Medway research recognised globally

A recent research article from the Urinary System Physiology Unit entitled Sympathetic nerve-derived ATP regulates renal medullary blood flow via vasa recta pericytes (published in October 2013) has been highlighted by the Nature Publishing Group and Frontiers (High Quality Open Access Publishing and research Network) as being one of the ‘the best performing articles in Frontiers’ of all time.

An analysis of article impact shows it is being frequently accessed and downloaded worldwide, most notably in the USA, China, Canada, Germany and India. The impact demonstrates the important and internationally recognized research being conducted in the School.

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iBSc Management in Primary Care

This one-year intercalated BSc in Management in Primary Care is designed for medical students who want to prepare themselves for working in primary care and community, public health or management.

The course modules are designed to help students develop critical appraisal skills and knowledge of research methods, as well as how to effectively manage a health care organisation. The ability to effectively manage organisations and make difficult decisions around budget allocations is more important than ever with the creation of the Clinical Commissioning Groups.

For more details see the Kent Undergrad courses 2015 page

A flyer is available – pdf format

For informal enquiries please contact:
Dr Rowena Merritt
T: +44 (0) 1227 816086
E: r.k.merritt@kent.ac.uk

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Scholarships at the Tizard Centre

The Isabel Schwartz Scholarship:  The Tizard Centre are delighted to announce that they will once again be offering this scholarship to a student accepted on one of our Master’s programmes in intellectual disabilities, autism or applied behaviour analysis.  The scholarship will pay the equivalent of Home/EU student’s fees and possibly some additional expenses.  Preference will be given to candidates who have a professional qualification in social work and/or an established interest in the area of forensic issues/secure services.

To apply for this scholarship you will need to write 3 paragraphs covering the following points:

  • what do you know about people with intellectual disabilities in the criminal justice system and the difficulties they face?
  • your relevant experience/background, clinical or research based, with offenders with intellectual disabilities.
  • why do you think you are the best candidate for this scholarship?

Please email your application to Vivi Triantafyllopoulou (p.triantafyllopoulou@kent.ac.uk) by the 26th September 2014.

Edward Newell Scholarship:  This year we will also be offering a second scholarship which is open to students on one of our master’s programmes in intellectual disabilities or autism.  The scholarship will help to pay for travel costs for any student choosing to complete a dissertation comparing the UK and France in relation to carers of people in autism.  To apply for this scholarship you should register your interest with Rachel Forrester-Jones (r.v.e.forrester-jones@kent.ac.uk) by 26th September 2014 with your ideas for the dissertation.

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Hope for those with visual loss

Together with NHS Greater Glasgow and Clyde, a leading Scottish medical technology company, Optos plc, and Strathclyde University, Kent researchers will help develop a new laser technology which will be able to monitor the functions of cells in the eye.

This new technology is aimed at detecting and monitoring eye disease at a very early stage. The research will create a new device which will be at the forefront of the fight to detect early visual loss.

The team at the University, led by Professor Adrian Podoleanu in the School of Physical Sciences, will provide expertise on optical coherence tomography (OCT). This builds upon its extensive research activity on imaging the eye, including being the first to demonstrate a transversal OCT image of the eye on a human in 1997.

The first clinical studies will involve the leading causes of blindness (Age-Related Macular Degeneration, Glaucoma and Diabetic Retinopathy) and are due to be completed by early 2017.

The research has been awarded £1.1m from Innovate UK and Optos to develop the new imaging technology that could show eye disease earlier than current devices can.

A successful outcome will see a further £9m invested to develop a fully licensed medical device by the end of 2018.

For more information contact Katie Newton.

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Final Week.

During this final week I was given the job of recruiting new participants. I really enjoyed this aspect of my clinical research experience- I spent most the early part of the week making a recruitment poster to inform potential new participants. I wanted to make sure the poster looked to have the right format and included all the relevant information; therefore, before I started to design the poster I did some research on existing posters that advertise various different studies. This really helped me to form a foundation, as before this I had no previous experience in designing posters of this kind. I wanted to convey the correct message to the potential participants, and ensure the best possibility of optimum recruitment.

On Wednesday me and Kyra had a meeting to discuss the progress of recruitment and to review my poster work. Kyra was really impressed with my poster and how professional it looked, this gave me great confidence for when I come to recruiting for my own study. Only a few minor amendments were suggested- I could see how they would improve my design so I was really glad to have Kyra’s critical analysis; Kyra is much more experienced in this field than myself. Before I could use this poster to recruit new participants it had to be submitted for ethical review, this was something I had not contemplated and was glad to be made aware of. Even though ethical review had been granted previously, any new additions had to be put through the same process.

