 Thank you everybody for coming this year's Joel Lecture 2023. We obviously missed one or two but then we caught up and were now back to a series of Joel Lectures. I have to say it's quite an exciting time, I think tonight, because we have a very special speaker that's going to tell us lots of interesting things. I was going to start by introducing the reason why we have this lecture really ac mae am ydych chi'n srebu'r ffaith yw UCL yn y lle lle oldig yn Y Llyfrgellfa Ysgol Cymru. Mae yw'r lle yn y Llyfrgellfa Ysgol Cymru, a mae'n 103 oed. Fe'i gael ei wneud i gael ein bod nhw'n bwysig llesen. Mae'n bwysig i'r lle i ymwneud ychydig yn ei gael i'r lle yw ymwneud yw'r lle. Mynd i gweithio ymddangos, mae'n credu lle lle lle yn y Llyfrgellfa Ysgol Cymru at the Middlesex Hospital Medical School in 1745. Sorry, I've got that wrong straight away, haven't I? This is when the medical school was established. I can't even read my own slide. I apologise for that. And prior to that, the Middlesex Hospital had built up quite a reputation for radiotherapy. And then we go along this period where the University College Hospital also had a medical school that started within the 12 months of each other. In this period, some massive undertakings developed a lot of x-ray techniques, or at least the beginnings of x-ray techniques. And in that same period, there were two guys that had a pivotal role in the development of this Joel chair. And these are the two people here. They're part of the Joel Bonato family. And they are from the east end of London, from a relatively modest background. They were born in 1850 around that time. And within 30 years, they had moved to South Africa. They had developed a mining interest for both diamonds as well as gold. And they made a small fortune and sold up their business to De Beers, a very large diamond company. And they sold that business for £5.5 million. And based on that, they then went into other developments in South Africa and eventually came back to the UK. And they made a large bequest to the Middlesex Hospital. And they wanted the Middlesex Hospital, and they made that bequest in 1912. They wanted the Middlesex Hospital to develop their radiotherapy techniques further. So they decided in the end, with the Council of the Middlesex Hospital, that they would have three appointments, one in the Department of Surgery, one in the Department of Chemistry, probably now more closer to biochemistry, and one in physics. And it was the Joel Chair in Physics that was established in 1920. And that chair was occupied by Sydney Russ, who was one of the early pioneers of medical physics applied in hospital work. And the Joel Chair has therefore been held originally by the Middlesex Hospital Medical School. The important thing is that it merged with University College Hospital Medical School. At one time they thought they might call it the Unisex Medical School, but that was decided against. And instead it became a joint medical school, and then that medical school joined with UCL. So the Joel Chair transferred to UCL. I think that's enough of the history of the Joel Chair. So the reason we're here is because it's a relatively important chair, and it was established early on and has since continued. But I wanted to say a few words about tonight's speaker, if I could find my notes, because Claire has so many things for me to tell you that I needed a written piece of paper. Let me run through one or two of these. She is currently the director of the near-infrared spectroscopy research group here at UCL, so Vice Dean for Impact for the Faculty of Engineering Sciences. But that's not all. She's got many honorary positions in many universities and hospitals, both in the UK and abroad. She has research projects in a wide range from autism, acute brain injury, sports performance, migraine and malaria. And she's started many international aspects of her research. And those have led to various things. For example, the global functional near-infrared spectroscopy initiative. And also she's founder and trustee of charity for young scientists in Africa. And these, I think, give a good idea of how broad her impact has been. And she really is an ambassador for UCL and for the area of this department, Medical Physics and Bioengineering. She's been supported by a range of research council funds, charity funds, industrial collaborations. And she's also been several awards, really. And I was going to just list one or two of the awards here. The Provost Public Engagement Award, the MRC Science Suffrage Award, Inspirational Teacher Award in the UK, Women in Science and Engineering Research Award, UCL Engineering Engagement Outstanding Contribution Award, British Science Association Media Fellowship to work with the Financial Times. And that's just a small selection of the awards that she's had. But when I looked up this, and I found out, I noticed there was one award that was not mentioned. And I felt it was quite important to let you know that she is, in fact, an Olympic gold medalist. Myself also. We are, in fact, joint holders of the gold medal. And the award I'm talking about, and in fact I've brought my medal along today, I'm not sure if Claire keeps hers quite as close to herself as this one. And I have it here. Gem, our head of department in those days, in 19... 2012, sorry, Gem. 2012. 2012, organised a two-day getaway, which was both for scientific discussion, but also we arranged a pentathlon event during that time we were away. And at the end of the two days, we got to the final event, which was an egg and a spoon race. There was a slight problem, I think, that one of the teams was accused of using Blu-Tac, but that was never accepted. And instead, Gem kept the peace by donating both of this. We were leaders of teams, by the way. We weren't individuals, leaders of teams. So I think you've heard enough from me, that instead I'm going to ask Claire to come along and give her a lecture tonight for the Joel lecture for 2023. Thank you. Hello, everyone. It's so lovely to be here. And I just want to start by saying it's an absolute honour to have been invited to give this lecture in the Joel chair. And it's a real pleasure, isn't it, to be back together in person with everyone, and it's really lovely to see all my amazing colleagues here and my friends and family that I've restricted to the front row so I can keep an eye on you all. Thank you for being heckling. So that's why I need to know all times where you are. So here's the title of my talk, but actually the more accessible title of my talk is this one. Blood, Babies, Brains and Bill Gates. And that's really what I've spent the last 30 years working on. I'm going to talk about my research and everything to do with Blood, Babies, Brains and a little bit about Bill Gates. But actually what I thought I'd do for this lecture is weave in my personal story of my career and the flavour of how I've led, I think, quite an unpredictable path in my career and what's taken me into all of the various projects that I've been working on. So it starts with my education. I attended a state school in Croydon called Coloma where I studied maths, physics and chemistry. I was taught physics by a nun which was an interesting experience. And actually my daughter, Julia, went to the same school and she achieved the heights of becoming head girl. I didn't achieve those heights because I was too busy smuggling boys into the sixth form block. So I had an interest always in maths and physics but I also had an interest in medicine. So for as long as I can remember, everyone said to me that I was going to become a doctor. And I knew that I wasn't that keen on biology and chemistry and I thought I'm not going to do very well at medical school if I don't like the squishy stuff. So I was very lucky that in the summer of 1984 when I was 17, I was enabled to attend an event called the London International Youth Science Forum. I was sponsored by BP to go to this event. This event gathers hundreds of students from all over the world for a two-week residential science forum in central London every summer. And because of my interest in medicine, I went to anything that had medical in the title. So this is the programme for the event that I went to and you can see it's a series of lectures and debates and visits and social events. And I choose to go on a visit to the Royal Marsden Hospital in Sutton. And when I went to that visit, I met my first ever medical physicist. I'd never heard of medical physics before but I met a medical physicist and I was introduced to the discipline and immediately I had that light bulb moment which I think I was incredibly lucky to have because I realised this was the way of merging my interest in maths and physics and my love for medicine. And in that moment I decided that that's what I was going to do. So I went back to my school and spoke to them about medical physics degrees and they'd never heard of it and they actually tried to persuade me quite hard to actually do medicine because this was a very unknown. And also my careers teacher who was a German teacher said you can't do physics, Claire, it's too hard. And I thought well that's a jolly good reason to do physics then. I read physics with medical physics at the University of Exeter and had an amazing time there. And then because I loved my degree and everything that I was taught there I was really keen to start working as a medical physicist which I did at the local hospital there in Exeter. And while I was there I did a master's degree, a research master's degree in the very glamorous topic of old men's snoring. So I did a master's degree in sleep apnea stop breathing when they go to sleep. So my time there was spent sitting up awake watching old men snore. So don't let anyone tell you there's no glummer in medical physics. So around this time I met a guy and he was in London and I thought, and he did turn out to be my husband, I thought I think I'm going to move back to London. And so then I started to put feelers out for jobs in medical physics and that's when I was introduced to Dave Delpy by a mutual colleague of ours someone in the Exeter Medical Physics Department knew Dave and had worked with Dave and said if you're going to do medical physics in London you have to do it at UCL with Dave Delpy. And Dave gave me a ring and told me about this job that was available as a research assistant in the Department of Pediatrics. It