Tag: Research

Unravelling the mystery of smaller lungs in low- and middle-income countries

Andre Amaral

In low- and middle-income countries (LMICs), a notable number of individuals have smaller lungs for their sex, age, and height, especially in South and East Asia, as well as sub-Saharan Africa. The key question: Why does this pattern persist in these regions?

This phenomenon extends beyond physiological concerns, and as indicated by recent studies, reveals a troubling link between smaller lungs and heightened risks of suffering from heart disease and diabetes. Dr André Amaral, an epidemiologist at the National Heart and Lung Institute (NHLI), explores this phenomenon.

The BOLD study

Chronic lung diseases affect millions of people of all ages worldwide. Approximately 20 years ago, the Burden of Obstructive Lung Disease (BOLD) study was set up by Imperial College London to find out more about the prevalence and determinants of chronic obstructive pulmonary disease (COPD), which back then, was already considered a leading cause of disability and death.

The BOLD study was conducted in 41 sites across Africa, Asia, Australia, Europe, the Caribbean and North America, and recruited more than 30,000 adults aged 40 years and over. The large coverage of world regions, and ethnic groups, as well as the large number of participants, all answering the same questions and undergoing the same measurements in a standardised manner, makes the BOLD study unique. Participants in this study provided information on several characteristics of their life. This included whether they had been diagnosed with lung disease, a heart disease, or diabetes, whether they smoke or ever smoked, their weight and height, and their highest level of education. The level of their lung function was measured through a medical test called spirometry, which measures how much air a person can breathe out in one forced breath.

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The Compressed Air Bath and its Therapeutic Uses in Mid-Victorian Britain

The Wharfedale hydropathic establishment and hotel (Ben Rhydding) with surrounding grounds. Etching, ca. 1860. Wellcome Collection. Source: Wellcome Collection.
The Wharfedale hydropathic establishment and hotel (Ben Rhydding) with surrounding grounds. Etching, ca. 1860. Wellcome Collection. Source: Wellcome Collection.

What happens when industrial technology meets nature? A French invention of the 1830s, the compressed air bath capitalised on the allure of ‘pure countryside air’ to treat a range of respiratory problems. Dr Jennifer Wallis, Medical Humanities Teaching Fellow, explores the fascinating history of these baths and their therapeutic uses in mid-Victorian Britain.

During the summer holiday season, many of us will have taken a break to recharge our batteries. Whether it’s gazing out over a clear blue sea or hiking through a forest, connecting with nature is often a key component of our holidays.

Tourists in the 19th century sought a similar experience. They yearned to escape the crowded city or the routines of home to immerse themselves in a new environment. The era is most associated with the seaside resort, which grew in popularity as the railway network expanded. But many Britons were also choosing to follow in the footsteps of their eighteenth-century ancestors by visiting spa towns like Malvern. Spa towns were renowned for their health benefits, from the freshness of the air to the energising effect of the mineral waters. Hotels and resorts sprung up in spa towns to cater for the health-seeking hordes.

One such resort was the Ben Rhydding Hydropathic Establishment in Ilkley, Yorkshire. It cashed in on a contemporary interest in hydropathy, a treatment regime based on baths and showers. Ben Rhydding offered its visitors a variety of activities to supplement these treatments: bowling greens, dances, and guided walks of local beauty spots. It also offered a rather unusual experience for the health-seeking tourist, one that used air rather than water: a compressed air bath.

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Team Science Leads the Way – But Hero Science Still Looms Large

Artwork by Mengmeng Tu, MSc Science Communication student

This festive period, Three Wise Women from the Faculty of Medicine will be giving us the gift of wisdom.

When it comes to tackling the world’s biggest health challenges, teamwork makes the dream work for Professor Wiebke Arlt, Director of the MRC Laboratory of Medical Sciences (LMS). Here, she discusses why it’s time that contemporary science shifted from a hero science to a team science approach – one based on productive collaboration rather than wasteful competition.

Going it alone is often glorified as the breakthrough way of achieving major milestones. However, if you look closely, most of these are achieved in a team effort and not by single individuals. Our perception of heroes rather than teams is often driven by the narrative and not the facts: when I was a child, I learnt that Edmund Hillary was the first to climb the highest mountain in the world, Mount Everest. Now I know that Hillary achieved this feat together with the Nepalese mountaineer Tenzing Norgay. Reading up on it, I discovered that they didn’t walk up the mountain on their own, but they were part of a large expedition team that worked together to achieve the goal. Hillary and Norgay were the second pair to be deployed as part of a systematic team approach to conquering the mountain.