Whilst waiting for ethical approval of the new poster, I decided to research new places in which I could recruit new participants. This would then mean that as soon as ethical approval has been given to the poster, I can go straight to these places and use my time efficiently.

Towards the end of the week myself and Kyra had another meeting to have a ‘handover’ of all the work I had done during this 6 week period. It was really important I gave Kyra all my work and explained how each bit related to the study- this will avoid any misinterpretation of my work and save Kyra time when reviewing my work. As we were going through all the work I felt a real sense of achievement, and felt proud of the fact I had helped contribute to the research process of this study. Kyra made sure I knew my efforts were appreciated and explained how she was going to use each different bit of my work- it was really good to see the overall way in which my work was going to be incorporated. Of course, I knew how each individual bit of work contributed- but it was really good to see the big picture and Kyra’s future plans.

As this is my last blog entry, I thought I’d take the opportunity to thank Kyra for this experience. I’m really grateful that the student vacation scheme is able to provide such exciting and unique opportunities for students. I would highly recommend applying for work experience like this as it really helps to develop a wide range of skills and I feel I have grown as a person in this 6 week period.

I hope you have all enjoyed reading my blog, I like to think I’ve provided you with a different insight into the clinical research process! 🙂

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Newsletter

Emergency surgery deaths alarm

 About 15,000 people a year die during emergency surgery according to Royal College of Surgeons (RCS) president Clare Marx. An excellent new briefing from the RCS sets out the main challenges facing emergency surgery and suggests some remedial actions for policymakers.
 
Around 1.2 million patients need emergency surgery of treatment every year. Emergency surgery accounts for about 80% of surgical mortality and there is widespread clinical variation. The RSC briefing sets out the variation in mortality following emergency laparotomies, which ranges from 4% to over 40%.
 
In KSS we have a track record of reducing that level of clinical variation quickly and have clinicians support and commitment to improve emergency laparotomy care.
 

Impact

 Patients that survive this operation often suffer post-operative complications and associated long stay in hospital. The effect on healthcare providers as well as patients should not be underestimated. According to the RCS, the “impact is felt beyond the emergency department; delays in emergency surgery can also affect patients undergoing planned surgery, for example, when planned operations are cancelled to free up medical staff for emergency work”. Improving emergency surgery will improve efficiency, reduce harm and shorten patient waiting times. A prize worth fighting for.

 

Scaling up improvement  

 In collaboration with other AHSNs in the South and West of England we plan to launch a project to improve outcomes after emergency laparotomy through the adoption and spread of an evidence based care bundle. The Emergency Laparotomy Pathway Quality Improvement care bundle has already been piloted at the Royal Surrey County Hospital (RSCH) – and three other hospitals outside KSS – and has led to risk adjusted hospital mortality rates reducing by 42%. The project will see this approach extended to at least 20 hospitals, from Kent to Avon, based on an approach that works with patients and their carers as partners in their care.
 
We have worked with RSCH and others to develop a bid for additional funding to the Health Foundation which has been shortlisted and, if successful, our intervention will allow hospitals to use their current performance data to develop strategies locally, to improve the quality of care delivered to patients undergoing emergency laparotomy. A reduction in hospital mortality is expected to follow. Our role is to develop and coach hospital teams to understand their performance and thereafter develop local solutions to problems in their own hospitals. This key educational aspect of our collaborative will allow hospitals to continue improving after this project is completed, or when circumstances in a hospital change that requires a new way of delivering care.
 
We anticipate the project launching its set up phase in early 2015. For more information, please contact Kay Mackay, Director of Improvement.
 
Kind regards,
 
Guy Boersma
Managing Director, KSS AHSN

 

KSS Patient Safety Collaborative: Proposal Paper for Consultation

 The paper explains proposals for the governance, operational structure and initial priorities for the Kent Surrey Sussex Patient Safety Collaborative (KSS PSC), seeking your feedback. There are some particular questions in bold throughout the document that we would appreciate your thoughts on in your response.
 