was six months before the end of a five year grant and somebody had left and he was very straightforward and said we've only got six months of money and there's no guarantee that the grant will be renewed. So I left a permanent secure position in Exeter in the NHS for six months of money here at UCL and within I think three or four months of me joining the funds for the next five years of research were secured. So it was a risk but it was one of the best decisions I'd ever made. And the research assistant post was to work with these particularly vulnerable patients. This is a premature baby born at 24 weeks gestation the normal pregnancy being 40 weeks. So this baby is born 16 weeks premature. And the question that the team that I was working with was trying to address was to understand the consequences of prematurity on these little baby's brains. So actually the survival rates of these babies are pretty good. The clinical management of these babies has improved enormously but there are concerns about what's happening in their brains at this very critical period. These babies are vulnerable to strokes and bleeds and those could lead to devastating consequences and handicaps. So you can imagine that the type of solutions for this challenge are fairly narrow because of the types of patients that we're dealing with. And this really introduced me very clearly to the concept of really what medical physics and bioengineering is. And my definition I'm sure many of your definitions is it's addressing an unmet clinical need with innovative physics and engineering solutions. And both of the parts of that sentence are so important. We only want to solve questions that are challenges that actually exist. So they have to be driven by the end user and in this case they have to be driven by the clinical team. But also we don't want to work on boring stuff. We want to work on stuff that's going to be challenging because we're going to push the boundaries of physics and engineering. That's where the exciting transformations are going to happen. And in these tiny babies we can't use conventional imaging. It's possible to do magnetic resonance imaging which I guess most of us would say is the gold standard of brain imaging but it's difficult you've got to transfer these babies in their incubators in a completely metal free environment into a magnet. You can do ultrasound imaging which is non-invasive and you can do it at the bedside for what the clinicians wanted to understand about what was going on in the brain. And so as physicists and engineers Dave's group and others had gone to their happy place. So this is the electromagnetic spectrum which is just basically radiation in its different forms. And so we can look along this spectrum and we can recognise the types of radiation that are already used in medical imaging. So radio waves are important in magnetic resonance imaging and of course most of you will be familiar with the idea of using x-rays either to image the body so the lower energy x-rays or to treat the body in terms of radiotherapy with higher energy x-rays and gamma rays. The area that Dave and others had focused on was the optical radiation. And if we look at this region here the visible part of that is a very thin sliver. But even with visible optical radiation just with white light that you're looking at each other with now you've got quite a lot about the human body. If we just look at these two tubes of blood this is a photograph I took on the intensive care unit at Great Ormond Street Hospital and a study that we were doing there where babies were undergoing a treatment where their heart and lungs were failing. And so the blood was taken out of their body and then put through an artificial oxygenation system and then re-put back into their body. So the lower tube is the blood that's come out of this baby that's really deprived of oxygen and the top tube, the red tube is the tube of blood going back in that's been fully oxygenated. So you can quite clearly see the difference in the colour of the blood in those two tubes and that's because of the different amounts of oxygen that's being carried in that blood. So if we can manage if we can measure the colour of the blood then we can work out how much oxygen it contains. And of course this is very easy to see in a clear tube when the blood is out of the body. How do we do that in terms of in vivo? Well let's just do a little demo. So my brother brought this torch which was very handy. So a white light source straightforward you could use the flash point on your iPhone. So just put my thumb in front of the white light and immediately it glows red. And that's because the hemoglobin in the blood, in the tissue, in my finger is fully loaded with oxygen and so the light that's returning that's transmitting through my finger is representing the colour of that blood which is red. So many people would have said that I've spent most of my career working on a glorified torch. That's probably a fair assessment but it has taken me to some interesting places as you will hear. So in terms of what I've just done we've put white light of all different colours into the finger and we've seen red light coming out and that's telling me that the tissue contains red oxygenated blood. The problem is I'm not really interested in fingers interested in brains so if we try and do this now we're not going to get very far because the white light is not going to transmit through my head but mostly it's not going to transmit through my skull. So we need to do some clever physics and the clever thing that we do with the physics is slide beyond the visible part of the spectrum into the near infrared and these are the types of wavelengths that you might be using with your TV remote control. So they're invisible to the naked eye but they have a very useful phenomena. This is a hand that's been transilluminated with not white a visible light but near infrared light and what you cannot see in the hand here are any bones and that's because the bone is transparent to this wavelength of light transparent to the near infrared and for that reason we can shine not white but near infrared light through the skull into the brain and do exactly what we did with my finger see what colour the brain glows and that will tell us how much oxygen is being carried in the brain. So in terms of the challenge that we had for the preterm infants on the intensive care unit systems were developed that enabled the delivery of this near infrared light through optical fibres to the baby's head and then sensitive light detection systems that essentially looked at the colour of the blood that emerged. That information is taken to a computer that had an algorithm that transferred the attenuation a sort of colour of the light into the concentrations of both oxygenated and deoxonated blood. So that's the principle of the glorified torch and in practice the clinical team that I was joining in the Department of Pediatrics had successfully started to show that this technique worked in babies and this is like a photo opportunity baby here most people who do optics would say that baby's got a lot of dark hair is that a problem and actually it's not a problem but it doesn't also look like a thankfully like a very healthy baby this is more like the babies that Dave and his team were studying when I joined the group so this baby is another premature baby the business end of keeping this baby alive is all focused around the ventilator the feeding tube the other monitors on the baby's chest so the other thing about bringing brain imaging into this environment is to make sure that we don't disturb any of that so you can just see the two black probes on the baby's head that those probes are delivering and receiving the near infrared light that's enabling the measurements of the oxygen levels in that baby's brain so if we go back to the picture that I showed you earlier the black lead here is an optical fibre and the near infrared spectroscopy probes are just underneath these babies bonnets so the name of our technique is near infrared spectroscopy because it uses near infrared light and spectroscopy is just a method of measuring the colour of something and so I started work with Dave and his clinical colleague John Wyatt on the neonatal unit and what I love about this photo it's I think the epitome of multidisciplinary collaboration because Dave who's sitting in the front here is the one manipulating the baby and John Wyatt who's the clinical guy Dave being an engineer is standing there actually very calmly with full trust that Dave knows what he's doing and I learnt so much from watching John and Dave I learnt the importance of communication and collaboration and sometimes keeping your mouth shut and your ears open and understanding the context of being working in that clinical environment meanwhile I was spending my time going between the neonatal unit and the laser labs that we had in the medical physics department just across the road so some of the work that I was involved in there was in this particular experiment in this photograph I was looking at measuring the time of flight of the light through different sections of tissue using really sensitive lasers and camera detection systems and because Dave and others had shown the feasibility of this type of technology for measuring brain oxygenation in these small babies they managed to secure industrial funding from a collaborator called Hamamatsu a Japanese company and the Japanese company developed the first commercial near infrared spectroscopy system called the Niro 1000 and it was called Niro because that was easier to say in Japanese than NIR and so I spent a lot of time sitting by babies cots watching these red lines going up and down indicating the oxygen levels in this baby's brain and Dave and others worked really hard on creating techniques that allowed us to find out really important things about the status of these babies' brains so I'd been working in the department by that point for about six months and Dave came to me and said have you thought about doing a PhD and I said no and for two reasons, first of all it's an awful lot of hard work and secondly I'm not clever enough to do that and Dave in his very wise way said if you change your mind come and talk to me so over the course of the next few months I took a look at all the other people around me who were getting PhDs and I thought