Obituary – Sandy Smith

It is with great sadness that we learned of the death of one of our Patient Partners Sandy Smith.  Sandy has been a Patient Partner (formerly known as volunteer patient) at the School of Medicine since 2014.  He has been a loyal supporter of medical education, coming to the school with his wife Margaret to share his health experiences with undergraduate students to aide their learning.  We would like to extend our sincere condolences to his wife Margaret, who helped him get to the School for teaching, and to his family.  Sandy will be greatly missed by us all.

 

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AI-Empowered Personalised Medicine System to Improve Cancer Treatments

AI-Empowered Personalised Medicine System to Improve Cancer Treatments: KATY Kicks Off Activities

New Horizon 2020 project will bring AI-based medical knowledge to the fingertips of clinicians and clinical researchers

9 February, Rome, Italy – The newly launched KATY project has set out to build a precise personalised medicine system empowered by Artificial Intelligence (AI). The novel AI tool aims to predict the response of kidney cancer to targeted therapies and identify the molecular evidence to support these predictions. Most importantly, the KATY system will offer human interpretable knowledge that clinicians and clinical researchers can trust, adequately evaluate and effectively use in their everyday working routine. KATY officially kicks off its activities with a first virtual meeting on 9 February 2021.

Personalised medicine has transformed how doctors diagnose patients and treat diseases. Researchers and clinicians are increasingly customising treatments to fit patients’ needs. In cancer care, targeted therapies have been developed as advanced therapeutic options for anti-tumour treatments. They are now part of the primary therapies for managing several cancer types. After profiling the molecular characteristics of a patient’s tumour, these characteristics are then translated into an appropriate therapeutic choice applicable in the clinic. The procedure requires identifying a molecular signature specific to the patient’s tumour and the signature’s association with the most effective treatment. However, the practice of targeted therapies in cancer treatment has been derived from traditional data analysis methods.

In turn, KATY’s AI-based personalised medicine tool is at the cutting edge of new treatments for cancer and may bring targeted therapies to the next level. Using KATY’s AI-based models in cancer care will boost the use of tailored, targeted treatments and answer a problem encountered daily by clinicians: Which targeted therapy would be the most suitable for a specific patient? Therefore, the project is striving to build a trustworthy, easy-to-understood tool for medical professionals to make better therapy decisions for people with cancer.

“The real challenge is building AI-empowered personalised medicine systems that can be accepted by and, even more, is worth the trust of clinicians and clinical researchers. It is not sufficient to build a wonderful, precise AI system that gives hints on how to solve big problems in medicine by using -omics resources. AI needs to dissipate the Dr Google effect for clinicians and in their relationship with patients.”, says Prof. Fabio Massimo Zanzotto, coordinator of the KATY project at the Università Degli Studi Di Roma “Tor Vergata”.

As a stress test and due to the lack of personalised clinical responses, KATY will initially experiment with data from patients with clear cell Renal Cell Carcinoma (ccRCC), a rare and complex form of kidney cancer.

KATY’s novel AI system will be built around two main components: A Distributed Knowledge Graph (DKG) and a pool of eXplainable Artificial Intelligence predictors (XAIPs). While the DKG is an intelligent repository storing large multi-omics patient and scientific information, the XAIPs will enrich the DKG and deliver understandable personalised medicine decisions. New knowledge generated by the XAIPs will be entered into the DKG and, in turn, will become available to other clinicians.

In a first step, medical professionals will be able to search and browse information in the DKG via a user-friendly interface on their smartphones or desktops. By linking patients’ data to extensive banks of -omics, biobanks, and publicly available datasets and other registries, clinicians and clinical researchers will be equipped to predict patient response to targeted therapies and the identification of molecular evidence to support these predictions. This predictive system enables clinicians to see new connections between existing datasets and individual patient data and, ultimately, select the treatment best suited to each patient.
In a second implementation phase, a simple user experience will be designed to guide conversations between the clinician and the patient regarding treatment choices in renal cancer.

In short, the goals of the KATY project are to:

  • reduce the burden of disease for renal cancer patients,
  • apply existing treatments in a more targeted way,
  • identify new evidence on the predictive value of AI solutions,
  • enhance the diagnostic capacity for complex diseases.

Over the next four years, KATY will be supported by € 8.5 million in funding from the European Union’s Horizon 2020 Framework Programme. Twenty internationally-renowned institutions from Austria, France, Germany, Greece, Italy, Poland, Portugal, Spain, Sweden, Ukraine and the United Kingdom form the project consortium.

PhD Opportunity – World-Leading St Andrews Scholarship in Health Psychology 2021 entry

World-Leading St Andrews Scholarship in Health Psychology 2021 entry

The University of St Andrews is pleased to offer a full scholarship funded by St Leonard’s Postgraduate College, to support an exceptional student undertaking doctoral research in the following project:

Plastic People: Interdisciplinary Approaches to Behaviour Change for Reducing Plastic Waste

 

Project description

Research into public attitudes, experience of, and knowledge about plastics and microplastics are at its initial stages. Little research has encompassed theories of behaviour and risk perception, yet human ‘behaviour’ is one of the key factors influencing plastic waste. Relevant behaviours span our purchasing decisions regarding single-use plastics, how we discard, reuse, or recycle these, choices around alternative reusable products, and how we engage with policymakers to eliminate plastic waste.

