Talking health innovation: Manchester as a living lab

Professor Alejandro Frangi, Dr Louise Hunter and Raluca-Elena Valcescu discuss the challenges and inequalities around health – and the groundbreaking research and innovations striving to address them.

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Hello and welcome to Talk 200, a lecture and podcast series to celebrate The University of Manchester's bicentenary year.

Our 200th anniversary is a time to celebrate 200 years of learning, innovation, and research. 200 years of our incredible people and community. 200 years of global influence.

In this series, we'll be hearing from some of the nation's foremost scientists, thinkers and social commentators, plus many other voices from across our university community as we explore the big topics affecting us all.

Today, we continue to spearhead advancements in health technology, research and innovation. By fostering a robust research ecosystem, the University is making significant strides in improving health outcomes and reducing inequalities.

Our guests will discuss how the University's current projects and initiatives are shaping the future of health, care, medicine, and biology, ensuring that Manchester continues to be a global leader in health innovation.

So, my name's Louise Hunter, I'm a Clinical Senior Lecturer in the School of Medical Sciences, and I also hold an honorary consultant post at the Diabetes Endocrinology and Metabolism Centre, down the road at Manchester Royal.

Alex Frangi, I'm a Professor of Computational Medicine at the University.

I have joint appointments between the School of Health Sciences at the Faculty of Biology, Medicine and Health, but I'm also a chair in the School of Engineering in the Department of Computer Science.

And I'm also the Director of the Christabel Pankhurst Institute on health tech research and innovation.

And I'm Raluca Valcescu, I'm currently the Faculty of Biology, Medicine and Health Officer. I studied here for four years, I did a master's integrated in Biochemistry, and while I was doing my final year, I ran for the elections, and I got elected to my role.

And what I do is basically just represent students, but at really high level committees.

I have meetings with the Senior Leadership Team, but also with the faculty team and we work around multiple manifesto points such as cost of living, estates, the student voice, and that's kind of what I do.

Well can we start with the University's prestigious and significant past in the health sector? Because there's a long list of medical breakthroughs and advances that have taken place at this university.

I mean, the Medical School was established here in 1874. What does that mean to all of you in terms of the reputation of the University, but also, the resources and facilities we have here?

There's that catchphrase isn't there: "What Manchester does today, the rest of the world does tomorrow.” And I think that's been true in many aspects of medical research and healthcare in Manchester, and we're very lucky to be part of that environment.

Yeah, and I think there is something about the culture and the DNA of the people as well, right? You can have great technology, you can have great medical schools but if you don't have the attitude to be an entrepreneur, to be an innovator, to get out of your comfort zone, then you're essentially a consumer of those technologies, right?

Or those innovations, but if you have that attitude to actually try to go above and beyond, that helps you to take things to the next level.

I think that is illustrated with a number of technologies that were introduced in Greater Manchester right from the very beginning. A lot of the new imaging systems, technologies for cancer treatment, graphene, and then how you could use these for medical applications. I think it’s that sort of exchange of ideas and I think that is facilitated by the geography as well.

So, I've been working relatively recently in the University and something that was really exciting to me was to see that you have this Oxford Road mile where all the universities, the hospitals, even our neighbouring university are all integrated there. And that fosters people to bounce off each other, to get to know each other, to be easy. That serendipity that normally leads to innovations and breakthroughs.

And cancer in particular, with the Christie Hospital being based in Manchester. There's a strong kind of thread, isn’t there, over time with Manchester's expertise in cancer treatment and research?

Yes, and technologies for instance, like the proton beam therapy that is in very few places. And the UK has one of the unique centres.

And it's not just the technology and treating patients with those, but it's also the development of the technology itself.

Another example is radiotherapy. We have a cancer research UK centre on radiotherapy. There is only a few of them in the UK, and we have excellence all the way from planning interventions to the delivery of those therapies, which are lifesaving technologies.

You got a perspective on this tradition?

I think as a student, like the first thing that I've seen is just the campus itself. It’s just a merge between the new and old. One of the buildings that I studied in as a student, quite a lot, is Stopford Building, and that just kind of shows the Medical School and also integrated with biology and research.

There actually is this museum space that shows some of the instruments of change and it just shows the pioneering spirit that universities always had.