if they can do it I'm going to have a crack so I went and saw Dave and I said all about that PhD conversation and Dave just had that look on his face of I've been expecting you so I started my PhD with a suggestion again from Dave which was we've got this technology working in babies but we really want to see whether we can use it in adults and no one has really attempted to do it in adults now the problem with adults is imagine a very small baby head that's very transparent you could almost shine a torch through it not quite the same with an adult head so my PhD was focused on developing techniques both measurement and analysis techniques to investigate cerebral oxygenation brain oxygenation in adults so I was working a lot in the lab doing studies on human volunteers like these but I was very lucky to meet two people that really changed the course of my career at this stage one of those was Huw O'n Rhys but he was working on the neonatal unit that's where I met him but he introduced me to Martin Smith who's a consultant neuro and esotys also sitting in the front row and likely to heckle at any moment who ran the adult neuro intensive care unit at the National Hospital for Neurology and Neurosurgery and so for part of my PhD I took my studies out of the laboratory and medical physics and into the clinic so this is a typical adult neuro intensive care bed we have a patient who is brain injured surrounded by lots of different monitors and the unmet needs in this situation is very similar to that in the neonatal unit the clinicians looking after these patients want to understand how best to help these patients to recover and also to see whether they are capable of a meaningful recovery and so I spent a lot of time thinking about the types of techniques that we could use that we could get to work in adults and we did a lot of work and published a lot of papers and it was very interesting to see the different ways in which this technology could be used so as well as doing studies on these patients in intensive care we also did studies on neurosurgery patients and these were studies where we actually were placing our optical sources and detectors directly on the brain tissue so these studies were having awake craniotomy so the skull was removed and we wanted to have a look at the influence of the skull on our signals and we thought there was no better way of doing this and doing measurements on the outside of the skull and then on the direct brain measures once the skull had been removed and this was all done in collaboration with the neurosurgeons at the National Hospital again really insightful really important and I learnt so much so doctors like Martin and natural teachers doctors teach each other all the time so if you just spend time in these environments and listen and turn up to the hideously early meetings at 6am or something you will learn a lot and that's really for me the heart of these interdisciplinary collaborations and the other thing that's important is to start understanding the languages of physicists that you need to speak to make yourself understood for somebody who's not in your own discipline and around this time it was clear that the Hamamatsu systems were really taking off and becoming very popular and this is the next generation of Hamamatsu system, the Niro 500 I did warn them to go down in the numbers because they'd gone from Niro 1000 to 500 but they ignored me, thought that was going to be quite self-limiting but anyway and then around this time Dave said to me do you know what there's lots of people that are asking you questions like technical support and that wasn't my role, I wasn't employed by Hamamatsu and he said I think you should you should just do a little leaflet like frequently asked questions so you can just hand it out to people so I said okay that sort of sounds like a good idea that won't be much work so in the same month that I published my PhD I also published this book which is the practical users guide to Niro and Frith but trust me I don't know your definition of a leaflet is Dave but he was like just add that in just add that in and this again was a bit of a game changer because lots of people wanted to know more about the technology and so they were given this book and my profile just rose because people realised I knew about this stuff so and also from Dave's generosity he was very good at saying oh I've been invited to give this talk in Berlin I really can't go but I'd like you to go so I've told them that you're going so I turn up they were expecting Professor Dave Delpy the godfather of this technology and then they got me it was fresh out of my PhD but again that was an opportunity for me to really cut my teeth and understanding not just what was going on in my own laboratory but how we communicated that to other research groups so I'd done my PhD and I was working on the adult intensive care unit and Dave said you really ought to apply for your own funding so I applied for both the welcome trust and an MRC non-clinical training fellowships and for those of you who are not in academia these are the ways to get your first own funding and start your own research groups and I was awarded the medical research council non-clinical training fellowship on the same day that I discovered I was pregnant with my daughter and spoke to the MRC about this and they said oh we've never been in this situation before I wasn't wholly surprised about that but it worked in my favour because they said we'll just tell us what you'd like how you'd like to manage this so I said well I'd like to still have the fellowship it was a three year full time fellowship so I said but I'd like it to be extended to five years so I can work part time and they said yes you don't ask, you don't get so once I'd had Julia I went to work and I returned to work three days a week and two years later I had my son Joe and I was on maternity leave with Joe when Dave said Mark Hope who was another founder of the technology was leaving UCL and there was therefore a vacancy for a lecturer so I didn't apply because I just thought I'm work part time I don't want to go full time but the night before the deadline I put an application in and I put a covering letter to say happy to apply for this but I want to continue to work part time because I thought I just wanted to be transparent about my situation and I was appointed lecturer at that time so I continued to work three days a week for a number of years and continued to volunteer my own children for medical research so I had got the fellowship I've returned to work from two lots of maternity leave but I was hungry to do more work and that needed more money and I thought a really good idea of what we should do on the adult new intensive care unit I wanted to create what I called a multimodal monitoring unit and so I wrote this grant this application for funding about what I knew which was measuring hemoglobin and oxygen and that was squarely rejected so I thought well they don't know what they're talking about I'm going to write another one to another funder that was squarely rejected and of course at this point you'll think well that's it I'm giving up on academia no one knows how important my idea is I'm not being heard and I think I'm just going to go and do something else and then when I calmed down a bit I thought well actually I should probably read the reviewer's comments and work out why they didn't give me the money so to this day I still don't know who this reviewer is please make yourself known to me and I will definitely buy you a beer this was the comment and those of you that have heard me speak about this before have heard this quote it's the best quote I think you could ever put on a grant application the reviewer told me to measure the important rather than making the measurable important and I think that's something we really need to hold on to we're very good sometimes as physicists and engineers to be very proud of the stuff that we can measure and thinking is that really what anybody needs to know so I'm just going to do a tiny bit of biochemistry to explain what I mean by this so this is a sketch of something called the respiratory electron chain and this is basically a description of how oxygen powers a cell to keep it alive so you have oxygen being carried on the hemoglobin that's carried in the red blood and the oxygen comes off the hemoglobin into the cell and it's metabolised by an enzyme called cytochrome and it's the metabolism of oxygen by this enzyme that produces something called ATP which is basically the fuel for the cell so this is the process that really tells you whether a cell is working properly now we know that we can measure hemoglobin using near infrared spectroscopy because it just changes colour but actually so does cytochrome and even though the colour change isn't in the visible part of the spectrum as it is with hemoglobin we can still measure it using near infrared spectroscopy so I became along with others and Ilyasus in the room was absolutely pivotal to this work in working out how we could measure this particular enzyme because we knew that it was super important because it really got to the heart of what was going on with what we call cellular energetics the equipment for this was complex and I would say this was definitely not a glorified torch it required us to make the measurements in a much more specific manner but we managed to do this and just bringing you to where we got to with this particular project we actually managed to get to the point where we were imaging for the first time ever oxygen metabolism in brain injured patients so we could get concurrent images of the oxy and deoxy hemoglobin the oxygenated and deoxynated blood and then oxygen metabolism at the same time and this was focused on understanding the process of cellular energetics during brain injury because if someone has a brain injury part of their brain dies but then other bits of their brain are still liable to potentially being recoverable but we need to understand what status that part of the brain is in and also importantly these types of measures can help inform the types of interventions therapeutic interventions that could help these patients we went on from this also to develop two different markers which I think were really important one was looking at the correlation between a metabolic so we call this a metabolic reactivity plot and the