Let the children take us to space

44 years ago a feather and a hammer were dropped at the same time on the moon by Commander David Scott of Apollo 15. An experiment that continues to cause wonder and inspire children today. Indeed, it may well have been an experiment children would have dreamed up for the astronauts to do. This post is simply to get the children of New Zealand thinking of experiments and possibilities once more.

We are going to have a rocket launch facility in our own backyard.  Wow!  If that doesn’t excite, then little will.  Rocket Lab inspires not just because big controlled explosions are cool (well duh!), but because those involved are innovative, and commercially savvy. Exactly the qualities I’d like to see fostered in the next generation.

Peter Beck, founder and CEO of Rocket Lab has promised that anyone can reach space.  Well said Peter. Here’s my vision to add to his.

  • Let that anyone be the children of New Zealand.
  • Let New Zealanders launch our first satellite (#NZS1 for want of a better handle)
  • Let that satellite be locally dreamed up and grown
  • Let there be a competition to gather ideas for what NZS1 should do
  • Let our children vote on which idea they’d like to see launched first
  • Let the money be crowd-sourced from within New Zealand (less than $2 each!).
Rocket Lab's vision for their launch facility (used with permission)
Rocket Lab’s vision for their launch facility (used with permission: http://www.rocketlabusa.com)

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Let the children take us to space

A wound in the scientific body: a hypothesis

The social and professional media have had a field day with Sir Tim Hunt’s comments concerning women in the lab. Juxtaposed with that in New Zealand has been a very earnest discussion about the gagging of scientists. The purpose of this post is simply to highlight that the two are not unrelated and how we handle one affects the other.

A wound (source wikicommons: https://commons.wikimedia.org/wiki/File:Wound_sewed.jpg)
A wound (source wikicommons: https://commons.wikimedia.org/wiki/File:Wound_sewed.jpg)

The reaction to Sir Tim Hunt’s comments has been swift and brutal. It amazes me how 140 characters or a couple of columns in a newspaper cannot only hang, but draw and quarter. It also amazes me how swift such judgment can be without recourse to gathering all the evidence first. The issue of bigotry and bias against women in science are very real and very felt. I do not intend to re-litigate any of those issues. It is the brutal nature of the response that concerns me. Not only has one man been thoroughly lambasted in every corner of the world – something of an overkill – but with him so have vast numbers of others been lambasted as the epithets have spilt over to include whole generations of male scientists. I have also noted a bigoted reaction to those condemning Sir Tim Hunt, equally replete with pithy epithets that do nothing but to wound, raise hackles and expose one’s own prejudices.

What has this to do with gagging of scientists? Simply, that it raises the fear index for anyone thinking of making public comments. I was speaking with a very well accomplished scientist the other day who will not speak to the media about their own work because of the very negative reaction of colleagues when they once did so. I hypothesise that following the response to Sir Tim Hunt’s comments, and the response to that response, that there are scientists who are thinking twice about publically speaking out on their science let alone on a controversial issue – a.k.a. self-gagging. The wound is deep. It must heal, because without those voices then the public debates about such issues as sea level rise, euthanasia, medicinal cannabis, science education etc will be all the poorer for the absence of those voices. The missing ingredient, the only known treatment for the wounds that have appeared, is compassion and forgiveness. Not terms that normally appear in the scientific literature, but universals that can alone heal the wounds and lift people up to where they can empathise with others irrespective of race, sex or creed.

A wound in the scientific body: a hypothesis

Send them home

New Zealand is the home of Home Haemodialysis and Christchurch the hub. Sending people home to dialyse is not only more convenient for them and more cost effective, but also has been shown to reduce mortality.  However, is this reduction in mortality sustained across changes in dialysis medicine over time?  This is an important question as Home Haemodialysis is now being considered seriously in many jurisdictions across the world.  The question was recently addressed by Dr Mark Marshall and colleagues across New Zealand and Australia in an article which appeared online ahead of print a couple of weeks back in the American Journal of Kidney Disease (see here, sadly behind a paywall).

What they did

Step 1 was to extract data from 1998 to 2012 from the Australia New Zealand Dialysis & Transplant Registry which prospectively collects information for all long term renal replacement therapy patients. This is a very important registry and the study highlights the importance of keeping data in this way.

Step 2 Placed patients into one of three time periods according to when they started their dialysis: 1998-2002, 2003-2007, 2008-2012.

Step 3: Identified the exposure of the patients to one of: Facility lead haemodialysis (facility HD), Home haemodialysis (home HD), or Peritoneal dialysis (PD).