Museums, as trusted agents in society, can play a significant role in reaching the public in innovative ways and acting as ‘catalysts for change’. A study on U.S. attitudes to climate change showed almost 75% trusted museums in relation to global warming – more than they trusted science television. Through storytelling and creating spaces for dialogue, museums engage audiences with complex issues – and as social spaces they could catalyse commitments to action. However, there is little research into whether and how public trust in museums can be used to prompt action, and even less examining whether reported intentions (during a museum visit) translate into longer-term behaviour change.

This novel inter-disciplinary project brings together behavioural science, conservation science, and museum practice and visitor studies. This doctoral studentship will develop a series of studies to answer the fundamental research question: What is the best way of engaging public of all ages to spur action on their behaviour to reduce plastic waste? To achieve this urgent goal, we will use theories from health psychology.  The COM-B system of behaviour identifies Capability, Opportunity, and Motivation as the drivers of behaviour. The student will engage members of public in a cycle of knowledge generation-development of message-evaluation using Research Studio at the Wardlaw Museum. The student will develop studies using methods such as survey and interviews to identify key factors in behaviour change, and risk communication principles for the development of displays/ programmes in Museum spaces.  Evaluation of outcomes will capture attitude/ knowledge change but will extend to include behaviour change and engagement with local policy and legislation change.

The student will be supervised by Dr Gozde Ozakinci (School of Medicine), Professor Sascha Hooker (School of Biology), and Dr Katie Eagleton (University Museums).

Informal enquiries regarding this scholarship may be addressed to Dr Gozde Ozakinci – email go10@st-andrews.ac.uk.

Full details on the the funding available and how to apply can be found on the University scholarships webpage

Funding awarded for TB research

The St Andrews tuberculosis research group together with global health partners have won a €4.9 million grant from the European Developing Countries Clinical Trials Partnership (EDCTP).  Led by Prof Kogieleum Naidoo, of CAPRISA in Kwa-Zulu Natal, the TRiAD consortium seeks to determine how new diagnostic tests can be used to improve tuberculosis treatment, especially for drug resistant disease(DR- B), in low and middle income countries. The consortium consists of 11 partners from Africa, Europe and North America. The team at St Andrews will be responsible for medical support to patients and research sites during trial set-up and will provide clinical mentorship in Africa as part of building capacity. We will also further investigate the utility of the innovative tuberculosis Molecular Bacterial Load Assay (TB-MBLA) in monitoring treatment response of patients with drug resistant tuberculosis. TB-MBLA was pioneered at St Andrews as the first culture-free biomarker for rapid measurement of treatment response in tuberculosis patients.

 

Exercise prescriptions needed to get patients active

A nation-wide health initiative, that will be rolled out widely in GP practices next year, will only work if formal referrals and prescriptions are used, according to a new study led by the University of St Andrews.

Social prescribing is a health care initiative which aims to help patients experiencing a wide range of physical health, mental health and wellbeing issues, including obesity and loneliness, to improve their health and wellbeing by connecting them with relevant opportunities in their local communities.

The health professional connects a patient with a link worker who, following consultation with the patient, connects him or her with an appropriate community-based opportunity, such as a jogging group or a befriending service.

The Scottish Government has committed to recruiting 250 social prescribing link workers by 2021 with Fife Health and Social Care Partnership aiming to have link workers in every GP practice in Fife by 2022.

The new research, funded by the NHS Fife Endowment Fund and published in Health and Social Care in the Community, reviewed the evidence on methods of connecting primary care patients with community-based physical activity programmes in the UK.

It identified that when a link worker was employed, methods involving formal referral or prescription, rather than informal signposting, worked best for connecting patients with, and enhancing their uptake of, physical activity programmes.

This may be, at least partially, due to those methods actively facilitating patient uptake of physical activity programmes, rather than leaving patients to do all the communication and organisation of uptake by themselves.

Lead researcher on the study, Dr Kathryn Cunningham, Chartered Health Psychologist and Research Fellow in the School of Medicine at the University of St Andrews, said: “Our findings are of particular significance given the growing focus on social prescribing.

“They address the lack of evidence about which methods work best for connecting patients with community-based opportunities to improve health and wellbeing and will help with the design of effective social prescribing schemes.”

Dr Gozde Ozakinci, Senior Lecturer in Health Psychology in the School of Medicine at the University of St Andrews, added: “Our review also shows that we need rigorous evaluation of, and transparent reporting of these schemes so that the knowledge is easily available to progress social prescribing practice and research.”


The paper, ‘Methods of connecting primary care patients with community-based physical activity opportunities: A realist scoping review’ by Kathryn B Cunningham, Rayna H Rogowsky, Sharon A Carstairs, Frank Sullivan and Gozde Ozakinci is published in Health and Social Care and is available online.