A feedback form is sent with this KSS PSC consultation document, please use the attached feedback form and send your comments on this proposal document by Friday 17th October 2014 to: s.wales@nhs.net

Free Intellectual Property Clinic – 8 October

If you have an Intellectual Property query and need assistance, you can come along to Venner Shipley LLP’s monthly free IP clinic on Wednesday 8 October and talk to Anton Hutter, Robert Cork and Catrin Petty of Venner Shipley, in confidence, at their Surrey Research Park office.

 
Further details about the clinic are available, here.
 
 

If you would like to publicise your Intellectual Property service, please send us your details.

 EU UK MALCOLM Dissemination and Consultation Conference

 
Date: Thursday, 16th October, 2014 
VenueOakwood House Hotel, Oakwood Park, Maidstone, Kent
Duration: 09:30 – 17:00 (10am start) 
Cost: Free to attend
 
This international, free to attend event will outline the latest market intelligence on the Assisted Living Capability in the coastal regions of South East England and Lower Normandy with a particular focus on the opportunities for businesses, academia, procurers and providers of health and social care. Delegates from the UK and France will gain valuable market insight, and learn: 
  • What the AL market looks like in Lower Normandy and the South East of England
  •  What are the regional opportunities for purchasers and providers
  •  Who commissions AL services/products
  • How businesses can respond to the opportunities identified in both regions

Places are limited so early booking essential

 
For more information and booking details, please click here.
 

NHS Innovation Challenge Prizes 

Applications for The NHS Innovation Challenge Prizes will be open from September 15 to November 7. It is a £650,000 prize programme that encourages, recognises and rewards innovations from the front line. Anyone working in or with the NHS is eligible to enter if they have an innovation that is proven, has the potential for spread and supports NHS England’s objectives.

 Designed with input from a wide cross-section of staff and stakeholders, this year’s challenges include diabetes, infection control, rehabilitation, use of technology and digital patient and clinician engagement. A series of targeted ‘acorn’ prizes will be awarded to small innovations with the potential to make a big difference.

 For more information, please click here.

 Involving hospital staff is key to implementing new technology

 During 2013-14, University hospitals of Leicester NHS trust (UHL) treated 1,194,000 patients (or 3,271 patients a day). With the numbers treated set to rise year-on-year, we need to better equip our staff to cope with the additional pressures that will bring.

 Like many trusts, our staff are feeling the pressure of the NHS constantly being in the media spotlight. The media focus is often on poor outcomes. It is almost forgotten that the vast majority of hard-working staff provide world-class patient care.
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Week 5- More scanning.

Today marks the end of a busy week scanning new participants for the study.

This week I played a much more active role in the scanning and communication with the participants. I got to help operate the ultrasound machine by freezing/clipping images and altering frequency, depth and gain of the scan in order to optimize the quality of the image. Before this experience, I did not realise that such variables could be altered according to each individual. Each individual has different morphology of anatomical structures, thickness of subcutaneous tissue etc. So taking images in pre-determined variety of settings enables us to produce at least one image of suitable quality for further analysis.
It took me a while to get used to the sequence in which buttons had to be pressed, but by the time the third participant had come in I didn’t need any prompt from Kyra!

As well as helping to operate the ultrasound machine, I took measurements and used a pen to mark specific areas on the lower back so Kyra can continue to place the probe in the exact same anatomical position on each participant. I took measurements such as the length of the probe head, distance laterally from each side of the probe head. I was quite nervous about this as I wanted to get accurate measurements so the positioning of the probe is correct.

I also learnt that you can get different viewpoints of internal structures, just by altering the plane of the probe. For example, if you position the probe parallel to the spine, you can gain a longitudinal view of the fascia and surrounding muscles. Whereas if you position the probe perpendicular to the spine, you can gain a transverse view of the fascia and surrounding muscles. I found the transverse view particularly interesting, as you can gain a bird-eye view of the vertebrae in the spine. Even with my limited experience in ultrasound imaging I could point out all the different structures of the vertebrae including: the spinous process, transverse process, foramen, lamina and pedicle.

With regards to the focus groups more work has also been done in this area. Using excel I grouped the data according to the scores of organisation, and using an excel formula I used Pseudo-Randomization to gain a number of scan samples from each score category. These randomized scan pictures were then put into a folder, ready for the focus group to analyse. During this process I realised the importance of avoiding bias and having solid, consistent methodology when randomly selecting samples from data. The fact we took a selection of samples from each score category meant that we avoided the most common scores becoming a majority of the scans for the sample group. We also selected a slightly different number of samples from each score category depending on size.

