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Academic Evening 2 - 9th July 2024

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Summary

Join recent university graduate Joshua and third-year medical students Jade and Taika for an academic evening session, where they introduce the National Medical Research Association (N Mra) and delve into exciting medical student research projects. As the newly appointed head of operations for N Mra, Joshua describes the association's mission to guide medical students in their research endeavors, and the different opportunities the association offers, like mentorship schemes and academic evenings. Presenters are given the chance to share their research projects, followed by a Q&A session. For this academic evening, they're joined by Sidney, a fourth-year medical student at the Anglia Ruskin University who gives an enlightening presentation on hepatocyte transplantation in children with liver diseases. Attendees can engage in discussions and have their questions answered in real-time, making this an interactive and educational experience for all medical professionals.
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Description

The National Medical Research Association (NMRA), established in 2022, is a student-led non-profit dedicated to equipping UK students and trainees with foundational skills in medical research. The organization aims to remove barriers to research entry by advocating for students in research environments and creating opportunities for both students and doctors. Through educational events, a mentorship program, and various resources, NMRA provides members with the skills, network, and confidence necessary for pursuing medical research.

We are hosting an online "Academic Evening" where you will have the chance to showcase the research you have been involved in. We welcome anyone to submit, at every stage of their career, and who has participated in any type of project - from preclinical to systematic reviews.

Everyone who will be selected will get the chance to provide a 10-minute informal presentation about their research and their journey in developing their project, receiving a certificate for their contribution, and the opportunity of getting involved with more projects or events with the NMRA.

Learning objectives

1. Understand the formation, objectives, and activities of the National Medical Research Association (NMRA) and explore how it provides resources and support to medical students and healthcare professionals. 2. Gain insights into the process and benefits of presenting and discussing medical research and understand the importance of developing a strong research network. 3. Analyze and discuss research projects presented by the speakers, focusing on their rationale, methodologies, findings, and implications for medical practice. 4. Participate in Q&A sessions, and critically reflect on different research topics, fostering a culture of inquiry and open discussion. 5. Learn effective strategies to increase involvement in medical research and explore opportunities provided by the NMRA, including mentorship schemes and educational sessions.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Ok. Hi, everyone. Thanks so much for coming. Just wanted to thank you all for attending tonight's academic evening. My name is Joshua. I'm a recent graduate of university, um the newly appointed head of operations um for N Mra and I'm also joined by I'm Jade. I'm on the events team. Um I'm a third year medical student at the University of Sheffield and I'm Taika. I'm a third year medical student at Queens University of Belfast and I'm the General Secretary of Mra this academic year. Perfect. And yeah, we just wanted to start off by working you all and also sharing a quick overview of like the plan structure of events for tonight. So we're gonna start off by introducing mm Mra and briefly discussing the structure of the society and its aims. After this, we'll launch into our four presentation today which each speaker being allocated around 10 minutes uh delve further into their chosen research projects. We've had a lot of great research projects sent to us and it was some tough decisions, deciding which ones we're gonna keep for the final four, but even just presenting tonight's an achievement. Um So for tonight, we one of our speakers to discuss more about the project, rationale their involvement in the project. And it's important overall, there's also gonna be some time allocated for a quick Q and A session after you speak here as well. And to finish a round up for the evening, we're gonna discuss some advice for getting more involvement, research concluded, final remarks and in the evening by announcing the winner of tonight's academic evening. Um So just a quick summary for people who are brand like new to N Mra, it stands for the National Medical Research Association and it was actually founded not that long ago um in January 2022 by current chair Naj Kumar when he was a medical student instead of UCL, he kind of had the vibe he felt there wasn't, you know, enough medical students both from the UK and internationally who were able to like develop a strong research network by themselves or even get much guidance about how to get involved in both good research but also develop the appropriate and relevant research skills. So this kind of led to the society's formation which has gone to establish a community which enables both students and medical students. So students who are both medical and involved in surgical healthcare to gain um mentorship, get a better access to a wider like research network and go on to even conduct their own research projects, empower them to take control and ownership of their own research careers as well. So as a society, we do this by helping people achieve their goals, by conducting and hosting such events like tonight, which is an academic evening um where we give students the opportunity to present and discuss their research. We hold educational events such as a systematic review and meta analyses, which is actually currently ongoing at the moment in the middle and is concluding this Thursday, which I would highly recommend attending for and also one of the most popular aspects of N Mra, which is our annual mentorship scheme which recruits both mentors and mentees to help further their development when navigating the often complex and research landscape. So a lot of the committee here actually are previous IVI mentees from the N Mra mentorship scheme or presenters from the previous academic evening. So there's at least that opportunity to get involved with within the N Mra community going forward and also using that experience and knowledge gain to help others. So hopefully, we'll have some time at the end to discuss more about Mn Mra between the mentorship teams um for educational sessions, opportunities to get involved as well. So if there are any questions, please just send it through on the chat or if not, you can ask us at the end. Um just double checking with my um cohost. If there's anything else they would like to mention or say for now before we introduce some of our speakers. Nope, all good. Perfect. Well, um, great. So without further ado, I'd like to actually introduce our first speaker of this evening. Um, is it ok if you invite him into the stage? Right. Do his introduction. Yeah, I can do that now. Perfect. Two seconds. So, yeah, our first speaker is Sidney. He's 1/4 year medical student at university and indicated in anatomy and development and human biology at K College of London. He's a president of PRA, which stands for the plastic reconstructive and aesthetic surgery, um Students Association and serves as the Secretary on the Medical Student Committee of the British Foundation for International reconstructive surgery and training AK A B first. Um, he has interests in surgery, particularly burns of reconstructive surgery, but outside of medicine, he particularly enjoys sports, music and writing novels. So without further ado um Sydney Bars, thank you for the lovely introduction, Joshua. Can I just make sure that you can hear me? You can hear you loud and clear. Lovely. I'm gonna try and share my screen. All right. Bear with me. Can you see my presentation? I'm just gonna try and move the slides. Can you see that? Yeah, perfect. Um, so as I said, thank you very much for the lovely introduction. Um, lovely to be here. Um, so good, good evening everyone. My name is Sidney. I'm 1/4 year medical student over at Angling Ruskin University. Um, and I've spent, um, the last year indicating at King's College London where this project was conceived and carried out by a team uh including my colleagues, er and my supervisor, Mr Fro at the Department of um Anatomy at King's College London. So today I will be presenting a systematic