Health inequalities in older people: a plan for action

INITIATOR FUND

Project period: August – October 2017

GW4 community leads
University of Bath: Dr Nikki Coghill and Dr Jessica Francombe-Webb
University of Bristol: Dr Demi Patsios
Cardiff University: Professor Shantini Paranjothy
University of Exeter: Professor Katrina Wyatt

Project overview

The focus of this project is to identify new approaches and ways of addressing inequalities in health among older people living in low income / economically disadvantaged communities. We propose to create a network of expertise (academic, professional, local) ready to respond to this grand challenge using innovative ‘bottom up’ participatory approaches including visual methodologies.

In England, those living in the poorest communities, on average, die seven years earlier. Determinants of deprivation include: accessibility to primary, secondary, community and preventative care and food. With an increasingly ageing population, older people living in deprived communities have reduced access to these services, compromising their health and social-care, often exacerbated in areas of conflict, political and social unrest.

Public Health and Primary Care often adopt top-down approaches, identifying behaviours or individuals as ‘problems’ and developing programmes to target the behaviours or individuals. This can result in programmes that widen rather than reduce inequalities. Our proposed sandpit supports an evidence-based, bottom-up, community engagement approach, supporting communities to identify barriers to their health and wellbeing.

Our expertise, the urban-rural disparity across GW4 and our global partners uniquely places us to address the ‘Health, demographic change and wellbeing’ grand challenge and contribute to the GW4 priority areas ‘Inclusive innovative and reflective societies, and ‘Social Justice, Inequality, local and global.’ We will work with research partners in Colombia and Namibia to develop transferable adaptive processes and approaches for these developing countries and the welfare of their older populations.

The funding, and resulting partnerships, will enable the development of participatory community-driven projects, well-placed to leverage future funding from e.g.: Leverhulme trust (Research Projects Grants), Nuffield foundation (Grants for Research and Innovation Projects) or NIHR (Public Research Programme) enabling the generation of evidence-based practice.

 

Transnational transformations in social protection: concepts, instruments and contexts

ACCELERATOR FUND

Project period: September 2017 – December 2018

GW4 community leads
University of Bath: Dr Rana Jawad
University of Bristol: Dr David Gordon
Cardiff University: Dr Rod Hick
University of Exeter: Dr Paul Cloke

Project overview

Our community aims to conduct world-leading research on social protection in both the Global North and South. We adopt the ILO’s definition of social protection as comprising income security across the life-course and in relation to specific contingencies, such as unemployment, and access to healthcare.

We will advance scholarship and policy learning by harnessing complementary strengths from across the GW4 institutions; and by identifying gaps in the academic literature, which has lagged behind developments in policy and practice over the past decade. Our community has clear relevance for GCRF funding streams and members of our community have been awarded funding under this scheme to-date.

Our aim is for the investment of the Accelerator award to lead to applications for funding totalling £750,000 within one year of the award. While the Accelerator funding is for six months, it is necessary to be selective about appropriate funding streams, and this may require a slightly longer time-frame, and being more flexible in response to particular calls as-and-when they arise.

An Accelerator award would provide a step-change for our community, and will leave a legacy of ongoing collaboration across the GW4 institutions in the area of social protection in the years to come.

Developing STEM education for marginalised groups in low-income communities

INITIATOR FUND

Project period: January 2017 – May 2017

GW4 community leads
University of Bath: Professor Catherine Montgomery
University of Bristol: Professor Justin Dillon
Cardiff University: Dr Jamie Lewis
University of Exeter: Dr Nasser Mansour

Project overview

The aim of this project is to build a research community that will share knowledge, expertise and resources in research and engagement with STEM education in low income countries, particularly for girls and women and indigenous or rural populations in developing countries in Sub-Saharan Africa and the Americas.

STEM education is seen as an opportunity to develop industrialising economies with improved access to employment for young people and graduates (Roberts, 2012). Advanced industrial countries have engaged in strong curriculum reform, adapting school practices to engage with problem solving, mathematics, and scientific thinking (Marginson et al, 2013).

However, issues of unequal access, approaches to pedagogy, limitations in resources and infrastructure mean that engagement with STEM education is a challenge in low income countries and ironically, this is where effective STEM education is most needed (Freeman et al, 2015).

