  Could you talk to us a little bit about the study and its history and what you have learned so far about the sort of benefits and some of the challenges of being able to bring lots of different datatypes together for research purposes?   Naomi: Yeah, sure. So, UK Biobank started recruiting 0.5 million participants in 2006 to 2010 from all across the UK with a view to generating a very deep dataset. So, we have collected information on their lifestyle, a whole range of physical measures. We collected biological samples, so we have data on their genomics and other biomarkers. Crucially because they recruited 15+ years ago, we have been able to follow up their health over time to find out what happens to their health by linkage to electronic healthcare records. So, we already have 8,000 women with breast cancer in the resource, cardiovascular disease, diabetes, and so on.   But perhaps most importantly, not only does it have great data depth, and data breadth, and the longitudinal aspect, is the data is easily accessible to researchers both from academia and industry, and we already have 18,000 researchers actively using the data as we speak, and over 12,000 publications already generating scientific discoveries from the resource.      Natalie: So, we have got 3 quite different approaches. Recruiting in different ways, different scale, different depth of data collection and analysis, but all very much around this ethos of bringing lots of different datatypes together for research purposes. I wonder if you could talk a little bit about how you might be sort of working together, even though you have got slightly different approaches. Are there things that you are learning from one another, from these different data infrastructures, or how might you be looking in the future to work together to address some of the challenges that might come up from working at scale?      Naomi: So, we talk to each other quite regularly. We have tried to learn from each other about the efficiencies of what to do and what not to do in how to run these large-scale studies efficiently. When you are trying to recruit and engage hundreds of thousands of participants, you need to do things very cost effectively. How to send out web-based questionnaires to individuals, how to collect biological samples, how to make the data easily accessible to researchers so they know exactly what data they are using.   All of that we are learning from each other, and you know it is a work in progress all the time. In particular, how can we standardise our data so that researchers who say are using All of Us can then try and replicate their findings in a different population in the UK by using UK Biobank or Our Future Health. So, can we come up with common standards so that researchers can better directly compare the data that they are using? So, we are in close contact with each other.   Natalie: Fantastic, thank you. And Andrea, from your perspective obviously you are collecting data in the US. Are you finding ways of working internationally and with other infrastructures like Biobank and Our Future Health around things like data standards? It sounds like something simple, but I can imagine it is quite complex in practice.   Andrea: Absolutely, and that dialogue and understanding and learning from each other both informally in meetings and talking as well through the published literature. So, all of these datasets are actively widely used, and seeing what is coming out in publications helps us know what researchers are doing with the data. And when you see different researchers either generating hypotheses from our datasets in a different way, or testing hypotheses differently, that helps us understand where some benefit might be added to our dataset or where we really may need to grow in a different direction to meet some other research needs.   I think that every study design always struggles with that balance between knowing exactly what we want to study and therefore building very specific questions and very specific protocols, but also allowing for the knowledge that we don't really know all of the discovery we need to make and bringing in datapoints that will really generate those new hypotheses for the future.     I think for our study in particular, UK Biobank has been so remarkable in this way, helping structure All of Us to be able to contact our participants like UK Biobank and say, “Hey, we didn't really know what we were going to get, but we have put all this wonderful data together and now we need to do a deeper dive.”   So, the engagement and long-term return of those UK Biobank participants has really enriched our data, and we have learnt from UK Biobank a lot there, and hope through growing our partnerships programme that we can continue to create partnered research opportunities to strengthen that data as well. That is a new thing coming out of our group. You may have heard of it previously as ancillary studies, but we recognise the partnership that is important for those research opportunities. So, we are reporting here that we are hoping to rebrand it to reach a larger audience, and that is led by Dr. Shelley, as partnered research opportunities that will allow us to re-contact, bring our participants back, and really deepen that dataset.   Natalie: Thank you. And Raghib, I know that it is a really important part of the Our Future Health model about going back to participants, but you are in quite early stages of working out what those opportunities might look like.   Raghib: Yes, very much early stages. Just to reiterate the point for me personally, having started my research in the UK about 20 years ago, I have certainly learnt a lot personally, but we have all learnt a lot from the model that UK Biobank established in terms of collecting data and providing it to researchers, and I see these 3 studies as very much complimentary.   All of Us again have done a lot more work in terms of providing feedback to participants about their risk of disease and genetic information, and as you say Our Future Health was set up deliberately to not just be a purely observational study, but to give participants feedback about their risk of different chronic diseases as well as the opportunity to take part in not just studies to collect data, but also interventional studies to see if we can change the natural history of disease and prevent diseases in our participants.   So, that has never really been done at scale before, and that is certainly a big challenge for us to do, not just in the UK, but anywhere, including the US and working with health systems as to how best to do that. So, you know we have spent the last 2 years really trying to understand how best to recruit participants and to provide data to researchers for the next couple of years, and long beyond that we will be looking really as to how we can maximise the benefits of providing feedback to participants and taking part in interventional studies.   Naomi: I think one way in which we can all learn from each other actually, is we know how to recruit hundreds of thousands of people, the general population, into research study, and the next challenge is how do you keep engaging them, telling them what you are doing. You can't collect everything when they first join the study, or they would be with you for days. So, what UK Biobank has been doing is sending out web-based questionnaires, a couple a year, to find out extra information about health outcomes, lifestyle factors. Inviting them back to specific assessment centres.   So, we are inviting 100,000 participants back for imaging, and then again over the next few years for a second scan. So, I think the real challenge here is once you have recruited them, how to find that right cadence of engaging those participants to keep contributing their data and their biological samples to really maximise the value of the dataset for research. That is an ongoing challenge for all of us. But I have to say, the UK Biobank participants, they are an amazing group of individuals, very altruistic.   Our Future Health and All of Us, we don't give feedback, so there is nothing in it for our participants other than knowing that their data may help the future health of their children, and their grandchildren, and the rest of the world. So, that is very humbling, to know that the data that they have generated, and we have collected on them, is being used in that way.   Natalie: That's a really interesting point, Naomi, about the difference between a research study that is designed for answering a particular question. You gather specific data for a specific purpose, and when it comes to recruiting participants into that you can be very clear about what it is you are trying to do.   But of course, for all of these programmes, the whole nature of them is that you are collecting a lot of data over a long period of time, and it could be used for all sorts of different purposes. You can't say at the outset exactly what those purposes might be and what those outcomes might be. So, there is a really interesting question, and of course I would say this with my ethics hat on, a really interesting question around sort of participant trust and confidence in those programmes.   Naomi, you spoke just then about one way of retaining engagement and retaining people's interest, but I wonder Raghib and Andrea, if you have got thoughts on those sort of questions of how you can create that environment where participants can trust what you are doing with data over a long period of time, when you can't at the point at which they consent, say exactly how that data might be used? You have got a sense of the kinds of purposes, but you can't be too specific         Andrea: Sure. We know, and I have learnt from my own peers in this role, that enrolment in the study isn't the end point of engagement. All of Us's approach on engagement has been communicating with the entire community and really being there in the community, and that has been very powerful.   One effort over the last year we are proud of has been what we are dubbing participant driven enquiry, and that is where we say, “Thank you participants. We have gotten a ton of data out there for use, and funded researchers to use it all the time, but what do you, the participants, really want?” We were able to then take papers that researchers write and help tell participants and explain it in lay language, so the participants can say, “Hey, I have a question. Could you answer that for me?” Maybe we can, maybe we can't, but it has been very interesting to hear what participants want to know, and that participant driven enquiry project has turned out to be a big opportunity there.    The question they came to was not easy. Certainly, we didn't expect an easy question, but they came to us asking, “Why is my diabetes worse than someone else's? Is it the environment? Is it my genome? Is it my access to care? Why can't my diabetes be as well controlled as someone else's?”  So, that has been huge, to interact directly with our participants and help really close the loop by answering questions in the language of research and show them how their data is contributing back.    Natalie: Thank you. And Raghib, how are you sort of grappling with these questions, particularly because you are recruiting so very heavily at the moment?   Raghib: So, as you say it is a challenge, and people do join the programme primarily based on trust that we will use their data for public health benefit and for the benefit of the whole population, but they also join on the basis that they will get back information about their own health and their risk of disease. To do both of those is not straightforward. I mean, the first of those, it has been well established by UK Biobank, and about 80% of our participants also say they are doing it primarily for to altruistic reasons, which is great. But 80% also said they would like to receive feedback about their own health, which is also understandable, and so we need to find ways to provide that in a timely way, but also in a way that the health service can manage. That is going to be one of our key challenges going forward.    But to echo what Naomi and Andrea have said, I mean to maintain participant's engagement with the programme is not easy. We need to make sure that they are receiving information regularly, are kept up to date with what we are doing with their data, with the work that we are doing with academia, with the NHS, with industry etc. It is easier now than it was before because Our Future Health has been set up as a digital cohort, so we have means of communicating much more easily with our participants. But yeah, as you say we are at early stages. Over time that does get harder, to maintain that engagement. So, we know in the next one to 2 years we need to step up our work on feedback and recontact.   Natalie: Fantastic. I really love the idea of like the participant-led enquiry. That is something that I think our participant panel at Genomics England would really like to hear more about.   So, speaking about sort of ongoing engagement with participants, one of the challenges we know around recruiting into large-scale studies like this is that many research datasets don't have equal representation from all communities. That might have an impact on the quality, the representativeness of the scientific outputs that you can generate, and potentially the benefits back to patients and participants.   How are you addressing this challenge in recruitment where you may have some communities that are not as engaged with scientific research. You may have elements of distrust or people being marginalised, having difficulty accessing research and these sorts of opportunities. Do you have any examples of what has worked really well? Raghib, if I could come to you first.   Raghib: Sure. So, I mentioned I worked on UK Biobank about 20 years ago. One of the things I was looking at then was how we could maximise participation, particularly of people from ethnic minorities into the project. Because of the age group that was chosen by UK Biobank for very good reasons, age 40 to 69, the proportion of people from ethnic minorities was relatively small. So, although it was representative for that age group, I think it was about 6%, or 34,000 out of the 500,000, that were from non-white ethnic minorities.   So, when Our Future Health was set up, we knew that the population has changed anyway. You know, the UK has become a much more ethnically diverse society. But also, because it is a cohort from 18+ and I think minorities tend to be younger on average than the white population, we knew we had an opportunity to really have a big step change in the number of people that could take part in a study like this. So, our aim is actually to get 10% of the whole cohort from ethnic minorities, so 500,000 out of the 5 million from ethnic minorities. Actually, so far we are pretty much on track. So, of the 1.8 million that have consented, about 180,000 are from non-white ethnic minorities.   That is extremely important, particularly for genetic research where non-European populations are very much underrepresented in nearly all genetic databases. Secondly, from a UK context, although it applies of course in all countries, is that people from more deprived backgrounds are also less likely to take part in this type of research. So again, we have made a very deliberate attempt to try and ensure we have adequate numbers from the most deprived quintile. Again, about 10% of the cohort so far, nearly 200,000 are from that most deprived quintile who both are underrepresented in research, but also have the worst outcomes. So, this is really our first study that has been big enough in the UK to look at that group properly and understand some of the factors at an individual level that we haven't been able to in the past.   Finally, geographically, so the first time again because it is a digital cohort, we were able to recruit people from all over the UK. So, every single part of the UK is now represented in Our Future Health, particularly coastal communities and rural areas that haven't been able to take part in this type of study before, as well as Northern Ireland. You know, for the first time we have got that full geographical coverage.   Natalie: Fantastic. I suppose a lot of that recruitment approach has very much been about going to where people are, rather than expecting them to come to you. Is that right?     