I know that we had a lot of pioneers in different areas, like Rutherford with the atomic model. I remember studying it when I was doing my Chemistry course as well.

So, it's quite interesting. One thing that made me very curious is, whenever I saw a new building and I saw a name associated with it, I would try to kind of search who that person was.

And although I never really studied in Michael Smith, I've just been looking into what he's done, and I've seen that he also got a Nobel Prize in Chemistry, or Physics I think it was. So, it's quite interesting to see how diverse our campus is and how it also acknowledges all these wins from the past, but also hopefully from the future as well.

The NHS was launched here in Manchester and the NHS and the University are linked. Can we talk about some of those links and connections?

Well, I think because we are, more or less, in the birthplace of the NHS, I mean the hospital that's now called Trafford General was that first hospital.

And so, it's put the University in a prime position to have that partnership with local healthcare organisations, pretty much from the very start.

And as Alex was alluding to, just the simple geography. So, I can be in the lab one morning and then I can walk across the road and do clinic in the afternoon. That facilitates collaboration and sharing of ideas very easily.

Can we talk about the devolved healthcare model in Manchester, which was, I think, first outside London, in terms of devolved health and social care?

Can we talk about what the opportunities are, and also the challenges?

Manchester was one of the first places, if not the first place, where the NHS resources were allocated regionally and then they were devolved, you know, the way that that is managed.

And then I think the lesson that was learned from this is that that proximity to the people, to the diversity, to the challenges helps to make better decisions, about the use and allocation of those.

And I think I believe that was a source of inspiring the current model of integrated care systems that now is utilised across the UK, well, across England, at least.

Where we do have digital provinces, or provinces of distribution of NHS services that are also associated with regional data capabilities.

We call them ‘SDEs’ or ‘secure data environments’, where data of that region is stored, and therefore, can be utilised with the right mechanisms to actually provide a better care for the people of that region as well.

I mean, there was a study, I think, carried out by University of Manchester researchers, published not that long ago, that showed some very interesting outcomes in terms of what the positive (and the negative) outcomes of Devo Manc have been. And as Alex was saying, putting the decision-making in the hands of local organisations, has meant that, you know, health and social care can work better together.

So, I think one of the positive outcomes was that satisfaction with social care provision had improved, and small but important improvements in A&E re-attendance, just showing that if you can improve that link between primary and secondary care, you can improve service use.

But because people were having to make decisions about funding, you know, a limited pot of resources, some outcomes were negative, and that's probably just having to spread the pot differently compared to other parts of the country.

Alex, you're the Director of the Christabel Pankhurst Institute. Can you tell us about that Institute, and also why it was given that name?

Yes, so the Christabel Pankhurst Institute for Health Tech Research and Innovation, that’s what it says on the tin: it’s health technologies research innovation. It’s a partnership with a number of local actors.

You know, it's a pan-University institute, all the University faculties are involved, so, Faculty of Biology, Medicine and Health, Science and Engineering, and Humanities.

But we also have external partners: we have Health Innovation Manchester, that brings innovation and accelerates the adoption of innovative technologies across the region; Manchester University Foundation Trust, that is our sort of flagship University hospital; the Greater Manchester Combined Authority as well, that provides that linkage with policy and decision making, and strategy, at the regional level; and then Bruntwood SciTech that provides infrastructures.

It's generally a partnership to make Greater Manchester the most vibrant, well-connected, innovative region, where we can develop technologies, but also trial technologies at scale. And that is quite important because that, in a sense, gives Greater Manchester the opportunity to be at the forefront of selecting what makes the best difference for the local people, but also to generate opportunities for innovation based on the local needs as well.

And we believe that by doing so we will have a bigger impact as well, nationally, internationally, because it's almost like a living lab at the scale of three million people.

And in terms of the name, so Christabel Pankhurst was together with Sylvia Pankhurst, were the two daughters of Emmeline Pankhurst. So, they were part of the suffragette movement.

Christabel was an alumnus from The University of Manchester, and she was both a person who was extremely passionate for making a difference, improving access to certain rights to the population, but she was also an alumnus from our university.

So, can we talk about what's unique about Manchester and health innovation here at this university?

Well, we're very lucky that we have umbrella organisations that bring together the University and other universities in the area with partner organisations such as, you know, healthcare providers, so, Health Innovation Manchester, the Manchester Academic Health Sciences Centre.