review titled an update on HEPA on hepatocyte transplantation um in Children with liver disease. The study aims to explore the potential of H CT um as a sort of alternative um treatment to orthoptic liver transplants. Uh In pediatric cases, the rising incidence of um liver disease in Children, particularly those who do not um respond to pharmacological treatments requires alternative uh surgical interventions. Traditionally, t which is orthoptic liver transplantation um has been um the the sort of the primary treatment but it comes with significant challenges as well um including the strict eligibility criteria, um long waiting times, um and shortage of suitable donors as well. So H CT has emerged as a promising alternative. This procedure involves extracting hepatocytes um from a healthy donor and transplanting them into the recipient's liver. Unlike O LT H CT can be repeated multiple times. Uh and avoids many of the complications associated with full organ transplants. So, the flexibility and and lower er risk profile um of H TT make it a very appealing option for Children who may not yet be candidates for full li for full liver transplants. Um or they might be um needing an sort of interim solution while waiting for a donor liver. So the study is the most recent systematic review on H CT uh consolidating and updating information on its benefits and limitations in pediatric patients. We aim to evaluate uh H ETS impact on various liver diseases in Children. Um considering certain factors like patient characteristics, uh transplant uh protocols um and, and, and uh and the types of liver diseases treated themselves. So given the continuous adva advancements uh in um in medical sort of technology and techniques, it's really important to provide like an up to date um assessment of H CT S efficacy and safety. So this will really help healthcare professionals uh make informed decisions about H CT for their, for their um for their pediatric patients. So we followed the Prisma Framework for this review. Um Our search included um Pubmed Embase and MEDLINE databases er covering studies published from 2004 to 2024. We focused on human participants aged 0 to 18, undergoing H CT for liver disease. Uh Data extraction was performed using endnote and qualitative thematic analysis followed the Braun and Clark methodology. We followed um the the Braun and Clark methodology and, and we've sort of focused on like um so he, so here are the inclusion and exclusion criteria that you can see we focused on peer reviewed clinical trials um that involved Children diagnosed with liver diseases who uh underwent the H CT intervention. And the exclusion criteria included studies on adults uh theoretical studies um and those not published in Engl in English language, er this rigorous selection process really helped ensure that there was um the studies included, were very relevant and uh of high quality to be included in in the review. So this is our Prisma er our prisma flow chart er and across three databases searched the search R er protocol um yielded a total of 2094 records, two duplicate publications were removed, er resulting in 2092 publications for the title and abstract reading out of those 2038 records failed to be included due to irrelevance. Um Out of the 54 reports shortlisted, only 25 had full text links and then a further 14 reports were eliminated. So all in all the total number of studies included were 11. So these are the the 11 studies that were all um included. They are all descriptive interventional cases, case report, sorry um of H CT and they were published between 2004 and 2020 across these studies. 27 Children in total um were reported to have undergone H CT with a total of 11 different diagnoses as well. And this table really shows a brief summary of the methodology and results. Um and the outcomes uh for each of the studies, the risk of bias was assessed using the rob vs tool and the Robbins eye checklist. Um And the overall risk was um was judged to be low and this was sort of AAA comprehensive approach that really ensured that our review was um thorough and also unbiased as well. So in our review, um a total of 27 Children underwent H CT, the survival rate was 85.2%. Um Among the survivors, 50 52.2% required bridging to O LT while 30 30.4% recovered without needing O LT innovations such as the use of alginate microbeads um have shown to improve engraftment and aid in managing metabolic disorders uh leading to um positive er and better overall outcomes for patients. So, out of those 27 patients who underwent H CT, 29.6% suffered complications. Unfortunately. Um and out of those uh fo 14.8% did not survive. One key minor complication wa was uh a six year old um boy who um was diagnosed with phenylketonuria and he received H CT um that had not been properly warmed to ambient to, to like room temperature causing tremor and hyperthermia. Um which really, which really emphasizing emphasized the importance of um heating, well warming the hepatocytes before infusion. Um H TT may cause neurological complications in neonates. Um following H CTA 66 hour old neonate er with ornithine transcarbamylase deficiency suffered a seizure, 10 days, post infusion that was uh that was likely caused by hypophosphatemia. So, some studies such as those by Jani er Meg 2010, Miri 2004 and stan 2005 and 2006 report that 100% of patients required O LT um after, after H CT and this indicates that in, in some studies, HCT was not really a sufficient treatment as a standalone um intervention, but the, the results do vary um such as the case with be 2012 Mayb 2018 and stan 2012 where 100% of patients recovered without um O LT. And this variation really er indicates that there is a lot more further research into H CT needed um about whether H CT is, is a useful bridge to t there was a weak negative correlation between the survival rate and complication rate. Uh a weak negative correlation between complication rate and dose and a moderate positive correlation between survival rate and dose which uh put together all indicate that um higher doses of hepatocytes are associated with better survival rates um and lower complication rates as well. The key findings um from the thematic analysis were that H CT was a successful rescue measure for patients with unstable metabolic conditions. The choice of veins for catheter placement, dependent on um patient specific conditions and anatomical variations as well. Promising breakthroughs in the management of diseases including um ornithine transcarbamylase deficiency, phenylketonuria, glycogen storage disorder, and um infantile oxalosis. Um opening sort of like a a safe uh alternative um treatment for patients, complications included hyperthermia infections, uh and neurological issues particularly in neonates. So, let's move on to the discussion. Um H CT is emerging as a promising alternative to um to treating sort of acute liver failure and metabolic disorders. Um to the traditional um O LT, our study demonstrated that 85.2% um overall survival rate post H TT with uh 30.4% of patients recovering without the need of O LT. This indicates that uh H CT can potentially bridge the gap between uh the scarcity of liver donors and also the high demand of liver transplants. The study is the most recent systematic review on H CT and addresses the potential solution for donor sort shortages and one of the major limitations um was the heterogeneity among the included studies, different patient characteristics, um underlying liver conditions. Uh and H CT uh protocols made it a little bit more challenging um to draw definite conclusions. We also noted that there was no sort of standardized um immunosuppression regimes um used across all of the studies which could influence the variability in outcomes. So, in conclusion, HCT is emerging as a promising therapy for pediatric liver disease, offering AAA viable alternative to traditional orthoptic liver transplantation. Uh It demonstrates efficacy in treating acute liver failure, um and metabolic disorders, ensuring sustained metabolic control and psychomotor development. Uh as we continue to advance um and sort of refined um H CT techniques. It is um it has a s has a has a significant sort of uh potential for improving patient outcomes, particularly those with um pediatric liver diseases. So in total, it sort of provides a comprehension um a comprehensive overview of the current state of H CT with the benefits and limitations er and really emphasizes the need for ongoing research and innovations uh in the field. Lovely. Thank you very much. These are my references. Um And then I would like to open up the floor for any questions. I can't really see your screens, but maybe we should stop sharing. Actually, let me go back. No worries. Oh, thank you very much Sidney for that presentation. Really enjoyed it. Um