Researcher profile: Cognition and industry

Jack Mellor is a Professor of Neuroscience at the School of Physiology, Pharmacology and Neuroscience at the University of Bristol. His work investigates the fundamental neural processes which underpin cognition, and which have profound implications in the treatment of many neurological and psychiatric disorders. We caught up with him to find out about his research journey, and how his lab collaborates with other departments, clinicians and industry partners.

Behavioural adaptation – Synaptic plasticity

Jack’s group focuses on the brain processes that enable us to learn and remember new information about our environment, and then adapt our behaviour appropriately. At a simple level this might be remembering where you left your bicycle but it can also apply to negative emotions associated with traumatic events and avoidance of associated places or objects. A process known as synaptic plasticity is fundamental to this adaptive behaviour.

It’s the process whereby a chemical signal is released from the synapse of a neuron, and diffuses across to a target neuron (or another type of cell). This signal can excite, inhibit, or otherwise modify the behaviour of the target cell. Over time, the amount of chemical signal that gets released, or the target cell’s response to it, can be modified based on previous activity. This adaptation at a cellular level then enables the brain and ultimately us an individuals to adapt our behaviour.

“Experience is so fundamental to shaping who we are as individuals, and how we contextualise our experiences is implicated in many neurological and psychiatric disorders,” explained Jack. “Memory is fundamentally dependent on the behavioural context of learnt information, and in my lab we aim to investigate the contextual factors that are important for the encoding of memory by synaptic plasticity at a neuronal circuit level.”

History

Professor Mellor graduated in neurophysiology in 1995 from the University of Cambridge, and stayed on there to study for a PhD under Professor Andrew Randall on the biophysics and pharmacology of inhibitory synaptic transmission at the MRC Laboratory of Molecular Biology.

Following his PhD, Jack worked for a short while at the Department of Science and Technology. “I was doing policy work, just to see whether or not that was something I was interested in. It was pretty fun, but I think ultimately it wasn’t where my strengths lay!”

Inevitably, the lure of returning to academia was too strong, and Jack accepted a position at Roger Nicoll’s laboratory at the University of California, San Francisco. “The US postdoc was funded by the Wellcome Trust; I was awarded a fellowship which funded me for two years out there, and another year back in the UK. So in 2002 I decided to head to Bristol to the world leading centre in neuroscience research that was there at the time.”

In Bristol, Jack was initially working in Professor John Isaac’s laboratory, before being awarded an MRC funded Career Development Fellowship which enabled him to set up his own group in 2004; more fellowships and a lectureship followed.

In 2011 Jack received an ‘Institutional Strategic Support Funding’ award from the Elizabeth Blackwell Institute with funding from the Wellcome Trust. Jack says: “The funding was designed to support me and give me time to prepare for applying for further Wellcome funding which I subsequently did. It really helped me develop some ideas I’d been working on at the time.” The follow-on application was successful and Jack was awarded a £1.1 million grant to understand how one of the brain’s key neurotransmitters called ‘acetylcholine’ influences brain activity. In collaboration with the pharmaceutical company Eli Lilly & Co., the team looked to translate the findings into new treatments to combat dementia and schizophrenia.

The Mellor Lab

“I’ve always been interested in the electrical properties of nerves and how they communicate and electrical measurement was my training” Jack continued. “At the time I was trying to evolve into neuron imaging and in particular calcium imaging [a technique which looks at the movement of calcium ions within tissues and cells issuing calcium-dependent fluorescent markers]. Part of the ISSF funding went towards developing these capabilities. This slightly different approach gave us an extra dimension to investigate how neurons and synapses operate”.

Even now, the group is still electrophysiology focused – but also performs a considerable amount of in vivo calcium imaging. “This way, we can measure and locate many neurons at once. It helps us to further understand the neural basis of cognition and how networks of neurons link up and then adapt their firing in order to allow us to adapt our behaviour.”

Collaboration is key

Professor Mellor’s group is involved in extensive collaborations with academic, clinical and industry partners. The collaborative work focusses on how network function within the hippocampus is modified by synaptic plasticity, and investigates novel compounds that might modify that plasticity – which might in turn lead to new drugs.

Simultaneously, the lab is investigating how these neural processes are altered in psychiatric and neurological disorders, leading to disruptions in cognition. Understand these processes – and the neuromodulators in question – has the potential to lead to new therapeutic avenues, and better treatments for a variety of disorders.

Mechanisms

Collaborations come together in a number of ways, as Jack explains: “We either seek out potential collaborators whose expertise might feed into what we’re working on, or else they might approach me with ideas,” said Jack. “I really enjoy a team approach to science and always appreciate the value of integrating different perspectives and ideas into our work. I have reached out to many collaborators in the past and am always surprised by how receptive most people are. It doesn’t always work but most of the time everyone gains something!”

The Mellor Lab has particular expertise in cholinergic drugs and muscarinic drugs, some of which have been moving through various drug-development pipelines over the years.

“There have been some just licensed recently,” said Jack, “which are quite interesting, in that they’re very similar to drugs we’ve worked on – and published on – with drug companies.  I wouldn’t say that any of that work with us thus far has directly contributed to drug development, but I think the body of work in general is important. And it’s been interesting to gain insights into how drug companies work and what aspects of our research are important to them.”

Reliable and robust

Jack contends that a key part of the relationship between the Mellor lab and industry relies upon ensuring that the research is reliable and robust enough that drug companies feel confident, and trust in the relationship:  

“I think that the ability to do reliable research is a key factor for external collaboration – we have to demonstrate the robustness of our output very clearly to potential collaborators.”

“At the moment my lab is researching a derivative of psilocybin in various assays that we run: drug companies use our expertise to gain information to help them in terms of formulating how they’re going to use these drugs and what sort of trials they want to undertake.”

Quid pro quo

What does the lab gain from giving their industry partners the benefits of their expertise? As well as funding, in the past they have also allowed post-doc researchers to be embedded at pharmaceutical companies, and they also fund PhD students.

