The Planet Earth podcast - 'Medical diagnostics, the value of nature'.
6 June 2012
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Richard Hollingham:Hi, I'm Richard Hollingham, welcome to the Planet Earth podcast from the unlikely setting of a hospital Accident and Emergency Department where natural world science is being used to diagnose disease. Also this time putting a value on nature.
Dave Raffaelli:How many konic ponies do you need to change the vegetation in such a way and keep it in a particular condition that is the best possible condition to stop flooding?
Richard Hollingham:Just come through into the brand new diagnostics development unit in the emergency department unit of the Leicester Royal Infirmary, and really it's a room full of equipment and absolutely no patients. The sort of equipment you would expect to find in a physics laboratory rather than the emergency department of a hospital. Now, this unit is designed to smell, look and feel disease and it uses technology developed by the University of Leicester for environmental sensors. With me are Paul Monks from the university, Professor of Atmospheric Chemistry and Earth Observation Science, and Tim Coates, Professor of Emergency Medicine here at the hospital. Paul, you should explain what is all this?
Paul Monks:This is our technology that we use for non evasive diagnostic development on patients. So, we've taken instrumentation that we use in the laboratory and outside in the environment for actually smelling the air, sniffing the chemicals in the air and we're now using it in the hospital environment to smell peoples breath.
Richard Hollingham:So what is the set up here? There looks like there is computer monitors there - a camera stand, a tripod there. Now, this I recognise. This a maspectrometer so you can analyse individual chemicals, a series of long metal tubes with complicated piping and the like.
Paul Monks:Yeah, what you've got in front of you is a state of the art - what we call a proton transfer reaction timer flight maspectrometer but it's a way actually of measuring and weighing molecules very, very quickly. So we can take the molecules coming out of your breath and weigh them and actually look at the composition in terms of the chemical composition of your breath and what we hope to be able to do with that is actually smell disease.
Richard Hollingham:I said I recognised this because I saw something very similar in a laboratory analysing air for pollution.
Paul Monks:This is exactly the same technology that we will actually be deploying later this month into London to measure the air pollution during the Olympics. So the same technology that we developed for sniffing air quickly we now use for sniffing people's breath.
Richard Hollingham:Now, Tim, we're in a room full of this equipment, but on the other side of this are the bays where there are patients coming in as we speak being attended to in the emergency department.
Tim Coates:That's correct and we've got a series of ports through the wall there both electronic and physical so that the patient the other side of the wall can be monitored using the equipment in this room. Now that means that the doctors and nurses in the emergency department can continue treating the patient while the monitoring is going on. So even the sickest patients can be in there and we can be monitoring them. Now that's something in the past that's been really difficult to do.
Richard Hollingham:And now are you using this? Who is this for?
Tim Coates:We're using it on a range of different patients just to see what sort of results we get because a lot of this technology is new to humans. But, for example, a patient with a chest infection coming in we know that different bacteria produce different molecules, we can sniff those molecules using the mass spec and perhaps tell which bacteria is in a patient's chest. Now that might help us give them the right antibiotic for their infection. We don't know that we can do that but that's the sort of potential we're looking at.
Richard Hollingham:And are you going to identify particular patients coming in and trying them out on this?
Tim Coates:So we've got a set of studies that are going to go on and will be looking at specific patients that we think are going to have some sort of benefit from this sort of technology and then we get consent from the patient and ask them if we can spend about half an hour - it's all non evasive so it doesn't involve any of the unpleasant things we do like blood tests and so forth and its amazing patients even when they are ill most of the time they're quite happy for us to be monitoring them and to be doing research that they know is going to benefit other people.
Richard Hollingham:And you mention that this is non evasive. You've got the tubes going through the wall. What do patients do? What do you attach to them?
Tim Coates:So they have a mouthpiece that they breathe in and out to get the breath sample. They also have a series of stickers that we put on the body - we have a series of cardiovascular monitors, again non evasive new technology to monitor their heart so we're really looking at their heart with the cardiovascular monitors, their lungs with the breath analysis and then we're also doing some imaging - you mentioned the camera and tripod, that's a high perceptual imager which has been translated across from space science, we're doing a battery of different tests on our patients.
