North Staffs Researchers Boost Glaucoma Treatment Safety

North Staffs scientists have used a £10,000 charity grant to help make eye surgery safer for thousands of glaucoma patients.

The research team, based at Keele University’s Institute for Science and Technology in Medicine, were awarded the funding by charity the North Staffordshire Medical Institute.

They have used it to try and improve outcomes of the trabeculectomy surgical procedure, commonly used to treat the eye disease glaucoma.

The condition – which is Britain’s second biggest cause of sight loss – occurs when the optic nerve and retina are damaged, caused by a build-up of fluid that increases pressure inside the eye.

Trabulectomy

A trabeculectomy involves making a small hole in the wall of the eye so that fluid can drain away, relieving the excess pressure.

However up to 30 per cent of the operations fail due to the body’s natural healing processes, which cause the hole to heal up and close again.

The researchers, led by tissue engineer Professor Ying Yang, have been looking for better ways to stop the eye from forming scar tissue and closing the new drainage channels.

She said: “The surgical procedure is the creation of an opening to allow the draining of fluid, but the body is automatically programmed to react if there’s a wound to try and close it.

“If it closes, this kind of surgery will fail. But your body doesn’t realise there is a benefit to this wound.”

Eye Cells

To address the problem, Prof. Yang’s research team have used conjunctival cells to create a mimic of human eye tissue under lab conditions.

They have tested the tissue with various drug doses to find the most reliable way of preventing inflammation and wound healing, without damaging the surrounding cells.

She added: “It’s difficult to work with a human eye and if you use an animal eye they’re not very representative. So we’re able to generate material in the lab that you can use to test whatever you wish – generate artificial wounds, add different growth factors and cytokines or test drug treatments.

“This will help us to predict what will happen in the patient’s eye after glaucoma surgery.”

The team has also been testing a new medical device to treat glaucoma called the XEN gel stent, which involves injecting a tiny gelatin tube into the eye to keep the drainage channel open.

They hope to use the results of their research to attract funding for a larger study.

Prof. Yang said: “The value of the Institute’s grant is that it’s kind of like a seed. We’re not just relying on this funding – through this we’re able to generate the proof of concept to attract more clinicians to participate in our research.”

Research Funding

The original grant was allocated in 2014 as part of the NSMI’s annual awards, which are funded by a combination of public donations, bequests and the income from room hire at the charity’s base on Hartshill Road, Stoke.

Once Britain’s first postgraduate centre, the iconic building is now used as a conference facility.

While the annual funding for 2018 has now all been allocated, researchers will soon be able to apply for the Institute and UHNM’s Firelighter Awards of up to £10,000.

For more information, visit www.nsmedicalinstitute.co.uk, like us on Facebook or follow us on Twitter.

North Staffs Researchers to Seek New Therapy for Chemo-Resistant Cancers

North Staffordshire researchers have been awarded £18,450 to develop a new treatment for chemo-resistant cancers.

The group, led by research pharmacologist Dr Alan Richardson, hopes to extend the lives of thousands of patients with breast, ovarian and lung cancers that have stopped responding to chemotherapy drug paclitaxel.

They aim to develop a new drug to stop cancer cells producing a protein that makes them resistant to the therapy.

Dr Richardson and his team will receive the grant from Stoke-on-Trent charity the North Staffordshire Medical Institute.

He said: “Patients who get ovarian cancer respond well to chemo, but they often suffer a relapse and when they come back they become resistant to treatment. At that point the number of options left are limited and there’s not a lot that can be done.

“Our goal is to discover drugs that make cells sensitive again to chemo.”

Ending Drug Resistance

Paclitaxel is normally given to patients through an intravenous drip and works by stopping cancer cells from dividing and growing.

The scientists, based at Keele University’s Institute for Science and Technology in Medicine (ISTM), have found that paclitaxel-resistant cells make too much of a protein called branched chain keto-acid dehydrogenase kinase (BCKDK).

They plan to test a range of chemicals in the lab with samples of pure BCKDK in a bid to block the gene that tells cancer cells to produce it.

Dr Richardson said: “I used to work at the Institute for Cancer Research in London and I started a screen to identify genes that contribute to drug resistance.

“Since then we’ve identified one gene and if we inhibit it, it makes the cancer cells more sensitive to paclitaxel. So we’re going to make drugs to inhibit this gene and hopefully extend people’s lives.”