Step 4: Compared rates of death for patients starting in each time period for each of the dialysis modalities after accounting for age, sex, ethnicity, primary kidney disease, and glomerular filtration rate at the start of therapy (ie how well the kidney was functioning).

What they found (with my commentary)

there is demonstrable survival benefit associated with recent era irrespective of the landmark initiation time.

Indeed, it was a 25% lower (adjusted) mortality for those starting dialysis in  2008-2012 compared to the 1998-2002.

Well done kidney docs – they are getting better and keeping people alive.

There is significant effect modification by modality [type of dialysis] (P <0.001), and separate models were developed in each subgroup: there is a 23% corresponding reduction for those on facility HD therapy, a 29% reduction for those on PD therapy, and a 46% reduction for those on home HD therapy

In other words, all things being equal, survival was improved more on home haemodialysis than either of the other types.

Hazard ratios for death according to era and mode of dialysis.  Lower numbers are better!  From: Marshall, M. R., Polkinghorne, K. R., Kerr, P. G., Agar, J. W. M., Hawley, C. M., & McDonald, S. P. (2015). Temporal Changes in Mortality Risk by Dialysis Modality in the Australian and New Zealand Dialysis Population. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. doi:10.1053/j.ajkd.2015.03.014
Hazard ratios for death according to era and mode of dialysis. Lower numbers are better! From: Marshall, M. R., Polkinghorne, K. R., Kerr, P. G., Agar, J. W. M., Hawley, C. M., & McDonald, S. P. (2015). Temporal Changes in Mortality Risk by Dialysis Modality in the Australian and New Zealand Dialysis Population. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. doi:10.1053/j.ajkd.2015.03.014

I note patients were only around 60 years old on average when they first initiated dialysis, yet 37% died before the end of the study period or could receive a transplant.  Folks – do your damnedest to avoid kidney disease – starting with avoiding diabetes.

Conclusions

  1. Survival has increased during the past 15 years
  2. Survival of peritoneal dialysis patients has increased more than facility haemodialysis patients
  3. The relative survival of home haemodialysis patients has improved the most

Has home haemodialysis caused people to survive longer?  This study can’t say, because it is an association study not one set out to demonstrate causation. However, it is evidence that supports the continued use and possibly even expansion of home dialysis in New Zealand and Australia.

For further reading, refer to the paper itself:

Marshall, M. R., Polkinghorne, K. R., Kerr, P. G., Agar, J. W. M., Hawley, C. M., & McDonald, S. P. (2015). Temporal Changes in Mortality Risk by Dialysis Modality in the Australian and New Zealand Dialysis Population. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. doi:10.1053/j.ajkd.2015.03.014

Send them home

Christchurch has breast cancer research hub

Guest post by: Kim Thomas, Communications Manager at the University of Otago, Christchurch

Research Radar UOC

A team of specialist cancer researchers have joined forces to focus on the impact of obesity on breast cancer.

The researchers all work at the University of Otago, Christchurch’s Mackenzie Cancer Research Group. The Group is headed by Canterbury District Health Board oncologist Professor Bridget Robinson, a breast cancer expert.

Researchers Associate Professor Gabi Dachs, Dr Margaret Currie and Dr Logan Walker have previously investigated various aspects of cancer but decided to team up and focus on the significant health issue of obesity.

Associate Professor Dachs says that international studies have shown breast cancer patients who were obese before or after diagnosis are less likely to survive than patients with normal BMI. Risk of dying from breast cancer increases by a third for every increment of 5kg/m2 in BMI.

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From left to right: A/Prof Gabi Dachs, Dr Margaret Currie, Dr Logan Walker

The three researchers are investigating different aspects of obesity and breast cancer:

  • Associate Professor Dachs is looking at molecular factors associated with obesity in cancer, particularly how fat cells communicate with cancer cells and negatively affect them.
  • Dr Margaret Currie is putting fat and breast cancer cells together to see how the fat cells make tumours more resistant to treatment. She suspects the fat cells provide ‘an extra energy hit’ to cancer cells by providing lipids, or fats, in addition to glucose.
  • Geneticist Dr Logan Walker will investigate whether the obesity-related gene responsible for the amylase enzyme in saliva (AMY1) contributes to breast cancer development. He will also explore the role of key genes that behave differently in breast tumours from obese women.

The researchers’ work is funded by the NZ Breast Cancer Foundation, the Cancer Society of New Zealand, the Canterbury and West Coast Division of the Cancer Society NZ, the Mackenzie Charitable Foundation and the University of Otago.

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Christchurch has breast cancer research hub

What is your number?

