Faculty of Health and Life Sciences

I was born in Oxford and grew up in a bilingual family with French and British parents so I feel European. I left Oxford in 2001 for a few years only coming back in 2013 to start my nursing degree – in between I lived in York, London and Madrid and also spent    some time in Thailand and Uganda.  

I studied for my nursing degree (BSc hons) at Oxford Brookes University between January 2013 and December 2015.

There was an exciting opportunity to be part of the Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), where I would be able to continue with clinical work whilst also carrying out a PhD with a scholarship I obtained.

Before becoming a nurse I worked in a variety of roles: For the National AIDS Trust as their World AIDS Day assistant, as an MSc student in Public Health at the London School of Hygiene and Tropical Medicine. After this I worked in health promotion roles in a    Primary Care Trust, a local authority and charities and community groups. I also worked in Madrid in a community group and worked on a short research project. When I moved back to the UK I started my degree in Nursing.

The transition to research student has been both a challenging and exciting experience. It is very positive that I am based in OxINMAHR HQ where I have access to academic and pastoral support and an encouraging working environment. I have PhD student    colleagues here and we regularly meet to discuss each other’s projects and ideas which is so valuable. We are also extremely lucky to have visiting Professors and Scholars at OxINMAHR who come from around the world to deliver inspiring lectures and workshops. I have also been fortunate enough to attend     one of the OxINMAHR writing retreats where over three days we have the space to write an article or chapter alongside peers and supervisors. This retreat is a fantastic experience and it also means we have regular feedback throughout the stay.

Readmissions to hospital within 30 days of discharge continue to rise in the UK and internationally especially among people aged 65 years and over.   

Returning to hospital can have an impact on the health and wellbeing of the person coming back to hospital and their care givers or loved ones. It can also get in the way of other care being organised in hospital and is costly to the NHS.   

Many different things are said to cause readmission to hospital, for example, problems with the care received during the initial hospital visit or because more support was needed once the individual had left hospital.   

At the moment we do not know enough about this from the perspective of people being readmitted by themselves. We do not know much about how people aged 65 years or over experience being readmitted to hospital nor what is important to them.   

This study aims to address this by interviewing people who have been readmitted to one Hospital Trust in England. They will have the option of being interviewed in hospital or at home. They will also have the possibility of suggesting the researcher speak to other    people that are significant to them. They will also be asked to show any paperwork or information they were given by the hospital when they first left.  

I love being able to read, think, and discuss issues that are central to nursing theory and practice, and that are influential to patient care. As a clinical academic I understand research in the context of clinical work. Simultaneously I can reflect on my clinical    work in light of the research and evidence I read. Being in this position is an absolute privilege and I very much enjoy it.  

However, there are challenges to combining research with clinical work and I have to be extremely organised to ensure I can fit both roles in. I give myself the time to plan weeks ahead as soon as my clinical rota is made available to ensure I can achieve my PhD    deadlines. There is also a need to focus when I am working on the PhD as I may not be able to come back to it for a few days. I have had to try a variety of different techniques to quickly get past writers block – things that help me include chunking my time and giving myself short periods where I shut off all    social media and emails and just focus on the task at hand. Once I have done a few 30 minute blocks I find that I get stuck in and can continue. There are times when nothing seems to work so then I try to focus on more administrative tasks or update my online reference system. Coffee is also a must throughout!      

I have been able to access a variety of workshops at Brookes, in particular I found the sessions delivered by the specialist healthcare librarians useful in understanding how to access different sources. The specialist librarians have also been invaluable at helping with my literature searching. The session on managing stress during postgraduate studies and relaxation techniques have also been helpful. 

OxINMAHR have also provided workshops including how to develop and maintain a social media profile as a doctoral student which was particularly interesting to me as someone who is interested in communicating research via social media. This session was delivered    by an expert and enabled me to discuss the best ways to remain professional and relevant using these platforms.  