Dr Richardson’s team will use the money to buy the state-of-the-art equipment they need to set up the initial tests. This will help them to apply for more funding to develop the drug further and eventually test it in patients.

The grant was allocated as part of the NSMI’s annual awards, which are funded by a combination of public donations, bequests and the income from conferences and room hire at the charity’s base on Hartshill Road, Stoke.

Once Britain’s first postgraduate centre, the iconic building is now used as a conference facility.

While the annual funding has now all been allocated, researchers will soon be able to apply for the Institute and UHNM’s Firelighter Awards of up to £10,000.

For more information, visit www.nsmedicalinstitute.co.uk, like us on Facebook or follow us on Twitter. Anyone interested in making a bequest is asked to email manager Jacqui Robinson at jacqui@nsmedicalinstitute.co.uk.

North Staffs Scientists Seek Cure for ‘Silent Killer’ Heart Defect Affecting 620,000 Brits

North Staffordshire researchers have been awarded £20,000 to help cure a heart defect that causes thousands of sudden deaths each year.

The experts hope to understand and control arrhythmogenic right ventricular cardiomyopathy (ARVC) – a condition that affects around 620,000 people in the UK and causes up to five per cent of young adult deaths.

Sufferers often fail to notice any symptoms, which can mean they do not know they have the genetic disease until it is too late.

While ARVC cannot be prevented, group leader Dr Vinoj George believes it could be controlled in the early stages through genetic engineering to stop it becoming lethal.

His pioneering study will receive the funds from local charity the North Staffordshire Medical Institute.

Dr George said: “This disease manifests with different severity. In some patients even a little bit of stress can trigger it, often resulting in sudden cardiac death.

“There are other people who live perfectly well with it and it can be controlled by drugs or devices that can be put in to maintain heart rate.”

He explained that ARVC is caused by a genetic mutation affecting the cell protein that ‘glues’ the heart muscles together. This leads to the death of cardiac cells, stopping the heart from pumping properly and causing an irregular heartbeat.

The same problem gene can manifest with different severities.

Genetic Engineering

Dr George’s team, based at Keele University’s Institute for Science and Technology in Medicine (ISTM), will create the ARVC mutation in human stem cells in the laboratory, before converting them into cardiac muscle cells.

They will then use optogenetic technology – which uses light to change the behaviour of mutated cells – to look for the genetic triggers that make the disease more severe.

He said: “We’re taking stem cells, we’re creating the protein mutation in the cell and then we’re making the cell behave like it would in the heart. Then what we’re doing is trying to use genetics to control how the disease can be reproduced and modified at the cellular level.

“Once we identify the genes that are responsible, then it will help us to find drugs or strategies to control that mechanism.”

Patients are usually diagnosed with ARVC on the basis of their symptoms, but the underlying genetic cause can only be confirmed by a test in a specialist clinic. This is often reserved for severe cases and the relatives of known sufferers, who have a 50 per cent chance of passing the disease on to their children.

Dr George’s study will use genetic data provided by St George’s Hospital in London, which treats a range of ARVC patients with various mutations and severities.

He added: “We hope to translate our work to benefit clinicians at the Royal Stoke Hospital in devising treatment strategies to control ARVC severities, potentially at a younger age.”

NSMI Funding

The grant was allocated as part of the NSMI’s annual awards, which are funded by a combination of public donations, bequests and the income from conferences and room hire facilities at the charity’s base on Hartshill Road, Stoke.

Once Britain’s first postgraduate centre, the iconic building is now used as a conference facility.

While the annual funding has now all been allocated, researchers will soon be able to apply for the Institute and UHNM’s Firelighter Awards of up to £10,000.

For more information, visit www.nsmedicalinstitute.co.uk, like us on Facebook or follow us on Twitter. Anyone interested in making a bequest is asked to email manager Jacqui Robinson at jacqui@nsmedicalinstitute.co.uk.

NSMI-funded scientists seek genetic treatments to fight frailty in older people

North Staffs researchers have won a £19,985 grant to investigate whether gene therapy can stop older people becoming frail.

The group, led by Dr Adam Sharples, hopes to pave the way for new treatments that will reduce falls and weakness in the elderly by switching off the genes that cause muscle wasting.