Please ensure that the paper’s DOI [https://doi.org/10.1111/hsc.13186] is included in all online stories and social media posts and that Health and Social Care is credited as the source.

Issued by the University of St Andrews Communications Office

Dean of Medicine made an Honorary Fellow of the British Pharmacological Society

Prof David Crossman has been made an Honorary Life Fellow of the British Pharmacological Society in recognition of sustained excellence and leadership in science, healthcare, and public service.  This is a fabulous achievement and marks his work furthering the disciplines of Pharmacology, Clinical Pharmacology and Therapeutics.

 

 

https://www.bps.ac.uk/publishing/blog/november-2020/announcing-our-new-fellows-for-2020

 

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Diabetes Educational Meeting

The School of Medicine is delighted to continue its long support of Prof Ian Campbell, Emeritus Professor of Medicine, and Merck in running a Post-Graduate educational meeting,  ‘Expanding the Benefits of Metformin: Research and Clinical Update’ which took place on November 6th by webinar for diabetes specialists from Jordan, Lebanon and Iraq.  The lectures were delivered by Prof Ian Campbell and Dr Harry Howlett from HHMS Global Diabetes Research and Education, Amersham.   The topics included an update of the benefits of metformin in type 2 diabetic subjects with heart failure and chronic kidney disease, and looking to the future the potential benefits of metformin in the treatment of cancer and dementia.

Reopening Primary Schools during the Pandemic

It is inexcusable to open nonessential services for adults this summer if it forces students to remain at home even part-time this fall.

 

As communities and families navigate the complicated issues around reopening schools, experts argue that children returning to primary school is essential, not only because of the educational, social, and developmental benefits for kids themselves, but also for the longterm economic and civic health of the country.  Every effort should be made to reopen them full-time in the autumn, according to an article in the New England Journal of Medicine co-authored by Meira Levinson, Muge Cevik and Marc Lipsitch.  Doing so safely will require reducing or eliminating community transmission while ramping up testing and surveillance.

Authors recommend that any region/city with moderate, high, or increasing levels of community transmission “should do everything possible to lower transmission” including closing nonessential indoor spaces such as retail establishments, movie theatres, restaurants and pubs.

The authors — Meira Levinson of the Harvard Graduate School of Education; Muge Cevik of Scotland’s University of St. Andrews; and Marc Lipsitch of  T.H. Chan School of Public Health; emphasise that “school closures have brought social, economic, and racial injustice into sharp relief, with historically marginalized children and families — and the educators who serve them — suffering the most and being offered the least.”

Until elementary school children physically return to school full-time, “many will lose out on essential educational, social, and developmental benefits; neither the economy nor the health care system will be able to return to full strength given parents’ caretaking responsibilities; and profound racial and socioeconomic injustices will be further exacerbated,” the authors wrote.  They added, “It is inexcusable to open nonessential services for adults this summer if it forces students to remain at home even part-time this fall.”

The authors argue that “children, families, educators, and society deserve to have safe and reliable primary schools should not be controversial.”  Primary schools should be recognized as essential services, school personnel as essential workers — and that school reopening plans should be developed and financed accordingly.  “Schools are more like grocery stores, doctors’ offices, and food manufacturers than like retail establishments, movie theatres, and bars.”  “Like all essential workers, teachers and other school personnel deserve substantial protections, as well as hazard pay.  Remote working accommodations should be made if possible for staff members who are over 60 or have underlying health conditions.”

The authors specifically emphasise opening primary schools as a priority although they also acknowledge that “fully reopening schools for middle and high school students should be a national priority, but given the more challenging transmission dynamics at older ages, we confine ourselves here to elementary schools.”

According to the literature review conducted by the authors (Goldstein E, Lipsitch M, Cevik M. on the effect of age on the transmission of SARS-CoV-2 in households, schools and the community. July 28, 2020 https://www.medrxiv.org/content/10.1101/2020.07.19.20157362v1) children aged under 10 years have lower susceptibility to infection compared to adults, but the susceptibility increases with age, especially over 15 susceptibility and infection rates reach similar to adults.  Authors argue that “opening secondary/high schools is likely to contribute to the community spread, and greater safeguards to reduce transmission is needed while opening secondary and high schools”.  The authors suggest that “compared to secondary/high schools, opening primary schools and daycare facilities may have a more limited effect on the spread of SARS-CoV-2 in the community, particularly under smaller class sizes and in the presence of mitigation measures.” Every effort should be taken to avoid crowding in the classroom and other mitigation measures should be implemented, to the extent possible, when opening primary schools.

This highlights that different approaches are needed when opening schools for different age groups.

For many reasons, decisions about school reopenings will remain complex and contested as the authors argue that school openings “is not just a scientific and technocratic question.  It is also an emotional and moral one.  Our sense of responsibility toward children — at the very least, to protect them from the vicissitudes of life, including the poor decision making of adults who allow deadly infections to spiral out of control — is core to our humanity.”