Driving innovation in research to improve health for all. Explore our latest news, features, blogs and case studies for a flavour of what we do and the research we support.
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.”
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.
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
Funding organisations are increasingly working to address inequalities in the grant life cycle. However, until recently, less attention has been paid to inequalities at the pre-award stage — which includes announcing opportunities, and preparing, submitting and reviewing applications.
Toolkits have been developed as part of a follow-up University of Bristol-funded project focusing specifically on how funders can implement some of these recommendations. They reflect the findings of two virtual workshops, held in May 2024 with members of the DORA funder discussion groups and representatives from research management organisations. As well as identifying specific opportunities to improve EDI and transparency in pre-award workflows, the workshop attendees highlighted two general themes that they consider critical to success: effective change management across all stakeholder groups (internal and external); and rigorous monitoring and evaluation of the changes being made.
The toolkits are intended to provide practical tools for funding organisations that are seeking to improve EDI in their pre-award funding processes and include case studies and checklists to help plan your own interventions. Each toolkit focuses on one of the three priority recommendations:
We hope that these will be living toolkits that can be updated and added to as they are used. We therefore encourage you to share your own experiences, case studies, and resource recommendations with us, as well as sending us any feedback you may have about the toolkits. You can contact us at info@sfdora.org.
Dr Eunice Lo receiving her award (l) and planting a Prunus lusitanica ‘Angustifolia’ (Portuguese Cherry Laurel) gifted by the Medical Research Foundation, in the University of Bristol Botanic Garden European Mediterranean flora collection (r).
The Medical Research Foundation has recognised Dr Eunice Lo from the University of Bristol in its 2024 Emerging Leaders Prize for scientists who are on an exciting upward trajectory to lead unique and innovative research in their field. Eunice Lo is a Climate Change and Health Fellow at Elizabeth Blackwell Institute for Health Research and Cabot Institute for the Environment.
These two institutes, and researchers they support, 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.
A spokesperson from Medical Research Foundation said: “We are already witnessing the catastrophic impacts of climate change on health, from changing and unpredictable patterns of infectious disease to heat-related illnesses and deaths. That’s why we are focusing more of our funding on the impact of climate change on health. Through the Emerging Leaders Prize, we are building on this support, helping future science leaders in the UK to advance their research and careers. Our 2024 winners are both making a significant impact in climate and health research.”
Eunice Lo said: “I’m delighted to receive this award from the Medical Research Foundation. Extreme weather and climate change are not just physical phenomena; they have real-life impacts both at home and abroad, on people’s health and on our health system.
“Recent research of mine shows that there were more deaths associated with very hot and very cold temperatures in 2020-2022, than there were deaths related to COVID-19, in South West England.
“Research that links up climate science with health science is extremely important. I will use the Emerging Leaders Prize money to launch a nation-wide UK Climate Impacts on Health Meeting, which will have a specific focus on human morbidity. This work requires collaborations with researchers and stakeholders in other fields, access to new health data, and learning research techniques outside of climate science.
“By coming together with our respective expertise from different disciplines, we will be able to get closer to finding the true health burden of some of the extreme weather events. We’ll be able to estimate the probability of these events and their health impacts occurring again in the future. And, by doing so, we will be better prepared for future weather and climate extremes.”
Dr Helen Bould is an Associate Professor in Child and Adolescent Psychiatry at the University of Bristol, who uses epidemiology and experimental psychology – as well as more recently qualitative work – to improve our understanding of the causes of eating disorders, and thus to develop better prevention and treatment options. In 2014 Helen was awarded a Clinical Primer from Elizabeth Blackwell Institute, a scheme aimed at giving early career clinicians the opportunity to try research. We caught up with Helen ten years later to see how having this opportunity and support early-on impacted her career.
First post
Dr Bould’s first post in psychiatry in Bristol was with Dr Jonathan Evans, who at the time was a senior lecturer in the University of Bristol.
“He had a split role: half his week was clinical practice and half his week was academic in the University. He was really enthusiastic and genuinely curious and interested in patients’ experiences, and I interpreted this as being partly because he wasn’t in clinic all the time and partly because he was conscious that we don’t know everything: we’re on a journey of understanding – and I thought to myself, I want to have his job! That was the point where I decided to pursue academic psychiatry.”
