Emmy and Benedicte learned about research into neuroscience and how to use modern medical technology, such as CRISPR, when on work placement with researcher Marianne Fyhn and her colleagues at the University of Oslo. Photo: Monica Jenstad

Learning about the human brain

Emmy and Benedicte learned about research into neuroscience and how to use modern medical technology, such as CRISPR, when on work placement with researcher Marianne Fyhn and her colleagues at the University of Oslo. Photo: Monica Jenstad

Oslo Cancer Cluster and Ullern Upper Secondary School arranged a work placement for students to learn about neuroscience at the University of Oslo.

Four biology students from Ullern Upper Secondary School spent two great days on work placement with some of the world’s best neuroscientists at the University of Oslo. In Marianne Fyhn’s research group, the students tried training rats and learned how research on rats can provide valuable knowledge about the human brain.

The Ullern students, Benedicte Berggrav, Lina Babusiaux, Maren Gjerstad Høgden and Emmy Hansteen, first had to dress in green laboratory clothes, hairnets and gloves. They also had to leave their phones and notepads behind, before enterring the animal laboratory where Marianne Fyhn and her colleagues work. Finally, they had to walk through an air lock that blew the last remnants of dust and pollution off them.

On the other side was the most sacred place for researchers: the newly refurbished animal laboratory. It is in the basement of Kristine Bonnevies Hus on the University of Oslo campus. We used to call it “Bio-bygget” (“the bio-building”) when I studied here during the ‘1990s.

 

Researcher Kristian Lensjø showed the four excited biology students into the most sacred place: the animal lab.

Researcher Kristian Lensjø showed the four excited biology students into the most sacred place: the animal lab.

It is the second day of the students’ work placement with Marianne. The four biology students, who normally attend the second year of Ullern Upper Secondary School, have started to get used to their new, temporary jobs. They are standing in one of the laboratories and looking at master student Dejana Mitrovic as she is operating thin electrodes onto the brain of a sedated rat. PhD student Malin Benum Røe is standing behind Dejana, watching intently, giving guidance and a helping hand if needed.

“We do this so we can study the brain cells. We will also find out if we can guide the brain cells with weak electrical impulses. This is basic scientific research. In the long term, the knowledge can help to improve how a person with an amputated arm can control an artificial prosthetic arm,” Marianne explained.

“The knowledge can help to improve how a person with an amputated arm can control an artificial prosthetic arm.”

Dejana needs to be extremely precise when she connects the electrodes onto the rat’s brain. This is precision work and every micrometre makes a difference.

 

Training rats

The previous day, Maren, Benedicte, Lina and Emmy helped to train the rat on the operating table on a running course. Today, the Ullern students will train the other rats that haven’t had electrodes surgically connected to their brains yet.

“We will train the rats to walk in figures of eight, first in one direction and then the other”, the students explained to me.

We remain standing in the rat training room for a while, talk with Dejana and train some of the rats. Dejana tells me that the rats don’t have any names. After all, they are not pets, but they are cared for and looked after in all ways imaginable.

“It is very important that they are happy and don’t get stressed. Otherwise, they won’t perform the tasks we train them to do,” says Dejana. She and the other researchers know the animals well and know to look for any signs that may indicate that the rats aren’t feeling well.

“It is very important that they are happy and don’t get stressed.”

I ask the students how they feel about using rats for science.

“I think it is completely all right. The rats are doing well and can give us important information about the human brain. It is not okay when rats are used to test make-up and cosmetics, but it is a whole different matter when it concerns important medical research,” says Emmy and the other biology students from Ullern nod in agreement.

 

Understanding the brain

Marianne is the head of the CINPLA centre at the University of Oslo, where Maren, Benedicte, Lina and Emmy are on work placement for two days. Four other Ullern students, Henrik Andreas Elde, Nils William Ormestad Lie, Hans Christian Thagaard and Thale Gartland, are at the same time on a work placement with Mariannes research colleague, Professor of Physics Anders Malthe-Sørenssen. They are learning about methods in physics, mathematics and programming that help researchers to better understand the brain.

“CINPLA is an acronym for Centre for Integrative Neuroplasticity. We try to bring together experimental biology with calculative physics and mathematics to better understand information processing in the brain and the brain’s ability to change itself,” says Marianne.

Physics, mathematics and programming are therefore important parts of the researcher’s work when analysing what is happening in the rat’s brain.

If you think that research on rats’ brain cells sounds familiar, then you are probably right. Edvard and May-Britt Moser in Trondheim received the first Norwegian Nobel Prize in Medicine in 2014. The award was given to them for their discovery of a certain type of brain cells, so called grid cells. The grid cells alert the body to its location and how to find its way from point A to point B.