At the moment I am enjoying this phase of being a clinical academic. In the future I would love to be able to use both my clinical and research skills in a role. The exact nature of the role I am not sure yet but I know that there will be many exciting possibilities in nursing! Working in a different country also appeals to me and I would enjoy using my language skills and seeing nursing in a variety of different contexts.

Oxford Brookes is my local university. I have lived in Oxford and worked at the Oxford University Hospitals NHS Trust for 15 years.

I gained a clinical academic scholarship in December 2017 to allow me to study for my PhD.

Working as an Advanced Nurse Practitioner in oncology – I am the nursing lead for the John Radcliffe Acute Oncology team. I continue to work in this role part time whilst doing my PhD. Academically, I did my initial training at the University of Ulster in Coleraine, graduating with a BSc (hons) Nursing with RGN. My first MSc was in advanced practice (palliative care nursing) from the University of Stirling, and I was one of the first cohort of Academic Health Science Network (AHSN) fellows from 2014 – 2017, studying for my MSc in Evidence Based Health Care at the University of Oxford and carrying out a practice-based project (‘Improving the care pathway for newly diagnosed cancer patients at the John Radcliffe Hospital’). I graduated from Oxford with a distinction in Nov 2017.

There is a huge amount of support available to research students. Part of studying at this level is deciding what seminars / teaching sessions to go to and which might be less useful. I feel that the peer support I have received from other research students has been invaluable.

I am looking at the experiences of informal carers (relatives, friends, loved ones) when a patient dies in the Emergency Department (ED). There are several examples in the literature of studies where the experiences of nurses and doctors have been studied, but there are very few examples of studies where the carers have been asked for their experiences.        

As a practice-based clinical nurse, I feel passionately that we need to listen to the voices of the people we care for. When a patient has died, we obviously can’t ask them, so the informal carers are the next best thing; yet, despite concerns being raised about the quality of death and dying in the ED since the 1970s, little has been done to work with the carers to improve things.        

I am planning on using a qualitative case study approach and look forward to getting rich data from the carers I talk to. Ultimately, I would like to design a nursing model for use in the ED with end of life care patients, but the end point will obviously depend on the results I get from my study. Another thing I am passionate about is making my research relevant to practice, and to that end I am involved in the end of life care group at the Oxford University Hospitals NHS Trust as well as being a member of the clinical ethics advisory group at the Trust (CEAG).        

As a research student, the best thing is having the time and space to think and (attempt to!) develop ideas. It is very challenging working clinically at the same time as studying and I have to be very disciplined with myself so that I use my time as productively as possible. I do find that I am working at University most weekends. Building a support network of friends and colleagues is essential. Luckily my husband is completely supportive; I couldn’t do this without him.

There is a wide range of research training available. Seminars delivered by other PhD students both from Brookes and internationally, have probably been the most helpful training I have had so far! My supervisors are a great resource too!

It’s hard to see beyond my next supervision session sometimes, but I do love teaching and would perhaps like to do more of that in the future, although I feel very strongly that I would also like to continue working clinically – after all, the best thing about nursing is patient contact. At some point in the future I would also like to write a novel and have already got several ideas and jot these down all the time.

I am a qualified Occupational Therapist that has 17 years post qualification experience, including 16 years in clinical practice. I actively sort to maintain my clinical professional development and consequently made use of many of the development opportunities available to me. This included working with academics and service users at Brunel University on co-deigned research projects. This led to a desire to do more research which in turn gave me the opportunity to do a NIHR funded Masters in Research in Clinical Practice. 

Having completed this, I started to look for PhD options.   

I came into contact with Oxford Brookes University as a result of an opportunity to do an occupational therapy PhD funded by the Elizabeth Casson Trust. Elizabeth Casson is credited with setting up one of the first occupational therapy schools, which was based in Oxford and later became part of Oxford Brookes University.   

I came to Oxford Brookes through the ECT PhD funded studentship. The studentship is part of a move to develop the occupational science strand of the MOReS group.

