19 May 2020

The APPROACH researchers: Interview series “Behind-the-scenes”, part 1

In order to showcase the variety of work we do in APPROACH, the following news items are dedicated to several of our researchers. They share the work they do for the project, what excites and challenges them the most, especially at times of the present COVID-19 pandemic, and how they see the impact of our project for the wider field of Osteoarthritis research.

Eefje van Helvoort is one of the researchers of APPROACH at the UMC Utrecht (The Netherlands). The main focus of her work on APPROACH is conducting the participant visits in the UMC Utrecht where she is responsible for the almost all parts of the visits (clinical examination, blood and urine samples, and MRI scans, among others).She is also participating in the development of the participant newsletter for APPROACH which is prepared in close cooperation with the Patient Council appointed for the project. Furthermore, Eefje is engaged with analysing patient data, although, she asserts, not all data is available yet. However, Eefje is able to focus her efforts on analysing the data from x-rays, clinical data and GaitSmart.

On her work within the APPROACH project she shares: “I like the variety of the work I do on APPROACH. I enjoy having contact with participants, but also organising visits within the hospital, writing manuscripts and giving presentations about my work on the project. This makes for a broad scope where I can have a day filled with patient visits but then have another one when I sit behind my desk, focused on writing or preparing for presentation.”

However, Eefje shares that there are challenges to her work too. The biggest challenge for her was to organise visits for big numbers of patients, since they live across the whole country and need to travel before their visit for a long time. This makes it especially hard to organise fastened blood sampling, for example. In that regard, she asserts, setting up the trial in the UMC Utrecht in the beginning of APPROACH was a challenge.

On the importance of APPROACH for the wider field of Osteoarthritis research, Eefje claims: “Ideally, APPROACH would be a first step to find different subtypes within the Osteoarthritis field as a first step to use those subtypes in future trials. Consequently, after many years this will, hopefully, lead to treatments for those specific subtypes. Currently, Osteoarthritis is seen as one disease, while there are several subtypes that will not benefit from the same treatments offered to everyone. Therefore, one should start at the beginning by defining these subtypes and finding appropriate treatments and biomarkers for them.”

The COVID-19 pandemic inevitably impacts Eefje’s work on the project. All visits at the UMC Utrecht are cancelled for 6 weeks now, she shares. The last visit in the UMC Utrecht took place on the 19th of March whilst there are usually 6 visits per week. Moreover, quality checks cannot be executed, as monitoring teams are not able to check data obtained across clinical sites. The annual meeting for all APPROACH consortium members has also been cancelled, which, according to Eefje, makes it harder to share ideas and data.

Eefje is now doing her job from home and she cannot work in the lab or hold visits for APPROACH. Nevertheless, she shares that now she has more time to focus on writing and analysis. Most importantly, she says: “I do not to worry about not being able to organise the participant visits but instead focus on the end results and what I can do at this moment. Probably once the visits can move on, we will organise them in according with the rule on 1,5 meters social distance. For the time being, I am focused on writing manuscripts and following relevant and useful courses.”

Pawel Widera works on the computational side of the APPROACH project. He shares: “In the past I've been trying, with the help of computers, to make sure that we recruit the right patients in our study. I've made predictions based on the historical data and ranked all the patients before and after the screening visit, to guide the decision on who should be invited from each recruitment centre. Now I'm focusing more on the analysis of the newly collected data, but in the future I will work on improving the original predictions and build a new selection model. We also hope to use the new model to identify subgroups of patients that could benefit from personalised treatment.”

What do you enjoy the most about your work on the project?
“I really like the fact that this is not a theoretical work. There is a lot of that in computing science. Toy problems where everything is ideal, because it makes it easier to work with. We are working on real data, and the work we do, can one day make a difference in the life of osteoarthritis patients. It has some disadvantages, however - the data are often messy, there is no obvious best approach, and we have to experiment a lot. But that's quite fun!”

What is challenging about your work?
“The so called "data wrangling" is a big part of this job, and can be frustrating at times. Fortunately, we completed the most demanding data harmonisation part of the work, so now we mainly focus on one dataset - the APPROACH cohort. Also, as this is a pioneering work, where we try something that hasn't been tried before, we cannot rely much on previous research, and we depend on experimentation. Most of the time our ideas fail to bring useful results, but if you try long enough, it will work. That can be frustrating sometimes too. Aside from the computational aspect of the work, the multi-disciplinary collaboration is a challenge. We use different language, different methods, we even write scientific articles differently. It took some time to get used to each other. Moreover, the number of people involved in the work is quite large, and APPROACH members are spread over several countries, so it is often challenging to effectively communicate as part of such a large remote group. It's not the same as a one-to-one conversation over a cup of tea.”

What do you think is the importance of the project for the wider field of osteoarthritis research?
“I think the APPROACH cohort will be studied for many years beyond the life of the project itself. The project members are already starting multitude of mini-studies, testing different hypotheses. I'm sure many discoveries lie ahead. Personally, I hope it will also help to demonstrate the usefulness of computational methods, which in medicine are not routinely used, and show that computers can guide the knowledge discovery process in a way that classical statistical analysis can't.”

How has the COVID-19 crisis impacted your work?
“My work is done exclusively on a computer (and a piece of paper sometimes), and I've been no stranger to working from home. However, when I usually do that, I maintain complete separation between the two worlds. My home computer is not set up for work, I connect remotely to my office machine, and I do all the work there. I'm very used to this, since connecting to servers to do some work from so called "dumb terminal", was considered normal "back in the days". This model worked great until a power cut in the university building turned off all the computers there. The building was in lockdown, and a special rescue mission had to be organised to turn the computers back on! Unfortunately, a number of things I was working on have been lost in the process.”

How have you adapted to the new circumstances created by the pandemic?
“I'm a heavy introvert, so I feel I didn't really need to adapt much. I'm rather enjoying the fact that there is less people everywhere! However, I'm a fan of volleyball, and I must say, I miss playing it a lot. I tried to replace it with home exercises, which helps a bit, but it's not the same.”

How do you mitigate the (negative) impact of the crisis on your work?
“As I spent much more time seating now, I force myself to exercise every day. Initially I spent a lot of time reading about the virus to understand where the risks are, and what not to worry about. Now, I have increased the time I spent on the mindfulness practice, and reduced the time spent on reading the news. I also arranged regular remote activities with friends and family, but I must say, nothing beats a real board game session!”