Raghib: That is right and thank you for reminding me. So yeah, we have had a different approach. So, we have opened up many, many more clinics than previous studies through a combination of mobile units, shopping centres, community pharmacy. Community pharmacy in particular has been very important. So, to date we have had about 400 different venues that we have been able to recruit. That is over 1 million people that have given blood samples, and that has really enabled people from every part of the country to take part. Secondly, we have kept clinics open in areas of greater deprivation and ethnic diversity much longer than in other areas, to maximise the opportunity for them to join. Thirdly, we do provide reimbursement for people with expenses to ensure they aren't excluded because of financial reasons, and again that has helped.    Natalie: So, really making those efforts is evidently paying off. Andrea, have you had similar experiences as All of Us? What has your approach been to try and ensure that you are getting a wider representation from different communities?    Andrea: It has really been a focus on the programme from the start to engage those who have not been included in research in the past and make sure the opportunity is there to participate. Our Engagement Division, led by Dr. Corrine Watson has really pioneered reaching those communities here in the US.   I think one other thing I will mention that we think about when we think about how to engage participants and reach people to return value back to those communities, is to make sure the people who are accessing the data also represent them, and we can build diversity within that researcher workforce. So, since our data was first released in 2020, we have recognised that the biomedical workforce also has a huge group of underrepresented individuals, and a lot of our researcher engagement and researcher outreach has focused on reaching those of diverse backgrounds and career paths.   To that end we have reached out and engaged historically black colleges as well as other minority serving institutions, really looking to make sure that their students and researchers can have the same access as more traditional research-based institutions in the US system.    That has been important because our system is built on cloud-based architecture and shared data that doesn't require a huge cluster on campus, and that helps remove a barrier that some of those institutions and researchers may have had. We also know they haven't been able to participate in the past, and we think that cloud architecture again can make the data much more feasible and be a huge support to diversifying the researcher workforce as we go forward. That circling back, helping them be the voices speaking to their community, helps build out that diverse participant community base as well.    Natalie: That's such an important point, because it is not just about the participants and the data you can collect, but also who is able to look at it? Who is actually able to undertake the research?    Naomi, can I bring you in here? I know that UK Biobank has been thinking a lot about researcher access to data and trying to ensure that the data that you hold, the really rich datasets you hold in UK Biobank, are more accessible to researchers from different backgrounds who may not have the same level of resources. Can you tell us a little bit about the work you have been doing on that?   Naomi: Yeah. So, just following on from what Andrea said, it is really important to get as diverse ideas as possible from across the global research community to really move public health forward.   So, what UK Biobank has done is we are putting mechanisms in place so that early career students, and career researchers, and researchers at all levels of their career from lower income countries, can access the data at a much lower fee. So, currently for most researchers it costs about £9,000 to access all of the data. So, that is 40 petabytes of genomic data, biomarkers, clinical outcomes, lifestyle factors and so on. So, early career researchers and those in lower income countries, it is about £500.   On top of that a group of big pharmaceutical companies have got together to create a global researcher access fund, which essentially covers this reduced fee so that all researchers no matter where they are from have exactly the same opportunity to access the data to advanced scientific discoveries. So, on top of that all our researchers now use our online secure research analysis platform. While there is no charge to access the platform, there are costs associated with compute needed to analyse and store the results.    So, AWS have donated research credits for early career researchers and those from lower income countries up to a total of about $500,000 per year, to use the research platform. So, researchers can apply to use these research credits to offset the costs of compute and storage. So, that means that we are trying to democratise access to researchers from all around the world.   I think actually our biggest challenge is not so much … we have largely dealt with you know subsidising the cost. It is actually making researchers from lower income countries aware that these resources exist, and that are applicable to them.   So, sometimes we hear from say researchers in Africa or South America, “Well, there is no point accessing UK Biobank because it is not relevant to our population.” You know, a third of our researchers are from China. So, even if UK Biobank hasn't got coverage of those racial ethnic populations, that doesn't mean that the associations that you find between risk factors and disease risk are not applicable to other different populations. And that is also why having different resources like UK Biobank, like Our Future Health, like All of Us, in different populations around the world, is so important in order to replicate those findings.    Natalie: Absolutely, and fantastic just to hear the attention that is being paid to trying to ensure that diversity of different types of researchers who will just bring different questions to the table, different perspectives on the data, different priorities, different types of questions.    So, speaking about that diversity of researchers, one really important part of his ecosystem that we haven't really touched on so far is around the role of industry. There are a lot of really important research questions being addressed by industry. Some that can only really come from, maybe it is pharmaceuticals, maybe it is tech.   From your perspectives, what kind of role can and should industry and commercial partners play in supporting the kinds of long-term research studies that you have set up, and ultimately trying to get to that point of sort of generating benefits back to patients and health systems. Naomi, can I start with you, for that sort of longer-term perspective for Biobank?   Naomi: So, industry are great partners for long-term studies like ours because they can bring additional funding, expertise, and technology. So, for UK Biobank, because it is so easily accessible to industry and academics alike on exactly the same terms, what it has meant is that industry, particularly big pharma and also now big tech, they can access the data, they see the value of the data for their own research purposes, and then they have invested into UK Biobank to do whole-exome sequencing, whole genome sequencing, proteomics at scale to increase the value of the dataset for their own drug discovery pipelines.   But of course, it means that the data that they have generated, which cost millions of dollars to generate, when you need deep pockets to do these kinds of study enhancements, then become available to all researchers. So, having access to these large-scale resources that have deep data on genomics, physical measures, other biomarkers, and clinical outcomes enables pharma to rapidly increase their drug discovery pipelines in generating new drugs and treatments for patients, and also those data are then shared with the rest of the global research community.     So, we found it to be a really exciting win/win in which industry get what they need to help move forward new drug targets and discovery, but also other researchers get what they need in order to make other scientific discoveries in different fields of research.        Natalie: Thank you. And Raghib, I know that for Our Future Health, that industry relationship is a really important part of the founding model. Will you tell us a little bit about how you are engaging and working with industry partners?   Raghib: Sure. So, as you said Our Future Health was set up in a different way, as a very public private partnership. Although the largest funder is the UK Government, more than half of our funding has come from a combination of life science companies, so pharmaceutical, diagnostic companies, as well as the medical charities, so the larger medical charities in the UK. That partnership is deliberate for all the reasons that Naomi has outlined. There are areas where academia and the NHS are very strong, and areas where industry is very strong, and by working together as we saw very good examples during the pandemic with the vaccine and diagnostic tests etc, that collaboration between the NHS and academia industry leads to much more rapid and wider benefits for our patients and hopefully in the future for the population as a whole in terms of early detection and prevention of disease. So, we have 16 life sciences companies that have joined as founding partners with Our Future Health who have contributed financially to the programme.    Equally importantly they have also contributed scientifically, so there is a huge amount of scientific expertise in industry, and they work with us with our Scientific Advisory Board with our scientists internally to think about the best use of the resource for drug discovery, diagnostics, new medical technologies, and new targets etc.    So, that is the vision, and so far, it is working well. It is a relatively new model to have set up a project like this in this way, but it has been a very collaborative approach, and we all recognise, all have similar aims, so recognise what we are working towards. You know, we meet regularly. We have a Joint Founders Board where as I say academia, NHS, industry, and the charities come together to decide on the priorities for the coming years.   Natalie: Fantastic. And Andrea, I suppose in the US it might be slightly different culturally from the UK, but the role of industry with All of Us, how are you engaging with those pharmaceutical, technology bodies, and partners as well?     Andrea: Absolutely, and maybe this goes back a bit to your first question. We at All of Us love learning from UK Biobank and have really seen them forge a lot of wonderful partnerships that have enriched and developed their dataset. We at All of Us have started with academia and working through partnership opportunities really intramurally at intramural centres that make up parts of the National Institute of Health. We believe that building on those close friends and family relationships we have both in the government and academia get us through our first step to be able to interface with commercial organisations. That really started with taking the first step this year to ensure broad availability of data that can maximise both use of the data available, as well as look forward to our partnership opportunities in the future.   So, commercial organisations as of 2024 have also been able to access the All of Us dataset that is that first step in thinking about what a partnership would be, and we are glad to build on the access that international organisations and academic organisations already have.   Natalie: A lot to look forward to here. We are going to have to wrap up in a moment, so I'd just like to leave you all with a final question before we have to end the podcast. There is huge ambition in all of the research programmes that you are leading and involved in, but what are you most excited about coming down the line in the next few years? What do you think is going to be feasible? What really gets you excited about the work that you are doing and where you see the potential benefits really landing in the next few years? Andrea, would you like to start?   Andrea: Thanks. There is a lot we are really excited about. I haven't had a chance yet to mention our paediatric cohort, and that in addition to expanding access for international research, in 2024 we were able to enrol our first paediatric participants. That really sets up the potential to observe participants across the lifespan. That is a huge advance for All of Us and we are excited about the paediatric work going forward.    Natalie: I love that, how do you come into the future with us? That is fantastic. Naomi.   Naomi: Yeah, if I had to choose one would be the possibility of being able to measure circulating proteins on all half a million participants. We have done this on about 55,000 participants, and just that subset alone is already generating fascinating insights for early biomarkers for disease through protein profiles and risk prediction of disease. I think having that on all half a million coupled with their genomics data and health outcomes, will bring a sea change in how we diagnose disease earlier. So, I think that is a really exciting avenue for us to go into over the next couple of years.   Natalie: Really enriching. That data sounds like a very exciting set of possibilities. Raghib.   Raghib: Thank you. There are so many opportunities here, but I will just maybe mention 3. So, the first, in terms of being able to combine the genetic data that we are collecting and all the other information about risk factors, and particularly the fact that we have this on a lot of young people, will enable us to identify people at high risk of diseases in the presymptomatic phase and then to be able to offer them both feedback about their risk of disease but also interventions that can change their natural incidences. That has never really been possible before. That is extremely important for all diseases for people, but also it is very important for our healthcare system.   So, those of you listening in the UK, I know the NHS is under a huge amount of pressure, and the current model of healthcare which has been in place really since the inception of the NHS, is to treat late-stage disease when people have already developed symptoms and signs. You know, it wasn't really possible to identify people earlier, but it is now, and Our Future Health will provide the evidence base to show that prevention really is better than cure, and to show that these approaches both lead to better clinical outcomes, but also are cost effective and a good use of resources. Of course, the new government is very much committed to this as well, you know moving from acute care to prevention, from hospitals to community, and from analogue to digital.     Finally, because our cohort has now become so large and does cover every part of the UK, and this wasn't something I necessarily thought about when we started Our Future Health, we are able to have unique insights into the health of the population across every age group, across every ethnic group, across every geographical area, and by deprivation, and to understand not just observationally in terms of risk factors, but also the impact of interventions on those different populations.   We can look at that, as I said at an individual level on millions of people to gain intelligence about what is going on in terms of public health, but also to see what will hopefully improve their health in the future. So, there are really, you know I have described transformational opportunities to improve health through both biomedical research and populational health insights now through the resource, and I look forward to working with colleagues across the UK and globally to deliver them.   Natalie: We will wrap up there. Thank you so much to our guests, Dr Raghib Ali, Professor Naomi Allen, and Dr Andrea Ramírez for joining me today as we discussed how collaboration, scale, ongoing engagement, can really unlock the potential of large-scale health datasets to drive brilliant new research and ultimately improve the lives of patients and the population.   If you would like to hear more like this, please subscribe to Behind the Genes on your favourite podcast app. Thank you for listening. I have been your host, Natalie Banner. This podcast was edited by Bill Griffin at Ventoux Digital and produced by Naimah Callachand.