I did have some questions um If that's OK, I don't know if the other cohost or if you had any questions yet, but um if not, I'm more than happy to. Um So, yeah, the first one that came to me was I noticed in the inclusion criteria, you said you wanted to only include papers in the last 20 years. Was there a specific reason why 20 not 1510 or 25? Why was it specifically 20 years for the inclusion criteria? Yeah. So um this was a, a discussion um I had with my supervisor. Um Initially we considered 10 as a sort of standard for um the past um uh to, to, well, to get a, a more recent update but um ultimately, we decided 20 just to get a AAA wider depth of um of papers and then sort of if we didn't have enough that the meta required number of studies, which was five, we would then need to cut down, I guess. So we wanted to go from a, from a wider option um just encompassing uh H CT S development over the past 1020 years. Cool. Awesome. And yeah, the second one for me, I, you mentioned when you're doing the, you're talking about some of the limitations that you felt like some of the different senses had different immunosuppression regimes. I wanted to know if there was any differences that you noticed or any major differences you feel like could have affected some of the results in the paper in terms of the regimes or um even if you thought it was maybe like different centers had different things. So for example, if this was done in the H IC environment, maybe they had a different regime compared to the LM IC environment due to the limitations of medical technology or um financing options. But II wanted to know if there was any differences in the regimes that you noticed that you felt could have affected results. Yeah, it was not one of the, the codes that we were looking for in our um thematic analysis, but it's something that we did pick up on having read through some of the papers. Um and the main thing that we, that kind of like, really show out to us was, um, that not all, not all studies had any information on the immunosuppression regimes that was delivered. Um, and those that were, that gave information didn't exactly state for how long? Um, and for, and which exact drug was used as well. Yeah, that's fair enough. Um, I did have one more question. Uh, we tried to max it, they just want to check just in case. And Tanika or Jade had any, any questions they wanted us to ask. But if not, I'm more than happy to do further and final one, sort of, that was a really good presentation. Firstly, before I asked my question is very thorough and really good insight on how the, how it was conducted. Uh My question was, can you think of uh sort of any reasons or any resistances that one might encounter for um H CT being the mainstay or sort of overtaking, um ct as the main say treatment? So it go, so you, you're asking about the, the criteria? Yeah. Yeah. Yeah. Um I think it, it should be a clinic, a clinical sort of um uh it, it, it's sort of evidence based, I mean, there isn't like a lot of evidence already out there. Um, that was published. I mean, this was the first, um sort of the latest systematic review with the, with the evidence. But, um I think one of the most uh important things to overcome is firstly understanding um what H CT um how does H CT work and, and, and also the outcomes um based on the specific types of diseases as well. Um Right now we've only covered 11. Um there's only evidence for about 11 different diagnoses um which I mean, isn't uh it's not a, a comprehensive uh it, it's not comprehensive compared to the, the number of different types of diagnoses. There are out there. Um And I think there needs to be more um research into the field. Firstly, to get that evidence of HCT being used in different types of metabolic disorders that were not included in this review. Um But to basically just go back to your question about the criteria. Um It does solve it is a potential solution to the, to the deficit of donors of liver donors. Cos currently we're waiting for um well, patients regardless are, are, are waiting for um a lot of um uh l donor, healthy livers um to, to, to be transplanted into them. But I mean, if you can take small snippets of healthy donors um channel them through um the hepatocyte harvest, which we talked about earlier. And then um one of the papers actually discussed about the domino effect where he would be implanted into a patient and then, and then re and then that would be then taken to er be transplanted into, into a different patient as well. So it kind of does help with the um with the solution of the deficit in um hepatis in patients requiring t um but it, but it's hard to say, I think it's early days for H CT uh in terms of replacing O LT. Um I think currently from the research that we've got, it's, it's a suitable bridge. Um but it, that doesn't necessarily mean that it's gonna overtake O LT if that answers your question. Yeah, thank you. Awesome. I'm just checking j any questions for you or happy for us to move them. Um, so I really enjoyed the presentation. It was really thorough. Um, as part of what we're doing with these academic evenings, we also like to look at how you got involved in this research. Um, obviously this is quite a niche topic that you've sort of stumbled upon. Is this a specific interest of yours? Did you come across it on placement? Was it from a lecturer? Maybe tell us a little bit about how you got involved. Yeah. So I was undertaking one of the modules I chose for my, um, during my KC O in er, indication was, um, surgical sciences that was a module. And, um, I came across my supervisor there and, um, we sort of had a meeting to, to discuss um, this project and then, um, really we, we both sort of conceived it together. We did the whole, uh, planning together registered to, to prospero um and then um recruited the wider team and er, and yeah, we took it from there but I mean, I could have done it without the team and, and without the supervisor. Um Mr Fo so, um yeah, I just wanted to say thank you to them. Ok. Well, thank you so much for your presentation. Sidney um, really liked hearing it. Um So yeah, we'll move on to our next speaker. Um We have shader who is a student at the bar and DNA School of Medicine. Um And yeah, without further ado we're introducing Sea. Hello, let me try to share my PDF. Perfect. You can see it clearly. Can you see that? Ok. Yeah. All right. So, um hi, everyone. I'm Sean. I'm a student from Boston London um School of Medicine. I'm in my fourth year currently and I'm presenting my research on the outcomes of perioperative intravenous uh infusion in femoral factor surgeries. So, hip fractures are very common. Uh The UK National Hip Fracture Database reported more than 75,000 patients with femoral fractures in 2022. And within these patients, the inci the incidence of anemia is very high and it has been reported to be as high as 44% on admission and rising up to 87% postoperatively. And um peroperative anemia has been associated with poor outcomes including poor functional morbidity, increased mortality, length of hospital stay delirium, and the risk of recurrent falls. Therefore, up to 70% of patients require blood transfusion to correct this anemia. And however, blood transfusion I is firstly expensive but um is limited resource. And um there's also severe um adverse events that comes with blood transfusion. Therefore, patient blood management has recommended the use of intravenous iron for surgical patients. However, evidence is limited regarding its use in emergency surgery, especially uh such as the context of uh femoral fracture surgery. What we did was we research the MEDLINE and base and Cochrane central databases including um trial protocol uh registries to look for RCT S comparing the outcomes of perioperative intravenous iron infusion with um placebo in adults requiring surgi surgical management for fe femoral fractures of all types articles with no available full text, no English translation and protocol reports with no clinical data reported were also were all excluded. And we compare, we assessed there is a bias with the Cochrane ro two tool and the quality of the of evidence with the grade tool. In terms of the outcome of interest, we looked at the proportion of patients receiving red blood cell transfusion primarily as well as the total number of red blood cell units, transfused hemoglobin concentration and discharge length of hospital stay mortality rate, infection rate, functional outcomes and the quality of life outcomes. We use our software to perform our statistical analysis. We calculated risk ratios and mean differences for dichotomous and continuous outcomes respectively. Some good analysis will will perform to look at the effect of um intravenous iron on the primary outcomes. For patients receiving perioperative TX. A patients