Next week a majority of my time will be spent on a completely new task involving the recruitment of new participants. This will give me yet another viewpoint on the organisation of a study and challenge me with regards to explaining the study in a format people will understand, making sure bias is avoided when recruiting, and finding places to promote the study.

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Week 7: Technicians, Labs and more statistics

I’ve been continuing work on the manuscript and the descriptive statistics while we await the full analysis from the statistician.

Tuesday I spent the day with the technicians at K&C Hospital. As someone who is isn’t very good with technology or the practical side of most things I wasn’t entirely sure what to expect! However, I really enjoyed it and felt like I took a lot of it in. We started by looking at the current dialysis machines that are in use, seeing the principles behind how they work and all the components that contribute to this. There are 2 different machines currently used.

We looked at the machines that were used in the 70’s through to today and it was amazing to see just how far technology has come in such a short space of time and how this benefits the patients.

I was shown the water purification room where water is cleaned and processed before being used. The discarded water is then recycled by using it in the laundry rooms or other areas, as it’s not at all dirty, just not of a standard high enough for using in dialysis.

The dialysis machine itself is much like a computer, with circuit boards and switches inside. It looked more complicated then I was expecting, but maybe that’s just my untrained eye! I was shown the equipment used for home dialysis and watched as a technician repaired one of the broken machines.

Whilst I was there they received a quote for the new dialysis machines they’d hoped to get (they last roughly 7 years). For 17 machines it was a quote near £250,000. Very expensive!

 

Wednesday I went to William Harvey in Ashford for the day. This was to spend time in the Microbiology labs. All of the microbiology for East Kent is done here, so it was busy as you can imagine. After a quick tour of the place as a whole I spent time in the different departments. They have multiple labs, specific for work in each area, such as Serology, Virology, Molecular, Urine analysis, Enterics, Bacteriology and General Microbiology. Much like the biochemistry lab that I spent time in the samples are received at the reception, labelled/barcoded appropriately and then added to their computer system.

First I spent time in the serology lab just getting an overview of the process. Of all the labs I saw this was most like the biochemistry lab with lots of automation. The test took longer and the machines were more expensive, but the principles were almost the same.

Next I spent time in the Molecular lab where genetics is used to determine the pathogen (if there is one) in the sample received. This is extremely accurate and will no doubt be the future, however, it’s time consuming and very expensive. The work is almost completely for respiratory diseases (at the moment). Fluid is collected, diluted and spun down, the dna is extracted, amplified using PCR and then run on electrophoretic gels and a photo taken of the gel to give the results. There are around 15 pathogens that are looked for, such as Influenza A and B. It was really interesting and a process I understood from practical’s I’d carried out at in year1/2 of Uni.

During the lunch break I attending a meeting which was discussing protocol for if something goes wrong, how its right to deal with and finding the root cause of the problem. It was sort of a group exercise to make sure everyone understood the process and why it had to be carried out.

I spent the afternoon in the General Microbiology lab which I loved. They receive samples that could be fluid or tissue. After being labelled and entered onto the system appropriately they are dealt with in the right manor. For example, you have to decide using the sample and any data that might have been given about the patient to decide which plates you need to use, if you need microscopy or staining etc. I really liked this element of it, there seemed much more variety in the work than in the Biochemistry labs. For example whilst I was there, I looked at CSF (urgent) fluid under the microscope to count the white blood cells that were present, I saw TB in a sample under the microscope, and also the difference between bacterial vaginitis and normal vaginal flora. I saw tissue from a voice box, a man’s knee and a lady’s hip and how these would be analysed. The majority of samples are spread on the appropriate plates and then left to culture, and be analysed. The microscopy results can be sent back straight away. If a tissue sample has come from someone who is post op, or had tissue taken from deep beneath the surface they will have an additional plate that is cultured in anaerobic conditions, as it would be inside you, for example your gut flora. Other plates used are chocolate, maconkey, blood agar, agars that are specific for staph. Aureus or mrsa.

MRSA screening is done on anyone who is due to have surgery or anyone that has a prolonged stay in the hospital and they therefore create a bulk of the work in this section of the lab. The swabs are spread on plates and cultured, along with a positive control. If MRSA is there the colonies, which are very rounded, grow a blue colour. All the plates are looked at, an empty plate is a negative but also a few other things can grow on the plates that are not MRSA so you have to know what you’re looking for as its only MRSA that you are interested in.