I am an Occupational Therapist and have worked for the NHS for 16 years. 

I am passionate about research and passionate about the need for OTS to be doing research, especially in mental health. 

The transition from clinical practice to research is like all transitions and can feel like a big step. It has, however, been a positive transition. I am really enjoying doing research. Everyone in the department has been very supportive and it’s been great to find out about the other research being undertaken.

Title of project: Developing an Occupational Therapy Theory based Intervention, for young people with emerging mental health problems: A mixed Method Investigation. 

My research seeks to explore adolescent perceptions and experiences of current engagement and participation in meaningful occupation; generating new insights to be used in conjunction with existing knowledge to develop a new occupational therapy theory based manual for intervention with young people experiencing early stages of mental health issues. The final aim is to test the feasibility of the manual and identify practical issues related to its use.

I love being a researcher. I had wanted to undertake a PhD for some time! I finally get to! Preparation is important and can really help. I would always recommend reading some of the self-help guides that are out there before you start.   

Talking to other people in the field who have research a similar subject is always recommended. I would also suggest talking to PhD students who in their second and third years to learn what pitfalls to avoid.   

I have valued the opportunity to learn about research-related computer packages such as NVivo and SPSS.

I would like to be a clinical academic researcher, continuing to do both research that is relevant to occupational therapy alongside working as an Occupational Therapist in the mental health field.

Embarking on a PhD mid-career can be daunting, challenging and at times may seem out of reach. However, the Doctoral Training Programme Studentship in Children and Young People has given me the opportunity to undertake a full time PhD to investigate the complex and sensitive issue of child protection. The central philosophy of the Doctoral Training Programme is multi-disciplinary research, drawing from psychological, educational and health perspectives. Coming from a professional background in health care, where the inclination is to concentrate attention within your own discipline, this programme has challenged my previously narrow disciplinary viewpoint.            

The focus of my study is the inter agency communication that occurs between primary health care professionals and child protection social workers. More specifically it explores the early stage of the statutory process when primary health care professionals refer or notify child protection services of their concerns about the safety and well-being of a child or young person. From the outside this would appear to be a simple task, however from reviews of fatal child abuse inquiries it is apparent that this communication process is not straightforward and is beset with problems and difficulties. The consequence of ineffective communication is that families remain unsupported and children remain at risk of harm and further abuse.            

In order to explore this communication process in depth, a qualitative multiple case study approach has been adopted. The unique aspect of this study is that it explores the referrals from the perspectives of both health and social care professionals. Additionally, the narrative written on the referral form is analysed as a function of the communication process. Therefore each case is made up of three elements, in-depth interviews with a health care professional and a social worker and a content analysis of the referral form.            

Health care professionals, who make a child protection referral during the period of data collection are invited to participate. The inclusion criteria being that they work in either universal child health services (for example, health visitors, family nurses and school nurses) or general practice (GPs). It is acknowledged that these professionals are well placed to identify children at risk of harm and to refer them to child protection services. Once the health care professional consents to be interviewed then the social worker who has taken up the referral is invited to participate, and the referral form is anonymised, thereby making a case for the study.            

There are a number of ethical concerns within the design of this study namely confidentiality, privacy and data protection. To overcome these issues the support of an administrator, acting as an information gatekeeper within social services, has been crucial in identifying the cases and recruiting participants to the study. The administrator is an employee of social services and has access to social service IT case management systems as well as the contact details of the professionals involved with the referral. As the investigator of the study, I cannot approach potential participants directly, nor am I able to access any identifiable personal information until they agree to participate. The administrator has a key role in inviting participants and providing anonymised data for case selection and analysis.            

Recruitment to the study is dependent on the goodwill and enthusiasm of health and social care professionals. Unfortunately high workloads, staff shortages and the prioritisation of vulnerable children’s needs are issues that have impacted on recruitment to the study. Data collection is on-going and in order to increase the pool of potential participants, two more study sites, both inner city boroughs, are being used for recruitment in addition to the first county wide study site. 