“I’ve got a couple of PhD students at the moment who are part funded by pharmaceutical companies,” said Jack, “and overall, I think it’s sometimes good to have the support of a financially motivated institution to demonstrate that there is a wider value to the work beyond simply the intellectual interest.”

Mellor futures

The Mellor lab is presently focused on a number of projects investigating the genetic risk factors involved in neurodevelopmental disorders, specifically schizophrenia – but which might also have relevance for other disorders. In 2023 they were awarded £2.1 million to study the biological changes that occur in schizophrenia. The award from the Medical Research Council will help scientists understand how genetic mutations in multiple different genes lead to common biological and cognitive changes and identify new therapeutic targets. The project forms a multi-disciplinary and cross-institutional partnership between research teams led by Professor Mellor with Dr Mike Ashby, Professor Jon Hanley and Professor Emma Robinson at Bristol, Professor Jeremy Hall at the University of Cardiff and Professor Dimitri Kullmann at University College London, along with clinical research teams led by Dr Mike Carter and Dr Kasia Sieradzan in Bristol.

“This work has strong links with epidemiology. We’re considering ways of processing large data sets and trying to work out where risk occurs and how it leads to the underlying neurobiology. I’m interested in the underlying neurobiological principles of these things and the sorts of data you can pull out from large genetic data sets. We’d hope to use the data to formulate hypotheses that we can then test in the group.

Unknown unknowns

Jack is also at the preliminary stages of projects investigating the effects of uncertainty on cognition and behaviour, as he explained:

“This project looks at how the brain processes different forms of uncertainty, and how we need to adapt our behaviour to cope with these, as well as the neurological representations of that uncertainty. Essentially, how your representation of uncertainty evolves and therefore what you decide to do about it.

“There’s a famous 2002 saying by (US politician) Donald Rumsfeld: ‘…there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don’t know we don’t know’.

“Rumsfeld got a lot of stick for that, but he was articulating a fundamental concept, which often doesn’t go down well from a politician. If you know that something is unknown, you don’t necessarily have to adapt your behaviour – but if something happens that is an unknown unknown – that is, something you were previously unaware that you didn’t know – then you’ve got to change: you modulate something. The difficulty we have in everyday life is identifying and distinguishing between these types of uncertainty, and adapting our behaviour accordingly.”

Overlaps

Indeed, there is a certain amount of overlap between the existing investigations into genetic risk and neurodevelopment disorders, and investigations into uncertainty.

“Many of the problems that people have in developmental disorders involve managing uncertainty,” said Jack, “and a lot of the treatments potentially involve neuromodulatory systems such as acetylcholine, dopamine, serotonin or noradrenaline, which are the systems that we study. So the projects link up quite nicely together.”

Working the intersection

Jack has always enjoyed working as part of a team and particularly working between disciplines. He was involved with an Elizabeth Blackwell Institute fellowship scheme where Jack supervised Dr Sonam Gurung who was awarded the Elizabeth Blackwell Institute Discipline Hopping Fellowship – a scheme which encouraged researchers finishing their PhD to do an extra six months to a year in another discipline – and was given an opportunity to extend her PhD studies on the biochemistry of GluK2 editing in his lab.

“I’ve worked at the intersection of biochemistry and physiology for many years,” he said, “and now we’re starting to work more at the intersection of animal behaviour and psychology.”

Jack believes that Institutions, such as the Elizabeth Blackwell Institute, that enable – and indeed encourage – interdisciplinary work are vital to supporting the multidisciplinary landscape that is so important in research.

Elizabeth Blackwell Institute continues to support interdisciplinarity in health research as part of its core mission. Find out more about what we do.

Influential climate scientists land prestigious Royal Meteorological Society awards

Two pioneering University of Bristol climate researchers have received recognition for the impact of their work at the Royal Meteorological Society’s 2024 Awards.

L-r: Professor Dann Mitchell and Dr Eunice Lo

Dr Eunice Lo, Research Fellow in Climate Change and Health and Professor Dann Mitchell, Professor of Climate Science at the University of Bristol have been recognised for their contributions to our understanding of the impacts of climate change, and were presented with their awards at the Royal Meteorological Society Annual General Meeting on Wednesday 4 June, 2025 at Hartwell House in Aylesbury.

Dr Lo won the individual L F Richardson Award which is given annually in recognition of a impactful scientific paper by a member of the Society who is in their early career in meteorology.

Dr Lo is a globally recognised climate scientist whose innovative research bridges meteorology and epidemiology to understand the human health impacts of extreme weather.

In 2023, Dr Lo published a paper titled “Optimal heat stress metric for modelling heat-related mortality varies from country to country”, in the International Journal of Climatology. She solved a long-standing issue in the field by finding a version of heat-stress that best identifies negative human health outcomes around the world. Her innovative research is not only advancing scientific frontiers but also providing essential information to reduce risks to human health in a changing climate.

She is playing a crucial role in the 4th UK Climate Change Risk Assessment, as well as contributing to the IPCC Sixth Assessment Report. Based at University of Bristol and with a PhD in Meteorology from the University of Reading (2018), Dr Lo has built an outstanding publication record with 32 scientific papers to her name.

Dr Lo said: “I am very happy to receive the L F Richardson Award from the Royal Meteorological Society. The excellent research published in RMetS journals has been a vital resource for my own understanding of the field, so being recognised for advancing science within this community is an absolute honour.

“My work at the University of Bristol has focused on extreme weather and its impacts on human health. It is incredibly exciting to conduct research in this rapidly emerging field alongside the Bristol Climate Dynamics Group, the Cabot Institute for the Environment, the Elizabeth Blackwell Institute for Health Research, and collaborators from other disciplines such as social sciences and the public sector.

“This award recognises a global heat stress-mortality paper that I published in 2023. The paper would not have been possible without the contributions of a consortium of collaborators from 12 countries. I would like to thank and share this award with all my co-authors. I look forward to sharing more of my research through RMetS journals and events, which have been successful in fostering a truly supportive community—one that I am grateful to be part of.”

Dr Lo was also jointly presented with the RMetS Award for Impact 2024, alongside Professor Dann Mitchell. The award recognises people, projects or programmes within the academic, scientific or business communities who have made significant contributions to educating, informing or motivating organisations in their response to meteorological challenges.