Providing equal access to quality education is a global challenge. UNESCO has named improving quality education and reducing inequalities as two of its 17 sustainable development goals (UNESCO, 2016). In sub-Saharan Africa, secondary education is expanding rapidly and many disadvantaged rural communities have their first secondary school (e.g. Tanzania, Malawi).

These are often poor quality though with very few students progressing from lower to upper secondary. Sciences in particular are challenged for shortage of qualified teachers and lab equipment for upper secondary. Hence, secondary education is a bottle neck for science specialists who face challenges in moving into health professions and teaching.

The grant calls for GCRF have identified “inclusive and equitable quality education” as a priority theme. STEM education can enable science knowledge for the other 7 priority themes and this project addresses an intersection with the Sustainable Cities and Communities theme, presenting a community-focused approach to STEM education that develops capacity for scientifically informed responses to local development challenges (e.g. related to health, clean water supply, energy efficient cooking, small scale agriculture).

Antimicrobial resistance

INITIATOR FUND

Project period: January 2017 – May 2017

GW4 community leads
University of Bath: Dr Barbara Kasprzyk-Hordern
Cardiff University: Professor Timothy Walsh
University of Exeter: Dr William Gaze

Project overview

Antimicrobial  resistance  (AMR)  has  been  identified  as  a  global  problem  requiring  urgent  and concerted multidisciplinary action (WHO AMR strategy and the O’Neill AMR Review commissioned by the UK government).

The problem of increasing antimicrobial resistance is primarily of concern within Global Challenges Research Framework 2. Sustainable health and well-being, however there are also challenges relating to 1. Secure and resilient food systems supported by sustainable agriculture and 4. Clean air, water and sanitation.

We are particularly interested in drawing on research strengths in GW4 partner universities in the area of antimicrobial resistance in environmental systems. We wish to explore  and  develop projects  for future collaborative  funding opportunities focused on using systems approaches to understand and tackle the problem of AMR in different environments and communities. We have identified potential synergies between genomic characterisation, environmental detection, novel sensors and transmission dynamic modelling between and within ecosystems of AMR determinants as areas of strength across the GW4 group, but which are not currently collaborating. Understanding the aspects of AMR transmission in different  environments is an  emerging  area  of research and is currently poorly understood. Research in this area will be crucial to identify interventions to prevent the global transmission of antimicrobial-resistant bacterial strains (and also resistant fungal pathogens) which impact on global heath, food security, and economic and social wellbeing.

There is  significant  scope  to  bring  together  this  expertise  across  the  GW4  to  use  systems  approaches  to understanding  and  tackling  AMR  in  different  environments  and  communities  to  benefit both ODA countries and the UK.

Research Working Group on Brain Injury (RWGBI)

ACCELERATOR FUND

Project period: January 2017 – February 2018

GW4 community leads
University of Bath: Professor Keith Stokes
University of Bristol: Dr Martin Bunnage
Cardiff University: Professor Derek Jones
University of Exeter: Professor Huw Williams

Project overview

The ‘Research Working Group on Brain Injury’ (RWGBI) draws together a multidisciplinary team of highly complementary expertise, from four universities, to investigate the impact of concussive /sub-concussive blows on brain structure and function. Such research is pressing, given the ubiquity of collision sports at all levels (amateur to professional) and recent high profile cases. Most players recover from concussion in days, but some develop long-lasting symptoms with emerging evidence of long-term changes in brain structure. However, despite much focus on this topic, there have yet been no prospective studies published.

Detailed neuroimaging and cognitive testing will be completed of professional rugby players, and non-contact sports professionals, at two time points; pre- and post-season. Exposure data (medically-diagnosed concussions, tackles/collisions involved in) will be correlated with pre- and post-season MRI/cognitive data, to identify whether training and match play have any neurological or cognitive impact, and if so whether these point to risk-mitigation recommendations.