Two more fascinating Case Reports from the latest issue of the journal. The first case (1:15) is of a 57-yo woman, with an intermittent posterior headache, which had an associated bilateral pressure-like sensation. Her symptoms had begun on a recent trip to Sri Lanka. https://pn.bmj.com/content/24/6/526  Following on is the second case (22:18), which features a 54-yo man experiencing deterioration in his speech and mobility. He had a background of chronic HIV infection with ongoing treatment. https://pn.bmj.com/content/24/6/507   The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Xin You Tai³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the June 2024 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Letícia Amorim and Brian O'Toole. Thank you for listening. 

In this presentation, Prof. Robert Gilbert, Professor of Biophysics in the Nuffield Department of Medicine at the University of Oxford, explain how science, for the scientist, is a source of enchantment.Prof. Gilbert and his team work on molecular mechanisms underlying pathology in humans, specifically cancer and membrane pore formation and cell adhesion. Their work is funded by Cancer Research UK, the British Heart Foundation, the Medical Research Council, the Biotechnology and Biological Sciences Research Council, and the Wellcome Trust.In this presentation, he talks about: Scientific discoveries that have drastically changed the worldUnpacking the mechanistic lens of scienceHow delight and play are crucial for scientistsThe beauty of the form and fit of scienceOn aesthetic delight in scienceHow enchantment is essential to the scientific processTo learn more about Robert, you can find him at: Website: https://www.strubi.ox.ac.uk/research/professor-robert-gilbert Email: gilbert@strubi.ox.ac.ukThis episode is sponsored by:John Templeton Foundation (https://www.templeton.org/)Templeton Religion Trust (https://templetonreligiontrust.org/)Support the show

Introducing What to eat to avoid osteoporosis from ZOE Science & Nutrition.Follow the show: ZOE Science & Nutrition

Introducing What to eat to avoid osteoporosis from ZOE Science & Nutrition.Follow the show: ZOE Science & Nutrition

Today, we're speaking to Dr Rebecca Payne and Professor Trish Greenhalgh. Rebecca is a GP and an NIHR In Practice Fellow, and works alongside Trish at the Nuffield Department of Primary Health Care Sciences at the University of Oxford. Title of paper: What are the challenges to quality in modern, hybrid general practice? A multi-site longitudinal studyAvailable at: https://doi.org/10.3399/BJGP.2024.0184Quality in primary care is a multidimensional construct embracing effectiveness, efficiency, safety, patient-centredness, equity, continuity, accessibility, and more. We report on how UK practices have striven to deliver on these aspects of quality as they move to a hybrid model that combines in-person with remote and digital care. The context for quality is currently very challenging, with resource constraints, staff shortages, and weak infrastructure. Digital systems intended to increase efficiency have produced some benefits for some people but have created new forms of inefficiency, increased fragmentation of care, contributed to staff stress, and widened inequities of access.