Professor Dann Mitchell and the health research team at Bristol Climate Change Group have created significant and lasting impact across the public, academic and policy domains, sustained over a number of years.

This has led directly to improved information for policy makers and planners. The impact is based on a strong foundation of pioneering climate science. For instance, Dann was a major driving force in setting up and establishing the HAPPI project, which provided new evidence on the benefits of limiting global warming to no more than 1.5C above pre-industrial levels, compared to 2C.

Working with the Met Office, as the University of Bristol Joint Chair for the Met Office Academic Partnership, Dann has helped to galvanise the research community around key gaps in research, providing a focal point for discussion on climate and health and informing the Met Office weather-climate health strategy.

Professor Mitchell and Dr Lo said: “We are thrilled to have been chosen for this Impact Award. It is an incredible feeling that as academics we can see our published work helping society in meaningful and positive ways. In our case, this was done through health protection, policy engagement and through strengthening the impact of climate on health in legal settings.

“The award is for climate change and health research from our team in Bristol, which is made up of climate scientists, epidemiologists, clinicians, and social scientists, and of course many of the impact we rely on has come from different individuals within this team – so this award is very much for all of them too.”

Professor Liz Bentley, Chief Executive of the Royal Meteorological Society, said: “This year’s Awards ceremony is especially meaningful as we celebrate 175 years since the founding of the Society.

“Returning to Hartwell House, where it all began, allows us to reflect on the extraordinary legacy of meteorological science – and to honour those who are shaping its future. Our heartfelt congratulations go to each of this year’s winners, whose work exemplifies the highest standards of excellence.”

Dr Lo and Professor Mitchell are part of the Climate Change and Health research programme; a collaboration between Elizabeth Blackwell Institute for health research and the Cabot Institute for the Environment.

Climate Change and Health research community

We are working together to improve our knowledge of the impacts of climate change on our human and planetary health. The Climate Change and Health research programme brings together experts from different disciplines to understand and address the complex and interwoven areas of climate and health. If you are University of Bristol staff, find out how to join this community

Heart failure and participation in physical activity

People with heart failure often experience extreme tiredness (fatigue). It can be distressing and affect people’s everyday life in a negative way. Researchers are looking at ways of supporting people with heart failure to do the amount and type of physical activity that is right for them. Findings will inform primary and community care professionals about what services and advice should be available. 

The Heart failure And Participation in Physical activitY (the HAPPY study) was supported by NIHR Research for Patient Benefit and Elizabeth Blackwell Institute through the Wellcome Trust Institutional Strategic Support Fund.

There were four parts to the HAPPY study. 

  • A systematic review of qualitative studies describing the experiences, beliefs, and behaviours of people with heart failure in relation to physical activity. using the PROSPERO protocol 2022;
  • An embedded Study Within A Review (SWAR) Equity, Diversity, and Inclusion (EDI) thinking in systematic reviews: A study within reviews (SWAR) on EDI tools for the awareness and consideration of EDI in systematic reviews 
  • A review of physical activity advice from heart failure charities
  • A consultation with stakeholders to identify current services and future priorities, using a person-based approach to develop guiding principles and a logic model to explain the main problems people with heart failure have with physical activity. 

The study looked at the published evidence (proof) on self-management approaches for fatigue for people with heart failure, and found 21 studies which included 515 people. The quality of the studies was acceptable but individual studies mostly involved a small number of people. But, the research team could not combine the results of the studies together statistically as none of the studies were that similar.

Conclusion

Evidence for health education, a person-centered approach, cognitive behavioural therapy (CBT), mindfulness, and some health supplements for heart failure seem to improve fatigue, but more research is needed to be sure. More well-designed trials are needed which take into account what fatigue means to different people.

Full study paper currently under review ( July 2024): Self-management strategies in people with heart failure-related fatigue: a systematic review. 

This work was supported by the National Institute for Health Research School of Primary Care Research (NIHR SPCR) as part of the Evidence Synthesis Working Group (ESWG) [Project Number 461]. Lorna J Duncan Beth Stuart, Clare J Taylor, Rachel Johnson (Co-PI) , Alyson L Huntley Co-(PI) 

Contact

For further information, contact alyson.huntley@bristol.ac.uk

Evaluating Explainable AI for healthcare

L-r: Jeff Clark and Raul Santos-Rodrıguez

Artificial Intelligence (AI) is set to transform healthcare decision-making, but building trust remains crucial. We hear from Dr Jeff Clark, one of our AI in Health awardees, about his project which aims to evaluate how clinicians understand and interact with explainable AI (xAI) so that systems can better meet their needs.

Explainable AI explained

It is critical that AI systems designed for use in healthcare environments can quickly be well understood by clinicians. Existing xAI research often targets developers rather than clinicians, leading to a gap between AI innovation and practical healthcare use.

Our project aims to address this gap by quantitatively investigating clinicians’ preferences between various xAI techniques, and assessing how they interact with such systems. We will measure speed and accuracy in interpretation, and analyse sensor data, to inform the development of more intuitive and user-friendly AI systems, thereby fostering trust and integration in clinical workflows.

Interdisciplinary collaborations

This interdisciplinary project brings together academic technical expertise from the University of Bristol’s School of Engineering Mathematics and Technology led by Dr Jeff Clark, with co-investigators Dr Alexander Hepburn and Professor Raul Santos-Rodrıguez, in collaboration with medics from the intensive care unit at University Hospitals Bristol and Weston NHS Foundation Trust led by Dr Chris Bourdeaux. Experiments will be conducted at the Bristol Digital Futures Institute.

Exploring usability and adoption

Previous studies have qualitatively explored clinical preferences for xAI, and this project builds on some of our own previous work where we interviewed a range of clinicians to gather their requirements for xAI systems within intensive care.