Having already been a master’s student at Oxford Brookes (2013-2014) I was very well placed to be aware of the research student opportunities at the University. Even more so I was lucky enough that my dissertation supervisor had a studentship available in a similar area to that which I undertook my master’s project in. This opportunity was incredibly attractive to me as I already had knowledge and experience of the department, my supervisor and direct field of PhD study.

I was attracted to Oxford Brookes to undertake my research for a number of reasons. Firstly being familiar with the department and its members for me personally was a real positive, as I knew what the department was like on a day-to-day basis. I also wanted to continue research working with children and the Oxford Brookes Psychology department has a very strong developmental focus, as well as a number of staff members conducting high quality research with children and families which was what I wanted to do. So I felt my research interests fitted in well to the department. I was particularly attracted to undertake my research at Oxford Brookes as it allowed me the chance to continue working closely with my previous dissertation supervisor Dr Luci Wiggs. Luci has been a fantastic supervisor and mentor throughout my time at Oxford Brookes, for which I am extremely grateful!

In the immediate time before starting my research studentship I completed an SQC (short qualifying certificate) and a conversion course Master’s in Psychology to allow me to make a change of career to Psychology via a return to education. My background prior to that had been an undergraduate degree in English Literature and History followed by re-locating to London to work in Financial Services recruitment for 4 years. In comparison to many of my peers I have one of the more unusual backgrounds for being a current PhD student. But I think I am a prime example of how there is no exact route into being a PhD research student!

I found the transition into the research environment fairly seamless, although at times intimidating! Partly I think due to the fact that I officially started a few weeks before actually giving in my dissertation for my master’s degree, my focus was already, to a certain extent, in an academic research capacity. Even more importantly, the existing research students were incredibly welcoming and helpful. We got a lot of information and informal support in the early stages and beyond from these students! In addition I was lucky enough to start alongside four other PhD research students who all came from a variety of different backgrounds and environments and we all made a real effort to bond, spend time together and help each other out which really helps when you settle into a new environment. During the first few weeks of becoming a research student there were various inductions and training, on a whole range of aspects, to help orientate us as new students into the research environment. This support was invaluable in helping us to familiarise ourselves with our responsibilities and what was expected of us but also what was available to us in terms of support from our supervisors, the faculty and the University as a whole. There was a broad and varied training programme for new research students. There was also a range of informal social events which were a fantastic way to build relationships with other new research students across the University. It was good to make some friends and connections as you tend to see these people again at various events and around the University and it’s nice to see some friendly faces!

My research project consists of two distinct studies. Collectively these studies aim to inform about UK parents’ help-seeking behaviours and help us to further understand the role of both maternal and paternal cognitions in infant sleeplessness.  

Sleep is essential to a child’s development. However empirical research suggests sleeplessness occurs in somewhere between 10 – 25% of infants and toddlers. Many of these sleeplessness problems, which commonly include initiation and/or maintenance issues, are considered to be behavioural in nature. Because of this one of the most common treatments of child sleeplessness problems are behavioural interventions, which follow the principle that as sleep problems are learnt the interventions look to change the behaviour, which causes and/or perpetuates the problem. They are recognised as being successful in treating behavioural sleeplessness problems in children and are viewed as the preferred and first-line treatment by health services.   

However these are only one of a range of possible management options and not all families are able, or want, to use behavioural interventions. In addition not all parents seek formal medical guidance and it has been found that higher proportions of parents desire than seek help. Such findings suggest there may be a gap between available and utilised help. Therefore while there is a broad variety of potential sources which parents can and do utilise when seeking information and advice regarding their child’s sleep, very little is known about what sources and/or treatment methods parents actually use and why. Through an online questionnaire, completed by parents of children aged 6-36 months, study 1 explored UK based parents help-seeking behaviours in relation to child sleep, including what sources parents most commonly use and why, their preferences for intervention approaches and perceived barriers to utilising particular sources or interventions.   