Introducing What to eat to avoid osteoporosis from ZOE Science & Nutrition.Follow the show: ZOE Science & Nutrition

Introducing What to eat to avoid osteoporosis from ZOE Science & Nutrition.Follow the show: ZOE Science & Nutrition

Introducing What to eat to avoid osteoporosis from ZOE Science & Nutrition.Follow the show: ZOE Science & Nutrition

The immune system is a recurring feature in the cases discussed in this edition of the Case Reports podcast. The first paper details the cases of two young women, sisters, presenting with overlapping conditions but resulting in tragically different outcomes (1:16). Both were in their twenties, had given birth recently, and developed limb weakness along with several other neurological symptoms. https://pn.bmj.com/content/24/5/422 Our second case is a 72-yo woman with a range of symptoms including diplopia, ptosis, myalgia, and worsening shortness of breath (21:27). She had had surgical resection of a malignant melanoma, and was receiving immunotherapy treatment. Her presentation resembled myasthenia gravis, but initial treatment did not yield a response. https://pn.bmj.com/content/24/5/428  The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Xin You Tai³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the June 2024 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. This episode was produced and edited by Brian O'Toole. Thank you for listening. 

Introducing What to eat to avoid osteoporosis from ZOE Science & Nutrition.Follow the show: ZOE Science & Nutrition

Introducing What to eat to avoid osteoporosis from ZOE Science & Nutrition.Follow the show: ZOE Science & Nutrition

Introducing What to eat to avoid osteoporosis from ZOE Science & Nutrition.Follow the show: ZOE Science & Nutrition Every 12 years, our skeletons undergo a complete transformation.Prof. Tim Spector and Prof. Cyrus Cooper discuss how to avoid Osteoporosis, a condition where bones become fragile, significantly increases the risk of fractures from minor incidents, often without any noticeable symptoms. Worldwide, it affects one in three women and one in five men over fifty, leading to pain, potential disability and loss of independence.In today's episode, Jonathan, Tim and Cyrus ask the question: How can understanding osteoporosis and implementing targeted lifestyle changes enhance bone health and reduce the risk of fractures?Cyrus Cooper is a Professor of Rheumatology at the University of Southampton, where he is also the Director of the MRC Lifecourse Epidemiology Unit and Vice-Dean of Medicine. In addition, he's a Professor of Musculoskeletal Science at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences at the University of Oxford.Tim Spector is one of the world's top 100 most-cited scientists, a professor of epidemiology, and scientific Co-Founder at ZOE. Tim trained originally in rheumatology and epidemiology. 

Introducing What to eat to avoid osteoporosis from ZOE Science & Nutrition.Follow the show: ZOE Science & Nutrition Every 12 years, our skeletons undergo a complete transformation.Prof. Tim Spector and Prof. Cyrus Cooper discuss how to avoid Osteoporosis, a condition where bones become fragile, significantly increases the risk of fractures from minor incidents, often without any noticeable symptoms. Worldwide, it affects one in three women and one in five men over fifty, leading to pain, potential disability and loss of independence.In today's episode, Jonathan, Tim and Cyrus ask the question: How can understanding osteoporosis and implementing targeted lifestyle changes enhance bone health and reduce the risk of fractures?Cyrus Cooper is a Professor of Rheumatology at the University of Southampton, where he is also the Director of the MRC Lifecourse Epidemiology Unit and Vice-Dean of Medicine. In addition, he's a Professor of Musculoskeletal Science at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences at the University of Oxford.Tim Spector is one of the world's top 100 most-cited scientists, a professor of epidemiology, and scientific Co-Founder at ZOE. Tim trained originally in rheumatology and epidemiology. 

What underpins effective research, knowledge generation and innovation? In this podcast, we hear a world-leading biomedical scientist discuss what constitutes effective knowledge exchange and supports translational research that can, ultimately, result in innovations that change the world for the better. Plus, a data scientist outlines the opportunities and risks associated with the proliferation in, but also greater regulation of, online data and what this could mean for future research. Chas Bountra is pro-vice chancellor for innovation of the University of Oxford – we spoke just a week before the University of Oxford was named as the world's leading university in Times Higher Education World University Rankings, for the ninth year in a row. The university claimed the top spot once more, based on its increased income from industry, the number of patents citing its research and its teaching scores. Chas is also a professor of translational medicine and head of impact and innovation in the Nuffield Department of Clinical Medicine. He is a director at Oxford University Innovations and has previously worked in industry as vice president and head of biology at GlaxoSmithKline and was the director of the Structural Genomics Consortium Oxford from 2008 to 2020. Sara de Freitas is an an author, educator and researcher with extensive expertise in data science and digital technologies. She is honorary research fellow at Birkbeck, University of London and a visiting professor at the Open University and the University of South Wales.

Introducing What to eat to avoid osteoporosis from ZOE Science & Nutrition.Follow the show: ZOE Science & Nutrition Every 12 years, our skeletons undergo a complete transformation.Prof. Tim Spector and Prof. Cyrus Cooper discuss how to avoid Osteoporosis, a condition where bones become fragile, significantly increases the risk of fractures from minor incidents, often without any noticeable symptoms. Worldwide, it affects one in three women and one in five men over fifty, leading to pain, potential disability and loss of independence.In today's episode, Jonathan, Tim and Cyrus ask the question: How can understanding osteoporosis and implementing targeted lifestyle changes enhance bone health and reduce the risk of fractures?Cyrus Cooper is a Professor of Rheumatology at the University of Southampton, where he is also the Director of the MRC Lifecourse Epidemiology Unit and Vice-Dean of Medicine. In addition, he's a Professor of Musculoskeletal Science at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences at the University of Oxford.Tim Spector is one of the world's top 100 most-cited scientists, a professor of epidemiology, and scientific Co-Founder at ZOE. Tim trained originally in rheumatology and epidemiology. 

Introducing What to eat to avoid osteoporosis from ZOE Science & Nutrition.Follow the show: ZOE Science & Nutrition Every 12 years, our skeletons undergo a complete transformation.Prof. Tim Spector and Prof. Cyrus Cooper discuss how to avoid Osteoporosis, a condition where bones become fragile, significantly increases the risk of fractures from minor incidents, often without any noticeable symptoms. Worldwide, it affects one in three women and one in five men over fifty, leading to pain, potential disability and loss of independence.In today's episode, Jonathan, Tim and Cyrus ask the question: How can understanding osteoporosis and implementing targeted lifestyle changes enhance bone health and reduce the risk of fractures?Cyrus Cooper is a Professor of Rheumatology at the University of Southampton, where he is also the Director of the MRC Lifecourse Epidemiology Unit and Vice-Dean of Medicine. In addition, he's a Professor of Musculoskeletal Science at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences at the University of Oxford.Tim Spector is one of the world's top 100 most-cited scientists, a professor of epidemiology, and scientific Co-Founder at ZOE. Tim trained originally in rheumatology and epidemiology. 

Introducing What to eat to avoid osteoporosis from ZOE Science & Nutrition.Follow the show: ZOE Science & Nutrition Every 12 years, our skeletons undergo a complete transformation.Prof. Tim Spector and Prof. Cyrus Cooper discuss how to avoid Osteoporosis, a condition where bones become fragile, significantly increases the risk of fractures from minor incidents, often without any noticeable symptoms. Worldwide, it affects one in three women and one in five men over fifty, leading to pain, potential disability and loss of independence.In today's episode, Jonathan, Tim and Cyrus ask the question: How can understanding osteoporosis and implementing targeted lifestyle changes enhance bone health and reduce the risk of fractures?Cyrus Cooper is a Professor of Rheumatology at the University of Southampton, where he is also the Director of the MRC Lifecourse Epidemiology Unit and Vice-Dean of Medicine. In addition, he's a Professor of Musculoskeletal Science at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences at the University of Oxford.Tim Spector is one of the world's top 100 most-cited scientists, a professor of epidemiology, and scientific Co-Founder at ZOE. Tim trained originally in rheumatology and epidemiology. 