Richard Hollingham:So this is from partly space science, partly from atmospheric monitoring, Paul, how did you decide to put them all together because surely that's the key to all this is that you are actually doing several things at once?
Paul Monks:As with all the best things in science it is serendipity and it's really a conversation in the corridor. We've actually been doing the breath analysis for a while in a very minor way and then I bumped into a colleague in the space research centre and said, "Well we've been doing this, do you fancy doing something with your imaging?" He, said, "Well actually we've been working on that", and then we found Tim, somebody from the medical profession, and as with all the great things it kind of came together and we decided to do this. And then, very kindly, the university gave us half a million pounds to buy the equipment to do this and since then it's mushroomed. It's really a land of opportunity for doing really cutting edge and breaking science.
Richard Hollingham:Tim, do you anticipate actually being able to diagnose some diseases with this? You talk about analysing breath, analysing bacteria or is that a longterm goal?
Tim Coates:That's a medium term goal. I think a lot of science people tell you, hey, there's a breakthrough and it's going to do this and they're talking five or ten years away. With this sort of technology we're talking, probably, two years away from having something that we can really be testing to see whether it makes a difference on patients.
Richard Hollingham:You've got because as we speak there are trolleys going backwards and forwards and this is early evening, so you would imagine this isn't the busiest time here. Could you imagine something like this making quite a big difference?
Tim Coates:We see about 450 patients a day coming through this department. The real trick in emergency care is to pick out which of those patients are really sick and needs emergency intervention and which actually aren't so sick and can go to their GP or to outpatients. We often have difficulty in making that decision and we sometimes get it wrong. So technology like this can help with that decision making to pick out patients that really do need our help so that we can concentrate on those patients and that's going to be a benefit.
Richard Hollingham:Tim and Paul thank you and later in the Planet Earth podcast we will put this equipment to the test on me. We will get some fresh air first on the Humber estuary near Goole in South Yorkshire. I went there to meet Dave Raffaelli from the University of York. Now Dave's the head of a major national seven year project to investigate the link between biodiversity and the services nature provides, such as food, clean air, water and flood protection.
Dave Raffaelli:This is the RSPB's Blacktoft Sands Reserve. It was set up originally as a wetland habitat because of its interest for the birds, particularly marshland birds like Marsh Harrier, avocet, heron's, egrets but also as you can hear in the background warblers and black headed gulls and things like that.
Richard Hollingham:Now, we're sitting down in a, I suppose, open air hide, there's no roof but we have got a slit that we can look out across the water here, the reeds, there are various types of duck there and a pony in the distance. I think we should mention the pony.
Dave Raffaelli: Blacktoft Sands is rather unique in this respect because it holds four individuals of something called a konik pony and these are almost wild animals and they've been introduced really to help with the grazing regime of the marsh to approve the biodiversity of the vegetation but they are also of interest in their own right because they are very close to some of the wild horses that we used to have in Europe about 5,000 to 7,000 years ago.
Richard Hollingham:So beyond the reeds we then have the river itself and we're at the confluence of the river Ouse and the Trent, so flowing from Nottingham and then down from York and into the Humber.
Dave Raffaelli:Yes, and of course that means that there's an awful lot of water. The Humber itself probably drains about a sixth of the land area of the UK because of the Trent and the Ouse and all the rivers that flow into them, so there's a lot of water comes down here but also within that water there's a lot of sediment as well and that's what produces these vast marshlands and mudflats which we find along the Humber and make them such interesting areas for nature conservation but also scientifically as well.
Richard Hollingham:And you're interested as much in the biodiversity and what's here and this stunning view and all the nature here as the hidden benefits of that nature.
Dave Raffaelli:Yes, if you look out at the area we're looking at the moment you can see it's dominated mostly by reeds and fragmities and these have many, many functions in the natural environment and that people don't really appreciate. Traditionally they were used for thatching, for making roofs and so on, but they have many other really interesting functions. So, they provide a kind of soft engineering for storm surges and for wave actions and so on which means that we don't have to build solid seawalls, so they take the energy out of the waves. They also filter water before it goes from agricultural land into the rivers and strip out all the nitrates and so on. So they have a purification function, they have a storm defense function as well as providing lots of biodiversity for us as well.