not receiving perioperative TX A anemia. Uh anemic patients, patients with intracapsular fracture, patients with actual capsular fracture and oh and um patients with extra capsular fracture. We categorized the follow up into short term, medium term and long term according to the um time frames on the slides and statistical significance was defined by AP value of less than 0.05. For a screening process, we identified 1000 and 33 papers from database searching in addition to 239 papers from the references of the systematic reviews. And we ultimately identified six RCT S which included 1000 and 292 patients with a mean age of 84.4 with 972 females and 316 males. And the medium follow up length was 75 days. The, the IV iron preparation used between studies were different with three studies using iron sucrose, two using ferric uh carboxy maltose and one used F one using ferric the, the maltose. In terms of the primary outcome, we found that patients receiving intravenous iron to have a lower transfusion rate and the risk ratio was 0.87. However, this failed to reach um statistical significance in terms of the secondary outcomes. We found that patients receiving intravenous iron to have a higher um postoperative hemoglobin level at week one. And this achieved statistical significance with P value of 0.024. However, the difference is very small at 1.93 g per liter, even though this might um alone is um unlikely to be clinically significant. And however, in wider context of um further peroperative management methods, this can form a marginal gains in these patients for the other second outcomes including the total number of red blood cell unit transfused, um postoperative hemoglobin level at discharge or short term follow up mortality rates, length of hospital, length of hospital stay or infection rates. Um These all did not achieve unset score significance, meaning there was no difference in two groups, narrative synthesis were performed for functional outcomes and quality of life outcomes because of the differences in the problems used. And um we found that there was no s like so no significant difference in um the instrumental activities of daily living score and the Barthel index score as well as the U the EQ five D or SF 36 scores for a subgroup analysis. Um In all five groups, we show we found no no significant difference in the primary outcomes. However, overall the um 95% confidence in the world were very wide due to the low num the low end number, especially for patients with receiving peroperative TX A because TX A is um only newly used as uh only newly used RR routinely in clinical care. There are several strengths to our, our review. First is that we strictly comply to our, our preregistered Protocol on Prosper Prisma and the Cochrane recommendations. We use a sensitive strategy and also perform extensive analysis to identify the effect of iron on on specific targeted populations. There are several limitations. However, including those regarding the inclusion criteria of the individual studies, for example, the hemoglobin levels that were are used for inclusion were different between studies and the patients were not included on the basis of iron deficiency, which can affect the way which they have. Um they respond to intravenous iron confounding factors affecting erythropoesis, for example, um renal failure or bone marrow disease were not controlled for in some of the studies. And there are several variations which can contribute to heterogeneity when it comes to analysis, including the variations in perioperative management methods, variation in IV iron preparation dosage and timing of administration as well as the variation in transfusion criteria and the follow up timings. In conclusion, we found moderate to low level of evidence suggesting that IV iron alone provides no clinically significant benefit in short term outcomes of the ones that we measured. And um further research is required to identify its efficacy when used in combination with more than perioperative optimization methods, including TX A erythropoietin and cell salvage. And these are the references and I I'll I'll just brief briefly talk about how um I came back with this um with my, my, the research team and, and the project itself. So I first met my supervisor at the most recent vote of Congress. He was giving a talk um to medical students regarding how to get involved in research in general. And um I stayed back and asked a couple of questions and he suggested um that he would be happy to be my supervisor. And he gave me a list of uh of topics for systematic reviews. And we found that um we found this to be the most feasible all of them all. And um I use uh various resources to learn about the process of systematic reviews. One of it is the A Mra um teaching series, which I found really helpful. And currently um this project has been accepted for oral presentation uh here as well as the upcoming CCO Congress in, in Serbia. And I've also submitted for publication, still waiting for a response. And I think that's it. Yeah. And uh I'll be happy to answer the questions. Oh, Yeah, really enjoyed your presentation, Sean. Um Definitely learned a lot. Um I have a question to start off with and I think you kind of mentioned it in the limitations as well. So you discussed having some older patients um like, I mean, average of 84 around that and you said they were likely to have had some maybe like compounding factors. Um again, with that demographic, I'd expect them to have some comorbidities. I was wondering, were there any comorbidities that you noticed that you felt that could have affected the results, like anything in particular or specific um comorbidities for the ones I mentioned, such as renal failure and, and bone marrow disease. So some has um some of the primary studies themselves have accounted for them. So they have excluded these patients, but some of the um studies have, in fact, they, they didn't mention if they had any. Uh So first, they didn't exclude these patients and these were not reported. So this can um it gives room for them to have some differences between the studies. And um other than that, some other differences include uh whether uh what other drugs they, they, they might be on, for example, if they're on aspirin or any anticoag anticoagulation that can increase the chance of bleeding and that can also affect the uh whether they achieve uh they need a blood transfusion basically. Mm Good uh sort of similar to Josh's question. But I was just wondering if the project, even within the project, there was um further analysis done to sort of see why the result was so different. So a heterogeneity analysis based on like the baseline hemoglobin, hemoglobin level or the age or the sex of the patient. Yeah, II did perform the ice analysis but I I wasn't sure why, why it wasn't shown on, on this slide because the most updated one, it it was it was supposed to show. But um basically I II did the II score analysis and for the primary outcomes there in general, the heterogenity was, was basically was was zero. OK? And um but there's some others, for example, like length of hospital stay, they can be up to um 33 which we defined as a moderate he heterogeneity. And this can be because of differences in like, um, social care and, um, how, how the hospital deal with, um, stay basically. So if there's, um, availability and at, at home or like transport to home, things like this that can affect length, length of stay. Yeah. Hi. I really enjoyed your presentation. Um, in terms of your interest is that purely in trauma surgery, do you have interest in different aspects of surgery? Emergency meds? Where do your interests lie? And how has it sort of led you to this study? I think I've always been interested in, in Ortho. Uh, I've been involved in, uh, a couple of research that, that fell apart and some are still ongoing and most of them are, are, are still around Ortho. And I think that that's something that I, I'm, I personally am looking to and go into. Yeah. Ok. Well, thank you. Um, I believe that's all the questions we have for now. So I really appreciate that. And, yeah, looks like we'll be able to move on. To our next speaker. So introducing next, we have Aa Keshi and she's a medical student who is currently in integrating at um James College London. So you out further with you? Um Yeah. AK oh hi, I'll just share my slides. Ok. Can I just confirm if you can see these slides? Yeah, you can see them. Ok, that's fine. So um hi, everyone. My name is Ali Kishi and I'm um um asthma and I'm a medical student. But this year I'm inter in a master's of global health, social justice and public policy. The research that I'm about to share with you is to do with the framing of debates surrounding legalization of medical cannabis, specifically in the United Kingdom. So I decided