Last night I had the honour to speak following the AGM of the Canterbury Medical Research Foundation (CMRF).  The CMRF are a fantastic organisation I’ve talked about before.  They are also one of three sponsors of my current research fellowship.  What I talked about was volunteers and clinical trials.  Two days ago the world celebrated Clinical Trials Day in honour of James Lind who in 1747 took some men aboard a ship and started to feed them citrus fruit to see if the Spanish (who had less scurvy than the British) were on to something.  I don’t know if he used volunteers or not, but I do know that since then millions of people have volunteered to be part of clinical trials.  I salute those volunteers.  I work with people who present to the Emergency Department with chest pain or are seriously ill in the ICU.  These people are vulnerable, often scared, and are asking “Am I having a heart attack?”  Yet, despite this, when approached and asked to participate in a trial they very rarely say no.  This shows to me an incredible generosity of spirit & a heart-warming willingness to do something for someone else, even when that someone else is a mythical patient some time in the future.  I salute those volunteers.  They are my heroes.

I didn’t record the talk last night, but have tried to reproduce it this morning and present it to you now. Click HERE to access from Researchgate. It is not the same as with an audience as some of it was interactive.  However, I hope you enjoy it.  It is about 20 minutes long (100Mb) and deliberately targeted at a lay audience.

logos w uni

What is your number?

Ten Commandments of PowerPoint™ presentations

In my “most cringing” file, ranking somewhere alongside brussel sprouts and Abba, are PowerPoint(TM) presentations that are unreadable and distracting. I have made it my mission to rid the world of annoying animation, fantastic fonts, garrulous graphs, and tortuous tables. The following are my commandments – ignore them and dreadful things will be visited on your presentations to the tenth generation, follow them and you will be showered with the blessing of satisfied audiences the world over.

  1. Thou shalt have no other PowerPoint but the compatible version

Make sure the version of PowerPoint you are producing your presentation on is compatible with that being used at the conference. Mysterious disappearing images and font changes can occur otherwise.

  1. Thou shalt not make thyself animated images

Little creatures running across the screen are no longer cute – just annoying. Everyone has seen them before. Furthermore, they have the disturbing habit of crashing programs. If you are new to PowerPoint they may excite you – do not fall into temptation.

  1. Thou shalt not sully a slide with masses of graven clipart

Any image displayed should be illustrative of a point being made. Rarely should one use more than one image per slide. Too many images are a distraction to the audience.

  1. Remember to contrast text and background and keep it sharp

Light coloured fonts must be on very dark backgrounds and vice-versa.   Yellows on pale blues, for example, are usually not visible when projected. Remember, the projector screen is going to have lights shining on it – so it will be much duller than your computer screen. A test is to try and read your computer screen from 5 or more meters away.

  1. Honour thy audience

This commandment requires you to consider your audience and their needs.   They can only take in “so much” information, so keep the number of PowerPoint slides to a minimum – no more than one per minute of presentation (preferably one per 3 minutes). Present your name and who you represent on the first slide (so they know they are in the correct room). Don’t display your full letterhead on every page. Be careful not to display images of half dressed women or cartoons that may offend someone in the audience.

  1. Thou shalt not write screeds of text

As a rule of thumb – No MORE than 6 or 7 lines of text per page. Unless there is a need to quote something AND for the audience to read that quote, then do not write paragraphs. Keep the text simple and short (bullet points). Remember – the text is to illustrate what you are saying and provide a skeleton to hang your points on. The text is NOT the presentation.

  1. Thou shalt not display small fonts

All fonts should be 24pt or above. It may look large on your computer screen, but to someone sitting 10 or 20 metres away from a projection screen it will be the equivalent of a 10 point font in a book.

  1. Thou shalt not display serif fonts

Serif fonts are those like Times New Roman or Garamond that tend to get thinner in the middle of the letter. These are good for reading on paper, but NOT for projecting as they are much more difficult than the non-serif fonts like Arial or Verdana to read. Also, only use the most common fonts that all computers are likely to have as you may find your favoured font is not displayed as you expect. Furthermore, avoid italics and any hand-writing fonts – they can’t be read.

  1. Thou shalt not use images as backgrounds

Images behind texts nearly always make the text difficult to read. Don’t do it.

  1. Thou shall at all times and everywhere minimise the use of graphs and tables and shall only display the necessary information

Alas, this commandment is one that is broken time and again. Any lines on graph must be AT LEAST 3 pt, preferably 5pt thickness. All axes must be labelled (preferably 24 pt). Put on the graph ONLY the data that you are going to speak about. If you are going to talk about a specific data point then put a large red circle around it. Similarly with tables – display ONLY the data you will talk about. You will find that you can’t fit more than about three columns and 4 rows of a table. If you have to, split the table up over a couple of slides. Alternatively, provide the full graphs and tables as handouts. Presenting graphs and tables that cannot be read easily by everyone in the room will irritate your audience and to fail to communicate.