They will study tissue samples donated by hip and knee replacement patients to find which genes cause unused muscles to break down – with the help of the funding from local charity the North Staffordshire Medical Institute.

Dr Sharples said they expect to find these genes are ‘marked’ by special chemical ‘tags’ that tell them to be active or inactive, known as epigenetic modifications.

The discovery could eventually allow doctors to give patients medication that will replace the effects of exercise.

He said: “It’s very difficult to persuade an older person who’s never exercised in their life to take up a fitness regime. If we identify genes that we already know there are drugs for we can give them to people who don’t want to or can’t exercise due to frailty.”

Discovery

The team, based at Keele University’s Institute of Science and Technology in Medicine, has previously found muscles can remember periods of growth, so they can grow larger later in life.

They will investigate whether the opposite applies after wasting – meaning muscles may break down more quickly if an injury is repeated.

If so, the muscle memory could potentially be ‘switched off’ in older people hurt in a fall, slowing down the wasting process that makes them more likely to fall again.

He added: “Can we intervene if a patient has had a fall and lost muscle to prevent that from happening again and make people less frail? The cost of frailty to the NHS is on the increase, especially with an aging population.

“The thing it impacts on is quality of life, so people can’t do simple tasks like walking upstairs or opening a can of beans. So our aim is not necessarily to extend life but to improve quality of life as people get older.”

Using the latest genome wide techniques, the team will study more than 850,000 sites on the DNA of patients with muscle wasting after an operation. They will then compare them to a control group of normal muscle samples.

Dr Sharples said: “What we’re going to do is take a chunk of muscle about the size of a broad bean, usually from the quadricep, and look at the difference between someone who’s had a trauma or an injury and had to have an operation and someone who hasn’t.

“Normally those people have some kind of muscle wasting in a very short period, even in two or three weeks where the limb is suspended.”

Grant

The grant was allocated as part of the NSMI’s annual awards, which are funded by a combination of public donations, bequests and the income from room hire at the charity’s base on Hartshill Road, Stoke.

Once Britain’s first postgraduate centre, the iconic building is now used as a conference facility.

While the annual funding has now all been allocated, researchers will soon be able to apply for the Institute and UHNM’s Firelighter Awards of up to £10,000.

For more information, visit www.nsmedicalinstitute.co.uk, like us on Facebook or follow us on Twitter.

NSMI Charity’s £58,000 cash boost for local medical research

Charity the North Staffordshire Medical Institute has announced a £58,000 cash injection for three “outstanding” local research projects.

The money will support new studies based at Keele University and the University Hospital of the North Midlands (UHNM), designed to improve treatments for cancer, heart disease and muscle wasting in the elderly.

A panel of experts led by Institute chairman Professor Shaughn O’Brien allocated the funds after reviewing applications for their annual grants.

Prof. O’Brien said: “We were very impressed by the research proposals we received on a wide range of topics, all of which could have been funded.

“The reasons for our choices were the outstanding quality of the applications, the importance of the disease areas and the strong track records of the departments involved in delivering research.”

The professor, a leading obstetrician and gynaecologist, oversaw the award process alongside colleagues from a range of medical disciplines.

They included gastroenterologist Dr Adam Farmer, clinical biochemist Professor Richard Strange and Professor of Biomedical Imaging Melissa Mather.

He added: “We are confident these projects will be of great value to the community of Staffordshire and to medicine as a whole.”

Award recipients

The panel awarded £18,450 towards a study into treatment-resistant cancers, led by Dr Alan Richardson at Keele’s Institute of Science and Technology in Medicine (ISTM). His team aim to restore the sensitivity of cancer cells to chemotherapy drug paclitaxel.

A second group based at the ISTM, led by Dr Vinoj George, were awarded £20,000 to investigate heart condition Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC). They hope to identify those at most risk from the disease, which can cause sudden death.

Cell and tissue engineer Dr Adam Sharples and his colleagues, also from the ISTM, were given £19,985 to research muscle wasting in the elderly.

The awards were funded by a combination of public donations, bequests and the income from room hire at the Institute’s base on Hartshill Road, Stoke. Once Britain’s first postgraduate centre, the iconic building is now used as a conference facility.

While the annual grants have now all been allocated, researchers will soon be able to apply for the Institute and UHNM’s Firelighter Awards of up to £10,000.