Richard Hollingham:And these sorts of functions they're terms ecosystem services and that's what your project is investigating and looking at - a rather ugly word but I suppose it does what it does.
Dave Raffaelli:Yes, I think the best way to think about them is that nature provides lots of benefits for us and this is one of several habitats we're looking at in the United Kingdom, so we're looking at coastal marshes like these, we're looking at upland rivers, we're looking at lowland farms and we're looking at urban areas as well down south in England and we hope to extend that to many other kinds of habitats, and each of these habitats has lots of biodiversity which provides those kinds of benefits for us. Food production from agricultural land, biodiversity provides that for us. In an area like this there's lots of recreation provided for us as well as well as climate regulation in forests and so on and what we're trying to do is find out how much of that biodiversity you really need to sustain those benefits in a changing world.
Richard Hollingham:So are you trying to quantify this and put numbers on this and say right we need this many reeds to stop the flooding here or we need this diversity of plants and insects.
Dave Raffaelli:That's right and unless we quantify those then they won't be valued properly in decision making so many of these so called benefits from the landscape, this ecosystem services, they don't actually have monetary value attached to them because we can't trade them. But, actually, if we didn't have them then we would have problems with flooding, we would have problems associated with climate change, carbon sequestration and so on and we're trying to put numbers of those so that when we need to make decisions about the way we manage our landscapes in the UK we can do that on a properly informed basis.
Richard Hollingham:And so when we peer out through this slit across the water in front of us it's almost like a pond, it's so still today, there's no wind at all and then there's the reeds and then there's a butterfly just flitting past, there's a pony in the distance and then the river and then into a haze of the hill and trees. You put numbers and say, right we need that and that will mean we get this amount of benefit from that.
Dave Raffaelli:That right. So the kind of trade offs that people like the Environment Agency, for instance, have to make on a daily basis but we all do in society is what should we do about whether we want to build sea defences to stop flooding or river defences to stop flooding. And one of the decisions that we might want to make is not to invest huge amounts of money into those sea defences but maybe to purchase adjacent agricultural land, which also has monetary value, in order to let that land accommodate the flood rather than trying to stop it and then push in the water further down stream. So that's why we're trying to put the numbers of these benefits so that people can have a common currency, if you like. It doesn't have to be money it can be anything but a common currency to provide a rational basis for actually making those kinds of decisions.
Richard Hollingham:Now I'm just watching that pony over there swishing its tail, swishing the flies away, grazing on the marsh, I guess it's grazing on some sort of grass or sedge or something over there. How do you put a number on the benefit of that grazing, or benefit or otherwise of that?
Dave Raffaelli:Well that's what the project is really all about. What we want to know is, and that's a very good example for this konic pony, is how many konic ponies do you need to change the vegetation in such a way and keep it in a particular condition but it's the best possible condition to stop flooding because although it all looks like reed here there is many, many species and the essential question is how many species of these reeds and sedges do you actually need in order to provide that benefit of flood regulation or water purification for us and of course the konic pony is one of the moderators of that biodiversity because by feeding selectively they can increase the diversity or decrease it, so that's a very good example of why biodiversity is important in these questions.
Richard Hollingham: Okay, so you gather all this information about the, literally, the birds, the bees, the marsh, the river, the ponies, all this stuff. How is that used?
Dave Raffaelli:Well this kind of information is fairly attractive to policymakers and that is evidenced in the recent government white paper on the environment which is all about the value of nature, in fact that is the title of it, and the idea here is that for the first time we will be able to actually attach proper values to all the things we took as public goods and therefore we don't attach any value to at all. And by producing this kind of information it allows policymakers to make quite large scale decisions about the way we manage our landscapes.
Richard Hollingham:And does that help preserve it?