Marianne did her PhD with Edvard and May-Britt, playing an essential role in the work that led to the discovery of the grid cells. Marianne was therefore very involved in Norway securing its first Nobel Prize in Medicine.

 

The dark room

Another room in the animal section is completely dark. In the middle of the room, there is an enormous box with various equipment. In the centre of the box, there is a little mouse with an implant on its head.

In this test room, there is an advanced microscope. It uses a laser beam to read the brain activity of the mouse as it alternates between running and standing still on a treadmill.

The researcher Kristian Lensjø is back from a longer study break at the renowned Harvard University and will use some of the methods he has learned.

“I will train the mouse so that it understands that for example vertical lines on a screen mean reward and that horizontal lines give no reward. Then I will look at which brain cells are responsible for this type of learning,” says Kristian.

The students stand behind Kristian and watch the mouse and the computer screen. When the testing begins, they must close the microscope off with a curtain so that the mouse is alone in the dark box. Kristian assures us that the mouse is okay and that he can see what the mouse is doing through an infra-red camera.

“This room and the equipment is so new, we are still experiencing some issues with the tech,” says Marianne. But Christian fixes the problem and suddenly we see something on the computer screen that we have never seen before. It is a look into the mouse’s brain while it runs on the treadmill. This means that the researchers can watch the nerve cells as the mouse looks at vertical and horizontal lines, and detect where the brain activity occurs.

 

Research role models

The students from Ullern know they are lucky to see how cutting-edge neuroscience is done in real life. Marianne and her colleagues are far from nobodies in the research world. Bente Prestegård from Oslo Cancer Cluster and Monica Jenstad, the biology teacher at Ullern who coordinates the work placements, made sure to tell the students beforehand.

“This is a fantastic and unique opportunity for students to get a look into science on a high international level. They can see that the people behind the research are nice and just like any normal people. When seeing good role models, it is easier to picture a future in research for oneself,” says Monica.

“This is a fantastic and unique opportunity for students to get a look into science on a high international level.”

Monica and Marianne have known each other since they were master students together at the University of Tromsø almost twenty years ago.

“I know Marianne very well, both privately and professionally. She is passionate about her research and about dissemination and recruitment. She also works hard to create a positive environment for her research group. Therefore, it was natural to ask Marianne to receive the students and it wasn’t difficult to get her to agree,” says Monica.

Back in the first operating room, Dejana and Malin are still operating on the rats. They will spend the entire day doing this. It takes time when the equipment needs to be found and sterilised, the rats need to be sedated and then operated on as precisely as possibly. It is past noon and time for lunch for Marianne, Kristian and the Ullern students on work placement.

Before I leave them outside Niels Henrik Abels Hus at the Oslo University Campus, I take a picture to remember the extra-ordinary work placement. And not least: to store a picture of the memory in my own brain.

 

Finally, time for lunch! From the left: Emmy Hansteen, Benedicte Berggrav, researcher Marianne Fyhn, Lina Babusiaux, Maren Gjerstad Høgden and researcher Kristian Lensjø. Photo: Elisabeth Kirkeng Andersen.

Finally, time for lunch! From the left: Emmy Hansteen, Benedicte Berggrav, researcher Marianne Fyhn, Lina Babusiaux, Maren Gjerstad Høgden and researcher Kristian Lensjø. Photo: Elisabeth Kirkeng Andersen.

 

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Cathrine Wahlström Tellefsen gave a talk to teachers on how programming can be used to teach science subjects in upper secondary schools.

Introducing programming to the curriculum

KUR programming event for teachers to learn to teach programming.

Programming is not only for computer hackers, it can also help teachers to engage their students in science subjects and inspire start ups to discover new cancer treatments.

 

Almost 60 teachers working in upper secondary schools in Oslo visited Oslo Cancer Cluster Innovation Park and Ullern Upper Secondary School one evening in the end of March. The topic for the event was programming and how to introduce programming to the science subjects in school.

“The government has decided that programming should be implemented in schools, but in that case the teachers first have to know how to program, how to teach programming and, not least, how to make use of programming in a relevant way in their own subjects.”

This was how Cathrine Wahlström Tellefsen opened her lecture. She is the Head of Profag at the University of Oslo, a competence centre for teaching science and technology subjects. For nearly one hour, she talked to the almost 60 teachers who teach Biology, Mathematics, Chemistry, Technology, Science Research Theory and Physics about how to use programming in their teaching.