This month's cases both feature sudden onset neurological syndromes. The first case (1:23) is that of a 26-yo Brazilian man who awoke from sleep with weakness in all four limbs. The signs suggest a possibility of Guillain-Barré syndrome or polio. A normal cranial nerve examination follows, with no unusual findings - https://pn.bmj.com/content/24/4/342  A 69-yo woman is the subject of the second case (14:33), after she presents with sudden onset unsteadiness and slurred speech when getting out of bed. A stroke was initially examined for by CT head scan, proving unremarkable, but a subsequent MRI scan showed an intense midbrain lesion. The patient subsequently improved, but then returned three months later with occurrences of the same symptoms multiple times throughout the day - https://pn.bmj.com/content/24/4/310 The case reports discussion is hosted by Prof. Martin Turner (1), who is joined by Dr. Ruth Wood (2) and Dr. Xin You Tai (3) for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the August 2024 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  Listen to the JNNP podcast, "Nutritional peripheral neuropathies, with Dr. Alexander Rossor" on Apple (https://apple.co/3WjTmrM), Spotify (https://spoti.fi/4bKOhNA), Web (https://bit.ly/4cYhx4m). Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. This episode was produced and edited by Brian O'Toole. Thank you for listening. 

In this episode, we talk again with Jen MacLellan, a qualitative researcher based within the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Title of paper: Unpacking complexity: GP perspectives on addressing the contribution of trauma to women's ill healthAvailable at: https://doi.org/10.3399/BJGP.2024.0024Significant challenges and uncertainties reside in how best to manage the link between mind and body in communication with patients and in healthcare pathways. Lack of supportive resources to deliver holistic, trauma informed care risks practitioners (inadvertently) avoiding discussion of the contribution of distress in the illness presentation. A trauma informed systems level approach would support integration of psychological support within multiple care pathways and support wellbeing of practitioners providing care.This study was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (NIHR202450). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Introducing What to eat to avoid osteoporosis from ZOE Science & Nutrition.Follow the show: ZOE Science & Nutrition Every 12 years, our skeletons undergo a complete transformation.Prof. Tim Spector and Prof. Cyrus Cooper discuss how to avoid Osteoporosis, a condition where bones become fragile, significantly increases the risk of fractures from minor incidents, often without any noticeable symptoms. Worldwide, it affects one in three women and one in five men over fifty, leading to pain, potential disability and loss of independence.In today's episode, Jonathan, Tim and Cyrus ask the question: How can understanding osteoporosis and implementing targeted lifestyle changes enhance bone health and reduce the risk of fractures?Cyrus Cooper is a Professor of Rheumatology at the University of Southampton, where he is also the Director of the MRC Lifecourse Epidemiology Unit and Vice-Dean of Medicine. In addition, he's a Professor of Musculoskeletal Science at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences at the University of Oxford.Tim Spector is one of the world's top 100 most-cited scientists, a professor of epidemiology, and scientific Co-Founder at ZOE. Tim trained originally in rheumatology and epidemiology. 

EPISODE 10: Mastering Sleep for High-Stakes EnvironmentsIn this episode, Martin and Jonpaul talk to Professor Colin Espie, a world-leading expert on sleep and treating sleep disorders, particularly using cognitive behavioural therapeutics (CBTI) to treat insomnia disorder. They discuss how sleep contributes to physical and mental health, the five principles of sleep health and the treatment options for insomnia. They debunk myths such as a 'sleepless elite' & explore the intricate relationship between sleep, memory consolidation and trauma recovery.Guest, Cast & CrewColin Espie is a professor of sleep medicine in the Nuffield Department of Clinical Neurosciences at the University of Oxford, where he founded the Experimental and Clinical Sleep Medicine Research Program at the Sir Jules Thorne Sleep and Circadian Research Institute. He is also the Clinical Director of the Oxford Online Programme in Sleep Medicine and has published over 300 scientific papers and several important books on the subject of sleep. Colin is also the co-founder of Big Health, which created Sleepio, a digital treatment for insomnia. Hosted by Martin Jones & Jonpaul Nevin https://www.ophp.co.uk Edited by Bess ManleyProduced by Wavell Room https://wavellroom.com/ResourcesColin's profile & contact info https://www.ndcn.ox.ac.uk/team/colin-espie Oxford Online Programme in Sleep Medicine https://www.scni.ox.ac.uk/study-with-us Sleepio – a digital treatment for insomnia https://www.bighealth.com/sleepio Colin's books https://colinespie.com/author/ The 5 Principles of Sleep Health https://colinespie.com/sleep-resources/ If you enjoy this content, please like and subscribe so we can keep improving. Remember to visit Wavell Room for their latest articles, podcasts, and newsletters. Chapters00:42 Introducing Professor Colin Espie01:39 The Importance of Sleep in Mental Health04:15 Why Sleep is Crucial: Physiological and Cognitive Perspectives06:07 Sleep Deprivation and Its Consequences14:34 The Concept of the Sleepless Elite19:52 The Five Principles of Sleep Health27:16 The Importance of Sleep in Peak Performance28:14 Understanding Insomnia31:12 Treatment Options for Insomnia34:03 The Role of Alcohol in Sleep36:11 Sleep Banking and Deprivation Training43:15 Cognitive Behavioral Therapy for Insomnia49:51 Final Thoughts on Sleep HealthUp NextNext week, we're taking a second deep dive into the science of sleep, this time with Professor Russell Foster, a world-leading expert on the mysterious phenomenon of circadian rhythms, which play a crucial role in optimal human performance. Hosted on Acast. See acast.com/privacy for more information.

Two highly unusual cases in this edition of Case Reports. The first case describes a 64-yo woman presenting to the emergency department with a five day history of bizarre behaviours (1:45). A BBC radio show prompts her, out of character, to reflect aloud about her childhood, and she experiences recurrent periods of unresponsiveness followed by intense agitation. She was kept in hospital for scans and discharged after two weeks, but returned soon after with a similar presentation - (link) A lifetime bodybuilder is the patient in the second case (21:12), with a practice of anabolic steroid injection over several decades. He presents with a three year history of unsteadiness when walking and tingling in his feet, as well as reduced dexterity. His symptoms are found to be brought on by a toxicity from an unexpected source - (link) The case reports discussion is hosted by Prof. Martin Turner (1), who is joined by Dr. Ruth Wood (2) and Dr. Xin You Tai (3) for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the June 2024 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  Listen to the JNNP podcast, "Nutritional peripheral neuropathies, with Dr. Alexander Rossor" on Apple (https://apple.co/3WjTmrM), Spotify (https://spoti.fi/4bKOhNA), Web (https://bit.ly/4cYhx4m). Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. This episode was produced and edited by Brian O'Toole. Thank you for listening. 

The first of this episode's two case reports features a 62-yo man, referred from ophthalmology with a drooping eyelid, chronic coughing, and excess sweating in the face provoked by eating (1:21). An MR scan finds abnormal deposits in his brain - (link) The second report describes two patients (17:05), firstly a 70-yo man presenting with abnormal facial movements and weight loss, and secondly a 90-yo woman with abnormal movements of her right arm and leg. Routine blood tests at presentation for both patients were normal at presentation - (link) The case reports discussion is hosted by Prof. Martin Turner (1), who is joined by Dr. Ruth Wood (2) and Dr. Xin You Tai (3) for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the April 2024 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening. 

In July 2022, we held an interdisciplinary panel at Magdalen College the University of Oxford on the role of beauty in science. The event was sponsored by Templeton Religion Trust and Magdalen College. The panel represented perspectives from diverse disciplines: mathematics, physics, biology, philosophy of science, and sociology.You can see the slides from the panelists' presentations on the YouTube video here: https://youtu.be/t6AQ9O2MLUY?si=VQpoyHYaMSWYpBoNThis is the second episode in the series; in our last episode we heard from Dr. Ben MacArthur and Dr. James McAllister. In this clip we're going to hear from three panelists:Dr. Milena Ivanova is Bye-Fellow at Fitzwilliam College, University of Cambridge. She is the co-editor of The Aesthetics of Science: Beauty, Imagination and Understanding (Routledge, 2020), author of Duhem and Holism (Cambridge University Press, 2021), The Aesthetic Nature of Scientific Experiments (Routledge).Dr. Robert Gilbert is Professor of Biophysics in the Nuffield Department of Medicine and Director of the University of Oxford's Medical Sciences Graduate School. He is the author of Science and the Truthfulness of Beauty (Routledge, 2018).Dr. Sabine Hossenfelder is the author of Lost in Math: How Beauty Leads Physics Astray (Basic Books, 2018) and Existential Physics: A Scientist's Guide to Life's Biggest Questions (Viking and Atlantic Books, 2022) and creative director of the YouTube channel “Science without the gobbledygook.”Support the Show.