In all that you do, remember that PowerPoint is but a tool to support your voice and your message. You should always be prepared to deliver your presentation if, for some reason, the PowerPoint projector fails.

Here endeth the lesson

John W. Pickering (C) 2005

Ten Commandments of PowerPoint™ presentations

Major government health directive monitored for efficacy and safety

Last year I was fortunate to become part of a team at Christchurch hospital led by emergency care physician, Dr Martin Than. About 7 years ago in response to some local issues with how patients presenting with chest pain were being evaluated for potential heart attacks, Dr Than began a research program that investigated what clinical, demographic, and biological (blood) factors could best be used to safely and efficiently rule-out a heart attack.

Someone turning up at the doors of the Emergency Department with chest pain desperately wants to hear those reassuring words “You are not having a heart attack.” Unfortunately, for the ED staff this a very difficult conclusion to come to rapidly. As a result, around the world, as many as 90% of patients being assessed for possible heart attack end up being admitted to hospital overnight or longer, although only 20% of them end up being diagnosed with a heart attack. Obviously this is not good for the patient or the hospital – especially given tight budgets and lack of bed space. Dr Than’s work addressed the problem with a large multi-national observational study which assessed if a decision making pathway (called an accelerated diagnostic pathway or ADP for short) could increase the proportion of patients who could potentially not be admitted to hospital instead referred for some outpatient testing(1). This was further refined in another observational study which reduced the number of blood biomarkers that needed testing(2). Finally, and uniquely a randomised controlled trial of the new ADP verse standard practice was run at Christchurch Hospital. This was very successful, nearly doubling the proportion of patients who could be discharged to outpatient care within 6 hours of arriving in the ED(3). More has been done since on refining the ADP … but that is for another post.

The Ministry of Health liked what they saw as did ED physicians and Cardiologists throughout the country. This has resulted in the MOH asking all EDs within New Zealand to implement an accelerated diagnostic protocol. In doing so they will join all of Queensland, and a sprinkling of hospitals throughout the world that have recently adopted an ADP. This kind of positive outcome to local research is what every scientist dreams of, and Dr Than and his team have a right to be proud. But wait, as they say, there is more. Thanks to a Health Innovation Partnership grant from the Health Research Committee we are able to put in place a mechanism to monitor the effect and safety of an ADP at eight hospitals around New Zealand. This is where I come in, as I am collecting, collating and analysing the data for this project.   It is very exciting to be involved not only in helping implement a change of practice, but to be able to assess if that change is effective across a range of New Zealand hospitals from major inner-city hospitals to small rural hospitals, each of which has to adapt an ADP to meet their own particular circumstances. As I write Middlemore, North Shore, Wellington, Hutt Valley, Nelson and Christchurch hospitals all have new ADPs in place. Most if not all EDs will have them by the end of the year.

Some of where accelerated diagnostic pathways have been implemented.
Some of where accelerated diagnostic pathways have been implemented.

The model of observational research -> randomised controlled trial -> local implementation with further research -> mandatory national implementation -> research the effect of that change on local and national levels -> refine processes etc, is I believe a very good one and one that should be standard practice for major health initiatives. The MOH, HRC, and various district health boards that have bought into this process should be commended. There are other similar initiatives happening around the country and a look forward to when as a health consumer I can have confidence in any procedure I may face as been similarly thoroughly assessed.

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Thanks to my Acute Care Fellowship sponsors: Sponsors

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and to the grant funding body:

HRC

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References

  1. Than, M. P., Cullen, L., Reid, C. M., Lim, S. H., Aldous, S., Ardagh, M. W., et al. (2011). A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study. Lancet, 377(9771), 1077–1084. doi:10.1016/S0140-6736(11)60310-3
  2. Than, M. P., Cullen, L., Aldous, S., Parsonage, W. A., Reid, C. M., Greenslade, J., et al. (2012). 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. Journal of the American College of Cardiology, 59(23), 2091–2098. doi:10.1016/j.jacc.2012.02.035
  3. Than, M. P., Aldous, S., Lord, S. J., Goodacre, S., Frampton, C. M. A., Troughton, R., et al. (2014). A 2-hour diagnostic protocol for possible cardiac chest pain in the emergency department: a randomized clinical trial. JAMA Internal Medicine, 174(1), 51–58. doi:10.1001/jamainternmed.2013.11362
Major government health directive monitored for efficacy and safety