Dave Raffaelli:That's one of the things which we hope to establish over the next seven years. There will obviously be a trade off between these kind of benefits, like carbon sequestration, how many tree species you need in order to do that and the biodiversity of the wood and what we're hoping to demonstrate is that you probably need quite a lot of that biodiversity in order to generate those kinds of benefits because even if you don't need them today you will certainly need different kinds of biodiversity in 20 or 30 years time for climate change, change in issues associated with population growth and food security and more demand on the land and we will want very different kinds of biodiversity in maybe 50 to 100 years time so we really can't afford to lose that today.
Richard Hollingham:Dave Raffaelli from the University of York and you can see some pictures of Blacktoft Sands Nature Reserve on our Facebook page - to find it just search for Planet Earth Online. I'll put some pictures of the diagnostics development unit here at the Royal Infirmary in Leicester which we're about try out. With me still is Paul Monks. What are you going to do to?
Paul Monks:What we're going to do is actually take a breath sample for you. What we've got just in front of us is a series of breath sampling units and what we use that for is regularising the amount of breath and what we're going to do is set you a target to breathe to and get you to what's called tidal breathing which is gentle breathing in and out. We will take the air and we will put it into our maspectrometer, we will add some water to it and we will actually take some fingerprints. So chemical fingerprints of your breath and then we will weigh the molecules in there and we will check whether, for instance, you are a smoker-
Richard Hollingham:I'm not a smoker.
Paul Monks:Or whether you have got diabetes, they are very easy things to see virtually instantaneously on the screen.
Richard Hollingham:Okay, let's give it a go. So this is the mouthpiece - it's looks like, I suppose, an asthma inhaler attached to a bit of piping with a long lead going off into the machine. So I've got to breath in time with the beeping?
Paul Monks:If you would be so kind.
What you can see on the screen now as you are doing this is actually the C02 which is what we use as a marker in order to do that and then on the top is the volume of air that you are putting out into our instrument. And what we're trying to do is get you here to regularise your breathing so that we can get the same amount of air into the instrument. And we can see on the maspectrometer screen behind us the chemical data coming up from the measurements that we [over speaking 0:16:56.4].
Richard Hollingham:I must say I was pretty rubbish at breathing in time with the beep - that was quite difficult.
Paul Monks:Actually, your breathing was quite regular but your volume was a bit all over the place.
Richard Hollingham:Oh okay, yes. So now we move over to the maspectrometer which is this shiny collection of tubes and here's the screen with my breath analysed.
Paul Monks:Yes. We're actually looking at the chemicals in your breath and we've looked at it in real time and that was one of the real innovations of the work that we're doing is that you can actually measure atmospheric composition, but also a breath in real time and what we've got up on the screen here are peaks like acetone, which is a diabetic marker, also ethanol just to check that you haven't had a drink this afternoon before you came to join us - no actually you've got a flat base line of ethanol so you're looking quite good.
Richard Hollingham:So is that okay?
Paul Monks:Yes, you will live.
Richard Hollingham:And for a hospital environment this is a fairly fearsome bit of equipment. I imagine it is also very expensive. You really need to miniaturise this don't you?
Paul Monks:To use the words of Star Trek, we're boldly going where no person has been before. I'm at a discovery phase, so actually you need big instruments with a lot of functionality in order to explore the human breath. The idea at the end of the day is actually to miniaturise these things and maybe even produce handheld diagnostics, something like the size of a glasses case that you would be able to breathe into. Maybe even one day your mobile phone.
Richard Hollingham:So coming back to the Star Trek analogy like a tricorder, like McCoy has.
Paul Monks:The ultimate non invasive diagnostic causes McCoy's tricorder. I would say where we are at the moment though is the bed in the sick bay of Star Trek; the instrumented bed is the phase that we're at.
Richard Hollingham:Paul Monks, thank you very much. And that's the Planet Earth Podcast. For the latest science of the natural world do visit Planet Earth on line and you can interact with us on Facebook and Twitter. I'm Richard Hollingham who has learnt I will live to present another podcast in the future. From the Royal Leicester Infirmary Emergency Department thanks for listening.