to undertake this research after seeing how quickly drug policy is shifting around the world, especially to do with cannabis and seeing how the legalization of medical cannabis um is heavily linked to racism and socioeconomic class. These issues often go unmentioned. However, when the issue is mentioned in the news or media, drug laws in the UK at the moment affect ethnic minorities and those from lower socioeconomic backgrounds disproportionately, for example, black people are nine times more likely to be subjected to police drug searches and receive harsher, harsher punishments than white people despite being less likely to be found in possession of drugs. Um So before I go into my analysis, I thought I would go through where different British political parties stand um in relation to medical cannabis policy at the moment. So um Liberal Democrats support a fully regulated cannabis market. Conservatives support complete cannabis prohibition, labor support medical cannabis decriminalization. And the Green Party support complete cannabis decriminalization. So um as a background to British drug policy in the past, um it stems from the belief that consuming drugs is always immoral because it harms the consumer. Therefore, it should be illegal. However, this raises the question about alcohol and ultra processed fast foods because these are also harmful. However, historically, they've never been illegal. Others, other researchers have shown that drug policy has always been linked to the economic interests of powerful nations. For example, during the British China opium wars, recently, we've moved into an era of global neoliberal. Essentially what that means is the responsibility for having good health, good wellbeing, good moral behavior has shifted from being the government's responsibility to being our individual responsibility. Therefore, that argument suggests that if a person wants to consume medical cannabis and they've decided that's the right thing for them. They should be allowed to do that. This argument though, about global neoliberal doesn't account for the economic benefits that would occur if medical cannabis was legalized. Um The, the um sorry, the market at the moment is incredibly lucrative. And as we can see, we've got two drugs um that have cannabis license at the moment in the UK. So um I'm not too sure how to pronounce it. But Epidiolex and side effects which are um like in the millions in terms of their sales at the moment. So overall, my research question was how are debates surrounding the legalization of medical cannabis framed in news articles from the Guardian and the Daily Mail from January 1st 2017 to December 31st 2022. The methodology I used is a type of qualitative analysis and it's called critical discourse analysis. Essentially what this does is it problematise how language is used to reinforce dominant social structures that reinforce social inequality. Um Examples of that would be capitalism, patriarchy or white male supremacy by using this form of analysis, I could interrogate how the media problematise or encourages medical cannabis legalization. So overall, I collected 10 news articles using random sampling. Um five from the Guardian as a left leaning media source and five from the Daily Mail as a right leaning newspaper. Um This is an example of one of the first stages of the analysis process, which is called coding. So initially you familiarize yourself with the content of all news articles, then combined with the preliminary literature review, you'll be able to pick out patterns. Um So excuse the handwriting. But in red, what I've got is economic terms. Um Yeah, so words like business or investment to do with profit making, which in reality, it makes you think that med if with medical cannabis is to do with how much it can help people clinically and medically. So in newspaper articles, why is the focus on profit and business and essentially capitalism? Then in green, I coded for words to do with politics and legal language, like still fluid or tricky legal status, which basically means it's still illegal. But obviously that will have a certain impact on the reader who's like reading these news articles and they won't associate cannabis with being illegal. They'll associate it with being like trick um tricky legal state having tricky legal status. Um Finally, I coded in pink language for miraculous world changing language. For example, one of the news, this news article wrote the transformational power that cannabis has to heal and change the world. So it's giving cannabis this kind of medical cannabis, specifically this out of this world um miraculous language which um in one of my findings, I analyze a little bit more. So overall, um I grouped all of my codes and I found three overall findings. The first of these was neoliberal capitalism and feminism. Both newspapers emphasized finances associated with the medical cannabis industry. This included adjectives such as fast growing multibillionaire and industry valuations of over 2.4 billion in the US. There was less emphasis on the actual clinical benefits or medical evidence which supports the idea that left wing political actors are more likely to be motivated by financial benefits as opposed to clinical benefits. In regards to feminism. Articles from The Guardian made legalization of medical cannabis into a source of female empowerment through ideas of financial independence and career advancement. For example, one of the, one of the articles from the Guardian stated that 36% of executive roles in the industry are taken by women as opposed to 15% as the average in the US articles from the Daily Mail on the opposite end of the spectrum in keeping with their conservative stance, use traditional maternal values to highlight the negatives of cannabis use. My second finding was to do with green washing or naturalistic fallacy, what this what this was was articles from The Guardian emphasized the greenness or the naturalness of medical cannabis such as praising green fingered industries. Use of the color green essentially purifies the view of cannabis or medical cannabis and it removes it from its historical context which was more discriminatory and painted ethnic minority groups as morally impure for using medical or cannabis for recreational purposes. Furthermore, both newspapers used dramatic phrases like healing and changing the world and divine health giving Alexa which suggests that legitimizing medical cannabis use in society is something miraculous and revolutionary. This again makes invisible the fact that cannabis historically was a part of healing and spirituality in nonwestern cultures before it was outlawed by the West. My third and final finding was social justice, social justice and social inequalities. Both newspapers played into perpetuating racist and classist stereotypes regarding medical cannabis. The daily mail quoted a person who said the average cannabis user today are just regular people not down and out which links historical drug use to people from lower socioeconomic class without interrogating the factors as to why this association exists. Staff members in one of the medical cannabis stores in the US all looked like Hollywood star turn health guru Gwyneth Paltrow, which implies that cannabis use is only socially acceptable in white people. However, both newspapers did advocate for widening access to medical cannabis. Oh, sorry. Um OK, so in order to link my findings to broader academic research, essentially, I found that the topic of cannabis legalization can be split into three social issues. An issue of class, an issue of race and an issue of gender privatization of health care under neoliberalism means that only people from higher income groups have the privilege to access medical cannabis legally in terms of racial inequities in Canada, black and indigenous individuals are excluded from the legal cannabis business industry, which is mainly owned by white wealthy males. And finally, in terms of gender gender inequality studies find that cannabis therapeutic research continues to exclude pregnant women and vulnerable populations from trials which perpetuates the exclusion of women from medical research. So in terms of the limitations of my research, um there was a very limited sample size. However, because this is a form of qualitative analysis, the focus was on the depth of my individual findings rather than making it Generali also um I acknowledge that the Guardian and the Daily Mail don't represent all left leaning and right leaning attitudes towards medical cannabis legalization respectively. Um Overall, um from my research, I came to three policy recommendations. So future policy reform should increase opportunities in the medical cannabis industry for people from historically disadvantaged groups. Furthermore, policy