These organisations provide that link, not only between the healthcare trusts, but the local care organisations, the commissioners that decide how to fund services together with the universities, other local partners, industry partners.

So, you have these opportunities for all these groups to come together, collaborate, develop innovative ideas, and certainly, I'm not sure whether there's other places in the country that have those organisations bringing everything together like that.

Especially in a devolved Greater Manchester, which you describe very nicely, Alex, as a living lab at the scale of three million people.

Yeah, and I think I was precisely going to emphasise this. It’s the confluence of multiple disciplines, excellence in each of them, the diversity of the population and the scale of the region that makes it large enough to be meaningful, and as well, enough to be manageable.

And I think that's fundamental because if you are any health tech company, any pharma company, and you want to deploy and test new technologies or new treatment options, you need to have all of those characteristics so that whatever outcome comes from that research, is meaningful, is potentially relevant, is translatable to other regions.

So, for instance, the diversity in terms of the South Asian communities, Afro-Caribbean communities that we have.

I'm originally from Latin America as well. I've met with a lot of Latin American people here as well, which makes this diversity a good living lab, not just to know what happens here, but how what happens could be translated to some other geographies. And I think that's why I believe that gives the opportunity for Greater Manchester to be a great place to collaborate internationally with.

Well, that moves us on nicely to particular projects. Any notable projects that you may be working on?

Yeah, so let me pick two. Both of them are connected with the Christabel Pankhurst Institute. One is from a dear colleague of mine, Will Dixon, and then another one is one that I'm working on directly myself.

So, Will is working on a project where the main goal is to say, why we need to do clinical trials by setting those ‘experiments’/ these randomised controlled trials, as a completely new study every time with all the set-up cost and time that it takes.

Can we, for instance, imagine that the population has technologies like remote monitoring and digital apps, and we could simply ‘enrol’ patients?

Of course, we then sign up and there are all kinds of technological challenges about obtaining consent in a dynamic manner. But how could you do a study where you look at monitoring patients, and enrol them in a dynamic manner and do that at a scale?

And so, he's studying that in a number of areas, and that is a great combination of technology, addressing a fundamental problem, which is how you generate evidence at a scale, and at pace, and in an inclusive way.

The second project we are working on is developing a proposal for the UK government to develop a centre of excellence in In-Silico Regulatory Science and Innovation. And that is another way to also generate, in this case, regulatory evidence on safety and efficacy at scale, by using an alternative to real patients, which is what we call ‘digital twins’ or ‘virtual patients’, ‘virtual chimeras’, that are fed from real world data at a scale, and that connect with our digital capabilities in the UK.

But then, utilising a way that you can scale up that evidence at the level of several millions, if you want, and that allows you to have that diversity and thoroughness of testing that is sometimes practically, sometimes ethically impossible to do with randomised controlled trials.

And presumably far less expensive and much quicker?

Absolutely. There are advantages. Well, first of all, I would say we don't advocate a complete elimination of randomised controlled trials.

We think that randomised controlled trials and similar human studies are very important in many senses.

But what we do believe is that you can reduce, refine, and replace some of those trials, and particularly use that as a gate stop for technologies that could potentially be harmful before you even engage in a randomised controlled trial.

Can you do simulations of those? And that would reduce the amount of physical testing with the consequence in reducing waste, the amount of animal testing with the advantages of improving welfare for animals, but also, the risk to patients that would otherwise go through trials on risky technologies.

Also, the risk in technology, which is important for our businesses, and to make a difference in terms of facilitating decisions on investment, in which technologies to invest, those that are potentially most beneficial for patients and those that will have a real impact.

That sounds very exciting. And Louise, you have any examples?

Well, it's not from my own personal work, but there's a lovely example of something called the ‘PALO study’.

So, that was led by University of Manchester clinical academics from the Manchester Centre for Genomic Medicine, and they worked together with industrial partners and healthcare partners, rolling out a rapid point of care. This made the news, you might have all heard of it: a gene test for babies who needed an antibiotic, so, there's a commonly used antibiotic ‘Gentamicin’, and some babies will have a genetic change that means that using Gentamicin could put them at risk of hearing loss.

So, allowing healthcare practitioners to do that test before the baby gets given Gentamicin, is potentially going to prevent hearing loss in newborn babies, which is wonderful.

