Charlotte Haigh
University of Leeds, UK

Geraldine Clough
University of Southampton, UK 

https://doi.org/10.36866/pn.98.15

H³ Symposium – Public Engagement as a pathway to impact

19 September 2014,
Hodgkin Huxley House, London, UK

Charlotte Haigh
University of Leeds, UK 

Charlotte Haigh welcomed everyone to the event. There were over 40 attendees and at least 50 people watching via live streaming of the event through The Physiological Society website. The first speaker was Sophie Duncan, deputy director of the National Co-ordinating Centre for Public Engagement (NCCPE), UK, who gave a presentation about how the concept of pathways to impact is your friend! She discussed the public attitudes to science survey, reflecting how we might use this information in our engagement activities and discussed the purposes and motivations for engagement. She also discussed what quality engagement looks like and showed some examples of established projects that have won awards from the NCCPE. She described the way all pathway to impact plans have a purpose, engaging the right people and having an appropriate process including an evaluation plan.

Lewis Hou (University of Edinburgh, UK) was the next speaker. He gave an insight into his science ceilidh event by playing the fiddle to the song ‘She’ll be coming round the mountain when she comes’ but changing to lyrics so the chorus began ‘I’ll be using my frontal cortex for this song’! He even managed to get the audience to sing along. This demonstrated how he breaks down the barrier between science and music. He also told us about a project supported by funding from The Physiological Society entitled ‘Deadinburgh’ where he worked with LAS theatre and other scientists to create a debate about the fate of Zombies. Davis Lewis (University of Leeds, UK) lead us through why, and how, he embeds public engagement in to the curriculum at Leeds and what the skills were that the students came out with which could directly lead to employment. He also discussed another project where students act as volunteers but run stalls at fetes to reach typically hard-to-reach audiences.

After lunch, Chloe Sheppard from the Wellcome Trust explained why public engagement is a core function of their work. She depicted engagement as : must do, smart to do and, wise to do. She talked through the different grant funding available at the Wellcome Trust for engagement work, through engaging science grants, or existing research grants. Chloe explained how each proposal had to have a programme of action that the engagement should take place throughout the grant period not just at the end, and that training should be involved and should always include some evaluation. We then moved to short presentations section from those that had submitted short abstracts. We heard from Helal Ahmed (Imperial College London, UK) talking about metaphors, similes and analogies and the importance of relating your research to the audience.

We next heard David Colquhoun (University College London, UK) talking about the thin line between public engagement and public relations. Bryony Frost (Queen Mary, University of London, UK) shared with us developments from her institution and how they work collaboratively between different engagement groups to support overall impact. Finally Harry Witchel (Brighton and Sussex Medical School, UK) showed us some fascinating data about how we can measure engagement of individuals whilst they are watching a computer screen. The next keynote speaker was Katherine Mathieson from the British Science Association who talked us through how we could easily get involved with working with the public through opportunities at the British Science Association. She explained the local branches, British Science Week (previously known as National Science Week), the British Science Festival, working with the sections, the CREST awards, the Science communication conference and the media fellowships scheme.

After the coffee break, we heard from Lizzy Baddeley (University College London, UK) and how the public engagement unit at UCL encourages researchers in providing support, training and funding for them to get involved in engagement with the public. She highlighted in more detail a project which now runs nationally known as ‘Bright Club’ which supports researchers to get involved in a comedy night discussion of their research in a slightly humorous way for 8 minutes to a public audience. Finally we heard from Anisha Tailor, Outreach Officer from The Physiological Society who highlighted opportunities for funding for outreach and public engagement events from The Society, and Charlotte Haigh who highlighted her project based around ‘Physiology Friday’ in 2014. The symposium finished with a rapid fire round giving the audience a chance to share their projects in 2 minutes. The event allowed time for networking between sessions and many people shared their thoughts and ideas about engagement hopefully promoting successful collaborations in the future.

H³ Symposium – Microvascular physiology: implications for understanding intravenous fluid therapy

28 November 2014,
Hodgkin Huxley House, London, UK

Geraldine Clough
University of Southampton, UK 

By 9.00, people were queuing at the door to gain entry to this oversubscribed one day symposium that aimed at going ’back to basics’ on the physiological principles underlying intravenous fluid therapy. The meeting was organised by Geraldine Clough (University of Southampton, UK) and Tom Woodcock (University Hospitals Southampton, UK) with indispensable support from Sarah Bundock the Physiological Society’s Events & Marketing Manager. It was jointly funded by the Physiological Society and the Association of Anaesthetists of Great Britain and Ireland. The aim was to bring together basic and clinical researchers, practitioners and educators to address some of the thorny issues around the use of crystalloids and colloids for fluid resuscitation and the mechanisms by which they may have their advantageous and sometimes disadvantageous effects. This aim was achieved, with a full house of 57 delegates attending the meeting on the day, more than half of whom were clinicians. Many more dropped in on our live stream of the event (https://www.youtube.com/user/PhysocTV) which also generated some discussion on The Society’s social media channels.