In addition I conducted a second study focusing more on parental influences on child sleep. Due to the prevalence of sleeplessness in infants and toddlers, factors that may influence their sleep have been extensively investigated. This has included the role of parenting and parental factors. It is now well established that certain parental behaviours used to settle and soothe children to sleep, such as those involving active physical comforting or extensive parental presence are associated with poorer child sleep or sleeplessness. Certain parental cognitions, that is the thoughts, feelings or beliefs parents hold about their child in relation to sleep, have also been linked to the presence of infant sleeplessness. However the majority of studies in these areas and also those investigating the links between parents’ thoughts and parents’ behaviours have focused on mothers; little is known about the role and potential influence of fathers on their infants sleep or the differences between parents.   

One specific parental variable that has been repeatedly linked to sleeplessness in infants is maternal cognitions. Parents may hold various different types of sleep-related cognitions, including about their own sleep (e.g. if I don’t get 8 hours sleep I cannot function the next day) and about their child’s sleep (e.g. when my child cries at night, I think something awful might have happened to him/her). When parental cognitions have been investigated it has only been cognitions relating to the child’s sleep that    have been explored. However it is well known that cognitions or dysfunctional beliefs about one’s own sleep can affect sleep in adults. It is plausible then that parents who hold such cognitions may also hold, or be more susceptible to developing maladaptive, dysfunctional or negative cognitions about their child’s sleep. However no existing empirical research has investigated these links, which is an omission as this may have implications for possible intervention targets.   

Various theoretical models have been proposed to explain the interplay between infant sleep and other factors. The transactional model acknowledges a variety of factors may play a role in infant sleep but suggests parental cognitions may act as drivers for how parents behave and respond to their child’s sleep. As with other areas of the literature there has been a focus on mothers. Therefore Study 2 will extend existing research by investigating a range of different types of sleep cognitions parents may hold as well as the bedtime practices employed by parents across and between parental dyads. Further this study will explore the potential impact on child sleep of parental discordance in relation to the cognitions parents hold and bedtime practices they use with their child.  

I really enjoy life as a research student, although it is not without its challenges. I relish the intellectual and practical challenges associated with being a research student. You are constantly being pushed to think about things in a new and different way. The freedom and flexibility to work in a way that best suits you is also a big positive of the life of a research student for me personally. I have also loved having the time and space to really immerse myself in the wider literature of my topic and regularly have contact with experts in my field in the shape of my supervisors to discuss all aspects of my research project.   

One of the main challenges I have experienced is not being physically based in Oxford. Living in Gloucestershire and attending the University on a weekly basis, the commute can be a bit of a major headache and so I tend to do as much as I can from home. While this has its benefits it can mean that being a research student is a lonely life, even if you don’t live a few hours commute from your University! I don’t think feelings of isolation are only experienced by those who commute but by all research students, particularly on those days where you feel you are not progressing as quickly as you would like, or are experiencing particular challenges. However, with a bit of planning and effort you can easily develop and maintain a good social and support network; I think this is key for all research students! One of the other challenges I have experienced is being able to effectively plan and manage my own time. I found daily, weekly and monthly planning of my activities and regular to-do lists have really helped me ensure I keep to the tight deadlines I have put onto myself.  

There is a huge amount of research training and resources available at Oxford Brookes. This ranges from University, faculty and department wide training opportunities that cover a diverse range of topics and aspects of being a research student. One of the challenges in broad training programs can be that certain aspects are only relevant to students in a specific area. One of the real positives of research training is that if there is a gap or you experience a specific need this can be addressed or arranged internally or externally if appropriate. In addition I have been lucky enough that the Psychology department staff members have been incredibly accommodating in providing or delivering any department specific training we required.   

One of the main ways in which the training offered personally benefited me was in being able to obtain an Associate Teaching qualification. As I previously had no experience of teaching in Higher Education this was invaluable to provide me with a strong foundation to develop my teaching abilities through experience. This is also a fantastic qualification for me to have obtained during my time at Oxford Brookes as it is attractive to future employers if I pursue future career opportunities that involve teaching.  