So, I thought that was a really nice example of researchers, healthcare, patients, industry, all working together to deliver really important change.

Yeah, real world impacts. When we talk about genomic research and we talk about health data, there are a lot of concerns about sharing data in the media, for instance, in reports.

Obviously, it can bring lots of positives, but how could we explain to the wider public those positives and reassure their concerns?

There is, I would say, the first and most important thing is: you need to work with the public and with patients. It's a co-creation effort.

It's not something, researching these areas is not something you do to patients, you do with patients, right?

And you work together with them right from the very beginning. So earlier this week, I had a meeting for a project that we are preparing, the one we were talking about In Silico methods, where we had a meeting with about 14 people from different geographies in the country, but also different ages, different ethnicities, different socio-economic backgrounds.

So, people that have been more exposed to digital technologies, people who are digitally natives, and people who are digital adopters, right?

So, you need to have this plural perspective to understand their concerns, their fears, their interests.

And my experience is when we work together with them, you get to understand the things that they are concerned about. You get to think about your own questions in a different perspective, and you also get the opportunity to convey confidence and trust on what is being done, in a way that also makes them realise that there are missed opportunities by not adopting and embracing some of these technologies.

But it needs to be done in a way that is jointly co-developed.

We've spoken a lot about the local Devo Manc context and Manchester context, but Manchester is an international university.

So, what examples do we have of medical research from here, benefiting people around the world?

It's quite important that the technologies and the findings that we do in Greater Manchester, given the diversity of the population, give us inklings, insights into how some of the same therapies or the same insights that we get could translate to other geographies.

And I think that, combined with the quality of the data we have, allows us to work with collaborators internationally to sort of replicate findings.

So let me give an example: a few months ago, a group of scientists from Manchester and other colleagues internationally, we published a paper in one of the Nature journals that was looking at how you associate fine associations between the detail anatomy of the heart and the genetic sort of fingerprint of the heart.

So, understanding how certain genetic variants are associated with specific morphological features. And that's something we did on UK Biobank, but then, now we're looking for collaborations to actually replicate those studies in other areas.

Do we find the same associations in geographies and areas where they are different to the UK?

Previously, we did a similar study where we look at associations between retinal scans and detail, you know. You could also think of this as a fingerprint of the vessels of the fundus, how they associate with myocardial infarction risk.

We did that, again, on UK Biobank data, and then we replicated that working with NIH colleagues in the US, in other data sets that have, for instance, much more prevalence of Hispanic populations and also for Caribbean populations as well.

So sometimes collaborations are a way of replicating findings. Another thing you can do is collaborate with other countries where they do have great ideas as scientists, but perhaps they don't have the digital infrastructure to test those hypotheses. And we have mechanisms for them to visit us, work together with colleagues in here, and develop those hypotheses with data that is from Greater Manchester as well.

So, we mentioned UK Biobank. This is a facility that's relocating, isn't it, to the campus? Can we just explain what that is?

Yes, so UK Biobank is a completely independent entity from The University of Manchester. It's a national resource of data at scale. It's basically undertook to do a very detailed phenotyping characterisation of patients at the order of a million people.

And there is a very large proportion of those, about 10% of those, that actually have also been imaged at detail. So, they have imaging from the brain, the heart, the bones, you know, all parts of the body in different modalities.

So, imaging gives us the characteristics about hohe disease is manifested, but also, we have all the information about their genetics. Well, UK Biobank has all the information about their genetics, their physiology, a number of sort of omics, variables.

So, it becomes a resource that anybody can access.

Now the headquarters of that resource will move from Stockport, where it’s at the moment, to the campus, and that will provide, hopefully a lot of opportunities as well, to collaborate even more deeply that we are already collaborating, not in any sort of preferential way, but in the sense that collocation also generates interactions and generates opportunities for exploiting the synergies that can exist there.

And we believe that while that is a great data asset. The University has super exciting opportunities in terms of clinicians, and other scientists, that are asking fundamental questions, people who develop methodologies in engineering and physical science and computer science that develop analytics tools, statistical tools, and that's going to be really, really exciting.

And the other thing is the adoption and the use of that data as well through particular startups and innovative companies that are looking to develop new AI solutions that can benefit from some of that capability to take things to the next level as well.

What's been your experience first as a student and then as a student officer in Biology, Medicine and Health?