Athletes, parents, schools, coaches, and sporting governing bodies of all contact sports worldwide are concerned that repeated exposure to sports-related concussion (SRC) may reduce quality of health/life in current and retired athletes. Given the popularity of collisions sports worldwide, this is a substantial community facing issues requiring considerable attention. Concern regarding SRC has been expressed through media and government bodies, e.g. poor management of SRC in the world’s biggest sport – football – has led The Telegraph (31/05/16) to ask football authorities to commission independent research on, ‘Does playing football increase your risk of dementia and other degenerative brain diseases?’ Discussing American Football, President Barrack Obama, at a Summit on concussion, said he was unsure if he would allow his children to play given the risks. In rugby, the case of Ben Robinson, a schoolboy who died after suffering repeated SRC, led to guidelines being adopted across the regions and nations of UK & NI for improving detection and management of SRC.

Meanwhile the UK government has asked schools to “team up” with sports clubs to improve fitness of pupils – which has met a backlash from public health physicians warning of the dangers of rugby. At the professional level, regulators are responding to concerns by making changes to rules to mitigate such risk. However, there are numerous unanswered questions that require quality empirical research. The funding support through the GW4 will enable pilot data to be collected to examine our initial research question: does a single season of exposure to rugby training and match play result in any detectable MRI or cognitive change? If this is the case then multiple-seasons of exposure could lead to greater neurohealth burden and possibly poorer outcome in some individuals, but this is yet to be determined.

Towards a rapid, hand-held, biosensor-based detector for Clostridium difficile

ACCELERATOR FUND

Project period: July 2016 – March 2017

GW4 community leads
University of Bath: Dr Pedro Estrela
University of Bristol: Professor Martin Cryan, Dr Andrei Sarua
Cardiff University: Professor Adrian Porch, Professor Les Baillie, Dr Niek Buurma, Dr Simon Pope
University of Exeter:
 William Leslie Barnes
Mr Tracy Wotherspoon, Microsemi Ltd. (industrial partner)

 Initiator project – GW4 Biosensor Network 

Project overview

The main impact of our project will be in healthcare, where we propose to tackle the major societal problem of antibiotic resistance by developing a rapid detector for bacterial infection (in our case for Clostridium difficile) that will lead to its appropriate treatment. The Chief Medical Officer of England, Professor Dame Sally Davies, has stated that “Antimicrobial resistance poses a catastrophic threat. If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics.”

Clostridium difficile infection usually presents itself as diarrhoea and is commonly associated with previous antibiotic use, mainly affecting the elderly and debilitated. In 2012 alone there were 1,646 CDI deaths in England and Wales (0.8% of all hospital deaths). Public Health England (PHE) has stated that, “In order to continue to tackle Clostridium difficile infections, additional interventions in the community, primary care and acute Trusts will need to be identified and actioned.”

This is what our detector hopes to realise – a diagnostic bedside test with a turnaround time of 10 minutes would not delay the appropriate management of patients for both antibiotic treatment and implementation of infection control procedures.

A biosocial approach to trauma research

INITIATOR FUND

Project period: July – November 2016

GW4 community leads
University of Bath: Sarah Halligan
University of Bristol: Dr Abigail Fraser, Professor Stan Zammit
Cardiff University: Professor Stephanie Van Goozen
University of Exeter: Dr Anke Karl

Project overview

Individuals exposed to trauma, particularly childhood trauma, are among the most vulnerable members of our society and are disproportionately likely to experience educational failure, severe social difficulties, or to be in the criminal justice system.

Research has highlighted links between trauma exposure and numerous negative psychological outcomes, including post-traumatic stress disorder (PTSD), psychotic symptoms, conduct problems, depression and substance use; as well as adverse physical health outcomes such as increased risk for cardiovascular disease.

Biological dysregulation, particularly in stress response systems, has been implicated in each of these adverse outcomes. However, research that takes a biosocial approach (i.e., studying the interaction of biological and social factors) to understanding the spectrum of trauma related negative health outcomes is limited.

The GW4 group includes researchers from different disciplines and methodologies, but each with an interest in trauma related adverse outcomes. Exploration of the synergy in terms of unifying underlying processes, including through engagement of a broader set of GW4 academics, is a major goal of the proposed collaboration.