Did you know that every 12 years, our skeletons undergo a complete transformation? Osteoporosis, a condition where bones become fragile, significantly increases the risk of fractures from minor incidents, often without any noticeable symptoms. Worldwide, it affects one in three women and one in five men over fifty, leading to pain, potential disability and loss of independence.In today's episode, Jonathan, Tim and Cyrus ask the question: How can understanding osteoporosis and implementing targeted lifestyle changes enhance bone health and reduce the risk of fractures?Cyrus Cooper is a Professor of Rheumatology at the University of Southampton, where he is also the Director of the MRC Lifecourse Epidemiology Unit and Vice-Dean of Medicine. In addition, he's a Professor of Musculoskeletal Science at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences at the University of Oxford.Tim Spector is one of the world's top 100 most-cited scientists, a professor of epidemiology, and scientific Co-Founder at ZOE. Tim trained originally in rheumatology and epidemiology. Follow Tim on Instagram.If you want to uncover the right foods for your body, head to zoe.com/podcast, and get 10% off your personalised nutrition program.Follow ZOE on Instagram.Timecodes00:00 Introduction01:21 Quickfire questions03:08 What is osteoporosis?06:10 Why might our bones become more fragile as we age?08:10 Your skeleton renews itself all the time10:30 Does menopause cause osteoporosis?12:48 What's it like living with osteoporosis?15:16 How common is osteoporosis in males?16:04 What are the symptoms of osteoporosis and at what age should you get checked?21:40 Some chilling statistics about osteoporosis23:10 Common myths about the effects of calcium and vitamin D on osteoporosis27:50 What is the latest science on vitamin D supplementation?34:10 Can vitamin D and calcium ensure children's bone density is healthy?34:55 Osteoporosis treatment options, including new drugs 37:20 The impacts of HRT on bone density39:30 What are the downsides to some of these treatments?43:00 Does physical activity help to prevent fractures?44:30 Lifestyle impacts: diet and nutrition49:40 Can exercise make your bones stronger?55:20 Ideal exercises to prevent osteoporosis57:10 Cyrus and Tim's top 3 actions to improve bone health59:10 SummaryMentioned in today's episode:Accumulation of risk factors associated with poor bone health in older adults, published in Archives of OsteoporosisRelevant studies:Influence of vitamin D supplementation on bone mineral content, bone turnover markers and fracture risk, published in Journal of Bone and Mineral ResearchPregnancy Vitamin D Supplementation and Childhood Bone Mass at Age 4 Years, published in JBMR...

This edition of Airing Pain focuses on the treatment of pain, the importance of catering treatment to a person's individual genetic makeup, and why addressing the psychological dimensions of pain is crucial in treating it effectively.  The process of finding a medication or treatment that works for a person often involves a lot of trial and error, which can be a frustrating process for someone to go through. This process can be side-stepped through the use of personalised medicine, where information about a person's genetic makeup is used to tailor and optimise their treatment so it is as effective as possible. Although medication is oftentimes a vital part of treating pain, incorporating psychological treatment alongside medication can be hugely beneficial when it comes to making pain management better for those living with acute or chronic pain. Changing how someone thinks about pain can enhance their response to the physical components of the treatment they receive. Our contributors for this edition discuss the ways in which the treatment of pain can be made more effective for people by incorporating personalised medicine or psychological treatments into a person's care plan. Please leave us a review on this platform or give feedback via our Airing Pain survey. Contributors: Professor Tony Dickenson, Professor of Neuropharmacology at University College London. Dr. Beth Darnall, PhD, Professor of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine. Director, Stanford Pain Relief Innovations Lab. Professor Irene Tracey, Vice Chancellor of the University of Oxford and a Professor of Anaesthetic Neuroscience in the Nuffield Department of Clinical Neurosciences. Read transcript Thanks: This edition of was made possible thanks to funding from the Guy Fawkes Charitable Trust and support from the British Pain Society. Time Stamps: 1:11 Paul introduces Professor Tony Dickenson,who he spoke to at the British Pain Society Annual Scientific Meeting 2022. 3:21 Professor Tony Dickenson discusses ‘precision medicine', ‘personalised medicine', and how looking at peoples' genetic makeup can help medical professionals treat pain more effectively.  14:21 Paul introduces Dr Beth Darnall, who he spoke to at the British Pain Society Annual Scientific Meeting 2023. 14:54 Dr Beth Darnall explains the psychological components of how people experience pain. 20:24 Paul introduces Professor Irene Tracy, who he spoke to at the British Pain Society Annual Scientific Meeting 2023.  20:57 Dr Irene Tracy discusses the work she's done on neuroimaging and how the human brain constructs the experience of pain.  23:22 Paul and Dr Tracy talk about what neuroimaging tells us about the multidimensional way the human brain reacts to pain. 26:06 Beginning of discussion about Empowered Relief, a psychology-based intervention that provides people with skills and tools to help manage their acute or chronic pain.  26:31 Dr Beth Darnall discusses the psychological side of treating pain and how empowered relief is used to help people manage their pain. 29:10 Dr Beth Darnall talks about the psychological tools people learn through Empowered Relief and how they help with pain management.    Additional Resources: Airing Pain 100: Glasgow Pain Education Sessions Empowered Relief  Pain Matters 80: What treatment really works 

Coming 10 April: This edition of Airing Pain focuses on the treatment of pain, the importance of catering treatment to a person's individual genetic makeup, and why addressing the psychological dimensions of pain is crucial in treating it effectively.   Our contributors for this edition discuss the ways in which the treatment of pain can be made more effective for people by incorporating personalised medicine or psychological treatments into a person's care plan.  This edition will be funded by the Guy Fawkes Charitable Trust and was created with support from the British Pain Society. Contributors:  Professor Tony Dickenson, Professor of Neuropharmacology at University College London  Dr. Beth Darnall, PhD, Professor of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine. Director, Stanford Pain Relief Innovations Lab. Professor Irene Tracey, Vice Chancellor of the University of Oxford and a Professor of Anaesthetic Neuroscience in the Nuffield Department of Clinical Neurosciences. 

The first case for this issue's discussion is one of a young man with a history of involuntary jerks and photosensitivity (1:20). Several more seizures followed his initial presentation with a general tonic-clonic seizure. A number of examinations were done including an MR scan and EEG - (link) Case two involves a 69-yo woman who developed non-convulsive status epilepticus, having been examined as a gastroenterology inpatient for abdominal pain (22:20). A positive PCR for Whipple's disease in stools and saliva, but negative in the CSF, prompted further testing - (link) The case reports discussion is hosted by Prof. Martin Turner (1), who is joined by Dr. Ruth Wood (2) and Dr. Xin You Tai (3) for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the February 2024 issue of the journal. Further reading: Panegyres PK. Diagnosis and management of Whipple's disease of the brain. Practical Neurology 2008;8:311-317.   Association of British Neurologists. Rare Diseases Ascertainment and Recruitment (RaDAR).   (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening. 

Dr Elisa Becker, Researcher in the Nuffield Department of Primary Care Health Sciences, discusses the role of disgust in protecting our health through the behavioural immune system, our relationship with eating meat and whether food packaging on animal products should go down the same path as cigarettes.Time Stamps: 00:00 - 02:56 - Introduction to guest, the topic and background 04:43 - 08:30 - What is the behavioural immune system? 08:31 - 14:01 - How does the behavioural immune system interact with food? 14:02 - 20:42 - Distaste or Disgust: What is the difference? 20:43 - 28:26 - Is disgust something you are born with, or do you learn it? 28:27 - 34:10 - Why is eating less meat becoming more popular? 34:11 - 36:36 - Should we be reducing our meat intake? 38:51 - 41:45 - Should meat be packaged to deter people from eating it? 41:46 - 44:18 - Outro

In the first case this episode, a 69-yo woman has developed severe pain around her right eye with blurring to the vision on that side (1:08), which prompts use of a "rediscovered" treatment technique by the ophthalmology department - (https://pn.bmj.com/content/23/6/527). The second case (15:23) is that of a 45-yo man with progressive pain in his lower limbs, hyperaesthesia and then weakness, who was initially diagnosed with meralgia paraesthetica by tele-medicine examination - (https://pn.bmj.com/content/23/6/516). The case reports discussion is hosted by Prof. Martin Turner (1), who is joined by Dr. Ruth Wood (2) and Dr. Xin You Tai (3), for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the December 2023 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  Please subscribe to the Practical Neurology podcast via all podcast platforms, including Apple Podcasts and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the Practical Neurology Podcast iTunes page (https://podcasts.apple.com/gb/podcast/pn-podcast/id942932053). We'd love to hear your feedback on social media - @PracticalNeurol. The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening. 

As the UK government proposes new plans to reduce the number of people who smoke, we talk to behaviour change researcher Nicola Lindson from the Nuffield Department of Primary Care Health Sciences to find out how the plan would work. Could we see a generation that is smoke free? Would banning flavours in e-cigarettes stop children from taking up smoking? Tune in to the latest episode of the Big Questions podcast to find out more.