other was looking at the correlation between activity measured with electrical signals in the brain and metabolism which we labelled neuro-metabolic metabolic coupling and I think this project I'm particularly proud of because it was really the impact of amazing collaborations myself and Martin myself a physicist Martin a clinician Elias and Martin Tisdell a neurosurgeon David Heighton who's mentioned in the paper here who's a neuro-nesotist and Fong Fang who was a intercalated medical student who did a PhD with us a very bright engineer and it shows me exactly where the sweet spots are with interdisciplinary research if you get the funding for those two different disciplines to work together that's where the step changes in the research happens so I was doing this work in adult intensive care but I was also still keeping an eye on what was going on with the baby work and during this time I was approached by a group from the Centre for Brain and Cognitive Development from Burt Beck and they've seen the work that had been going on in neonates and they were interested to see whether any of those technologies could be transferred to babies slightly older so these are babies in the first 6 to 12 months of life they were studying these babies because they wanted to look at the brain development of these infants and they needed to understand more about what's going on in these babies' brains now these are a very different type of subject and patient, they're not a patient but a subject to try and put optical imaging on so with the neonates yes they're very vulnerable and they're delicate but they don't go anywhere they are stationary in the cot meanwhile these babies are quite capable of moving their heads and potentially moving around so at the same time in parallel there was a lot of amazing engineering developments going on led by Jim Hebden and Nick Everdale in creating systems that allowed us not to just look at brain oxygenation in one region of the brain but to map it across the entire brain so that worked by having not one source and detector but having multiple sources and detectors that were shining light through different parts of the brain and as they did so creating a colour map of the oxygen levels in the babies brain and then we can imagine that we can say well there's a certain amount of oxygen in this babies brain denoted here with the white circles if we give the baby something to do something to look at or something to listen to or something to feel part of the baby's brain that's processing that information will start using oxygen and as the oxygen is being used up we can see the colour map change so this is a way of getting simultaneous maps of oxygenation across the baby's brain now to look at brain function which was the real key that we wanted to get to in this group but wanted to understand so this is the theory this is what we needed to build and this is what was built alongside an amazing imaging system actually that Jen built so this is the UCL near and for ed system called the NTS system which I think stands for NYX topography system it's a very amazing it's an amazing system because it does everything you want it to do exactly as you want it to do it it produces the spectroscopy data that you want but because of the way in which the signals are multiplex both the source and detector it allows a really flexible geometry of where you can measure on the brain so you can get simultaneous measures on the brain and if for example you want to change the alignment of the probes on the brain on the headgear you can just swap them around and measure whichever brain regions you want now the physics and engineering in this is good but the real important thing with these studies particularly with babies is to get the front end right so Anna Bloddy who's in the room here and Sarah Lloyd Fox so Anna's an engineer we employed Anna and Sarah Lloyd Fox who's a neurodevelopmental psychologist to work on developing this optical headgear so we started off with an approach where we just had the fibres basically perpendicular to the baby's head we lost probably about 60% of our data because it was very unstable we weren't getting good coupling on the baby's head we solved that in part by putting a little prism in the fibre so that we could bend the light through 90 degrees and this gave us a much neater headgear to put on the baby's head that worked up to a point but we had light losses at the prism interface so we then worked with an optical fibre company called Loptec who developed a curved fibre which were very unusual at that time which meant the light would just go around this bend and it enabled us to create this plug and play optical fibre system which really was the game changer in opening the doorway to doing functional neofred spectroscopy studies on a whole array of infants and this is just a selection of some of the infants that we studied at the Centre for Brain and Cognitive Development in their baby lab so when we talk about measuring brain function what do I actually mean well here's our baby with the headgear on and we're measuring the colour of the baby's blood at all different regions of the brain so now let's imagine that we show that baby is a stimulus, something that's going to activate their visual cortex what we see in each of these individual channels is the presence or absence of this increase in oxygenation this is the red line showing the increase in oxygenation this is the red line showing the blood getting redder right so this is a signature to show that part of the baby's brain is active and processing that information imagine that we have multiple signatures of different sizes because not each part of the brain is going to be activated we then combine those into an image and the red spot on this image is showing us the centre of activation for this baby's brain so that's the process by which we understand brain function using this technique so Sarah Lloyd Vox who I've already mentioned was doing a PhD at the time and she really pioneered the use of this technology in understanding brain function in infants these are some photographs from her study so this is an infant first of all looking at a social image this is the actress on the screen doing itsy bitsy spider and then we interspose this with images of non-social so like trains planes helicopters tractors now we knew there's a lot of studies that have already been done looking at the behaviour of infants when they looked at these two different types of images so this is a video of an infant just looking at different types of images and what you can see is that we've got the head gear on this baby it's a very old video so the version of head gear does look a bit blue Peter but it stayed on the head which was good so this is on a loop so now at the moment the baby's watching the trains planes helicopters automobiles that baby's actually not interested in what's going on on the screen she's looking at her blanket and not particularly interested in a minute the actress is going to come on the screen see in the corner doing itsy bitsy spider and you can immediately say that baby's behaviour change that baby's engaging with a human the brain is recognising that that's a human interaction not interacting with an inanimate object Sarah did a range of these studies in infants and the aim of this study was to look at infants at risk of autism so she did studies first of all in a group of infants at low risk of autism no family history of autism and these were the data that she got from that group so the red line again is showing the increase in brain oxygenation when they're looking at the social the itsy bitsy spider actress she repeated exactly the same study in a group of infants with high risk of autism and these are infants that had a sibling with autism now it's just worth saying that all of these infants were studied between four and six months of age and autism isn't diagnosed clinically until the second or third year of life so this is way before any behavioural signs would have been evident and these are the data that she got from the high risk infants so we can see a very moderated response in the oxygen levels when the baby was looking at the social and it's almost as if these babies are not seeing the difference between a human and a tractor and if you looked at the difference in the behaviour you wouldn't have spotted any difference in the behaviour between these two groups you had to be looking at what was going on in the brain so this was the first time that anyone had shown that as young as four months of age we could use brain imaging to start to understand babies' responses to the world around them so these babies were followed up they aged to the point where they could have a clinical diagnosis assessment of autism so Sarah followed these babies up and she looked at how the responses that had been measured at four to six months of age correlated with the outcome of the clinical assessment for autism so again on the slide that I'm showing you here the green is the cohort of low risk infants showing that nice response and the purple is the cohort of high risk infants showing the moderated response what she did was split them into different groups depending on the autism diagnosis so in the low risk group none of the infants went on to be diagnosis autistic in the high risk group those infants that were not diagnosis autistic still had a positive response but if we just look at the infants that were in the high risk group that did receive an autism diagnosis at three years those are the infants that had a moderated negative response and so this was the first time that anyone had shown that the brain responses that we measure in the first six months of life are associated with autism outcome in toddlerhood and we are still understanding lots about autism but I think the one thing that everyone would agree on is the earlier it is diagnosed the earlier some interventions if appropriate can be implemented for these infants so I think this is a really important piece of work and I would give full credit here to Sarah for pursuing this work and doing it so diligently at the time we were interested in expanding the use of the technology this is an example of doing baby to baby interactions two babies connected to the same imaging system so we can start to look at how babies not just interact with the world around them but also with each other