However, quantitatively assessing how xAI fits into the clinical decision making workflow has not been well explored, especially whilst under time constraints and the cognitive demands associated with clinical practice. We are preparing to conduct a clinical user study to assess how clinicians engage with different xAI examples, measuring their comprehension and usability. We will compare established xAI techniques, and measure participants’ responses both through a questionnaire and sensors recording whilst they engage with the explanations. Sensors will include eye tracking, so that we can identify which parts of the explanations clinicians spend the most time looking at, and outputs from wearable devices such as heart rate so that physiological state can be assessed in relation to cognitive load.

The project will provide insights into how clinicians interact with different types of xAI outputs, helping to develop clinical dashboards that are both informative and easy to interpret. Ultimately, this will support the safe adoption of AI in healthcare by making it more transparent and trustworthy.

Improving patient care

So far on the project we have engaged with our clinical collaborators and two long-standing international collaborating xAI experts to develop the experimental design. We have devised the protocol to capture the most important factors with regards to xAI understanding and engagement within the context of intensive care unit decision making. Since we will now make use of the facilities available at the Bristol Digital Futures Institute, we have identified the available sensors, are liaising with the team there and are preparing for a pilot study.

By quantifying clinicians’ interaction with xAI outputs, we will generate evidence that guides the design of future healthcare AI systems to ensure that such systems can quickly be well understood whilst under cognitive load. Once complete, results from our project will be submitted for publication at a leading academic venue, fostering broader knowledge sharing and supporting external funding bids.

Our goal is to better understand how clinicians interact with xAI to enable development of systems that are not only technically sound but also practically valuable to clinicians, ultimately improving patient care.

Future plans

We are currently preparing to conduct experiments at the Bristol Digital Futures Institute, where we will be collecting sensor data whilst clinical participants are presented with xAI outputs.

In addition to supporting future grant applications to continue this academic research, results from this project will also contribute to the design and development of decision support systems for intensive care we are already in the process of building with our clinical collaborators here in Bristol.

For more information about this project, please contact Dr Jeff Clark jeff.clark@bristol.ac.uk

Pioneering research ranks world’s most populated cities for flood and drought risk

Map shows global drying and wetting hotspots.

A new report has revealed how the 100 most populated cities globally are becoming increasingly exposed to flooding and drought.

The study, led by WaterAid with academics from the University of Bristol and Cardiff University, shows widespread drying throughout European cities including the Spanish capital Madrid, which was ranked second among the 49 drying cities, and UK capital London, ranked 44th.

Cities across Africa and Asia are emerging as most at risk to extreme climate shifts, preventing access to clean water and affecting water security for urban communities bearing the brunt of climate change, according to the report.

Findings also indicate almost one in five (17%) of the cities studied are experiencing ‘climate whiplash’, defined as intensifying floods and droughts. A similar proportion (20%) have seen a major switch from one extreme to the other, known as ‘climate hazard flips.’   

Co-lead scientist Katerina Michaelides, Professor of Dryland Hydrology at the University of Bristol, said: “The findings from our study illustrate just how differently and dramatically climate change is expressing around the globe – there is no one-size-fits-all.”

All European cities analysed exhibit drying trends over the past 42 years, including Madrid, the French capital Paris, and London, which could lead to more frequent and long-lasting droughts.

Of the cities facing ‘climate hazard flips’, around 13% are switching to a more extreme wet climate, while the remaining 7% are shifting to a more extreme dry climate. This affects more than 250 million people globally in cities including Kano in Nigeria, Bogota in Colombia, and Cairo in Egypt, significantly limiting access to safe and clean water.

Professor Michaelides said: “Places that were historically wet are becoming dry and vice versa. Other places are now increasingly battered by both extreme floods and droughts. A deeper understanding of localised climate hazards can support more intelligent and bespoke planning in major cities.”

The study compares each city’s social and water infrastructure vulnerabilities alongside new data on climate hazards spanning 40 years to identify which are the most vulnerable to extreme climate changes and the least equipped to handle them.

Vulnerabilities examined range from poverty to poor water and waste systems. Severe urban flooding can damage sanitation facilities, spreading diseases such as cholera and typhoid, whilst water shortages during droughts can leave millions of families without essential water.

Dr Sean Fox, Associate Professor in Global Development at the University of Bristol, who also contributed to the research, said: “as the nature and intensity of natural hazards change, their impacts on urban communities will be significantly shaped by social and infrastructural vulnerabilities. In other words, risk isn’t just about the chance of a flood or drought occurring, it’s also about how prepared communities are to deal with these hazards.”

Hotspots of heightened risk comprised two key regions: south and southeast Asia, and north and east Africa. Cities identified as the most vulnerable include Khartoum, in Sudan, Faisalabad and Lahore in Pakistan, Baghdad in Iraq, and Surabaya in Indonesia, Nairobi in Kenya, and Addis Ababa in Ethiopia.

The report also places European cities like Barcelona, Berlin and Paris at a higher risk than those in North America and Australia, due to the continent’s aging water and waste infrastructure, potentially leaving urban populations more exposed.

Co-lead scientist Michael Singer, Professor of Hydrology and Geomorphology, and Deputy Director of the Water Research Institute at Cardiff University, said: “One interesting outcome of this study is how many of the climate hazard trends appear to spread over broad regions, suggesting that there may be significant adaptation challenges to new hazard regimes, but also regional opportunities for collaboration between nations to become more resilient to climate change in urban centres.” 

From recent drought in cities like Madrid and Cape Town in South Africa, to large-scale flooding across cities in Bangladesh and Pakistan, WaterAid claims 90% of all climate disasters are driven by too much or too little water. It warns that weather-related disasters such as flooding and drought have grown four-fold in the last 50 years, putting major pressure on vital water access and sanitation systems and making it harder for communities and economies to prepare for, recover from, and adapt to climate change.

In light of global aid cuts, Water Aid – the world’s leading water, sanitation and hygiene charity – is calling on the UK, global governments, multilateral banks, and the private sector to work together to unlock investment and implement solutions to tackle climate change and water crises, strengthening global security.

Tim Wainwright, WaterAid UK’s Chief Executive, said: “We urge the UK to show leadership and maintain its influential role in tackling global climate and health challenges -– essential to creating a secure world free from poverty. Now, we need to turn commitments into action – for leaders to build and invest in systems worldwide that can withstand extreme weather and keep clean water flowing globally.”