Prof. Martin Turner (1) hosts Dr. Ruth Wood (2) and Dr. Xin You Tai (3), as they puzzle through two Case Reports from the latest issue of the Practical Neurology journal. The first case (1:11) is one of a 27-yo man, whose initial presentation suggests a form of multiple sclerosis, but turns out to be something more rare - (https://pn.bmj.com/content/23/5/414). The second case (19:16) is that of a 59-yo woman, with a two month history of progressive confusion and gait difficulty against a background of schizophrenia - (https://pn.bmj.com/content/23/5/453).  Additional reading: Practical approach to the diagnosis of adult-onset leukodystrophies: an updated guide in the genomic era -  https://jnnp.bmj.com/content/90/5/543 (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  Please subscribe to the Practical Neurology podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the Practical Neurology Podcast iTunes page (https://podcasts.apple.com/gb/podcast/pn-podcast/id942932053). We'd love to hear your feedback on social media - @PracticalNeurol. The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening. 

In the third episode of this new series of the Practical Neurology podcast, Prof. Martin Turner (1) hosts Dr. Ruth Wood (2) and Dr. Xin You Tai (3) in a discussion of two Case Reports from the latest issue of the Practical Neurology journal. The first case (0:36) is one of a 78-yo man with variable slurring speech and swallowing difficulties - "Bilateral hypertrophic olivary degeneration in symptomatic palatal tremor" (https://pn.bmj.com/content/23/4/346). The second case (19:21) is a first-person report from the "Me and My Neurological Illness" section, with a 56-yo man living with Parkinson's getting into difficulty while swimming in open water - "Near-drowning in Parkinson's disease: common or uncommon?" (https://pn.bmj.com/content/23/4/354).  (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  Please subscribe to the Practical Neurology podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the Practical Neurology Podcast iTunes page (https://podcasts.apple.com/gb/podcast/pn-podcast/id942932053). We'd love to hear your feedback on social media - @PracticalNeurol. The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening. 

In honour of World Hepatitis Day, today we focus on the Hepatitis B virus (HBV), a virus that can be transmitted through contact with infected blood and from mother to child during labour. HBV can also be transmitted sexually. It infects liver cells and causes both acute and chronic infections, which can be severe. Since HBV was discovered in 1965, we have made great progress in reducing the burden of infections and disease through prevention and antiviral treatment, but much is left to do. The World Health Organization has called for enhanced efforts along four main pathways: i) increasing awareness of HBV infection, ii) promoting prevention strategies, iii) expanding access to testing and treatment; and iv) improving surveillance, data collection and research. Today we will discuss these topics with a focus on the European Region with our three guests: - Dr. Erika Duffell, Public Health Physician, the European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden - Prof. Anna Maria Geretti, Editor in Chief, STI journal; Professor & Consultant in Infectious Diseases & Virology, Fondazione PTV, University of Rome Tor Vergata, Rome, Italy; North Middlesex University Hospital and King's College London, London, United Kingdom - Prof.  Simon de Lusignan, Senior Academic General Practitioner (GP) and Director of the Royal College of GPs Research & Surveillance Centre, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom Hosted by: Dr. Fabiola Martin, Sexual Health, HIV, HTLV specialist, BMJ STI Podcast Editor, Brisbane, Australia    Relevant papers: Hepatitis B virus infection in general practice across England: An analysis of the Royal College of General Practitioners Research and Surveillance Centre real-world database https://www.journalofinfection.com/article/S0163-4453(23)00130-5/ Impact of maternal HIV–HBV coinfection on pregnancy outcomes in an underdeveloped rural area of southwest China https://sti.bmj.com/content/96/7/509 Prevalence of hepatitis B immunity and infection in home self-sampling HIV service users https://sti.bmj.com/content/98/4/286 Hepatitis A and B vaccination in gbMSM in Ireland: findings from the European MSM Internet Survey 2017 (EMIS-2017) https://sti.bmj.com/content/99/5/337 Hepatitis A and B vaccine uptake and immunisation among men who have sex with men seeking PrEP: a substudy of the ANRS IPERGAY trial https://sti.bmj.com/content/99/2/140 Hepatitis A, hepatitis B and HPV vaccine needs and coverage in MSM initiating HIV PrEP in a sexual health clinic in Paris https://sti.bmj.com/content/99/5/361    

In the second episode of this new series of the Practical Neurology podcast, Prof. Martin Turner (1) hosts Dr. Ruth Wood (2) and Dr. Xin You Tai (3) as they delve into two Case Reports from the latest issue of the Practical Neurology journal. First up this month (0:42) is a young man, presumed suffering from a drug overdose, with symptoms of transient global amnesia. This case is determined to be an example of "Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted diffusion (CHANTER) Syndrome" (https://pn.bmj.com/content/early/2023/04/17/pn-2023-003724). Next (13:07) is a young woman with urinary retention and leg paraesthesia over multiple days. Investigations showed this to be "Conus medullaris syndrome as a presenting feature of MOG-associated disease" (https://pn.bmj.com/content/early/2023/01/13/pn-2022-003560). (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital. Please subscribe to the Practical Neurology podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the Practical Neurology Podcast iTunes page (https://podcasts.apple.com/gb/podcast/pn-podcast/id942932053).    The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening.

This week on #Neurosalience we have two guests, Dr. Natalie Voets and Dr. Andreas Bartsch, who have both been working together to advance the use of fMRI as a complementary yet promising and important technique for guiding neurosurgery. Along with clinical researchers around the world, they have been writing a massive white paper for the OHBM Best Practices Committee on the presurgical mapping of language function. They were also both co-authors on a clear and comprehensive 2022 paper published in the British Journal of Neurosurgery, titled: “Functional MRI applications for intra-axial brain tumors: uses and nuances in surgical practice”  Here we have an in-depth discussion of the state of the art of fMRI as it's used in the context of Neurosurgery. While fMRI is becoming a more commonly used tool for helping inform surgeons of brain tissue to be avoided during surgery, standards and best practices are still being worked out as the technique itself has so many stages including acquisition, brain activation paradigm design, processing, and finally interpretation. Natalie and Andreas are not only trained in neuroimaging, but very much in the weeds of daily surgical practice, so have extremely useful insights on all aspects of how fMRI can be and should be used for pre-surgical mapping. Dr. Bartsch is currently with Radiologie Bramber, and affiliated with the University of Heidelberg. He's an MD/PhD Radiologist and Neuroradiologist who studied at Charite Hospital at the University of Berlin, Tufts University in Boston, as well as at the University of Oxford.  Dr. Voets is an Associate Professor at the Nuffield Department of Clinical Neuroscience at the University of Oxford and a Special Advisor in Neuroimaging at Genesis Cancer Care. She is also an Intraoperative Awake Neurosurgery Technician at Oxford University Hospitals NHS Foundation Trust. Episode producers: Omer Faruk Gulban Jeff Mentch Brain Art Artist: Kai Kiwitz Title: Mapping the Human Connectome Description: Mapping the human connectome requires workflows that can deal with ever-increasing amounts of data. Here, the cellular architecture of the human cortex has been analyzed by a deep-learning based approach on a cell-body stained brain section. Visualizing what the approach has learned about the cellular architecture results in stunning images that illustrate the beauty of the human connectome.

Viscosupplementation is a procedure that involves injections of hyaluronic acid, most commonly into the knee joint. In the United States, one in every seven people receive a hyaluronic acid injection as first line treatment for their knee osteoarthritis. However, the effectiveness and safety of viscosupplementation has remained controversial. On this week's episode of Joint Action, we are joined by Bruno da Costa to discuss viscosupplementation, their effectiveness and safety.Dr. Bruno R. da Costa is Deputy Director of Trial Methodology Program at Nuffield Department of Population Health, University of Oxford, and Associate Professor of Clinical Epidemiology at the Institute of Health Policy, Management and Evaluation, University of Toronto. He has a Ph.D. in Clinical Epidemiology and Biostatistics from the University of Bern in Switzerland, a M.Sc. in Medical Statistics from the University of Leicester in the UK, and a M.Sc. in Physical Therapy from the University of Alberta in Canada. Dr. da Costa is considered to be an influential scientist in the field of musculoskeletal and cardiovascular disease and methodological research on comparative effectiveness. He has co-authored over 100 scholarly peer-reviewed publications, which have been published in prominent peer-reviewed scientific journals such as The New England Journal of Medicine, The Lancet, Journal of the American Medical Association (JAMA), and The BMJ.RESOURCESViscosupplementation for knee osteoarthritis: systematic review and meta-analysisCONNECT WITH USTwitter: @ProfDavidHunter @jointactionorgEmail: hello@jointaction.infoWebsite: www.jointaction.info/podcastIf you enjoyed this episode, don't forget to subscribe to learn more about osteoarthritis from the world's leading experts! And please let us know what you thought by leaving us a review! Hosted on Acast. See acast.com/privacy for more information.