So just a bit of a journey, when I first came here, I was introduced to all the labs and we've done quite a lot of work around different areas, and it was quite exciting, and I really did feel that as an individual, it did help me grow to understand how the biological ideas and how to approach a lot of the stuff that was actually discussed before.

Because I remember that in my last year project, I've done this project on biomarker research in age-related macular degeneration, and I've enjoyed it quite thoroughly. What I've done as well is looking between the control samples and disease samples, comparing them, finding new biomarkers. And although it was like a pilot study, it just kind of shows the importance of research and how even pilot small research projects can help to the bigger, wider contribution of research.

And what's funny is, while I was doing my master's project, I remember that the disease that I was studying had primarily two types, the dry and wet version of age-related macular degeneration, and the dry version had no cure, but while I was doing my master's thesis, there was an FDA-approved cure for it, which just shows how fast-paced everything is.

From my experience, of course, as a student there was quite a lot of obstacles because my study was impacted by the pandemic, so everything had to be flexible. But from an officer point of view, now I see how much work is put into actually promoting this flexibility and how, for the future, we can actually promote this accessibility to study, having a more flexible approach to lectures and to assessments.

We all know that AI is impacting the way that assessing and teaching is going to happen in the future, so it's quite exciting to see how, from a student, things went well with just the caveat that the pandemic happened, but then as an officer, seeing how the future might look like in the realms of teaching and learning.

And, in terms of interdisciplinary work, do you see students getting more opportunity in that line?

To be fair, my whole degree, doing Biochemistry, was quite interdisciplinary because I had to work a lot with a mass spec, which is more like Chemistry, but also having to analyse a lot of data and delving into databases and so on and so forth.

I've seen how it is to delve into computational biology and it's something that I want to do for the future. As you mentioned before, I found it quite interesting, the fact that we can simulate or emulate patients or just make predictions based on different types of data.

I've actually done a smaller-scale exam on a question of getting biofuels out of different organisms. I really hope that for the future we're going to delve more into it and I really hope there's going to be more opportunities because technology and computational approaches are definitely going to help us quite a lot, especially in the research field.

As important as physical health is mental health and maybe if we can start with you, Raluca and the way mental health impacts on students. I'm sure you see some of that impact in your work.

Do you know of projects addressing this such as the BeeWell project for schools?

I did hear about the BeeWell project, it doesn't really fall within my remit, but I can tell you there's a lot of other things happening at faculty level that are addressing support and mental health for students.

Primarily, we all know because of the cost-of-living crisis, students just want that extra support. So, one really good initiative is cozy campus spaces, so students being able to go to these places that are heated and have microwaves and hot water available.

But also, what's been happening in the faculties is that we have more support services such as the school or support hubs, just to provide more levels of support for students.

And also, one really important thing, that looking back as a student, I really regret not participating in is, and something that I really enjoy about Manchester is, the amount of activities that you can get involved in.

The idea of societies doesn't exist in Romania that much, so when I came here and I saw that there are so many societies I would be like “oh it would be so great to get involved”.

But unfortunately, as I said a lot of students might be facing financial issues, but because of that, the University’s put up an ‘Access to Recreation Grant’, so students can get involved in societies, can get involved in volunteering, and overall, hopefully these little steps are just going to help us and help our students feel more at ease, feel that they belong to the campus.

But mental health has always been a very hard issue to tackle, but hopefully we are taking the right steps of implementing that student voice so students feel more at ease.

I think we need to think more and more that aspects like health are extremely integrated with other dimensions of our life, and our society. You cannot think about a patient as just that person that crosses the door of a hospital and is in the hospital for a number of hours.

These people live in a city that has traffic, pollution, cost of living crises, other aspects that have to do with policing, with crime, with access to resources, to technology.

And I think what we are going to be seeing more of is that sort of human centric view on the future.

I hope we will see more of that, in the sense that it will help us to understand the individual as a whole, not just as parts or moments of that individual, and that will help us to bring along more of those aspects that have to do with mental health.

I think, mental health in many ways is kind of the orphan topic that is a byproduct of the other things we do wrong, and then we find this out and then we need to do something with.

Well, I think if we could tackle all of these other elements, we indirectly are going to be tackling that, but also if we tackle mental health, we will understand that there is a lot of ramifications and areas where we need to improve society as a whole and the relationships between people as well.