and most recently we have the opening of the world's first toddler lab at Birkbeck and my niece here, Lizzie has got a four-year-old who we are carrying on the family tradition of donating our children's brains to science in fact I must get a picture of Ollie for this slide so what's happening now is this amazing coincidence of technology so what we've got now a wearable near-infrared spectroscopy system so the infants have got a little backpack electronics for the system but they're just wearing a little bit of headgear that's all they think they're having again but the real game changer is that they are now engaging with a virtual reality environment that we can programme so the figure that I'm showing you here is from a study being led by one of the researchers that's worked in my group Kiara Bulgorelli and she's looking at the development of empathy in toddlers so this toddler will be playing with an avatar and she will build a relationship with this avatar and then the avatar will fall over and what we're looking at is the baby's brain responses to what happens when that avatar falls over and looking at the development of autism at this really early stage so this is incredible now where this work has taken us but it's just started with pretty simple collaboration seeing whether we could get this technology to work in this age group of infants so meanwhile what was happening to my career well by this point I've been promoted to senior lecturer and I'd increased my hours from three to four days a week and then in common with lots of women at this stage of their careers I just assumed the next step was out of reach and unfortunately that is true that many women are not forthcoming and putting themselves forward for promotion but I was very lucky to attend a women's only promotion workshop which was run by the head of HR at UCL at that time and I met a professor of chemistry a female professor of chemistry who sat on the promotion panel and she said I think you ought to send me a copy of your CV and I'll give you some honest guidance of whether I think you're ready to go for promotion to professor so I did that and it turned out I was so I was promoted to professor in 2008 while still working part-time and I think it's worth saying that the previous dean not the one in this photo had said to me you'll never make professor part-time I haven't found him yet but when I do so that was a big moment no expectation I was the first person in my family to go to university zero expectation that I would become a professor and I remember telling mum and she just collapsed on the floor so great moment and I couldn't have been achieved without all of the people I've already mentioned so what else was going on then was I was getting approached by lots of sort of random studies people saying do you think we could use brain imaging to do X, Y and Z most of the time the answer was a flat no but this study I was very intrigued with we had a group from Oxford who were looking at malaria patients in India and they wanted to understand more about serial malaria coma and so they asked if they could borrow a system and take it out to India and start measuring these patients so I was like okay we can train you up and we can help you design a project and design the studies so they took the system out and it didn't really go to plan the infrastructure in the hospitals as you can see was not what we were used to dealing with and this is my first experience of doing any type of global health work but we had a really dedicated researcher on this project called Christina Colova and she put a huge amount of time into this project and I said whatever happens Christina you've got to have an output from this project so I encouraged her to write a short paper it was proceedings for a conference really just to describe some of the data that had been collected in these malaria patients and I do remember I didn't say this to her I didn't want to disheartner but I do remember saying to myself no one's going to read that paper but she needs it she needs the output for her CV and that's important for her so it turned out that someone did read that paper and they also had read Sarah's papers on the work that we were doing in the baby lab and the group that read the papers were the Medical Research Council International Nutrition Group led by Andrew Prentis and Sophie Moore and the late Mamadou Darbo and they read the paper and they asked me a question could we use neofred spectroscopy to image the brains of infants in Africa to understand the impact of early years adversity and that was quite a lot for me to unpack because I knew absolutely nothing about global health and I frankly didn't know anything about the experiences of infants in this part of the world the field station that they work in is in a small village called Kenaber in a rather remote region of the Gambia so I started reading up about what they were talking about so the rather startling statistics is that half of the world's children are living in poverty and this means that they're exposed to a range of different risk factors including cancer and malnutrition infectious and non infectious diseases low quality healthcare and inadequate early years education all the things that we take for granted when we're nurturing and rearing our own children and again another rather startling statistic from this paper that was published in 2016 says that one in three one third of preschool aged children in low middle income countries are failing to meet their developmental milestones either in cognitive or socio-emotional development because of the early adversity that they suffer in the first stages of their lives and this equates to over 80 million children most of whom are living in sub-Saharan Africa so once I looked at some of the background to this and I realised how enormous this problem was and rather ashamed that I didn't know about it I spoke to Andrew and Sophie and said well how are you currently measuring brain development in your infants and they said we measure the size of the baby's head and actually this is a good thing to do because if the brain's not growing the head won't be growing and their head circumference data which is shown here so this green line is the line that these infants should be achieving with their head growth if they were growing appropriately and we can see that all of the babies that they measured are falling off that healthy growth line and so there's clearly indications here that these babies' brains are not thriving and so there's clearly work to be done in understanding why that is the case and importantly how we could intervene and protect these babies' brains so of course the next part of the conversation was we're going to need some funding to do this and that's when I was first introduced to the Bill and Melinda Gates Foundation and particularly to a scheme called Grand Challenges Exploration Scheme which is the best grant application scheme to get involved with because the application is two page long and the funding details are two lines long now I don't know what things are currently but it's at least 120 pages probably isn't it now for work tribe and all that stuff the amount of money that you got on the phase one was 100,000 and if you showed that you could use that money wisely then you could be put into an application for phase two funding for a million dollars the current success rate when we applied for phase one for phase two funding was 2% so it was definitely a carrot but it was a very small carrot a long way away so we put in an application with a question can we use functional neofer spectroscopy to understand brain function in Gambia and Infants over the first two years of life and we got the money so with the money we built a scaled down version of the imaging system because we didn't have enough money to build a whole one and we basically put it in a box and took it as access luggage over to the Gambia and we arrived at the field station and these are all the boxes that we brought either the bits that we stored in our suitcases or as access luggage this is the brain imaging system that we transported and I'm just going to show you very glad that I took these photos what happened over the next couple of hours so within an hour Sarah who's seen here and Maria Papadimitriou who is a PhD Maria is a physicist on the team again the physicist psychology pairing were setting up the system as they would do in London and within an hour and a half we were training a local field worker Seiku and in just over two hours we had our first mother and baby come in for a study and so we ran a study just as we would do in the UK the only adaptation that we made was we re-film the videos with Gambian actors rather than UK actors and just a few minutes later we'd finished our first study and this little lad looks really pleased and slightly startled as he should do because it turns out and I'm still willing to have some I've been saying this for ten years someone to correct me this is the first baby to have their brain imaged in Africa it just took somebody to put it in a box and take it out there and make it happen and so we looked at the data from that first study Sarah analysed it and at three o'clock that afternoon I was due to give a seminar at the field station to describe why we were there as a team and what our plan was and it was amazing to be able to show them the data that we collected already that morning so the data that I'm showing you here are the selected channels and regions of this baby's brain that are showing this response to show brain activation and so we'd shown in one baby this work so the temptation is to pack up and go home then and say we got it to work but we didn't we stayed we studied another 41 babies who were in the age group four to eight months we went back and followed those babies up a few months later and then a few months after that so we got data on these babies up to 18 months and 16 months a cross sectional study of not to two months old and 18 to 24 months old because we promised the Gates Foundation that we'd look at the feasibility of this technology over the first 1,000 days of life and that is from conception so that takes you up to the baby's second birthday so this is a video of a little chat probably about 18 months old doing the study and I show you this video for two reasons the first is there were a number of people