In this new series of the Practical Neurology podcast, Professor Martin Turner (1) invites Dr Ruth Wood (2) and Dr Xin You Tai (3) to discuss the nitty-gritty details of two Case Reports from the latest issue of the Practical Neurology journal. This month, they start by commenting on a case of a woman in her 70s with renal failure who developed confusion and seizures after receiving aciclovir, and was subsequently diagnosed with aciclovir-induced neurotoxicity (Aciclovir-induced neurotoxicity - https://pn.bmj.com/content/23/2/157). They also talk (starting at 23:05) about an unusual case of an acute posterior spinal artery syndrome in a man in his 60s with vascular risk factors (Posterior spinal artery infarct - https://pn.bmj.com/content/23/2/160). (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital. Please subscribe to the Practical Neurology podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the Practical Neurology Podcast iTunes page (https://podcasts.apple.com/gb/podcast/pn-podcast/id942932053). The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening.

Welcome once again to the global health unfiltered podcast, a podcast about unspoken realities about global health in Africa and the world.  Today, we will be talking about funding global health initiatives; who funds what? How are the decisions made? Are African countries too reliant on external funding for public health? And we have an awesome guest with tons of experience in this sector who will be sharing his views with us. We would also like to acknowledge the sponsors of this episode, the “Promoting Decolonization using innovative knowledge practices" grant hosted by the Center for Tropical Medicine and Global Health of Oxford University's Nuffield Department of Medicine. Dr. Sam Oti is a Senior Program Specialist at Canada's International Development Research Centre (IDRC). He operates out of the Nairobi-based regional office for Eastern and Southern Africa, where he serves as the primary point of contact for IDRC's global health initiatives.  He is also a commissioner on the Chatham House Commission for Universal Health and a co-founder of the Network of Impact Evaluation Researchers in Africa. Additionally, Dr. Oti hosts “MedxTek Africa”; a popular podcast highlighting digital health and health technology innovations from across the African continent. In 2020, Dr. Oti co-founded the Global Health Decolonisation Movement in Africa – a professional network that is seeking to mobilize a critical mass of African voices to speak out about what we perceive as the manifestations of coloniality in global health. The movement's mission strongly aligns with the Africa CDC's call for a “New Public Health Order”.Resources:https://wellcomecollection.org/articles/Y1FlZxEAAEolDkdAhttps://www.oecd-ilibrary.org/development/development-co-operation-report-2023_2c087f8b-enhttps://academic.oup.com/isq/article/66/1/sqab092/6473249 Follow us on Twitter (@unfiltered_gh), LinkedIn (Global Health Unfiltered!), and Instagram (@ghunfiltered).Keep up with us on Twitter: @desmondtanko @ulricksidney and @DrellaamoakoContact us: unfilteredgh@gmail.comAudio Production and social media marketing: Diana NkhomaResearch intern: Chisomo MwaleTheme music: Antidote by KetsaArtwork: Chidiebere Ibe

We've talked about a lot of different types of research on this podcast...from investigations into drought, to space exploration, to the future of food. But what about researching 'research' itself? That's right, on this week's episode of the Big Questions Podcast, we're going meta! We chat to Dr Patricia Logullo, a meta-researcher from the Nuffield Department for Orthopaedics, Rheumatology and Musculoskeletal Sciences, about why it is so important to examine the practice of research itself, and how scientists such as herself help to ensure research reporting is transparent, complete and reproducible.   

This is the first episode of a six-episode series that we will be realising once a month for the next six months. This special series is thankfully supported by the "Promoting Decolonization using innovative knowledge practices" grant hosted by the Center for Tropical Medicine and Global Health of Oxford University's Nuffield Department of Medicine. In these six episodes, we will showcase the contributions of six African global health leaders.Our first guest in this series is Raoul Kamadjeu, a physician, co-founder, and managing editor of the Pan African Medical Journal. He is driven in all his projects by a simple motto - Start small, but think big! He got his doctorate in Medicine in Cameroon and completed his MPH in Belgium (Université Libre de Bruxelles). He experienced the broad spectrum of public health practice, from the district in Cameroon to international arenas with the World Health Organization and the US Centers for Disease Control and Prevention. He worked with the CDC from 2004 to 2006 as Public Health Informatics Fellow and from 2007 to 2014 as a medical epidemiologist. He currently works for UNICEF HQ (Public Health Emergencies) and is a Ph.D. candidate (Epidemiology), with the City University of New York (CUNY), Graduate School of Public Health and Health Policy. His expertise spans fields as varied as epidemiology, biostatistics, informatics, communication, computer programming, and project management.Follow us on Twitter (@unfiltered_gh), LinkedIn (Global Health Unfiltered!), and Instagram (@ghunfiltered).Keep up with us on Twitter: @desmondtanko @ulricksidney and @DrellaamoakoContact us: unfilteredgh@gmail.comAudio editing and social media marketing: Diana NkhomaResearch intern: Chisomo MwaleTheme music: Antidote by KetsaArtwork: Chidiebere Ibe

This episode of our podcast discusses the links between diet, the gut, and depression symptoms, asking one crucial question: Can changing our diet help improve symptoms of depression? Our guests are Dr. Najaf Amin, senior research associate in the Nuffield Department of Population Health at the University of Oxford in the United Kingdom, and Rachel Kelly, a U.K.-based mental health campaigner who has been outspoken about how diet helped treat her own depression.

If our internal body clock is telling us it's 3am, but the external environment is telling us it's 12 noon, that's called jet lag. It's a mis-match between what's going on inside our bodies and what's happening outside. Those who have travelled abroad - particularly to somewhere in a significantly different time zone - will be familiar with the feeling, but it's not just stepping off a plane that can cause it. 'Social jet lag' is a particular problem for shift workers, for example. An out-of-sync body clock can make us feel terrible, so, is there a cure for the condition on the horizon? We speak to neuroscientist Prof Aarti Jagannath from the Nuffield Department of Clinical Neurosciences about her work investigating potential drug treatments for jet lag.

Are you ready to sleep better at night and do it naturally?   One of the top-rated podcast episodes on my podcast was episode 3, which all about sleep, and I know it's one of the most helpful topics that you want to learn more about.   In this episode, I speak with Professor Colin Espie, Co-Founder and Chief Scientist of Big Health and Professor of Sleep Medicine in the Nuffield Department of Clinical Neurosciences at the University of Oxford.    A world renowned sleep expert, Professor Espie is focused on improving the clinical assessment and treatment of sleep disorders, particularly using Cognitive Behavioural Therapeutics (CBTx), and studying sleep's relationship to mental health. He has published more than 300 scientific papers in his career and has been elected as a  Fellow of the British Psychological Society, the Royal Society of Medicine, and the American Academy of Sleep Medicine.   Prior to founding the University of Oxford's Experimental & Clinical Sleep Medicine research programme in the Sleep & Circadian Research Institute in 2013, Professor Espie was the founding Director of the University of Glasgow Sleep Centre. In 2015, he was appointed an Honorary Fellow of the British Association for Behavioural & Cognitive Psychotherapies, and was awarded the Mary A. Carskadon Outstanding Educator Award by the Sleep Research Society in 2017. A highly sought after public speaker, Professor Espie regularly shares his latest research on sleep and sleep disorders, and serves as scientific expert in television and documentary interviews.    Listen in as we talk about: [2:10] Why so many people struggle with sleep [4:00] Do people struggle more with sleep today vs. 30-40 years ago? [5:45] The biggest culprits that affect our sleep [8:00] What cognitive behavioural therapy is and how it can help you with sleep [15:20] The impact of sleep medications, lights, technology, and alcohol are not conducive to proper sleep [25:10] Why it's important to follow what feels good to you when it comes to sleep Notes from Natalie: Sign Up for Natalie's Newsletter  Get Canva Pro free for 45 days here Collaborate here!   Resources Mentioned in This Episode: Overcoming Insomnia: A Self-Help Guide Using Cognitive Behavioral Therapy Techniques" by Dr. Colin Espie Episode 3: Must-Have Tips for Better and Restful Sleep with Suzy Cohen Sleepio App   Connect with Dr. Colin Espie   Twitter LinkedIn www.bighealth.com    Connect with Natalie Tysdal On Instagram On YouTube On Facebook Website