Sexual health swabs make up a large amount of the work load too, testing for chlamydia and gonorrhoea primarily. I was told by one of the BMS’s, who had worked in this field for ~30 years, that around 20 years ago when he carried out chlamydia tests, a good rate would be to get 8-10 done weekly. Now with the advances in technology the machines carry out hundreds of tests each day!

I also managed to speak to some of BMS’s about how they got to this position as it’s something I’m really interested in and considering as a career option. I had a brilliant day and would love to work in a place like that so it was great for me to gain that little bit of experience and a taster of what day to day work as a Biomedical Scientist would be like. My favourite day of the placement so far!

 

Sorry this blog is extra-long! Only 1 week left now! Hoping to get the statistical analysis back so we can go full steam ahead with the discussion and get as much done as we can before my last day.

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KSS AHSN Newsletter – 19 September 2014

Better together

Last weekend the Independent on Sunday reported that the number of councils no longer helping adults assessed to have moderate or low needs has risen by 17% in five years. That’s according to a survey of social services leaders carried out by the Association of Directors of Adult Social Services. It also cited separate research by the London School of Economics showing that half a million people who would have qualified for care in 2009 are no longer entitled.

For many people working in health and social care, this will confirm their own perceptions. But this is not simply a social care issue. It’s a growing challenge which needs everyone working for the well-being of older people to collaborate on addressing.

Combination

Last week I wrote about the Barker Commission’s findings. In particular, their report advocates the combining of health and social care commissioning. That is just one approach to addressing a major challenge for the current system. The underlying message – however it’s achieved – remains that health and social care budgets need to be allocated to maximum effect.

This almost certainly means investing in out of hospital care – regardless of whether it’s labelled “health”, “social” or “domiciliary” care.

Social investments

There’s some great examples from Kent, Surrey and Sussex of work already underway. The First Community Health and Care (FCHC) Council of Governors has created a community development fund. FCHC works closely with Redhill and Reigate YMCA and has additionally used the fund to support the charity financially. Going forward, it intends to sustain the fund by using retained profits held in reserve to donate to local organisations.

These and other local initiatives are undoubtedly moves in the right direction. The challenge is how we capitalise on them as wide and fast as possible. For many long-term conditions, there is increasing emphasis on care at home and we should not forget that integration needs to empower care givers in all settings to deliver good outcomes; they need to be on the inside and not treated as another separate “provider”. Social investment can have a significant role here.

The key principle as ever is building services around the service user. It’s crucial that the individual interests of separate organisations don’t impede progress. Supporting the integration agenda as part of our focus on the care and well-being of older people is an area in which KSS AHSN can add value. By supporting existing networks to collaborate more closely and sharing best practice more widely, we will help bring the benefits to more KSS residents more quickly.

Hold the date

Just a reminder that the date of our EXPO and awards is 13 January 2015. I look forward to sharing more information with you shortly.

***

KSS Patient Safety Collaborative: Proposal Paper for Consultation

The paper explains proposals for the governance, operational structure and initial priorities for the Kent Surrey Sussex Patient Safety Collaborative (KSS PSC), seeking your feedback. There are some particular questions in bold throughout the document that we would appreciate your thoughts on in your response.

A feedback form is sent with this KSS PSC consultation document, please use the attached feedback form and send your comments on this proposal document by Friday 17th October 2014 to: s.wales@nhs.net

NHS and PHE South Region’s sustainability conference: Putting Sustainability into Practice

Where: Reading Town Hall, Blagrave Street, Reading RG1 1QH
When: 10.00 – 16.00 on Wednesday 1 October 2014

The overall aim of this event is to share good practice and inspire us to new more sustainable ways of working and living.

The day will include participative workshops on the topics below:

  1. Adaptation and Resilience
  2. JSNA – sustainability chapter
  3. Pharmaceuticals and Medicines – green bags, inhaler recycling
  4. Optimising Social Value
  5. Commissioning and Procurement
  6. Active Transport
  7. Sustainable Carbon Emissions – measurement and modelling of carbon for providers and commissioners
  8. Health Co-benefits – making it real

To apply, please click here or email Georgina Dove: georginadove@nhs.net

NHS Innovation Challenge Prizes

Applications for The NHS Innovation Challenge Prizes will be open from September 15 to November 7. It is a £650,000 prize programme that encourages, recognises and rewards innovations from the front line. Anyone working in or with the NHS is eligible to enter if they have an innovation that is proven, has the potential for spread and supports NHS England’s objectives.