change in the future should implement cannabis decriminalization projects and address the long term social and economic effects including mistrust and authorities of previous criminal records. Um That brings my presentation to an end. I have my references attached at the end as well. Sorry. No. Oh, thank you for that presentation. Um Thought that was definitely pretty interesting. I definitely learned a lot. So really nice spending your head on there. Uh I did have one question that came to mind um really like the topic, really like the concepts and I was wondering, I feel like you talked a little bit about it on the limitations, but I was wondering if you could do a follow up study to kind of like further address this like lack of knowledge um like like like of Knowledge Bank that's already out there because you, it feel like a pretty original study. How would you go about this in terms of like increasing the knowledge um Knowledge Bank about this chosen topic? Um Well, II try to do it in a qualitative way, which basically means that you look at newspapers and you look at the language that they're using. Um but I think quantitative analysis, like for example, looking at how many news, how many um clinical trials or how many studies in general mention race, gender, social class when it comes to talking about medical cannabis, that would be a really good addition to any types of qualitative analysis. Because II think in general, medical research is saturated with like um quantitative evidence, like statistical evidence. And then that means that a lot of these issues go unmentioned because no one's actually analyzing the assumptions that people hold when they do statistical analyses. Um But yeah, so in answer to your question, I would say if different forms of analysis are done on existing studies, um mainly quantitative, then that could supplement these qualitative starts of analysis where you analyze language and media and news. That was really great lie. I think, I think it was a really original topic and I was very interested to see where it was going. Um Just a question about like where your interests lie and how you came across um this topic. And what made you investigate this further? Yeah. So um part of my master's this year, I did a um module called Critical Policy Research, which basically looks at how, how the government or however whoever's in charge will make certain policies. Um And then that will be translated into how the public think about an issue through news that's like the middle steps. So it's like the government, then the news, then um people and I found I've always been quite interested in what is, what is illegal and what's legal, like, how do people come? Like, why is, why is cannabis illegal? For example, when it's been used for ages in um societies like nonwestern societies. So that's why and II always used to watch documentaries about that kind of thing. So I think that's why when I came onto this topic and medical cannabis was really big in the news because I think it had, it's in the UK it's over the last few years, it's been moved from class one to class two, which basically means it can be used now in clinical research to find evidence which can then then further policies can be made from that. So that's basically what inspired me to do this research. But in general, I'm quite interested in mm like I've got quite like, I'm interested in quite a lot of things. Um At the moment, I'm doing a dissertation on homeopathy which is a type of alternative medical system. And I'm basically looking at how the Western healthcare system is very um reductionist and it basically doesn't incorporate spirituality or religion into their forms of biomedical health. So, yeah, I'm quite interested in like religion and that kind of and um also feminism and feminist studies as well. Well, yeah, so obviously we will really enjoy that talk it sounds like you've come about it from a really interesting perspective doing your installation, looking at a legislative and a more sort of social view of these issues. But coming back to your medical background, what do you think the physician and general doctor's role is within this debate in addressing these social issues and even the medical issues with using medical cannabis? Um It's, it's that, that's definitely a challenging question. I would say that where doctors come into this in general is just not holding, it's just being more educated on the topic and how it's not, it's not as simple as cannabis is illegal. Therefore, it's bad. There's more, there should be more of a nuance to understanding of it as well as in medical education. There should be more of a um emphasis on different medical systems from around the world and the different chemicals that they use as opposed to it just being a clear cut. Um These drugs are illegal therefore bad. So I think it starts in medical, medical education like if there's more of, yeah, like an emphasis on the different ways people go about achieving health and wellbeing and how the world's health and wellbeing have different meanings around the world. Um Compared to the West, I hope that answered your question. Thank you. Awesome. Well, thank you so much for your presentation. Really enjoyed it. Fine. Thank you. And I believe we'll be moving on to our next presenter So our next presenter is um Zi Qing Zhan and she is a medical student at the University of Oxford. So we're just gonna call her on to the stage now. And yeah, hopefully you'll be able to see her, her presentation today. I think there's some tactical errors. I can't seem to be she's out of now. Yeah. Ok, perfect cool. So um sorry, can I check if you can hear me? Yeah, you can hear me. OK. OK. Um Can you see my screen? We can it's just um we can see like full screen, you can kinda see the presentation background and outline if that makes sense, like the slides on the side. Oh OK. Um Let me try again. Sorry, that's fine. Um Some people prefer converting to pediatric if that helps but OK. Um Can you see that now? OK, perfect. Um So hi everyone. I'm um a medical student at the University of Oxford and today I'll be presenting um my third year research project which is um titled Phenotype and Characterization of the immunosuppressive mechanisms of magnant pleural effusion. So um before I begin, I would just like to share a bit more about um my journey since this was um request this event. Um So this was um a component of my third year Medical Sciences degree. And um what we did is we kind of contact different um supervisors and um so for some of us and myself included, it was um quite a challenging journey actually because we had to find our own supervisors and I was rejected a few times and I changed my project once. But in the end I settled on this project, which is at the um the for spiritual respiratory translational research um in the Awful Department of Medicine at Oxford. And um it's a lab based project. So a bit different from what you've heard today, which means that I kind of did my own um experiments. I did lots of cell culture pipetting and flow cytometry. And um it took a while for me to optimize the experiments. So I spent about 10 weeks in the lab, followed by data analysis and writing up the report. So today, I'll just share a bit more about um this project and what it's about. So to provide some background, um malignant pleuro fusion or M pe um refers to accumulation of um excess pleural fluid um in the e excess fluid in the pleural cavities to cancer. Um And this is estimated to affect up to 15% of cancer patients. Clinical management remains largely p um and median survival is about 3 to 12 months from diagnosis. So, some typical symptoms um include breathlessness, chest pain, and um some common cancers that cause MP include malignant pleural mesothelioma, um MPM, which is the primary cancer of the pleural space um as well as non cancer of breast cancer, as well as some other cancers that metastasized to the pleural space. So, um it has previously been shown that um the promotes cancer cell growth, but there no suppressive properties remain clear. So, to develop better, um we need a better understanding of the poor space microenvironment, which is why um we conceive this project. So the aim is to phenotype and characterize the immunosuppressive effects of MP. Um initially focusing on the PD one PD L1 pathway. So, um the PD one or programs programmed cell death protein, one is at cell surface receptor um which binds to programmed death, ligand, uh programmed death ligand one PDL one on um cancer cells and this prevents T cell activation and contributes to cancer immune escape. So, um as some of you may know, immune checkpoint inhibitors have been developed including um volume, which is NT PD one and Ipilimumab, which is NT CTL four. And the combination of these um has been approved