Elizabeth Blackwell Institute for health research and Cabot Institute for the Environment are working together on a Climate Change and Health research initiative to improve our knowledge of the impacts of climate change on our human and planetary health. We support a community of researchers from different disciplines to understand and address the complex and interwoven areas of climate and health. Find out more about the Climate Change and Health research initiatve.

Paper

‘Water and Climate: Rising risks for urban populations’

Further information

WaterAid is an international not-for-profit determined to make clean water, decent toilets and good hygiene normal for everyone, everywhere within a generation. We work alongside communities in 22 countries to secure these three essentials that transform people’s lives. Since 1981, WaterAid UK and its Country Programmes have reached 29 million people with clean water and 29 million people with decent toilets.

Smartwatch technology helps people quit smoking

According to a University of Bristol-led study, smartwatches could help people give up smoking. The researchers tested a smartwatch fitted with a custom app which used the smartwatch’s in-built motion sensors to detect typical smoking movements. The results, published in JMIR Formative Research, showed the technology has the potential to help over two thirds of trial participants quit the habit.

Smoking is the primary cause of preventable illness and premature death, harming nearly every organ of the body and reducing both quality of life and life expectancy. However, quitting is notoriously difficult, and many people try all sorts of ways to stop smoking, with limited success. 

In this feasibility study, researchers developed software that uses smartwatch motion sensors to identify the typical hand movements of cigarette smoking to help detect a smoking lapse. If the app detects the person is smoking, the smartwatch delivers a relapse prevention message, just at the moment it is needed, to help with their quit attempt.

Researchers tested the intervention on 18 people, interested in quitting smoking, who wore a normal Android smartwatch loaded with the custom app for a period of two weeks.

Participants reported that the smartwatch intervention increased their awareness of smoking, which helped with some of the more automatic aspects of smoking behaviour and made them think about what they were doing, motivating them to quit.

Researchers found that a smoking relapse prevention intervention and the use of a smartwatch as a platform to host a just-in-time behaviour change intervention are both feasible and acceptable to the majority of participants (12 out of 18, 66 per cent) as a relapse prevention intervention.

The researchers believe this is the first just-in-time intervention for preventing smoking relapse that runs entirely on a smartwatch, so doesn’t need to be paired with a smartphone. 

Chris Stone, Senior Research Associate in Wearable Technology Application Development in Bristol’s Tobacco and Alcohol Research Group, and Integrative Cancer Epidemiology Programme (ICEP), explained why the approach could help people quit smoking: “For those who are trying to give up, an initial lapse is a vulnerable moment, and risks leading to a full relapse to smoking. People like smartwatches. They like the idea of it delivering a message at the point that they smoke. Therefore, if we can identify this point of lapse, and deliver an intervention precisely at that point, we have an opportunity to improve the success of the quit attempt.

“In carrying out this project, we have aimed to harness the latest thinking in intervention design, and deliver it in a convenient wearable package with minimal burden to the user and maximum engagement with behaviour change; and in doing so, make a difference to people’s lives.”

Chris Stone recently met with University of Oxford’s Professor Trish Greenhalgh at an event hosted by Elizabeth Blackwell Institute. The event brought together researchers and clinicians with Professor Greenhalgh to discuss digital health research developments ahead of her public lecture on digital health inequalities.

Chris Stone said: “It was good to meet with Professor Greenhalgh; her comments on my work, resulting from the wisdom of an obviously well-experienced senior academic, have certainly been thought-provoking and a cause for reflection. My research involves developing innovative applications of wearable technology to improve lifestyle health choices through ecologically-valid, data-driven behaviour change interventions. With wearable devices we can capture health behaviour data “in the wild” and use it to drive targeted and personalised “just-in-time” interventions for behaviour change.”

The research team recommend a longer-term effectiveness trial be carried out as the next step.

This work is part of the Smoking Cessation theme of the Cancer Research UK-funded Integrative Cancer Epidemiology Programme (ICEP).

Paper

Presenting and evaluating a smartwatch-based intervention for smoking relapse (StopWatch): feasibility and acceptability study’ by Chris Stone et al. in JMIR Formative Research

Watch Professor Greenhalgh’s lecture: Healthcare in the digital age: A new era of inequality?

AI to develop vaccines thanks to world-leading supercomputer

Isambard-AI, by Bristol Centre for Supercomputing (BriCS), at University of Bristol, is set to become the UK’s fastest and most powerful supercomputer following build completion in Summer 2025. Purpose-built for AI research, it is designed to provide open-source intelligence and is already transforming research and driving AI-led breakthroughs in critical areas like automated drug discovery and climate research. 

Professor Simon McIntosh-Smith, Director of BriCS and professor in high-performance computing at University of Bristol, described the supercomputer as ‘potentially world-changing’. 

Speaking to BBC Radio Bristol, Professor McIntosh-Smith said: “We’ve actually got a little bit of the system already up and running, we already have people using it to do things like look for new drugs and new vaccines to treat people.” 

He added that the team are using the computer to develop treatments for heart disease, emphysema and different types of cancers. 

“It can do a lot of the grunt work, a lot of the things that would just be beyond humans, simulating the way that drugs actually work inside the body, at the molecular level. 

“Where artificial intelligence comes into it, is rather than trying all possible combinations of things it actually tries a whole bunch of random possibilities, looks at which are most promising, and then hones in on those. 

“We could be saving millions of lives with some of the things that we’re talking about here and I find that tremendously exciting – it’s brilliant to be able to actually be doing it right here in Bristol.” 

Elizabeth Blackwell Institute supports a growing AI in Health research community at Bristol. The 2024 AI in Health award 2024 was designed to help colleagues make their research AI-ready. One project ‘Assessment of the integration of molecular docking with AI-based design of personalised vaccines’ led by Imre Berger and Iart Luca Shytaj builds on their online AI-based platform Custommune capable of designing personalised epitopes for preventive and therapeutic vaccines. 