I mean there’s growing recognition, isn't there, that psychological wellbeing and improvements in quality of life can be as important, more important, than certain phenotypic physical outcome measures in studies.

So, you know, University of Manchester clinicians and researchers were heavily involved in the flash glucose monitoring study that has really changed glucose monitoring for people with type 1 diabetes and that demonstrated an improvement in quality of life, and that's really important for people, it's not just the numbers, it's how they feel about living with their condition as well.

And at the same time, this is very connected to productivity as well, within the region and therefore the economy.

So when sometimes we tend to think “oh, you know, we need to be careful that we do research, but you know the access of industry.”

Of course we need to be careful that things are done ethically and responsibly, right?

But at the same time, we need to realise that having a more productive society where people enjoy, not only in terms of their leisure time, but also their work experience, that leads to people who are more fulfilled, and therefore with a lot of these side effects.

Alex, I know you have referenced the phrase ‘new social contract’ and how that's needed between university research and the wider public.

I mean, Louise, have you a view on that?

Well, I'd like to think that you know, the mindset of the academic community has changed for the better over recent years in terms of involving the public, patients, service users, in research and research design as part of the course.

Alex's phrase about "you're not doing research on people, you're doing research with them” is absolutely true, and one of the things that we learnt from watching people's behaviour during the Covid pandemic was how interested people are in healthcare data, what research is going on.

And the University puts a great deal of emphasis, rightly so, on involving the public and patients, and people of Greater Manchester in our research.

So, in my own field, at the Centre for Biological Timing, when we talk to people about the research that we do and the influence that the body clock has on health, people are really interested, they're fascinated. And we should never underestimate the intelligence and the curiosity of the general public to be involved and engaged in research.

So, I'm glad that we are mindful of that, and that we're making efforts to get people involved right from the start.

So, looking into the future, you know, what impact will digital tech, AI, advanced materials have in getting positive healthcare outcomes do you think, Alex?

So, I think AI will have a major impact. I would say it's not just AI; it's digital data and access to computation at the scale as well, and we are privileged to be in the home of Alan Turing. It's very inspiring for me, being in Computer Science and in Medicine to walk through the area as well.

Tim Berners-Lee's family, Tim Berners-Lee is one of the people who developed the internet, I was curious a few years ago in his history. His parents were also working for Ferranti here in Greater Manchester, and his dad worked in the first electronic house record system that was developed in the UK.

And I think we will see, in the future, a bigger use of all those technologies. I mean, in a sense it's unbelievable.

We use hospital data in a very fragmented way today, I mean, for care for patients. As a dad of a few kids, if you go to A&E, you tend to be asked the same questions multiple times in any hospital, not just in Greater Manchester, because, fundamentally, sometimes the systems are not connected. Then you can imagine when you have that fragmentation you have a lot of paper material, that doesn't look good for net zero.

You have also potential errors of things being missed out, dots not being connected. So, I look forward to a system in the future that, through AI, and other technologies, and through the involvement of patients and NHS practitioners that help us to identify the many needs, will be a lot more well connected, better, more streamlined, more efficient, where errors will be fewer, where hopefully we will overcome the worries about biases by having access of these digital technologies to everyone, by involving patients, the public, and citizens, and especially right from the get-go of these technologies.

And I also would like to see those technologies being used in the life cycle of medical products as well. So, not only in the hospital as a care provider, but also in all of the industries that actually provide technologies and consumables to hospitals to operate.

For instance, you were talking about materials and AI. So, can we discover, you know, new chemical sort of products? There are companies that are pharma companies that effectively are AI companies doing drug discovery.

But similarly, we will do the same with medical devices, that we will be able to engineer devices that are more personalised, that are more diverse in the sense that they operate well in different types of subgroups of the population because we understood their difference, about them, and we can produce them at a scale. And the pace of acceleration will come to a large extent by AI and I would say more broadly computational sciences and engineering, which is kind of a bit of a broader context, I think will be crucial in making that happen.

In the Centre for Biological Timing, where I work, there's a large group of researchers who are trying to understand our body clock and how that makes an important contribution to our health and how it helps us thrive in the environment around us.