to be used for M PE. And that's why we're particularly interested in um such molecular pathways um including PD one PDL one signaling um in order to help identify biomarkers that predicts treatment outcomes with these um immunotherapies. So to kind of go through the materials and methods um because I understand that not everyone might have done that project before, um which is why I chose to use um a diagrammatic representation. Um So, to um achieve our aims, we used patient derived pleur specimens um and cancer cell lines with different etiologies in order to have a good comparison. And for the main experiment, we cultured five different cancer cell lines in nine different types of fluids and we incubated them for 48 hours. Um And then we performed flow cytometry um using antibodies against PDL one HLA A and CD 47. Um And then following that as an exploratory investigation of some of the molecules that we know to be immunosuppressive, we performed lex essays um to measure interleukin eight il eight epidermal growth factor EGF and transforming growth factor beta TGF beta um as well as finally, a luminescence cell viability sa to measure extracellular ATP. And um so this is a summary of the samples that we used and the kind of characteristics of the patients that the samples were originally from. Um just to illustrate um that we used um five cancer cell lines and nine different types of fluid. So, um we used five MP fluids and that's what we're kind of trying to test and um two heart failure pleurops as comparison as well as two types of control fluids. So one of them being um a normal um cell culture medium supplemented with 10% F DS. That's what we call R 10 and human serum. So those two are the control fluids. And um so now we move on to discuss some of the results. So first, in order to establish that our experiment um is viable we have to check that the cancer cells proliferate normally when they're cultured in through a fluid. And we're able to demonstrate this by taking photographs under the microscope that they agree to complement and that um the fluids are biologically active. Um Next, we did flow cytometry. So um this is kind of um this uh diagram just illustrates some of the um gating steps that we use in order to derive um a measurement that we can use to compare the expression of different molecular markers. And this measurement is called mean fluorescence intensity or MF I. Um And this, so MF I is used here as a proxy for protein expression levels. So now we want to discuss the main results of the study um overall PD L1 expression um but not HIV or CD 47 was significantly increased in cells cultured in MP and um heart failure fluids, but not those cultured in the control fluids. So, um and, and this is like compared to control. Um and there was no significant difference between um heart failure or MP fluids. And um when we compare the cell lines, we kind of calculate the fold change in average MF I for each condition um with respect to the MF I for the same cell line cultured in R 10. Um So the most obvious difference is see when we compare between cell lines where um PD 174 cells were associated with the greatest four change in PD L1. And a possible hypothesis is that these cells could be secreting certain factors that interact with the surrounding fluid to upregulate PD L1 and other immunosuppressive molecules which we then further investigated. So, um moving on to the L assays, the data show that there was no significant difference in IO H EG F or TG FB to one expression um between MP and non MP fluids. Although the mean concentrations are higher in MP fluids. Um So all of the samples had higher than serum and more MP samples than non NP samples are higher TGF P one than serum. And all samples are lower um EGF than serum. So, um of the molecules tested, we think that IL eight has the most um kind of convincing evidence to be contributing to increased immunosuppression in MP fluids. And um in particular, as we um noticed that T MP fluids had very high IL eight and TGF beta one expression. Um And we hypothesized uh and we used a correlation test um which revealed um a rank order a correlation coefficient of 0.5591 which indicates a uh a moderately positive correlation between eight and TGF P one. So it might suggest that certain um patient samples um express high levels of both cytokines and this could be independent of the cancer type. Um Meaning that kind of there's heterogeneity between um between different cancers and between different patients So next, we compare the levels of these three molecules um and post culture with patient derived cancer cells. So um this means that we compared the original fluids with um the fluids after they were cultured with cancer cells for 48 hours. And in general, we find that the concentrations of IL eight and EGF but not TGF beta one increased in cell culture supernatant um compared to the original fluids. So, the increase in il eight in our tendons serum was not necessarily lower than in the other fluids, which indicates that um the MPM cancer cells naturally secrete il eight. And when we compare between the cell lines and between fluids, it becomes apparent that il eight increase dependent more on cell line intrinsic factors than on the fluid to which the cells were exposed. And again, we found a greater increase for PV 174 than for the other cell lines, which is again a reflection of tumor heterogeneity. Um And um whereas for the other molecules like EGF and TGF beta one, we think that um there is less evidence because um the levels were lower and um the change was less significant. So the last um part of the experiment we did was to um do a preliminary test of extracellular ATP. And we used um human serum, three non MP fluids and six MP fluids. And from this, we found that um in general, there is um higher levels of Extracell ATP in MP um compared to the other fluids. And the reason why we chose to test um Extracell ATP is because it's um so ATP is released um into the extracellular space in response to immune cell activation, cellular stress and inflammation. Um So we want to see if this pathway is contributing to immunosuppression um in uh in M PE. And um although this is preliminary, um this result is preliminary, we think that it would be worthwhile to perform essays with larger sample sizes and repeats. So, moving on to some of the um strength strengths and limitations study. So um some strengths would be that we used um patient derived samples from human patients instead of um so instead of I guess animal models, because um the animal models for um M PE are not very reliable or are not very good. And um we've also um managed to establish a a controlled environment where we keep all variables constant except for the fluid types. We also use um direct measurements of proteins and extracellular molecules. Um instead of like for example, if we did um other methods like PCR, then that might not fully reflect the expression of proteins. So, some limitations however are that um because we use cell culture, so this may not be able to fully replicate in, in liver conditions like in a human patient. And um there may be some differences in the cell density and numbers which may slightly affect MF I that we measure using first cytometry. And um our study used quite a small sample size, especially for the non MP fluids. So, um in the future, we would like to explore um doing this study with larger sample sizes. And um this brings me to some of the main findings and conclusions of the study. So, um based on what we found and um in relation to um existing literature, we were able to infer certain potential molecular mechanisms of immunosuppression. Um in MP, um with the most evidence being for enhanced PDL one expression and signaling as well as secretion of eight by cancer cells. So there is some preliminary evidence for um exercise at P or pathway as well. But more studies would be needed to confirm that. And we think that studying these pathways may help to ela mechanisms that makes some cancers more susceptible to immunotherapy than others. And the clinical significance of this would be that um in terms of the management of MP, we think that more targeted and active treatments might help since we can, since we've established um this these kinds of um possible mechanisms of immunosuppression. And as I mentioned previously, due to the differences between cell lines, we think that there's um certain levels of patient patient heterogeneity, which means that um it would be important to have a more personalized approach to treatment as well as patient stratification to kind of see. Um the biomarkers that um make some patients more susceptible to immunotherapy than others. And um therefore, some future directions would be to assay a larger number of samples um possibly to conduct further