For more information, visit www.nsmedicalinstitute.co.uk, like us on Facebook or follow us on Twitter.

Institute set to announce research grant winners

Researchers across the region will find out this week if their projects will be funded by the North Staffordshire Medical Institute.

A committee of experts has been sifting through applications for the charity’s annual research grants and is set to announce its decisions following a meeting on Monday, February 19th.

It will award sums of up to £20,000 towards three schemes designed to enhance understanding of disease and create more effective treatments. Previous recipients have included research groups investigating cancer, diabetes, heart disease and premature birth.

Jacqui Robinson, manager at the Institute, said they were keen to attract as many applications as possible to ensure the best possible quality. She said: “There’s only a limited amount of funds available so we consider what’s most appropriate and in line with the Medical Institute’s guidelines.

“The committee is made up of established scientists and researchers so they know whether or not it’s going to work and whether it’s feasible.”

The committee also includes several lay members to provide a different perspective on which projects are worth funding.

They sift through up to 20 applications each year, which must already have been through an independent peer review process and gained approval from a local ethics committee if patients will be involved.

She added: “If they need ethical approval and we don’t receive a copy they won’t get any money.

“We encourage as many people as possible to apply and it’s open to any allied health professionals in North Staffordshire. We need to be sure that the quality is there though.”

Researchers are invited to apply for the annual awards – normally worth around £60,000 a year – via the Institute’s website every autumn.

Applications are now closed for the 2018 research awards, but are due to open shortly for the Firelighter Awards in collaboration with the University Hospital of the North Midlands NHS Trust.

For more information keep an eye on our website, like us on Facebook or follow us on Twitter @nsccentre

In their own words: NSMI-funded scientists on their groundbreaking work

North Staffordshire researchers undertake innovative brain injury study involving surgeons and scientists

In a new study started in 2017, a North Staffordshire research team has succeeded in keeping adult human brain tissue alive in a dish outside of the body, using samples of tissue donated by living patients undergoing surgery for a brain condition called ‘Chiari malformation’.

Clinical lead for the study, consultant neurosurgeon Mr Nikolaos Tzerakis explained: “The Chiari malformation is a fairly common problem in Neurosurgical practice. Simply put, the part of the brain at the back of the head which is called the cerebellum, lies lower than the normal level.

“This creates crowding in a tight bony space called foramen magnum, which then causes some difficulty in the circulation of the brain fluid. Patients with Chiari malformation present with headaches mostly during coughing, laughing and straining.

“When surgical treatment is required the usual operation is called Foramen Magnum Decompression, during which we remove a small part of the bone at the back of the head and the spine. On a few occasions, some cerebellar tissue has to be removed to allow adequate decompression and circulation of the brain fluid.

“This sample would have been of no use until now because according to the classical surgical protocol it is removed and disposed. However, this tissue has living nerve cells and they can be grown in the laboratory without any additional risk to the patient.”

Patients with Chiari malformation are widely believed to have essentially healthy (viable) tissue because the brain tissue is misplaced rather than diseased. In the past, scientists studying the human brain have been limited by the difficulty in obtaining tissue for such studies. Their options have been limited to samples removed post mortem – which can quickly die – or tissue from cancerous or diseased brains.

Proving the successful use of Chiari tissue in a dish has the potential to be a very useful new scientific development, which could help in the study and discovery of new treatments for brain injuries and diseases which could be investigated using such a model.

Before they could start their research, the scientists went through a three-year planning process including an exhaustive review within the NHS to make sure their methods were ethical.

They sought consent from a number of patients, some of whom agreed for their cerebellar tissue to be kept for the research study, rather than be incinerated, as would be the normal practice.

Clinical Lecturer Mr Jon Sen, a neurosurgeon, said: “It made me think ‘why has no one thought of doing this before?’ The simplest ideas are often some of the best ones, but it still took a lot of banging our heads together in the neurosurgery department to reach the idea of trying to obtain tissue from our Chiari patients. #

“A key issue is that Chiari is the only surgery we ever do where we take out brain tissue that we could consider within a ‘normal’ enough limit that we could develop a meaningful tissue injury model from.”

The study – supported by a grant from the North Staffordshire Medical Institute – is being led by Professor of Neural Tissue Engineering at Keele’s medical school, Divya Chari.