Designed with input from a wide cross-section of staff and stakeholders, this year’s challenges include diabetes, infection control, rehabilitation, use of technology and digital patient and clinician engagement. A series of targeted ‘acorn’ prizes will be awarded to small innovations with the potential to make a big difference.

For more information, please click here.

The Sir Jules Thorn Award for Biomedical Research

One grant of up to £1.5 million is offered annually to support a five-year programme of translational biomedical research selected following a competition among applicants sponsored by the leading UK medical schools and NHS organisations.

UK medical schools and NHS organisations are eligible to submit one application annually.

Prospective applicants should note that:

  • The closing date for Preliminary Applications is 3 October 2014
  • Only one application per institution is permitted
  • The Award may not be used for Cancer or HIV/AIDS related research.

For more details, please click here.

Future of Health Conference 2014

UCLPartners is joining with NHS England and Dods for the second year running to host Future of Health. The national conference won Event of the Year at the British Media Awards in 2014 for setting the pace of change for long-term conditions, multi-morbidity, and integrated care.

Future of Health will be attended by:

  • NHS England Board Members
  • NHS England National Directors
  • Chairman/Directors from Clinical Commissioning Groups
  • Directors from Commissioning Support Units
  • Directors from Health and Wellbeing Boards
  • Public health/long-term conditions leads from local authority and acute trusts

Future of Health will be an action platform for primary, secondary and tertiary care to join with social care and charities and industry experts to shape the future of person-centred, coordinated care integrated, patient-centred healthcare.

For more information and to register please visit: www.futureofhealth.co.uk

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Week 4- Data Entry.

This week has been quite a pivotal week – plans have put into motion to begin the next stage of research, its also been very rewarding as I finished a job I had been doing throughout the last couple of weeks.

As I approached mid-week I managed to finish analysing all the scans I had been given last week. This meant we were now ready to start putting plans into motion to have a focus group analysing a small selection of the scans id looked at… this will help us to finally establish whether there is a correlation with pain; something both me and Kyra are very interested in discovering. But before the focus group can take place, we need a systematic way of grouping the scans according to their score, to gain a varied selection for further analysis. This involved me having to input the score for each scan onto a database- Thankfully this job was so much quicker than actually analysing the scans! We hope to have begun contacting people for this focus group by early next week.

Wednesday was a fascinating day as I got to go to the second annual Medway Research Festival with Kyra. This was a valuable opportunity for me to meet researchers from Universities of Kent, Greenwich and Canterbury Christ Church. This was a great Networking event for many of the academics- As I am an undergraduate, I used this as a chance to walk around and see what other innovative research is being done on campus. It really inspired me as a student and I loved looking at modern technology such as the 3D Printer and new equipment designed to help surgeons perform customised knee surgery. I left the research festival feeling proud to be part of a university that collaborates with other universities to help to produce such amazing research. Attending the festival made me realise that researchers (like the academics on campus) need to do their work so steps can be taken for the world to evolve and grow. I felt quite shy as a student regarding networking with all the academics, but I gained so much from observing each stall-the variety of research was huge… from sustainability research to mental health research. I definitely hope to have the opportunity to attend similar events in the future- hopefully in more of a position as an experienced academic to network.

Towards the end of the week I developed my knowledge on current fascia research and it’s anatomy by watching some DVDs with lectures from leading world experts. I found this very useful, as information I struggled to understand in some journals became clear when hearing the authors talk about their work in a different way. I loved the passion they had for their area of expertise, this exercise bought clarity to my current knowledge of Fascia and its role within the body.

I also got to witness an ultrasound scan being performed on a new participant. New participants are being recruited from another study involving a strength and conditioning programme, so Kyra can see the impact that it has on the Thoracolumbar Fascia. Observing Kyra communicating with the client showed me that it was important to allow the participant to feel engaged with the research and allow them to feel in control as the participant. Kyra educated the participant at the end of the scan as to what the different structures were on the ultrasound. I was really impressed with Kyra’s ability to identify the different structures on the ultrasound, and accurately count the different vertebrae of the spine to reach the correct level. She also showed me how even a slight change in pressure through the probe can change the whole look of the scan- through this I gained a new appreciation of the complexity in operating the ultrasound machine. Now I have observed one session of data collection, I hope to play a more active role in the next one in terms of communicating with the client and explaining the reasons for this study.

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