studies with proteomic and transcriptomic such as single cell RNA sequencing, um measuring PD one in T cells, cultured and NP CO culture of cancer cells and T cells. And most importantly to um establish more associations between the biology and the clinical outcomes of the patients and um clinical trials to compare drainage versus no drainage of MP in these patients. Um So these are my references and that concludes my presentation. Thank you very much. Wow. Um We enjoy your presentation with you um especially um I really like the future directions as well in terms of like extending it in terms of um considering like a future trial down the line. The photo was great. Uh Just one quick question for me. Um I was just a little bit curious about the rationale for using sperms correlation coefficient between the two luminous assays assays. And I was just kind of curious about um what made you feel like? OK, like let me go to sper for that one for the analysis. Um OK, so I think um mainly because we noticed um that certain like samples had high levels of both types of molecules and we just wanted to see if kind of um it kind if, if the same kind of fluids had um high or low levels of both molecules. And that's why we wanted to show kind of a correlation between the two molecules um in, in the fluids. Yeah. And um we used this BMN correlation test instead of something um uh in in instead of other types of tests because um I think at the time our data was um it wasn't normally distributed um because there was kind of um some extreme values um where some um samples at really high levels of expression and some have very low. So uh we used a spin correlation test for the non normal distribution. So presentation, it is really, really interesting topic and it's really nice to have a bit of variation with you talking about a lab based project in contrast to what we've had before. Um in terms of approaching a lab based project, I don't know about your medical school, but a lot of medical schools don't really give much teaching on that. So, how did you find sort of getting into the project and understanding all of the techniques on top of the statistical analysis? Um Yeah, that's a really good question. Thank you. Um So actually, um I think for us, we were quite fortunate in the sense that um we were doing so I was doing like a medical sciences in my third year. And um actually all of us kind of do that at Oxford. So they do teach us. Um They do have some teaching about the different techniques and methods um of um of so it's kind of a bit like biomedical sciences in a sense. Um Although I would say that initially, I had to learn a lot of the uh a lot of it on my own because um it's not um it wasn't really taught in detail, I would say. So, for example, um for my project, I used quite a lot of photo, so I had to kind of read up a bit more about it. And um I think my um my labs and my research group um and my supervisors, they were very supportive and they were always able to find someone to um kind of guide me through the initial steps and how to um kind of analyze the data from the software that they were using. So I think that was really helpful. OK, thank you. Hi. Uh Sorry. Camera. Hi, how are you? Um I just wanted to ask you a quick question regarding so like the kind of journey you went on, you, you touched on it a little bit at the start regarding this being a third year project, I think. Um Do you just wanna tell the audience a little bit about why you may have spoken to a supervisor, how this project came about and about what you may have learned along the way? Yeah, sure. Um So I think the reason why I chose this project actually is because I um at the time I was really interested in oncology, so quite interested in um things to do with cancer. And this project, um as you can see was about um malignant pleur e fusion. So kind of um related to my interest in cancer and um how I actually got to know the supervisor was through a tutorial. And um we were actually discussing some um a topic about, I think it was about um some of the um immune kind of um mechanisms behind cancer and immunotherapy and things like that. And so, so I just expressed to him my interest in this topic and um he shared a bit about what he did in his lab and what his group were doing and I thought it was really interesting. So I asked if I could possibly um do a project with him and that's how it all started. Um And I think um what I um what I learned through um doing this is actually um I learned a lot of independent research skills I think, which is very useful because um we were, I think me and like other students in the lab were giving, we were given a lot of independence to kind of develop our own projects. And to be, I think, to be very involved in the initial stages of planning and um to be able to be able to do the experiments ourselves, I think was quite empowering and I think it was especially useful to um to learn how um kind of like translational research projects work. So how um projects from the lab can um eventually have clinical relevance? I thought that was something that I learned. Awesome. Well, I really enjoyed hearing those um presentations. You so I really enjoyed it. Um Yeah, thanks for answering all of my questions. Thank you. No worries. So, yeah. Um Thanks everyone so much for coming. I really enjoyed the quality level of all the presentations that were done today. Um And yeah, thank you so much for answering all the questions. There is a feedback form that I do need to attach into the chat. Um So please fill that out so for people who can get the um certificates for attendance. Um and also just to help us in terms of improving um future content going forward as well. So that would be great. I'm just gonna send that now for everybody. And yeah, I'm just checking before we round up and our winner. Does anyone have anything to say Jade Niraj? It is a big well done to all the speakers. Um I think a big part of getting involved in research is coming to events like this. Um It was really good to see a really wide variety of projects from different backgrounds. Um So yeah, big well done to everyone who came tonight. Yeah, just a second. That actually, I mean, I wanted to say, you know, this is we, we, you know, with N Mra, we're very much kind of building uh a community health and stuff. So for example, Jaden presented at the last academic evening and then, because she did really well, you know, I had a conversation with her about doing this project as a full publication. And also was like, do you want to join the committee? Because for me and F Murray, it's important that we keep people who have, you know, a high level of interest and high level of aptitude within the field to kind of pursue that. So I'm very keen to kind of perpetuate that. And if anyone amongst the speakers or attendees is keen to follow in those footsteps, I'd encourage you to keep attending such events and to reach out to us if there's anything you want to do with us, um You know, we, we are very open to trying new things and I think that's how it should be in the spirit of how research is conducted. I mean, why would I turn away a good idea? But I know couple years cool. If that's already, then should we make an announcement of a winner and get this on with? Awesome. So, um we as a committee behind the scenes, we've been listening really well to all of your presentations. Um And you know, everyone's doing really, really well, everyone had an outstanding presentation. I'm happy to give you guys any particular feedback if you'd like to at the end or afterwards, if you wanna email us. But um yeah, I'm very glad to announce that um we, we're gonna be awarding a certificate for the best certificate uh for the best presentation to AA for her work on cannabis and its perception in the media. So, really well done. Thanks so much for coming to presenting a really unique piece of work that we don't see much in the medical field. Uh Thank you very much. I really appreciate the opportunity and yeah, thank you. Amazing. Yeah. So, um I will, I'll be in touch with you afterwards. At some point. I will send you some, some bits and pieces for, you know, for um certificates and just for doing really well. I'd probably also have a discussion with you about how you wanna pursue that work in the future and, you know, if you wanna work with the committee as well, so I'm more than happy to have those conversations and once again, really well done everyone for coming and uh thanks to all, everyone who attended again for, you know, committing time out to your evening and listening to us all these really interesting and um kind of inspiring talks. I hope that some, you know, you guys might take some inspiration to try something like this, yourself side will be ok. Fantastic. Yeah. Thanks again for coming, everyone.