Luca Shytaj, Senior Lecturer in the School of Cellular and Molecular Medicine said: “Support from Elizabeth Blackwell Institute enabled us to explore integrating AI into a software we developed to predict how the immune system recognizes external threats, in particular viruses, and to test these predictions in the laboratory. We focused on HIV and cytomegalovirus (CMV), which cause lifelong infections for which no approved vaccines exist. Developing personalised vaccines (tailored to an individual’s immune system) could help address this challenge.  

“While our AI predictions were not always as precise as the current gold standard, they successfully identified two new potential vaccine targets for CMV. This suggests that AI can offer a fresh perspective on immune recognition of viruses, uncovering new insights that could aid personalised vaccine development.” 

Professor Pat Kehoe, Director of Elizabeth Blackwell Institute said: “Harnessing AI for healthcare improvement has vast potential, extending beyond vaccine development to other forms of drug target identification and development; more optimal use of harnessing important clinical information from patient registries; and how AI can be integrated to bring efficiencies and improved diagnoses into healthcare settings. We will be also supporting researchers to look at how with the development of AI it does not give rise to any unintended forms of marginalisation and health inequalities.” 


Upcoming AI in Health workshops:

Artificial intelligence in Health: socio-digital transformation, ethics and governance
Tuesday 6 May 2025 11:30 – 13:30, Life Sciences Building, Tyndall Avenue, BS8 1TQ
More info and book

Artificial intelligence in Health: genomics, protein design and drug discovery
Thursday, 22 May 2025 11:30 – 13:30, Life Sciences Building, Tyndall Avenue, BS8 1TQ
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Join our AI in Health research community

Meet our AI in Health awardees

Modern methods for longitudinal modelling in epidemiology 

Eilers PHC, Marx BD. Practical Smoothing : The Joys of P-Splines. Cambridge University Press; 2021. Accessed March 6, 2025. https://doi.org/10.1017/9781108610247

Rigorous and robust statistical analysis lies at the heart of scientific endeavour. It provides the means to draw reliable conclusions from data, quantify uncertainty and distinguish genuine effects from random variation. Within epidemiology, modelling repeated measures in the same individuals over time helps us understand how people grow and develop over time and identify when adverse changes in people’s growth and development might occur. This allows researchers to identify when monitoring or support might be needed to improve people’s life course trajectory.

The challenge of growth modelling

Dr Ahmed Elhakeem, a Research Fellow in Epidemiology at the Bristol Medical School, is an expert in statistical techniques which can identify change in physical and psychological health trajectories.

Dr Elhakeem was recently awarded an MRC-NIHR Better Methods, Better Research New Investigator Research grant. The grant, ‘SITAR enhancements to support state of the art analysis on individual growth curves and their correlates’, is worth £540k over the next three years, was submitted in collaboration with Dr Richard Parker and Professor Kate Tilling and external collaborators in the UK, USA, and Canada.

Many developmental processes display non-linear patterns of change with age, especially during the growing years, which makes it challenging to accurately model their trajectories. One method that Dr Elhakeem uses is splines, which are flexible mathematical functions used for smoothing and interpolation of data in regression modelling, as Dr Elhakeem explains:

“Historically, the standard approach has been to make use of polynomial functions to approximate nonlinear curves. However, these can struggle when trying to reproduce complex patterns of change. Splines are highly flexible cutting-edge tools for analysing complex nonlinear change – they are made up of piecewise polynomials that are joined together at break/turning points called knots”.

Dr Elhakeem’s MRC-NIHR grant builds on collaborations and expertise developed using funding from the Elizabeth Blackwell Institute Discovery Research Support Scheme, which supports early career biomedical researchers in developing their research to explore and implement cutting edge methodologies.

Visiting researcher

“The Elizabeth Blackwell Institute Discovery Research Support Scheme allowed me to develop collaboration with Dr Li, an expert in splines, who was completing a Fellowship at Simon Fraser University. We invited him over as a visiting researcher to the Bristol Medical School in October 2022,” said Dr Elhakeem. “He kindly agreed to deliver a 1-day workshop to BMS on applied spline analysis for epidemiologists. The workshop was restricted to 20 attendees to allow productive interactions and hands-on practice, and all workshop material and code was made available to interested researchers.”

Following the well-received workshop, Dr Elhakeem, Dr Li and co-applicants are working on a number of papers using the technique; for example, assessing the association of birth weight on early life growth trajectories. Dr Elhakeem elaborates:

Early life growth dynamics

“This paper investigates the association between birthweight for gestational age centiles and infant and child growth curve features. It’s an ideal example to fully realise the value of spline methodology given the rapid and complex changes in body size during the first few years of life, that has limited previous research.”

Continued collaborations

“Dr Li and I continue to work together and collaborate on research projects and larger follow-on funding applications” said Dr Elhakeem.

“Collaboration with Dr Li has enabled me develop skills in implementing cutting edge methods of analysing complex change trajectories” said Dr Elhakeem. “I have been actively promoting and supporting use of splines by epidemiologists in workshops and tutorials. In 2023 I ran a session called “What is nonlinear trajectory modelling with splines?” at the 2023 National Centre for Research Methods Research Methods e-Festival. This included a segment on the knowledge gained in this project.”

Dr Elkaheem continued, “I am also building an interdisciplinary network, starting from the workshop, and extending to online tools beyond this grant, thereby generating a new activity pipeline around splines and future developments to ‘trajectory/change’ analyses, as well as co-supervising PhD candidates.”

Healthcare in the digital age: A new era of inequality?  

We were delighted to welcome University of Oxford’s Professor Trish Greenhalgh for our 11th annual public lecture on 3 February 2025. The sold-out event filled the City Hall in Bristol, with a mix of staff and students from the University, people working in health and care, and members of the public. 

Digital tools should make healthcare more efficient and accessible, but do they make everyone’s lives easier? Despite the belief that advances in digital technology are good for us, they are creating new barriers for some people. Accessing healthcare now requires digital skills and devices, leaving those without these resources at a greater disadvantage.  

In her illuminating and thought-provoking lecture, Trish Greenhalgh, Professor of Primary Care Health Sciences at the University of Oxford, explored how the digital age of healthcare is worsening health inequities. 