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Closing the Gender Health Gap: A Call for Sex and Gender Equity in Biomedical Research Policies

When it comes to healthcare, there are clear and stark inequalities between women and men. Marina Politis, Alice Witt, and Kate Womersley explain how, at its root, this gender health gap derives from a research and data gap, and how the MESSAGE project is working to improve accounting of sex and gender dimensions in medical research.

Everyone aspires to receive gold standard treatment when seeking medical care. What if, however, this standard, was only ever set out to be gold for one group of people? Much of our medical evidence base has been based on a male norm, with women underrepresented at all stages of the research pipeline. Subsequently, when a woman suffers an out-of-hospital cardiac arrest, she is less likely to receive bystander CPR than a man. Once in the hospital, she continues to be less likely to receive optimal care than her male counterpart.

The gender health gap in cardiovascular disease – poorer outcomes women experience due to the “male default” in health research and healthcare – is just one of many conditions for which there are disparities between women and men. From dementia to diabetes, and osteoporosis to obesity, sex and gender differences and similarities remain neglected in UK and international research.

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Getting to the Heart of the Matter: Sex Differences in Cardiomyopathy

Artwork by Mengmeng Tu, MSc Science Communication student

This festive period, Three Wise Women from the Faculty of Medicine will be giving us the gift of wisdom.

Could variation in the architecture of men and women’s hearts explain why their risk of cardiomyopathy differs? Dr Paz Tayal, Clinical Senior Lecturer in Cardiology at the National Heart and Lung Institute is investigating this with the aim of improving outcomes for patients affected by this disease of the heart muscle. Dr Tayal also discusses the ‘juggle struggle’ of balancing work and family life, and the importance of truth telling in academic medicine.

As winter sets in, I start to pack away the summer dresses and bring out the woolly jumpers and sturdy boots. When I do this, I will not be going into my husband’s closet to find things that fit me, nor indeed will I be wearing his shoes.

That seems obvious right, because we are different sizes.

We don’t think twice about that, yet in medicine, we are only just beginning to realise that male and female patients might need to have tailored ways to diagnose and treat disease.

Even in health, male and female hearts are not the same. At birth, the hearts of male and female babies are about the same size. However, at puberty, male hearts have a faster period of growth compared to female hearts. Whilst this eventually settles down, throughout adult life the mismatch persists, and the female heart remains smaller.

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Tackling syncope – a significant diagnostic challenge for many

Syncope–a transient loss of consciousness–occurs in 42% of people by the age of 70. Professor Richard Sutton, Emeritus Professor of Clinical Cardiology, discusses this common medical problem, and how he has pioneered a “true but still insufficiently small interest” in it.

I have been Emeritus Professor of Clinical Cardiology at Imperial since 2011. Prior to that, I had trained in Cardiology at St George’s Hospital, the University of North Carolina, and the National Heart Hospital in London, becoming Consultant Cardiologist at Westminster Hospital in 1976. There I focused on cardiac pacing as a subspecialty. From a clinical perspective, cardiac pacing eradicated syncope (transient loss of consciousness) in patients with conduction tissue disease of the heart. So, I sought to extend the role of pacing into related syncope conditions.

My primary interest therefore became the symptom of syncope. I began this in the late 1970s, and formed a close relationship with Worthing Hospital which carried a heavy load of older patients, many of whom presented syncope. I founded an outreach clinic at Worthing which led to the receipt of many challenging patients with syncope in whom there was no obvious cause.

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Margaret Turner Warwick Centre: Can we take your breath away?

The Great Exhibition Road Festival is a free annual celebration of science and the arts each summer in South Kensington. The event showcases a diverse range of activities for people of all ages.  One of those activities, led by researchers from the Margaret Turner Warwick Centre and volunteers from the charity Action for Pulmonary Fibrosis, included an interactive activity that gave the public the opportunity to walk in the shoes of someone living with pulmonary fibrosis. Find out first-hand from Elisabeth Pyman, what happened on the day and hear from pulomary fibrosis patient, Andy, what it’s like to live with the condition.

The June weekend of the Great Exhibition Road Festival was one of quintessential British summertime weather. This celebration of science was hosted by Imperial College London in collaboration with the local community and provided a wide range of topics for people of all ages to explore. Under intermittent spells of rain, crowds of a multitudinous diversity explored the “awe and wonder” of science, the theme of this year’s festival. To welcome the public, artists and scientists populated the streets and buildings surrounding Imperial’s South Kensington campus like a sudden desert bloom.