I am hoping to continue with a varied and challenging career in academia. While I would love to expand on my existing research, I know from many of my colleagues (and own experience!) that applying for and obtaining funding for research in the current economic climate can be incredibly challenging. As part of my PhD studentship funding, I did a fair amount of teaching on various undergraduate modules. I really enjoyed this and I am definitely interested in higher education teaching opportunities.

I was a cardiology registrar at John Radcliffe (JR) Hospital and was keen to do clinical research to expand my skill set. My training programme director informed me of a study that he had been made aware of via one of the cardiology consultants at the JR. I discussed the study further with Dr Shakeeb Moosavi at Oxford Brookes who had been awarded funding from the British Heart Foundation to investigate the effect of inhaled furosemide in patients with heart failure. This sounded ideal.

The topic of the research and the fact it had already been awarded funding was the main attraction to study at Brookes,as it is one of the areas I am hoping to specialise in.  I was also impressed by my supervisor and the dynamic cardiorespiratory group.

I was a cardiology registrar at the John Radcliffe Hospital. I had completed 3 years of cardiology training and applied for an ‘out of programme experience’ for research for 3 years.  I will return to complete my final two years of cardiology registrar training at the John Radcliffe Hospital after completing my research.

It initially took a little while to get set up with a computer and desk space but I was able to go to the library within the John Henry Brookes building and work there. I had a large computer, plenty of desk space and the surroundings were quiet, so I was able to do plenty of background reading around the topic. I also attended all of the induction sessions during this time. There was plenty of support and resources available and I was clearly signposted to where to go to get further help/information.

Aims of the investigation:

• to investigate the effect of inhaled furosemide on experimentally induced breathlessness in healthy volunteers and to determine which specific form of breathlessness (dyspnoea) it relieves (Year 1).
• to assess inhaled furosemide on exercise capacity via cardiopulmonary exercise testing or 6 minute walk test (Year 1)
• to analyse blood biomarkers for heart failure (BNP, NT-proBNP, Troponin) pre and post exercise and to measure the amount of inhaled furosemide that is absorbed into the blood stream. (Year 1)
• to characterise key features of the breathlessness relief response to inhaled furosemide in advanced heart failure patients (Clinical trial - Year 2 and 3).

Background

The prevalence of chronic heart failure (weak heart pump) is increasing in the UK; over 50% of heart failure patients in the community experience daily breathlessness or tiredness which affects their quality of life by restricting activities. Breathlessness accounts for ≈50% of the symptom burden among hospitalised patients and uncontrolled breathlessness is frightening, degrades quality of life and undermines the will to live.

Different forms of breathlessness

Breathlessness is generally accepted to arise when the brain perceives information reporting when the demand for breathing does not match the signals reporting the amount of breathing – a mismatch. Analysis of unpleasant sensations evoked by different respiratory stimuli in normal subjects or by different clinical conditions in patients have identified specific distinguishable sensations:

• Air Hunger (AH) refers to an uncomfortable urge to breathe. Prolonged breath-holds culminate in intense AH. Increasing the amount of carbon dioxide inhaled with a fixed rate of breathing generates this sensation.
• Work or Effort (WE) refers to an uncomfortable sensation that arises when breathing requires excessive respiratory muscle activity, similar to breathing through a small straw. This increases the work required to take a breath in. Patients with weak breathing muscles and interstitial lung disease all report WE.
• Chest Tightness is reported by asthmatics or in subjects who breathe in a substance that results in airway narrowing.