 

What is KUR? KUR is a collaborative project between Oslo Cancer Cluster, Ullern Upper Secondary School and other schools in Oslo and Akershus. It aims to develop the skills and competence of science teachers. Every six months, KUR arranges a meeting where current topics are discussed.

 

Programming and coding

“Don’t forget that programming is much more than just coding. Computers are changing the rules of the game and we have gained a much larger mathematical toolbox, which gives us the opportunity to analyse large data sets,” Tellefsen explained.

Only a couple of years ago, she wasn’t very interested in programming herself, but after pressures from higher up in her organisation, she gave it a shot. She has since then experienced how programming can be used in her own subject.

“I have been a Physics teacher for many years in an upper secondary school in Akershus, so I know how it is,” she said to calm the audience a little. Her excitement over the opportunities programming provides seemed to rub off on some of the people in the room.

“In biology, for example, programming can be used to teach animal population growth. The students understand more of the logic behind the use of mathematical formulas and how an increase in the carrying capacity of a biological species can change the size of its population dramatically. My experience is that the students start playing around with the numbers really quickly and get a better understanding of the relationships,” said Tellefsen.

When it was time for a little break, many teachers were eager to try out the calculations and programming themselves.

 

Artificial intelligence in cancer treatments

Before the teachers tried programming, Marius Eidsaa from the start up OncoImmunity (a member of Oslo Cancer Cluster) gave a talk. He is a former physicist and uses algorithms, programming and artificial intelligence every day in his work.

“OncoImmunity has developed a method that can find new antigens that other companies can use to develop cancer vaccines,” said Eidsaa.

He quickly explained the principals of immunotherapy, a cancer treatment that activates the patient’s own immune system to recognise and kill cancer cells, which had previously remained hidden from the immune system. The neoantigens play a central role in this process.

“Our product is a computer software program called Immuneprofiler. We use patient data and artificial intelligence in order to get a ranking of the antigens that may be relevant for development of personalised cancer vaccines to the individual patient,” said Eidsaa.

Today, OncoImmunity has almost 20 employees of 10 different nationalities and have become CE-marked as the first company in the world in their field. (You can read more about OncoImmunity in this article that we published on 18 December 2018.)

The introductory talk by Eidsaa about using programming in his start up peaked the audience’s interest and the dedicated teachers eagerly asked many questions.

 

Programming in practice

After a short coffee break, the teachers were ready to try programming themselves. I tried programming in Biology, a session that was led by Monica, a teacher at Ullern Upper Secondary School. She is continuing her education in programming now and it turns out she has become very driven.

“Now you will program protein synthesis,” said Monica. We started brainstorming together about what we needed to find out, which parameters we could use in the formula to get the software Python to find proteins for us.

Since my knowledge in biology is a little rusty, it was a slow process. But when Monica showed us the correct solution, it was surprisingly logical and simple. The key is to stay focused and remember to have a cheat sheet right next to you in case you forget something.

 

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Kronikk: Dine helsedata kan styrke helsenæringen

Ketil Widerberg, daglig leder i Oslo Cancer Cluster.

This opinion piece was first published on 9 May 2019 in Dagens Medisin, by Ketil Widerberg, General Manager at Oslo Cancer Cluster, and Christian Jonasson, Senior Adviser at NTNU. Both are also members of a work group for innovation and business development for the Health Data Program for the the Norwegian Directorate of eHealth. Please scroll to the end of this page for an English summary.

 

Vi får nye forretningsmodeller innen helse som er basert på digitalisering og persontilpasset medisin. Her kan Norge virkelig lede an!

Christian Jonasson, seniorforsker ved NTNU.

Christian Jonasson, seniorforsker ved NTNU.

Ketil Widerberg, daglig leder i Oslo Cancer Cluster.

Ketil Widerberg, daglig leder i Oslo Cancer Cluster.

HELSE BLIR digitalisert og medisin blir tilpasset den enkelte pasienten. Dette er to megatrender som vil endre forretningsmodellen for helseindustrien. Forrige uke kom Stortingsmeldingen om nettopp helsenæringen. Den åpner for store muligheter for Norge.

I bilindustrien erstatter gradvis digital mobilitet den tradisjonelle boksen på fire hjul. Et eksempel er at Tesla blir verdsatt høyere enn tradisjonelle bilprodusenter blant annet for sin evne til kontinuerlig datainnsamling fra bilene. I helsenæringen vil vi se det samme.