Trish studied Medical, Social and Political Sciences at Cambridge and Clinical Medicine at Oxford before training first as a diabetologist and later as an academic general practitioner. She has a doctorate in diabetes care and an MBA in Higher Education Management. She leads a programme of research at the interface between the social sciences and medicine, working across primary and secondary care.  

The event was introduced by Pat Kehoe, Director of Elizabeth Blackwell Institute who shared some insight into Elizabeth Blackwell’s life and legacy, and Evelyn Welch, Vice-Chancellor of the University of Bristol, who welcomed Trish. Evelyn highlighted how Trish’s work seeks to celebrate and retain the traditional and humanistic aspects of medicine in healthcare, while also embracing the exceptional opportunities of contemporary science and technology to improve health outcomes and relieve suffering. 

L-R: Trish Greenhalgh, Evelyn Welch, Pat Kehoe

Trish began her lecture by explaining the changing nature of healthcare; how it’s become fragmented, more complex, how patients are made individually responsible for tasks which previously would have been the duty of a healthcare professional, and how our electronic record (or digital facsimile) is what gets treated rather than the patient. 

She acknowledged the next generation of researchers, mentioning three people’s work that she had included in the presentation: Francesca Dakin, Nuffield Department of Primary Care Health Services, who is from an Anthropology background; Sarah Rybczynska-Bunt, who is based at the University of Plymouth and works in Sociology; and Laiba Husain, also based at Nuffield, who works in the field of Psychology. 

She shared learnings from the ‘Remote by default 2′ study, further research building on work undertaken when the country first went over to remote by default during the early part of the COVID-19 pandemic. The study, which included research on 12 UK GP practices, patient and public involvement groups, and the National Institute for Health Research who funded it, looked at the impact of the shift to remote and digital modalities for both triage and clinical care.  

Trish illustrated differing experiences by sharing fictional character case studies of people with different needs, backgrounds and digital know-how, highlighting how individuals face barriers in navigating the healthcare system. 

She concluded that different packages of support were needed to help GP Practices create a tailored approach to healthcare delivery and serve their different communities. “We need to rethink our approach to digital access and address structural and societal problems, rather than relying solely on technological fixes.”  

Conversations with researchers and clinicians 

Before the lecture, a group of early career researchers and clinical colleagues had the pleasure of meeting Trish Greenhalgh at Royal Fort House. 

“Meeting with Professor Greenhalgh was a fantastic networking opportunity for us as early-career researchers. My research interests include the self-management of long-term musculoskeletal conditions, co-creation and behaviour change techniques. It was great to chat about her expertise in health research, and our latest work developing an inclusive, co-created sleep app for teenagers in the UK. Her perspectives on translating research into real-world impacts were especially valuable.” Sarah Bennett, Research Fellow, School of Psychological Science. Find out more about the Sleep Well Study 

“It was a great experience to hear about the breadth of research being done by colleagues in Bristol to address health inequalities. It was very useful to share our research plans for the Accessible Results study and we gained important insights and inspiration from Professor Greenhalgh’s work on digital inequalities.” Jessica Watson, NIHR Academic Clinical Lecturer, Centre for Academic Primary Care (CAPC).  Find out more about the Accessibility Results study 

Trish reflected on the opportunity: “I spent the afternoon meeting people from the Elizabeth Blackwell Institute, and also from more widely across the university. And this idea of having an interdisciplinary institute that can draw down on the expertise across faculties and be a bit of a crucible. It’s a real honour to have met you all and to have heard about that institute, because it’s something that’s very dear to my heart.” 

Your opinions matter 

Are you interested in contributing feedback and ideas on the services provided by your GP Surgery? Consider joining its Patient Participation Group or, if it does not have one, you could talk to the Practice Manager about starting one.  

Catch up

EBI Public Lecture 2025 recording – talk and slides only

EBI Public Lecture 2025 recording – full event with Q&A

EBI Public Lecture 2025 audio recording

Meet out new AI in Health awardees

In October 2024 we ran a funding call offering rapid access to short-term pump priming funding to University of Bristol researchers pursuing innovative applications of AI in health or biomedical research.

The hope is that the funded activities will lead on to developing and submitting external bids for future research programmes and projects that use or address AI in health and biomedical research contexts.

Here we announce the successful applicants from this call – find out more about the latest AI in Health awardees and their projects…

Asme Boussahel – Cryptic Chatter: Decoding Multicellular Interactions with AI Microscopy

Obesity affects 13% of the global population and is linked to 2.8 million deaths annually. Despite extensive research, the mechanisms driving obesity, especially the cellular interactions in adipose tissue remain unclear.

Asme explains: “This knowledge gap is partly due to the overreliance on animal models, which often fail to translate to human outcomes. Advances in 3D cell culture and bioprinting enable the recreation of complex cellular environments in-vitro, providing a powerful tool for understanding tissue-specific mechanisms.

“I have developed a novel human in-vitro adipose tissue model by co-culturing adipocytes and macrophages in an extracellular matrix (ECM)-mimicking hydrogel. This model replicates changes in cellular function and cell-cell and cell-ECM interactions in obesity. However, characterising these interactions remains challenging without isolating the cells from the 3D tissue-mimicking environment, which risks altering their phenotype and limiting the insights gained.

“I have adopted state-of the art live imaging methods, which allow real-time observation of cellular dynamics in 3D over extended periods. Analysing such models is inherently complex due to the presence of ECM components, multiple cell types, and the long culture durations. The use of imaging dyes is often unreliable, failing to distinguish between cell types. Moreover, the imaging generates massive datasets, making manual analysis inefficient and limiting.

“To address this, I am employing AI and machine learning algorithms to analyse these complex imaging datasets. AI models enable segmentation of cells, classification, and tracking of interactions in both healthy and obesity-induced conditions, providing deeper insights into the cellular mechanisms that contribute to obesity and metabolic dysfunction.”


Jeff Clark – Quantifying explainable AI interpretability for healthcare settings

AI is increasingly deployed to support decision-making in healthcare settings. Explainable AI (xAI) plays a critical role in helping users to understand AI suggestions. However, most xAI research is targeted at AI developers and technical practitioners, with limited focus on how healthcare professionals engage with xAI systems.