The main objective of the award activity is to expand existing links to include further GW4 members, in order to generate a sustained network of collaboration with associated research outputs. Consistent with this, we will aim to outline proposals for two to five collaborative projects by the end of the funding period.

The UK Biobank GW4 research collaborative

INITIATOR FUND

Project period: July – November 2016

GW4 community leads
University of Bath: Dylan Thompson
University of Bristol: Cathy Williams
Cardiff University: Jonathan Hewitt, Jeremy Guggenheim
University of Exeter: Jess Tyrell

Project overview

The UK Biobank is a unique biomedical resource and contains detailed demographic, health, social, genomic and environmental information on half a million UK citizens. These data are linked to a range of health outcomes, such as GP and hospital records and a large proportion of participants have completed cognitive tests, and given blood/DNA samples for genetic studies. One hundred thousand of these people will have detailed MRI imaging undertaken in the next few years.

This resource is an ideal vehicle to address the effects of demographic, genetic and lifestyle variables on health and wellbeing. Additionally the large range of data it contains allows for innovative environment and societal factors to be studied in relation to heath. We propose to inform researchers from the four universities about the potential of this biomedical resource and to facilitate collaboration between teams with different areas of expertise in exploring the opportunities this provides.

The UK Biobank is an on-going and expanding research platform that is likely to provide scientific information for the next forty years and most likely beyond. That degree of longevity provides a sustainable infrastructure on which our UK Biobank GW4 research collaborative can flourish and grow. By combining our research strengths and expertise across the four host Universities of GW4 we anticipate identifying novel research areas within UK Biobank, which will provide our institutes unique opportunities that could be missed without the GW4 collaboration.

Our objectives are

  1. To create a diverse, interdisciplinary community of UK Biobank researchers across the GW4 Universities
  2. To develop a culture of UK Biobank usage within GW4
  3. To leverage internal and external funding and sustained research output.
  4. To identify and promote research themes within UK Biobanks that will form ongoing self-sufficient research entities across the 4 Universities

 

GW4 Cancer Research Consortium

Initiator Fund

Project period: February – May 2016

GW4 Community Leads
University of Bath: Dr Adele Murrell, Dr Lorenzo Caggiano
University of Bristol: Professor Paul Martin, Dr Axel Walther  
Cardiff University:
Dr Matt Smalley
University of Exeter: Dr David Allard, Dr Jackie Whatmore, Professor Willie Hamilton

Project overview

The GW4 Cancer Research Consortium aims to foster cross-disciplinary collaboration, by capitalising on the breadth of complementary expertise and high-impact cancer research across GW4. Translating cancer discoveries into cures is a major public health challenge worldwide, and in the last two decades advances in diagnosis, treatment and care have led to longer survival times for a number of different cancers. As the ageing population continues to grow, cancer will only increase as a serious social and economic health challenge.

Within the GW4 universities there is already substantial research effort into the environmental and lifestyles causes of cancer, the contribution of genetics, biochemistry and cell biological processes to the aetiology of a wide range of malignancies. There is also research into the prevention and pharmaceutical intervention in cancer.

We aim to identify resources required to underpin large strategic grant applications, and establish a cross-centre non-clinical doctoral training programme in cancer complementing the work of GW4 Clinical Academic Training Community.

Pre-clinical Translational Biomedical Research Network

Initiator Fund

Project period: February – May 2016

GW4 Community Leads
University of Bath: Dr T Perry, Dr R Gill
University of Bristol: Professor Raimondo Ascione
Cardiff University:
Dr Chris Marshall, Dr Derek Jones
University of Exeter: Professor John Terry

Project overview

Historically as little as 2% of fundamental scientific discoveries have progressed from the bench to the bedside. This is an issue of the UK system, with substantial research funding not being transformed into patient, societal, and economical benefits. We aim to boost the development of discoveries, and test their safety and efficacy in novel research facilities aligned to NHS, Home Office, and GLPMA standards, to facilitate their translation to the bedside.

We offer a unique pipeline of pre-clinical research models highly relevant to human disease and anatomy and state-of-the-art research equipment, with more than 150 biomedical scientists and experts. Via this community we will have a unique chance to work together to develop new therapeutic agents and devices to be tested as a final-step validation prior to first-in-man testing.