Meanwhile, another transformation was taking place in a stand tucked away at the end of the road in the Creative Science zone. Researchers from the Margaret Turner Warwick Centre and volunteers from the charity Action for Pulmonary Fibrosis were on a mission to spread awareness about a rare lung condition known as pulmonary fibrosis. This condition is associated with a build-up of scar tissue that leads to a steady decline in lung function, with many patients becoming terminal only five years after diagnosis. Currently, there are 32,500 UK residents living with a diagnosis, but the actual number of people affected is estimated at around 100,000.

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HIV antiretroviral therapy: Getting to the heart of the matter

The HIV landscape has completely transformed since the start of the pandemic. A HIV diagnosis in the 1980s was considered fatal, as people usually progressed to AIDS due to the lack of available treatments. 42 years later, we have an array of different drug options and as a result, people diagnosed with HIV today can now expect to have near-normal life expectancies. Here, Dr Akif Khawaja from the National Heart & Lung Institute (NHLI), highlights the impact of HIV treatment over the last 42 years and how it influences cardiovascular research today.

HIV Treatment: from AZT to U=U

At the start of the pandemic, there were no available treatments. Patients would progress to AIDS and were only offered palliative care. It wasn’t until 1987 that the first antiretroviral drug, zidovudine (AZT), was licenced for the treatment of HIV. A major challenge with HIV treatment soon became apparent, as the virus can rapidly mutate and change its genetic code to become resistant to the drug supressing its replication. This challenge was quickly seen by clinicians as their patients would start to rebound from antiretroviral monotherapy (one drug regimens) as HIV became drug resistant and was able to replicate again. The introduction of combination antiretroviral therapy in 1996 has been monumental to HIV management. A change in treatment guidelines meant that patients who would have previously been given one drug, were now given three drug combinations, each targeting different parts of the HIV life cycle. This approach meant that patients could suppress HIV replication and achieve a sustained undetectable viral load, meaning that the level of virus in their blood is so low, it can no longer be detected by diagnostic tests.

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Navigating digital health: a guide to data and artificial intelligence in healthcare

Kelly Gleason introduces a guide, Navigating Digital Health, co-produced with 20 local diverse public partners (aged between 18-78, ethnicity: White, Black & Asian, 60% women and 40% men) to help the public navigate data and artificial intelligence and wider resources. Kelly is Imperial CRUK Lead Nurse and leads the Public Involvement for the CRUK Convergence Centre and the NIHR Imperial BRC Surgery and Cancer Theme. The guide and supporting resources are part-funded by the NIHR Imperial BRC.

What the public need to know about the guide:

  1. It’s made for the public by the public (with a large and diverse group of public contributors) and supported by experts in the field.
  2. This is a gentle introduction to data science and AI to allow anyone to begin to learn about this field.
  3. It can be used by patients or family members to understand more about these issues generally or to contribute to public involvement programmes in research.
  4. It can help people make informed decisions about accessing new technologies to support their health.
  5. The guide is supported by various forms of media, including the written word, podcasts and animated videos (see links at the end of this blog). (more…)

Making Waves at the National Heart and Lung Institute

Helen Johnson, Communications and Marketing Manager at the National Heart and Lung Institute (NHLI) discusses her recent project ‘Making Waves’, which set out to update the Department’s imagery across their buildings to better reflect the diversity of NHLI’s community and inspire the next generation.

“Sometimes our stories make us stronger”

This is what one of our contributors said to me during her interview, and I couldn’t have summed up ‘Making Waves’ any better. This project set out to showcase the people behind the great science and teaching that the NHLI is known for. 

We don’t always think about it on a daily basis but when you actually look at who is celebrated in the imagery on our walls, it tends to be people who no longer work for the Department, and they tend to also share characteristics in terms of their age and race. But, then again, it is just a portrait of that person, so we don’t necessarily know their whole story by just looking at an image. Everyone has their own story. 

The founding premise of ‘Making Waves’ was that anyone should be able to look at these new portraits and see themselves. So that everyone can know they are welcome at NHLI  and in science – that they belong. I was tasked with this vision by my Head of Department, Professor Edwin Chilvers, who was keen we brought our imagery more up to date to represent who NHLI is today. The leaky pipeline in science for those holding protected characteristics has been much reported, and is easy to see when you look for instance at the number of Black Professors across not just NHLI, but across the whole of Imperial. One set of portraits will not solve this, but hopefully by showing a greater variety of successful people and their journeys, others will be inspired to continue their own scientific paths.

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