Inhaled furosemide as a novel treatment for breathlessness

Furosemide acts in the kidneys to increase urine production. It is used extensively in a tablet and injectable form to relieve breathlessness due to fluid on the lungs and ankle swelling in heart failure. By relieving excess fluid from the body via increased urine production, the pump function of the heart improves as the filling pressures within the heart are reduced9. In over 1/3 of patients with advance heart failure resistance develops requiring increasing doses of furosemide to provide adequate relief of fluid overload and this can result in kidney failure. Inhaled furosemide may offer a valuable addition to current heart failure treatment by alleviating breathlessness without significantly raising circulating blood levels of furosemide. It has also recently emerged as a novel intervention for breathlessness in patients with asthma, Chronic Obstructive Pulmonary Disease (COPD) and cancer with the advantage of not suppressing breathing, eliciting sedation or having extensive side effects. No study has yet assessed the effect of inhaled furosemide on relief of breathlessness in patients with heart failure, a patient group who are more likely to benefit from inhaled furosemide than any other breathless patients.

The proposed plan of work 

Year 1:

Study 1 is performed on healthy volunteers and aims to determine which specific form of breathlessness is relieved by inhaled furosemide. Days 1 and 2 are practice sessions to familiarise participants with the equipment and to ensure participants can identify the different types of breathlessness. Days 3 and 4 include inhalation of a mist, either furosemide or a ‘dummy’ mist of salty water. The volunteers and the investigator will not know which mist is being inhaled. Before and after the mist inhalation they will perform breathlessness tests to replicate air hunger or work/effort. This involves two 4 minute periods using a mouthpiece, similar to a snorkel, attached to a breathing circuit of plastic tubing where the level of inspired carbon dioxide can be altered (air hunger) or resistance can be added to the circuit (work/effort). The degree of breathlessness will be recorded on a visual analogue scale (VAS). This is a 100ml scale with no breathlessness at one end (0mm) and intolerable breathlessness at the other end (10mm). Participants will regularly indicate on the scale the amount of breathlessness they are experiencing. Also the different sensations of breathlessness will be recorded. Attached is a flow diagram with a brief description in the legend.

Sample size n= 20

Study 2 sets out to determine the feasibility of inhaling furosemide, performing breathlessness tests and exercise test in patients with chronic heart failure and to assess the amount of furosemide that is absorbed into the systemic circulation. This will lead onto a clinical trial. Each patient will attend on 4 occasions and undergo breathing tests of air hunger (as described in study 1) and exercise tests pre and post inhalation of a mist using slow, deep breaths or fast, shallow breaths. The exercise test will be either the distance the patient walks voluntarily in 6 minutes or cardiopulmonary exercise testing which will be performed on a static bike attached to equipment that enables the peak workload, peak breathlessness, peak oxygen and carbon dioxide levels to be determined. The patient and the investigators will not know whether the mist is furosemide or a ‘dummy’ mist of salty water, in this way they act as their own controls. Blood tests will also be performed looking at established cardiac biomarkers (BNP, NT-proBNP and troponin) to assess their response to inhaled furosemide and exercise. Blood tests will also be performed to assess how much furosemide is absorbed directly into the blood stream from an inhaled dose.

Sample size n = 12

Recruitment: Patients from the John Radcliffe Cardiology Clinic identified by the consultant and via the community heart failure nurses.

This study is a feasibility study as the primary measures of breathlessness have not been previously used in this patient group. A sample size of 12 patients reflects a conservative estimate of the likely number of suitable advanced heart failure patients that can be expected from the two sources of prospective recruitment over a 1 year period. The data generated will enable power calculations to be made for the follow up clinical trial in Years 2 and 3. Descriptive statistics will be presented for (i) Air hunger (AH) sensitivity during experimentally induced AH (ii) the distance the patient walks voluntarily in 6 minutes or in the case of cardiopulmonary exercise testing, the peak workload, peak breathlessness, peak oxygen and carbon dioxide levels in relation to the mist inhaled (furosemide or saline) and the breathing pattern used (slow, deep breaths or fast and shallow breaths).

Year 2 and 3

A study of 40 patients with a diagnosis of heart failure to assess the effect of breathing in furosemide as a mist to see how it affects their breathing and ability to exercise, similar to study 2.