Jeff explains: “This gap is significant, as explanations must be quickly and intuitively understood, given the time constraints and cognitive demands placed on healthcare professionals. Without effective explanations, healthcare workers are unlikely to trust AI systems, limiting their potential to improve patient care. Safe AI implementation in healthcare requires systems that meet clinicians needs, including xAI components that clearly explain processes and outputs.

“This project builds on recent work conducted with clinicians at Bristol Royal Infirmary (BRI), where requirements for xAI systems were gathered [1]. We aim to quantify how well clinicians understand different types of explanations, measuring their speed and accuracy in interpreting them. These findings will advance the design of xAI systems, fostering trustworthiness and supporting integration and adoption in clinical workflows, enhancing the impact of ongoing work designing clinical dashboards with AI components. The work will generate new insights into xAI usability, enhance clinician-AI interaction, and improve patient care.”

[1] Clark, Jeffrey, et al. “Exploring the Requirements of Clinicians for Explainable AI Decision Support Systems in Intensive Care.” arXiv preprint (2024).


James Hodge- Feasibility of Artificial Intelligence (AI) for Patient Registries

Patient registries are fundamental to healthcare research and clinical practice, enabling the collection, analysis, and sharing of patient data to study outcomes, assess treatment efficacy, and inform policy. However, the rapid expansion of healthcare data presents significant challenges, including the manual effort required for data curation, integration of diverse data sources, and maintenance of data quality.

James explains: “Artificial Intelligence (AI), and more specifically, natural language processing (NLP), has the potential to transform the development and management of patient registries by automating processes and enabling real-time insights. This research aims to evaluate the feasibility of AI in addressing these challenges and optimising patient registry workflows.

“Currently, we are hosting a national registry for TSC (Tuberous Sclerosis Complex) at the University of Bristol. TSC is a multisystem, chronic health condition which is associated with tumour growth in various areas of the body leading to significant physical and mental health complications. The purpose of the national registry is to document the manifestations and progression of this condition across paediatric and adult patients. Data entry will be performed manually, as usual, across 20 TSC specialist clinics in the UK.

“This project will fund a research fellow to conduct a feasibility study. The aim is to establish a pilot study to assess the feasibility of using AI in the TSC patient registry. The key research questions are: 1. How effectively can AI automate the extraction and integration of structured and unstructured data from multiple healthcare sources?; and 2. Can AI-driven quality assurance methods improve data consistency and completeness in patient registries?”


David Murphy – AI Prediction Of Peptide Ligand-surfacome Interactions – Proof Of Concept

Artificial intelligence promises to reveal many biological secrets based on its ability to predict the complex interactions between proteins that govern cell function. Particularly important in this regard is the way the cells communicate with each other over long distances using protein hormones that circulate in the blood that interact with distant target receptors located on the surface of cells that mediate biological responses. These long-distance biological signals can go wrong in disease.

David explains: “The collection of human cell surface proteins is called the “surfaceome” and consists of ~4000 proteins, most of which are not understood in terms of their functional interactions. Conversely, there are lots of proteins circulating in the blood that have no known function, but presumably interact with a binding partner protein to elicit a physiological effect. One such “orphan ligand” is the 39 amino acid glycopeptide copeptin. Whilst circulating copeptin has emerged as a biomarker for many chronic cardiovascular conditions and associated metabolic dysfunctions, its normal physiological functions are not understood, and its role in disease remain a mystery. 

“We will carry out two complementary screens to identify surfaceome copeptin binding partners. The first will be computational, the second will be in cell culture. We will partner with Isambard-AI, one of the most powerful computers in the world, to carry out a deep learning-based in-silico pulldown screen to model putative copeptin protein-complex interactions using state-of-the-art protein interaction prediction methods; and identify putative copeptin receptors using an unbiased cell-based proteo-genomic CRISPR activation screen.”


Jess Wheeler -Using generative AI (language models) in qualitative health research: Building collaborations and developing a framework to securely test and evaluate the use of generative AI in qualitative health research, and impacts on people who are part of minoritised, marginalised communities and most impacted by health inequalities?

Generative AI language models (e.g. GPT or BERT) are rapidly emerging global technologies, already in use in qualitative health research (QHR), promising increased efficiency and breadth of data inclusion, in research that is notoriously time and labour intensive. However, frameworks for ethical oversight, quality evaluation and standards of practice in the use of language models in QHR, are hardly yet established.

Jess explains: “A major concern is the use and impact of language models in QHR, on the evidence-base and associated healthcare advances, relevant to the health and lives of diverse, minoritised, marginalised populations, already subject to health inequalities. Currently, use of language models in QHR is piecemeal, with researchers making use of available tools despite numerous potential limitations, including: limited technological performance; hidden and inaccessible methodologies and algorithms; and proprietorial ownership issues. These limitations make most platforms entirely inappropriate for testing and evaluating outputs in relation to confidential, highly sensitive, QHR data.

“Through a series of collaborative meetings, we will draw on local expertise (in language model architectures, qualitative health research, healthcare ethics, and in patient and public inclusion and involvement) to critically evaluate ethical, technical and practical concerns, and to create a framework for building a safe, high-performance, responsive, generative AI platform, with appropriate ethical oversight, suitable for testing and evaluating language model QHR outputs, specifically in relation to those most impacted by health inequalities.

“This collaborative development project is the first stage towards seeking funding to build a secure world-class AI platform, able to securely incorporate extensive QHR datasets.”


Upcoming AI in Health workshops:

Artificial intelligence in Health: socio-digital transformation, ethics and governance
Tuesday 6 May 2025 11:30 – 13:30, Life Sciences Building, Tyndall Avenue, BS8 1TQ
More info and book

Artificial intelligence in Health: genomics, protein design and drug discovery
Thursday, 22 May 2025 11:30 – 13:30, Life Sciences Building, Tyndall Avenue, BS8 1TQ
More info and book

Keep up to date with events and opportunitites – Join our AI in Health research community