said we'd never get this to work and the second is it's very useful to have these videos on an iPad when you're trying to recruit mothers and babies because quite reasonably they will be worried about what you're asking them to do and it's very helpful to be able to say my daughter and my son have had all these things on their head and it's good that two of us on the team were mothers it's actually unusually three women on that team and we could say that we wouldn't ask you to do this we could also unwrap the headgear and put it on the mother's arms and say look it's not hot it's not going to burn or anything so this little boy is looking at the video and you can probably just see just then he's watching somebody do peek-a-boo in this mirror here showing what he's seeing and his behaviour is so engaging and at the end of this little thing he actually does a little peek-a-boo himself so it's really clear that he's engaging with this situation and so the data that we're collecting is showing us what's going on in his brain but I think it's a great video to say how accessible this technology is in an age group that is conventionally very difficult to measure because if he doesn't like what he's doing he will get off and walk off so all the engineering making the headgear there he is doing his little peek-a-boo so we came back from these various trips and I said to Sarah you need to write a paper because this is a first and we need to get this published quickly a paper that was published in Nature Scientific Reports detailing the studies that we've done in the Gambia and I knew that we were on the edge of a different type of application of brain imaging so I established an initiative called Global Effnirs with the intention of providing information to the global health community about the opportunities of this brain imaging but also to the brain imaging community to say you need to start looking at the challenges that are being faced in global health and see if we can address some of these this was a lot of work and I decided in 2013 to take a sabbatical which took me all over the world because I needed to immerse myself in the world of global health because I didn't know anything about this and as part of that sabbatical I ended up in the Gates Foundation in Seattle the headquarters and I found myself in a poster session there were 400 posters in that session and I was chatting away to a guy at my poster who was interested in what I was doing and then the next thing I knew this was the guy that I was talking to Bill Gates is like Elvis came into the building he just appeared, no warning and I was with a colleague of mine who took this picture and timed the interaction which was seven and a half minutes so I had seven and a half minutes to convince Bill Gates that this was a great project he's a tech guy right so he didn't really need selling on the tech but again this photo reminds me of the importance of public engagement it was very kind to list some of the awards that I've received for public engagement and I think that's because it's really important you just need to be able to explain to anyone what you're doing and particularly to the world's richest man if you want to get some money out of his pockets so this conversation a site visit to London a huge amount of work by the whole team led to some significant funding from Bill Gates and the establishment of the Bright Project which is the brain imaging for global health project and the aim of this project is refold first of all to characterise the trajectory of brain development in both typical and atypical development in infants that have experienced adversity to identify early biomarkers of when that brain development is disrupted and then to inform targeted interventions to protect the baby's brains and so the study is involved recruiting 225 babies in the Gambia and 60 babies in the UK and it starts with following these babies up from birth to two years of age as we've done in the pilot but then Sarah and Sophie worked incredibly hard Sarah Lloyd Fox and Sophie Moore Sarah a developmental psychologist Sophie an international nutrition expert in getting more money out of Gates to add on bright kids so now the study expands all the way up to five years of age which is an important age because it's preschool so we get a preschool marker so the bright study encompasses a range of different measures it's the broadest measurement cohorts of any global health study looking at brain development and we look at home visits we're looking at caregiving practices we're looking at measuring the brain both with neofres spectroscopy and EEG, we're looking at behavioural measures parent-child interaction questionnaires health questionnaires, parental mental health growth measures, biological samples, DNA you name it, we're measuring it so it's a huge project with the most dedicated team to make all of this work and rather than singling out any particular output I'm just giving you a snapshot here and I think this slide is already out of date when I looked at it this morning I think there's at least two more papers that I should add to this so the next tranche of funding which we've just secured we're just about to sign the contracts on from Gates is for the third phase which we're going to call bright impact how do we take all that data how do we take all the learning from this project how do we take what we've understood about first of all making measurements in that environment but also what we're seeing about the trajectory of brain development in the two different populations and really create tools that can be very widely available global health tools that's already happening through the global FNIRs initiative we have studies happening in Bangladesh and we now have I think a really special example now cross-population, cross-cultural measures where we can do exactly the same measurements in three different populations and look at the comparisons between brain development in those populations and I sort of set a call to arms for the rest of the nearer Fredd community at a conference in after I'd met Bill Gates and I said right you need to start speaking to global health people in your institutions and understand what their challenges are and see if we can really address them and so now this whole global FNIRs initiative has really taken off with as you can see studies happening all over the world and this brilliant initiative now which I love from the Ivory Coast which is a pop-up mobile brain imaging lab and this isn't hard to do it's complicated but the technology is available to allow us to do this and to get to some of these populations these kids are working in cocoa farms they don't have access to any education so we're looking at the impact of their low levels of literacy on their brain development and also I think another real game changer Sophie Moore who I've already mentioned was able to secure significant funding from the Wellcome Trust to start the first intervention so a nutritional intervention of infants of the type that I've described where we're using the markers from our bright project as outcome measures so we'll really start to understand now whether we can create effective interventions in these groups I guess the ambition doesn't stop so I put this picture up of a field assistant who works in the region of the Gambia where we do our studies and he goes out and consents and recruits the babies and the mothers and I guess what I'd really like to achieve is to put a brain imaging system on the back of this motorbike a solar-powered brain imaging system so rather than having the babies having to come in to the clinic to have the measurements done we can just have the brain imaging system go out to them so you can imagine that this type of project takes a huge amount of dedicated people and I'm extraordinarily lucky that we have all of these people both in the UK and Africa working on this project and I've shown you some of the research outputs from this project but I think it's important to say also that as leaders of these types of projects we're also responsible for the career development of our groups and so I'm enormously proud and I think this is a gain out of date I think we have four completed PhDs with three in progress our team have achieved really impactful things with the funding that they've drawn in from a range of different fellowships and also academic promotions and with the exception of one person who's in the audience, I've just seen Liam where are you Liam, who's one of the PhD students who's doing incredibly well all the other accomplishments on this side are with female engineers and physicists and psychologists so there's a lot of talk about women in science but one of the things that we can really do is empower women to become their own leaders in their own fields and give them the opportunity to reach their full potential and it is possible this was the first time I'd led an almost exclusively female team and I'm enormously proud of everything that they've achieved so meanwhile, as you can tell I had to talk about this project to lots of different audiences and I wanted to understand more about how I should really engage with different audiences particularly a more general public around this work I saw and secured a British Science Association Media Fellowship and that involved me being seconded to the financial times in London writing a range of different science I was a jobbing science journalist for the summer some on topics which I knew well others on things I absolutely knew absolutely nothing about like carbon capture and genetics I came off that experience and I actually met Nigel who I think has joined us online and I was absolutely so enthused by the work I was doing at the financial times and I said Nigel we've got to find a way of bringing this back to the faculty so that we can really empower people to talk about their work to a range of different audiences and so we had a long chat and it was from that conversation and others that the role of Vice Dean for Impact was created and I'm really honoured to currently be in that role that's happening across the whole of the engineering faculty to a range of different audiences so I guess this is my career timeline in summary and a couple of things about this none of it was expected or particularly planned but I think the opportunity for me to work part-time when I needed to with the