 

NYE MODELLER. Med digital persontilpasset medisin vil nye forretningsmodeller vokse frem. Vi ser eksemplene daglig: Roche, et globalt legemiddelselskap, har nylig kjøpt opp helsedataselskapet Flatiron. Oppkjøpet gjorde de for å kunne utvikle nye kreftbehandlinger raskere, for nettopp tid er viktig for kreftpasienter som kjemper mot klokka. Et annet legemiddelselskap, AstraZeneca, har ansatt toppleder fra NASA. Norske DNVGL, som tradisjonelt har jobbet med olje, gass og shipping, har nå helsedata som et satsingsområde.

Helsemyndigheter erkjenner også endringen mot mer datainnsamling. Legemidler blir mer målrettede og brukes på stadig mindre undergrupper av pasienter. Dette utfordrer hva som er nødvendig kunnskapsgrunnlag for å gi pasienter tilgang til ny behandling. Mens det i dag er kunnskap om gjennomsnitt for store pasientgrupper som ligger til grunn for beslutninger om nye behandlingsmetoder, er det med persontilpasset behandling nettopp viktig å ta mer hensyn til individer og små undergrupper. De amerikanske helsemyndighetene (FDA) har derfor lagt frem retningslinjer for hvordan helsedata kan brukes som beslutningsgrunnlag for nye legemidler.

 

NORSKE FORTRINN. Legemiddelverket i Norge gir uttrykk for at de også ønsker å være i front i denne utviklingen – for også de ser at helsedata gir bedre beslutningsgrunnlag.

Hvordan kan så Norge lede an? Norge har konkurransefortrinn knyttet til et sterkt offentlig helsevesen, landsdekkende person- og helseregister og biobanker som kan knyttes sammen gjennom våre unike fødselsnummer. Dette er få land forunt! Derfor kan vi utnytte dette konkurransefortrinnet for å ta en posisjon i den store omveltningen av helsesektoren og helsenæringen.

Nedenfor følger noen forslag som vi mener vil styrke Norges stilling.

 

PLATTFORM. Vi kan starte med å lage en norsk dataplattform. Selskap leter globalt etter helsedata av god kvalitet. La oss utvikle en dataplattform hvor helsedata er raskt og sikkert tilgjengelig for norske og utenlandske aktører. Et eksempel er helseanalyseplattformen. Her må data gjøres tilgjengelig for alle aktører og for alle legitime formål. Samarbeidsmodeller må utvikles som sikrer at verdiskapingen blir i Norge og pasientene får bedre behandling.

Vi kan utvikle bedre økosystemer. Verdiskapingspotensialet for helsedata ligger i skjæringspunktet mellom offentlig og privat. Dagens offentlige forvaltere av helsedata må derfor samarbeide tettere med norske oppstartsbedrifter og internasjonale aktører.

 

INNSYN. Vi kan bruke personvern som konkurransefortrinn. Hver og en av oss eier våre egne helsedata. Derfor er det viktig med digitale plattformer som gir oss innsyn i egne helsedata.

Hvordan vi kommer til å bruke helsedata om få år, er vanskelig å forutse, akkurat som det var vanskelig å forutse hva konsesjonsutlysningen for oljeutvinning i 1965 ville føre til. Historien viser imidlertid at slike avgjørelser kan ha stor betydning for fremtidens verdiskapning i Norge, og for pasienter i hele verden. La oss derfor ikke overlate til tilfeldighetene hva vi i Norge gjør med våre helsedata.

 

 

English summary:

Digitalisation and precision medicine are influencing emerging business models in the health industry. It is time for Norway to lead the way!

As precision medicine develops, data gathering becomes ever more important. Instead of relying on results from a big patient group, cancer researchers are using big data to find out how treatments can be customised for small patient groups and individual patients.

Norway has a competitive advantage on health data: thanks to its strong public health sector, national health registers and biobanks that can be connected to unique personal ID numbers.

We suggest creating a common platform for Norwegian data, where high quality data can be accessed securely by legitimate national and international companies. Through collaborative models, we can ensure that the medical breakthroughs stay in Norway and benefit the patients. We need to develop better ecosystems that inspire simple collaboration between international key players, Norwegian start ups and the public agencies that handle health data.

Data privacy can be used as an asset. If we ensure everyone has complete access and insight into their own personal health data, people can be empowered to share it for the common good.

The decisions we make today will have great ramifications for the future value creation in Norway and for cancer patients across the world. We should not leave it up to chance.

 

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From left to right: Jacques Li, Sam Chong, Diana Murguia Barrios and Jason Yip studied how patient recruitment to clinical trials can be improved in Norway with both financial and non-financial incentives.

Should Norway implement a clinical trial league table?