So, certainly, broadly speaking I think advancing that understanding to a point where research can inform how policymakers shape the environment around us, and also show us, as human beings, how to live best in the sort of 24/7 constantly on, constantly lit environment that we live in will be really important.

And perhaps more related to my own work, where I'm trying to understand how the body clock regulates energy metabolism, that understanding being useful to perhaps work out how we can intervene pharmacologically in metabolic disease or perhaps pinpoint those people who might be particularly vulnerable to the negative effects of shift work, for example. So, it's a very exciting field, and hopefully five to ten years down the line we'll be able to look back at all the developments that there have been.

Looking ahead, personally, Raluca, what can you see yourself doing in five years’ time?

Honestly, I just graduated, and now, with my role being completely different from being a scientist, basically working in higher education, I feel like I have so many new opportunities.

I could continue working in higher education or one of my dreams is also, as I said, I'm quite excited about computational biology. So, I could always take a PhD into studying a bit more around it and return to it. I'm also really keen on mass-spec, as I've done my project around mass spectrometry. So, I guess for me, the future is quite open when it comes to opportunities.

I suppose, at the moment, it’s what comes first, like the opportunities, but I would really enjoy getting back into research.

Everything seems so interesting that sometimes pinpointing just one area is quite hard. As I said, computation seems really interesting, biofuels. I never thought that I would really think about that, but it's such a big issue that could help around climate change and so many other things, or even biomarker discovery is really interesting.

And, as I said, even smaller pilot-type projects can help the wider population and just the wider knowledge. So, yeah, I guess my opportunities are just open.

And would they be, do you think, still here in Manchester?

Honestly, I hope I do, I really like, I like the city so much. I really like the diversity of the city. I think it’s the first thing that I've seen as an international student, maybe that's why I really liked being here.

I felt welcomed, I felt like I found my people, and that I found my community. So, I really do hope that I'll be in Manchester, yeah.

So, to end this podcast we are future-gazing and looking at, asking you, what you hope the third century will bring in this area for the University and/or society?

I think I'd like to see personalisation of medicine becoming the norm, and that's going to need the University and healthcare partners, industrial partners, to work together. But you know, you can envisage a future where the amount of data and the different types of data that we have on an individual means that treatments can very rapidly be personalised to that individual, and for that to be commonplace, that would be a fantastic place to be in a century’s time.

So, what are the equivalents in the future? I would say, there are two ideas that I think would be quite important. One is, I hope, genuinely, that we do a reversion as a university, as an organisation, or universities in general. We have been, over the last hundred years, going into a diversification and specialisation, that I believe has led us into rabbit holes. We know infinitely a lot about infinitesimally a small amount of things.

And I think that, as a person, I think it makes us lose perspective sometimes.

And what we need is almost like going back, this universal knowledge of the Middle Ages, can we actually try to sort of put things back in a better way, in a more deep way? And I hope that the existence of technology will help us to get there by removing things that perhaps are less helpful, that detract us from developing our soul, our body, our intellect, but that actually, this digital world doesn't detract us from the physical as well, that it gives us more opportunities to enjoy relationships, to enjoy contact with nature as well, because that's what will, I think, help us to sort of bring things back.

And I believe that, from that perspective, we are going to actually get better technologies. Perhaps not necessarily more sophisticated.

Thank you. Raluca?

I guess I'll answer these questions through two different avenues: one of them being a
graduate biochemist and the other just being a student.

So, as someone that just graduated from Biochemistry, I would like that, maybe, in the future, as I said, I've done some research around biomarkers and it's very fast-paced, and with all the technologies that we have in place maybe we get to a point where we can map out multiple biomarkers.

We all know that genes and their products are connected in a very complex way, so just getting to that point where we can map everything, to prevent diseases instead of curing them. Because a lot of the diseases, once they reach their later stages, they're very hard to cure or impossible, so that would just be a really hopeful mindset for me as a scientist.

But from a student perspective, I'm just thinking about what the future might look like when training students to get into healthcare, into being scientists, or into medicine. As we all know, VR exists; AI exists; and with these tools, teaching can be retransformed. And if this is happening at the moment, how can this look in the future?

Would it be easier for students to just go and see 3D models of different organs and have that visual type of learning? Or perform surgeries? And so on and so forth.

It would be really, it was just kind of crazy to think about all the things that might happen in the next hundreds of years.

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Talking health innovation: Manchester as a living lab

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