support of people like Dave and Jim Hebden who you'll hear from later was incredibly important I'm a great believer in work-life balance and I'm very relieved that I was able to have that time that I did as my children were growing up so I worked part-time for a total of 18 years and only relatively recently started working full-time so I've talked about our responsibilities of really bringing on our own research groups so I just want to end the talk by talking about other types of responsibilities that we might have as medical physicists and engineers and the next generation of scientists who are going to do all the things that we're too stupid to do they are going to solve the problems that we've created so we have to invest in them and so I'm really proud that my initial association with the London International Youth Science Forum when I was 17 has resulted in me returning to the forum as its academic president and we now have attracted the Princess Royal as our royal patron of students from over 80 countries the first speaker is a Nobel Prize winner we have a Nobel Prize winning speaker now every year these students are in for an amazing time and they're going to be exposed to world-leading science and because of my involvement in the forum but also because of the work that I've done in Africa I looked out and one of the talks I was giving at the forum a few years ago and thought where are all the African students they're just not in the room and so together with my late husband Tim Rook we established this small charity called Young Scientists for Africa and so this provides scholarships to enable talented young scientists from all over Africa to attend the forum and take their place as the youngest continent on the planet and the fastest growing continent on the planet these are the people that we should be investing in for the future of their science and the future of science in the world and this is just some of the students that we've sponsored there's Tonya from Zimbabwe Rebecca from Kenya with a big smile and Gracious from Tanzania and Pamela from South Africa and again I'm really proud of the number of female scientists that we have on our scholarships as well so I think there are ways of paying back sometimes then obvious but when they present themselves to you it's really important that you take them up so I've mentioned my husband Tim who was an enormous support in this charity those of you that know Tim will know that I was married to Tim for 31 years in November of 2020 Tim had a cycling accident and he suffered a catastrophic brain injury it threw me into a world that I knew well from a professional perspective but now I found myself as a relative not as a professor and it was a journey that I never expected to go on this is just a flow chart of a representation of what happens to people who have a severe brain injury Tim went into it was unconscious at the scene and so I was thrown into this world of trying to understand what it was going to mean for him and our family but I was extraordinarily lucky to have Martin Smith literally on speed dial who would have literally hours and hours and hours of conversation with me about the situation about the clinical perspective and Tim had his accident in November of 2020 he had an injury called a defusaxonal injury which is probably the worst kind to prognosticate very difficult to understand what the likely outcome of this injury will be but it became apparent that for Tim he wasn't somebody that was going to emerge and regain consciousness and Tim dies in February of 2021 and really that experience as you can imagine as traumatic and life changing as it was he got me thinking about whether I could indeed return to work but it was the support the unwavering support of Nigel, the Dean Andy, the head of department and everyone else around me that gave me the opportunity to have a sabbatical and it was during that sabbatical that I was given space and time to think about what my next steps might be during that sabbatical I was contacted by group that had actually managed Tim's End of Life Care or been instrumental in that and one of the groups that they work with which is the Coma and Disorders of Consciousness Research Centre led by Jenny Kitzinger at Cardiff University this is a multidisciplinary group of researchers that look at the cultural, ethical, legal and societal dimensions of Coma and other disorders of consciousness and look into how support can be given to understand really what's feeds into vision making in these very complex situations and also the support that can be provided to relatives and as I started to look into this when I had time to do so on the sabbatical I realised that this was a really important area for people to understand who were trying to help and one group that have been trying to help are those people developing brain imaging systems to see whether they could image people's brains to understand what the likely trajectory is for people in recovering or not consciousness now I apologise this is a complicated slide but there's sort of no apology because it's a complicated topic but this slide just outlines some of the brain imaging studies that have been positioned at patients who are unconscious and you can see that there's lots of different studies there's lots of different paradigms that have been used and if you can see I've just highlighted some of the sort of summary results so an example here is that 33% of unresponsive patients showed a positive response and that's the terminology that's used in these studies there is a huge gap in understanding between what a positive response means for that patient does it mean a meaningful recovery does it even mean that the patient is likely to become aware again is it an artifact of the imaging what does that actually mean a very young part of our science this paper is published this year so we are looking at a new era of brain imaging in these patients that are really groups trying to get to the essence of what what we are understanding about consciousness and I guess now I've got a personal perspective on this the one thing that I can say as a relative is that it's incredibly complex it's ugly, it's dynamic but most of all it's uncertain and so even me who knows the reality and the facts and could face the reality of our situation couldn't help but hang on every word about where there was any hope of some information that might tell me what might happen and so it's a very emotionally heightened atmosphere for relatives and for the doctors looking after the patients and so we have to bear in mind that as physicists and engineers and developers of brain imaging systems unlike many other clinical situations we will find ourselves in the stakes for these patients are incredibly high they're the highest stakes it's basically life or decision making and if these types of data are being used to inform those decisions we have to be incredibly careful this is a quote that comes from a national clinical guidelines from the Royal College of Physicians which I think sums it up so while it is acknowledged there is a small cohort of patients who presently present behaviourally as being in a vegetative state but demonstrate covert responses with an imaging scanner the prognostic significance of these findings is as yet unclear and this raises the ethical dilemma of whether or not how to disclose this information to clinicians and patients families so it comes back to what I've discussed all the way through my talk we can measure things is it the thing that we actually need to know that we're measuring first of all what's the relationship the important relationship like between the people that are driving those brain imaging studies and the clinical teams looking after the patients and how is the data interpreted and communicated both to the clinical teams and the relatives in this very heightened emotional context and this is something that I've obviously become very interested in as part of my sabbatical I was interested in the brochure foundation and this is a foundation a philanthropic foundation that's situated on the beautiful spot on the shores of Lake Geneva that looks into the ethical, legal and societal implications of new medical and health developments and Jenny Kittson just said you might want to consider spending some time there on a residency thinking about this problem and maybe doing some writing so I was lucky enough to secure a writing residency fellowship in March of this year and the title for my fellowship was Aging for End of Life Decision Making in Patients with Prolonged Disorders of Consciousness and you can see the setting that I spent a month in absolutely idyllic and the perfect place to really think over this very difficult material and think about how I might be able to contribute with the combination of personal and professional experience so I wrote a number of things one of the things that I wrote has just been published this month in the Journal of Neurosurgical Anesthesiology it's an editorial which is looking at the use of functional neuroimaging in patients with disorders of consciousness and you can see that the caveat that I've put there is caution as advised and I've written this purely from a professional not a personal standpoint and the points that I raise in this editorial is that we have the following issues to consider the choice of imaging modality must be guided by the status of the patient and not all imaging modalities are equal in this setting we need to really understand whether protocols that have been exclusively developed for conscious awake patients are suitable for use in unconscious patients and I should say that some of the protocols that are used to elicit responses in unconscious patients is one protocol that's being used 25% of awake volunteers don't show any responses with that particular protocol so we have to make sure these protocols are appropriate we're often used to presenting as I have today group data but now we have to interpolate that group data down to the individual patient level and there's a clinical decision sometimes a life and death based decision on the data that we're presenting for that individual patient that's a very big difference from publishing a paper that's got group statistics surrounding it there is a scarcity of outcome data there are very few studies where the outcomes have been followed up and the nature of