Geraldine Clough opened the meeting by reminding the audience that during the Great War of 1914-18, the eminent physiologists William Bayliss and Ernest Starling (along with Charles Sherrington and Henry Dale) served on the first Special Investigation Committee of the Medical Research Committee to find a treatment for wound shock. Based on earlier work by Bayliss on the use of gum acacia to sustain circulating fluid volume and restore blood pressure communicated to the Physiological Society in March 1916 (Bayliss, 1916) and on Starling’s seminal work on the heart and on fluid exchange across the capillary wall, they introduced the use of intravenous colloid therapy. In his talk on the ‘Revised Starling Hypothesis’, Charles Michel (Imperial College London, UK) went on to review the physiological forces and nature of the barrier that determine fluid and solute exchange. He described evidence showing that microvascular absorption is transient in most tissues and that slight filtration prevails in the steady state, even in venules; attributable in part to the presence of the endothelial cell glycocalyx (Levick & Michel, 2010).

Professor Michel then presented new modelling studies exploring the effects of progressively reducing plasma colloid osmotic pressure on fluid filtration and their implications for efficacy of intravenous fluid therapy. The basic science theme was continued by Kenton Arkill (University of Bristol, UK) who showed us how to assess the permeability parameters of the blood vessel wall using 3D electron microscopy of LaDy GAGa stained glycocalyx. While high resolution transmission electron microscopy revealed individual fibres and their organisation, the highlight was the dancing bacteriophage. The morning session was concluded by Tom Woodcock whose 2012 paper (Woodcock & Woodcock, 2012) was the original impetus for the symposium. Tom challenged the tenet that the patient will benefit from therapy to restore or expand the plasma volume while minimising the interstitial fluid space; and that this could be achieved by infusion of colloid solutions. Through a series of clinical vignettes and reminiscences he reminded us that the rationale for fluid prescribing requires a physiological paradigm that explains what is seen in experiment and practice. As the previous speakers had done, he concluded by arguing for the potential of the glycocalyx to provide such a paradigm. Advised that we needed to keep ‘roughly’ to time because of our live streamed audience, discussions went on unrecorded over lunch and poster viewing.

We regrouped after an excellent lunch with lovely chocolate desserts (and fresh fruit) for a series of presentations from clinical researchers. The use of colloids has been justified by the belief that an infused colloid solution should preferentially resuscitate the intravascular fraction of the extracellular fluid volume through an enhanced oncotic gradient across the capillary wall. Weighed in the balance by Matthias Jacob (University of Munich, Germany) were the pharmacokinetics of colloids and crystalloids at the capillary wall. He argued for the importance of the avoidance of volume overloading beyond the needs of the patient and presented evidence for the ‘volume effects’ of colloids vs crystalloids and the markedly higher intravascular persistence of iso-oncotic colloids (80-100%) versus crystalloids (around 20%); at least while the glycocalyx was intact.

In recent years the beneficial effects of colloids have been challenged. Christiane Hartog (University of Jena, Germany) provided a comprehensive overview of these concerns. She presented data from clinical trials of the use of semisynthetic colloids during surgery and in the treatment of hypovolaemia after trauma, burns and in sepsis. A lively debate followed around the evidence of the clinical benefit of semisynthetic colloids compared with fluids containing albumin and crystalloids. After replenishment of our own circulating volumes, Monty Mythen (University College London, UK) continued the clinical theme, presenting evidence for the importance of fluid management. He then pointed out that the evidence base supporting practice in this area is lacking answers to a number of important questions. He advised the pragmatic ‘What?’, ‘Why?’, ‘How?’, ‘How much?’ and ‘If at all?’ when it came to the prescribing of intravenous fluids.

Towards the close of the afternoon, Gordon Drummond (University of Edinburgh, UK) reminded us that coverage of fluid therapy in medical textbooks and in physiology teaching is patchy and lacks rigour. He argued that while knowledge moves on, the innate conservatism of many authors of textbooks results in simplified ‘explanations’ of the topic that fail to take account of the challenges to current understanding engendered by recent research progress. The poster prize was presented by Mike Grocott (University of Southampton, UK) to David Read, Royal Derby Hospital and University of Nottingham, UK for his poster on ‘Change in blood pressure and cardiac output show poor correlation with Contrast Enhanced Ultrasound assessed visceral blood flow’.

Over yet further volume expansion, the consensus of the assembled researchers, clinicians, teachers and opinion holders was that the joint meeting was a great success and that we had managed to address some of the omissions in vital knowledge in the field and produce an improved paradigm for improved prescribing of intravenous fluid therapy. How to get it into the textbooks before the next century was another matter!

References

Bayliss WM (1916). Viscosity and intra-venous injection of saline solutions. J Physiol 50, xxii-xxiv.

Levick JR, Michel CC (2010). Microvascular fluid exchange and the revised Starling principle. Cardiovasc Res 87, 198-210.

Woodcock TE, Woodcock TM (2012). Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. B J Anaesthes 108, 384-394.