The students in the picture are Jacques Li, a doctor and entrepreneur from France; Diana Murguia Barrios, an economist and political scientist from Spain; Jason Yip, a chemistry engineer from England; and Sam Chong, a lawyer and economist from Malaysia and Australia.

We asked four MBA students from Cambridge University to evaluate how patient recruitment practices in Norway can be improved.

The number of clinical trials in Norway has been declining over the last few years. There are many reasons behind this trend, but until now there have been few concrete solutions. With the number of cancer patients on the rise, there is a growing need for access to better treatments.

Oslo Cancer Cluster asked four students from Judge Business School at Cambridge University to research how the number of clinical trials in Norway can be improved. The students were Jacques Li, a doctor and entrepreneur from France; Diana Murguia Barrios, an economist and political scientist from Spain; Jason Yip, a chemistry engineer from England; and Sam Chong, a lawyer and economist from Malaysia and Australia.

“The number of clinical trials in Norway is less than half of the number in Denmark.”

The group focused on one of three factors that influence the number of clinical trials in Norway, namely: the patient recruitment practices. After a comparative analysis with other European countries, they came up with two main recommendations on how Norway can improve patient recruitment.

 

Image och doctors and nurses walking in corridor

How do we motivate hospitals and doctors to recruit more patients to clinical trials?

 

One: Motivating hospitals

The group compared patient recruitment in Norway to France, United Kingdom and USA. Norway was the only country where hospitals don’t have any non-financial incentives to recruit patients to clinical trials. If a hospital’s reputation could be improved in a concrete way by having clinical trials, patient recruitment could also be improved.

The group proposed to create a league table for all hospitals, with cancer trial participation as one of the metrics. This would create competition between hospitals, encourage collaboration between smaller hospitals and larger ones, and make information about clinical trials accessible to patients.

If hospitals were ranked against each other based on clinical trial output, they would more actively recruit into trials due to the reputational incentive.” 

The group also uncovered a misalignment between the funding source and the implementers of the clinical trials. Funding is passed from the Norwegian Health Ministry to the regional health authorities, instead of directly to the hospitals who conduct the trials. The group recommended that the hospitals need direct financial incentives to conduct the trials.

“Regional health authorities in Norway need to ensure that funding provided to them for research is passed down to the hospitals conducting clinical trials.” 

 

Two people holding hands.

How do we raise awareness among patients and doctors about clinical trial participation?

 

Two: Raising awareness

A second discovery in the report was the lack of awareness about clinical trials among both patients and doctors. Patients in Norway lack access to relevant information that would empower them to opt into clinical trials. There was similarly a lack of exposure to clinical trials among early career doctors and a lack of initiatives to collaborate on clinical trials among advanced career doctors.

“Raising awareness among stakeholders is key to improve clinical trial recruitment.” 

The students suggested working in partnership with patient organisations to raise awareness among patients. They recommended a national awareness campaign to inform where patients can find up-to-date information about clinical trials. All hospitals could keep lists of their ongoing clinical trials available on their websites.

If patients knew the benefits of clinical research, they would select a hospital that is ranked highly.” 

The group also provided recommendations to raise awareness among doctors to work on clinical trials. Rotational programs and supplementary courses on research methods and clinical trials may spark interest among medical students to pursue work in clinical trials. Seminars and workshops can help to both raise awareness and inspire collaborative efforts among doctors in their advanced careers.

 

Oslo Cancer Cluster wishes to extend a big thank you to everyone who agreed to be interviewed for this research project:

  • Ali Areffard, Medical team, Bristol Myers Squibb
  • Øyvind Arnesen, Chairman of the Board, Oslo Cancer Cluster
  • Siri Kolle, Vice President Clinical, Inven2
  • Jónas Einarsson, former Chairman of the Board of Oslo Cancer Cluster and one of the founders of Oslo Cancer Cluster Innovation Park
  • Maiken Engelstad, Deputy Director, Ministry of Health and Care Services
  • Katrine Bryne, Senior Advisor, Legemiddelindustrien (LMI)
  • Kristin Bjordal, Business Manager for Research Support and Research Manager in Oslo Hospital Service (OSS) and Chairman of the Board of NorCrin
  • Ida Kommandtvoll, Advisor, Department of Strategy and Analysis, The Norwegian Cancer Society
  • Knut Martin Torgersen and medical team, Merck
  • Steinar Aamdal, the founder of The Clinical Trial Department, Oslo University Hospital

 

View and download the following PDF of the Cambridge report to learn more.
Note: This is a short version of the report, the fuller version also includes an Appendix containing detailed information about all the underlying data and interview material. Please get in touch with Communications Adviser Sofia Lindén if you are interested in reading the full Appendix.

 

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