this it's very difficult some of these patients will die and so we don't know what their full outcome may have been or not and again as I've already mentioned the way in which we discuss and communicate these technologies is really has to be born in mind the expectations of the relatives because whatever we think and however reasonable and sensible and rational we may be in that situation it's very hard to not become incredibly emotional about the idea of technology giving you an answer that you're craving it's not a magic bullet so I think that's where the caution needs to come from so broadening out this idea of the responsibility that we have in developing technologies we have to acknowledge that brain imaging has become democratised in the last few years there are many companies now well established near and spread companies who are developing wearable systems for a range of different applications and interestingly the big players are in the game too so you're probably familiar with the neurolink initiative from Elon Musk Meta are in the game as well a company called Kernel the 50 million dollar Fitbit and what I spent some time doing at 5 o'clock this morning was looking at these websites and frankly trying to understand their mission statements so let's look at neurolink neurolink wants to create a generalised brain interface to restore autonomy to those with unmet needs medical needs today and unlock human potential tomorrow I've worked in brain imaging for a long time but I've absolutely no idea what that means and the idea that Kernel I'm not dissing any of these initiatives I'm just saying let's be careful about what are we asking them to do what do they think they're doing and do we need it the idea that better data means better brains I don't know what the definition of a better brain is if the idea of a Fitbit measuring brain health I have no idea how I would determine brain health in a subject so these systems are very easy now to engineer and so we need to be aware that they're going to be used for lots of different purposes and of course we need to be aware that there's a commercial imperative here so this also from the Kernel website asking for recruits for volunteers for studies in looking at altered states of consciousness some of those I think using ketamine and also a really big driver in this field now is the gaming industry so we have the coincidence of well funded initiatives commercial imperatives a very enticing idea that we can put these systems on and understand our brains and that's something that we need to watch and I'm not the only person that thinks that so this is a report published by the Royal Society and the Royal Society acknowledges that there are profound ethical political, social and commercial questions that need to be addressed as soon as possible and we need to regulate these technologies and they have a call to action which unsurprisingly includes multidisciplinary collaborations early and often ethical considerations and public consultations now I only started looking at this because of the experience that I had and my thoughts around the use of brain imaging I don't think we're teaching this I don't think we're putting this on our syllabuses in understanding the fact that just because we can create a technology should we and how should we use it and also the organisation for economic development have created a guidelines for responsible innovation in neuro technology and nine very sensible points on here promoting responsible innovation safety, inclusivity, collaboration social deliberation capacity for advisory bodies safeguarding of data, stewardship and monitoring misuse but we should be doing that as standard but I don't actually know where that's happening because when I go to brain imaging conferences and I've been the president of a society for brain imaging I can't see this being represented on any of the programs and so I think it's time that we add these into the discussions, not just about how good we are at developing systems it's about understanding our ethical responsibilities about how they're used so finally I'd like to thank a few people it's impossible to have given this talk without the work of the people on this slide and many others actually and I'm sorry for those that I've omitted and it's been a pleasure working with all of these different teams over 30 years and at a personal level I'd like to thank first of all my brothers Simon is here and my other brother John is online and I showed this picture at my inaugural I'm not going to look at him because he's going to be crying and I think I said at my inaugural my brothers have always held me up even when I didn't want to be like in this picture but I will just say that in the last two years if they hadn't have held me up I wouldn't be here today for my mum who's amazing who's also here and I'm not looking at her either my mum taught me something early in my life which I've held on to she taught me it isn't about being confident it's about being brave and I think that's incredibly important women are always told you're not confident enough you should increase your confidence but do this to increase your confidence there's lots of days I don't feel confident I didn't feel very confident this morning I feel brave sometimes when you're not feeling confident and also my relentlessly awesome children our children Julia and Joseph for trusting and believing in me that the sun would come out again one day and finally this is definitely where I'm going to lose it the two men I've lost who have helped me more than anyone thank you very much thank you Claire well it's an honour for me to be asked to give the vote of thanks for this wonderful talk I've known Claire for all that 30 years I think we joined within a year of each other and it's been an honour to have been her colleague over that time I just wonder about something that I personally feel about Claire is her ability as a communicator which we've seen today not only is she a brilliant scientist but she is a world leading communicator she is outstanding and she inspires people in fact while you come up with a title Blood, Babies and Bill Gates I was thinking there thinking maybe your talk should be people, passion and Princess Anne I've been with you and you've met Princess Anne on at least three different separate occasions I see there's at least a fourth she's stalking me so that's good to hear no she has been an inspiration to all of us all of her colleagues, to her students to her undergraduates and that's really important and you can see why today in this talk she is just an awesome communicator and she had no notes she was speaking because with the passion she has in her heart for her work and because she wants to communicate she sees that as being very important anyway so I express my thanks to Claire do you want to take any questions are there any questions at all from the audience which maybe one or two I can't believe Dave doesn't have a question the difference between working at a hospital and working in a lab if you're having a bad day in one you might be having a good day in the other one that's a bit like the work home balance the obvious thing is I think in one of the collaborations where I did with Martin it was managing expectations from both of those environments so clinicians will typically underestimate how long it takes to get ethics for a study and engineers will definitely underestimate how long it's going to take to engineer a system so it's understanding managing expectations I think the other thing that's super important is understanding the local rules there is a much stronger hierarchy than we have in engineering and physics are quite rightly and so just again observing and listening and understanding where everyone fits into that is really important and you know obviously I'd worked in a neuro intensive care unit for many years before I became a relative but it's to remember their real people's lives and they're going through the most sometimes the most difficult periods of their life and you asking those relatives or Martin asking those relatives to consent for their loved one to be a volunteer and a study for which will be of no benefit to them it will just go into a paper that's a group statistic blah blah blah I think we just need to remember that that we are asking people to do something that's really very precious and very important and we should be ultimately respectful when I always learnt a lot from Martin who was really the gatekeeper in that environment of looking after his patients and the relatives so we need to remember that be respectful time for one more question can I just make a suggestion which is with the portal system that you've got now it will be really interesting to wear one of these while you're giving this lecture well you know where's Elias where is he so Elias you've done loads of you've had people walking around Queen Square with them on and doing all sorts of things and we did an anagram study Dave in the lab where we got people in the lab to solve anagrams because we wanted to look at the impact of people's blood pressure being raised and it was awful I mean you know academics trying to solve anagrams and competitive and you know almost their heads were blowing off so you know I think the serious point is that you know a lot of the work that we've been doing Elias and many other people here we've tried to make brain imaging bring it to the point where you don't know you're having your brain imaged you know that's the quantum mechanics thing you know you're going to change something by observing it so you want to make sure that as much as possible people don't know they're having their brain imaged and that's really important in something like the toddler lab we want to study these toddlers in their natural environment and not have their behaviour influenced by the fact that they're having their brain monitored so yeah there's a very serious point about the different environments we can do that in. I'm not sure I want Elon Musk having my data though just saying I'd like to stress maybe we'll wind up the audience wind up the audience so we can see their signals so he's awake yeah okay well so I just want to express our thanks on behalf of everyone here for a fantastic talk thanks to Naomi Robert for arranging this event today it's been fantastic and if we just finish with a round of applause for Claire