Sample size n = 40

The primary outcome measure will be the visual analogue scale (VAS) ratings of breathlessness. A power calculation was performed to achieve 80% power testing at the 5% significance level stated a sample size of 34 would be required to find a mean difference of 20ml on the visual analogue scale (0 to 10mm scale). 20mm VAS is universally accepted as clinically meaningful. Allowing for drop-outs we aim to recruit 40 patients. This sample size determination is based on a 2x2 crossover design, and a standard deviation of 20mm VAS (derived from a the median difference in VAS in 10 patients with advanced heart failure reported in a previous pilot study of breathlessness relief by oral morphine).

Novel Contribution

If successful, this will be the first documentation of the:

• effect of inhaled furosemide on breathlessness relief and exercise capacity in patients with heart failure
• specific component of breathlessness that is relieved by inhaled furosemide
• amount of furosemide absorbed into the systemic circulation from inhalation
• effect of inhaled furosemide on established cardiac biomarkers

I enjoy the atmosphere at Oxford Brookes University. There are opportunities to get involved with the running of the university, for example attending committee meetings. There are also excellent courses available to attend relevant to research. There are also plenty of opportunities to showcase your work, such as on-line conferences, poster presentations and the postgraduate symposium.

Oxford Brookes University offers excellent training opportunities under Professor Susan Brooks. There is plenty of support within and outside your own department for advice.

After 3 years, I hope to be awarded a PhD.  I will return to my cardiology registrar post at the John Radcliffe Hospital to complete my training. I am planning to sub-specialise in heart failure and devices (e.g. Pacemakers).  I will then apply for a fellowship, followed by a consultant post. Once established as a consultant I hope to set up a research facility to continue to conduct research in the field of heart failure.

My degree is a cotutelle PhD programme concerning the mathematical modelling of metabolic systems. It is split equally between Oxford Brookes (supervised by Dr Mark Poolman) and the University of Malta (supervised by Prof. Cristiana Sebu).

I learned of the opportunity during a presentation held by my supervisors at the University of Malta. I gained interest in Systems Biology due to its multidisciplinary nature, which incorporates skills from Applied Mathematics, Computer Science, and Biology.

When I first visited Oxford Brookes, I found the environment and support services provided to very welcoming, and the training offered interesting and extensive. Moreover, being able to live in the beautiful cosmopolitan city of Oxford is an amazing experience.

I obtained a BSc (Hons) in Mathematics and Physics from the University of Malta in 2018. My dissertation consisted of developing a Machine Learning algorithm aimed at planning the fastest set of routes for a fleet of delivery vehicles to traverse in order to deliver goods to customers. Prior to embarking on my PhD, I worked at an accounting firm where I assisted in Data Science and IT Auditing projects.

Cellular metabolism consists of all the chemical reactions performed by a cell in order to live and grow. It can be regarded as a network of reactions connected through common intermediate molecules called metabolites. As one would expect, the large number of reactions and relationships involved within a cell make insights difficult to obtain through eye inspection alone. Hence, mathematically devised algorithms are used to inspect the structure of the system by studying the interactions between the different components.

Throughout the years, many algorithms have been developed to generate such insights. However, many are hindered by high inefficiency when studying big models. This project aims to develop techniques and tools that enable analysis to be carried out in a more efficient manner, thus requiring less computational costs. More specifically, it aims to do this by extracting insights from the basic mathematical structure of the system, which, while resulting in less extensive information, can be carried out very quickly. I aim to study multiple optima instances in linear programming, and the relationships revealed through the left null-space of the stoichiometry matrix. 

I love the collaborative aspect of my PhD where, apart from having access to the resources of two universities in two different countries, I am also able to travel and meet researchers from different parts of the world. One of my favourite aspects is the freedom to conduct my own research whilst working in a team and benefiting from the extensive knowledge of my supervisors. I like to stay motivated through being inspired by my hard-working colleagues, and by organising my tasks using daily to-do lists.