This new scientific advance also has the potential to reduce the need for animal testing, and could allow the Keele University scientists to simulate the effects of injuries on brain tissue in a laboratory environment.

Prof. Chari said: “I feel passionate about the need for models to reduce animal experimentation. In my early training, I learned to reproduce brain and spinal cord injuries in rodents so I know first-hand the major ethical and technical difficulties these have.

“In animal models there’s potential for substantial suffering – they can lose movement and bladder control, become quadriplegic.

“Our aim is to develop a successful dish model for use in laboratories, that’s relevant to human injuries. We’ve previously proven we can develop models in a dish using tissue derived from rodents, but this is the first time we’ve done it using human tissue.

“Make no mistake, this is a huge undertaking and the success of the work relies on collaboration of a big team working across the hospital and laboratory units. This includes neurosurgeons Mr Nikolaos Tzerakis and Mr Rupert Price, research nurse Holly McGuire and scientists Dr Jacqueline Tickle and Dr Christopher Adams at Keele University.”

The study was a long time in the planning, however, the process accelerated rapidly when the team finally received their first tissue sample this summer.

Researcher Dr Jacqueline Tickle said: “The time for collection from the patient and processing in the laboratory was less than an hour. It has to happen very quickly so there’s less time for the tissue to die and it remains viable.”

The tissue samples were cut into slices of varying thickness to examine the tissue survival and observe major brain cell types.

At first the researchers had no idea what to expect.

Prof. Chari said: “The fact that we have seen tissue survival for well over two weeks made us excited because we had no idea whether we could get it to remain viable for even 24 hours. The fact that we can detect the major cell types present in the brain is very positive”

“When an incision was made in one of the samples to replicate an injury, the researchers believe they can see some changes that are typical of genuine brain injuries.”

Prof. Chari and Mr Sen added: “This is still very, very early. We’ve only got the tissue from two patients so far. Getting the tissue depends on many factors- whether the patient consents to donating the sample, whether the surgery goes ahead as planned, and ultimately whether the surgeon makes the decision to remove the tissue.”

“So we are in it for the long haul, but we all believe it is worth the effort, because the first results are pretty exciting. The main outcome at this stage is that we’re confident that the tissue can remain viable for a relatively long time, if the conditions are kept right.

“It suggests that we could make an injury model in these tissue samples and then look at responses to therapeutic manoeuvres.”

Professor Shaughn O’Brien, chairman of the North Staffordshire Medical Institute, said: “This is an outstanding research project and a unique and clever approach to the study of neural/brain tissue which will attempt to replicate the real life situation in human tissue but without being in any way additionally invasive for any patients.”

The North Staffordshire Medical Institute is a charity funded by public donations that provides grants for vital medical research in the Staffordshire area.

To find out more about their work, visit nsmedicalinstitute.co.uk.

Sunshine vitamin D holds the key to beat childhood asthma, North Staffs scientists claim

A North Staffordshire research team hopes to prove spending time in the sunshine is the key to improving childhood asthma.

The experts, led by consultant paediatrician Dr Will Carroll, believe many asthma attacks in children can be linked to a deficiency in vitamin D – a substance produced by the body when it is exposed to sunlight.

Their preliminary research has found asthmatic youngsters are hospitalised more often in less sunny parts of the country.

Controlled trials

Dr Carroll now hopes to prove that giving children vitamin D supplements will cause asthma complications to fall, in a study part-funded with a £19,884 grant from the North Staffordshire Medical Institute.

He said: “We know from the analysis that in regions of the UK that are more sunny they have lower rates of childhood asthma.

“But between October and February each year, the sun doesn’t get high enough in the sky in the UK to produce vitamin D anyway, so we have to rely on supplementation in those months.

“Previous studies have shown that small doses of vitamin D can reduce asthma exacerbations in children.”

The team, based at Keele University, plans to start with a small study in which asthmatic children will be given either vitamin D or a placebo and the progress of their asthma will be monitored.

They will use this to help them design a much larger controlled trial to take place in several locations around the country.

Dr Carroll, an expert in paediatric lung disease, added: “The purpose of the programme is to show that it’s more effective to give vitamin D to children than a placebo.

“The vitamin D available now is colourless and odourless, so that helps us to do our research. What we’re hoping to find is that it reduces asthma exacerbations in children.”

Health advice for asthma

If the programme proves a success, it could mean dramatic changes to the official health advice around taking children out in the sun.

At the moment, parents are advised to cover kids up as much as possible and use high-factor sunscreen to prevent the risk of burns, heatstroke and ultimately skin cancer.

But if vitamin D is important for respiratory health doctors may start advising that children spend short periods outdoors without sun protection.

He said: “If you cover yourself in sun cream you don’t get vitamin D because you need to have exposure to UVB rays.

“Nearly all children in the UK have insufficient levels of vitamin D. We’re designed as human beings to be semi-clothed and to live outside, we’re not meant to be indoor creatures.”

There are currently 5.4million people living with asthma in the UK – one of the highest rates in Europe – including 1.1million children.

The lung condition killed 1,468 people in 2015 and costs the NHS an average of £1billion a year.

The North Staffordshire Medical Institute is a charity funded by public donations that provides grants for vital medical research in the Staffordshire area.

To find out more about our work, visit http://nsmedicalinstitute.co.uk/

By Meg Jorsh

Understanding Grief – an Interview with Linda Machin

By Meg Jorsh

Grief affects all of us at some point in our lives. When a loved one dies we may feel crushed, overwhelmed. Then it fades to a quiet pain that hides behind everything we do until we finally learn to live with it.

But for some of us, relief never comes. The waves of sadness continue to mount, so that everyday life seems tiny by comparison. For these people bereavement holds risks of its own – depression, anxiety disorders, substance misuse, sudden cardiac events and potentially suicide. They need professional help to adjust to their new way of living.

Unfortunately it can be hard to tell the difference between those treading water and those not waving, but drowning. It has been the life’s work of bereavement expert Dr Linda Machin to better understand the landscape of loss and the ways individuals grieve. Her pioneering research has helped countless professionals to understand grief and bereaved people to feel better understood.

“I think a lack of understanding can make grief longer-lasting than it needs to be,” says Dr Machin. “It can bubble along even worse for some people if they feel misunderstood and their care isn’t addressed appropriately.

“People who begin to grieve chronically can also become depressed and anxious, the ultimate potential risk is suicide. You only have to look at the media attention to Princes William and Harry and their comments about losing their mother to appreciate the long-lasting and persistent nature of grief. They were young people then but it can apply to people at any stage of their lives.”

Models of Bereavement

Dr Machin is best-known in her field as the creator of the Range of Response to Loss model and Adult Attitude to Grief scale. These psychological tools allow professionals to categorise a bereaved person’s  grief according to their levels of overwhelmed, controlled and resilient reactions. A more overwhelmed person may be so distressed they feel they can never be happy again, whereas a more controlled person may refuse to accept the reality of their loss. On the other hand, a resilient mourner may feel they are able to cope with their pain.

“The AAG scale is a kind of a triage system,” Dr Machin explains. “The interventions that are deemed appropriate are based on the scale. Some people who are very overwhelmed by their grief will need a very different intervention to someone who’s closed down on their grief but is still not coping.”

“NICE have produced guidance for bereavement intervention – the first group is one where people simply need signposting to practical advice and support from family and friends. The second is one where people do need some opportunity to talk about things that are troubling to them. Then the third are the group who are most vulnerable and are likely to need longer-term intervention by therapists.”

Further Research

The more recent development of the AAG scale to identify  vulnerability was funded by the North Staffordshire Medical Institute for research with two Marie Curie hospices (Hampstead and Belfast), the Dove Service bereavement support team in Stoke-on-Trent and the bereavement service of St Giles’ Hospital in Lichfield. It is now being used by a range of UK organisations including Marie Curie and Cruse Bereavement Care, as well as internationally by groups in Canada, Iceland, Portugal, Australia, Pakistan and the USA. Dr Machin is also working on a modified version for people affected by terminal illness.

“It’s  looking at the whole question of mental health and loneliness,” she says. “The ultimate aim is that this is a method that allows the practitioner to enhance their work with people as  they progress from end of life care  to bereavement.”

Dr Machin and her team, based at Keele University, received a £4,500 grant from the North Staffordshire Medical Institute in 2011. For more information on the medical research charity or to make a donation, visit our website at http://nsmedicalinstitute.co.uk/. You can also like us on Facebook at @nsmedicalinstitute or follow us on Twitter at @nsccentre.