The road to research
However, getting into research proved difficult, at first. Helen met with Professor Glyn Lewis, who was then a professor of psychiatric epidemiology in Bristol, who helped her get involved with a few small projects including analyses and writing up the research for publication, as well as continuing with her clinical training.
In February 2014, Helen wrote an application for the Elizabeth Blackwell Institute Clinical Primer Scheme.
“The Elizabeth Blackwell Institute interview process was a very positive experience. I had a really good conversation with interested academics and I came away thinking, ‘well I think that went quite well!’ Luckily I was correct and was offered the post.”
Clinical Primers
The Clinical Primer Scheme was a program from the Elizabeth Blackwell Institute designed to let clinicians experience academic research, and consider whether it might be a suitable career path. Helen’s project, titled ‘Body Dissatisfaction, Eating Disorders & Schools’, was conducted in the School of Social and Community Medicine with Dr Evans and Prof Lewis.
The project involved working with record-linkage data from Sweden regarding eating disorders in girls born in Stockholm in 1984 to 1995. This clinic data was linked with data on which schools the children went to (from 15 to18 years old), and the study aimed to see if some schools had more female pupils with eating disorders than others.
Helen found that schools with a higher proportion of female students, and schools with a higher proportion of highly educated parents, had higher rates of girls with eating disorders, even once individual student characteristics were taken into account. This suggests that there may be differences in the cultural milieu the students experience in different schools, or that eating disorders could be socially contagious.
The work may help clinicians to reduce the risk of eating disorders by identifying schools where young people are at more risk and intervening early. Helen presented the study at the European Society for Child and Adolescent Psychiatry Congress 2015 in Madrid, and published it in the International Journal of Epidemiology.
She was also collaborating extensively with epidemiologists in the Medical School. “The statistics and epidemiology departments in Bristol are amazing; I learned a huge amount from them”.
As well as establishing relationships with cross-disciplinary researchers in Sweden, the project proved beneficial in other ways, as Helen explained. “The Elizabeth Blackwell Institute project was the first time I’d had time to do academic work without having to fit it in around any clinical responsibilities. I was able to work on a standalone project which I finished off during my doctorate, and I also started another project which became the first chapter in my PhD.”
Relocation to Oxford
Helen submitted a DPhil application to Oxford University, which was successful so immediately after the Clinical Primer, Helen relocated to Oxford to study for her doctorate, which was born from a talk given by Bristol University’s experimental psychologist Marcus Munafò, about shifting people’s interpretation of different facial expressions – something he was exploring with young offenders at the time.
“I was working in an inpatient unit with people with eating disorders, and I wondered if you could change people’s perception of their body size in a similar way: a large proportion of people with eating disorders are very concerned about their body size, their shape and their weight, and may misperceive their size. When I explained this idea, Marcus he was really supportive of me investigating it. So that became an interdisciplinary piece of work with Marcus and Professor Ian Penton Voak at Bristol.”
Professor Munafò put Helen in touch with Prof Catherine Harmer at Oxford University, who was investigating mood and emotion recognition – Helen’s project was parallel to her interests, but in a different field. Prof Harmer became one of her supervisors.
“During the Clinical Primer I had Professor Glyn Lewis and the epidemiologists and statisticians helping with Swedish record linkage data and the ALSPAC data, and I was also working with Marcus and Ian designing experiments around body image. Marcus and Ian, alongside Dr Andy Skinner, a methodologist who was working in their group at the time, remained involved in my PhD work and are co-authors on most of the outputs from my PhD.”
Back in Bristol
Following the completion of her PhD, Helen returned to Bristol and in March 2019 she, alongside her Bristol colleagues, was awarded an MRC/MRF grant for a project called ‘Emotional Dysregulation, self-harm and eating disorders: a mechanistic investigation’.
“I was in the last two months of writing up my thesis, and the MRC/MRF put out a call for grants in the area of eating disorders and self-harm. The timing was perfect, the subject matter matched perfectly with my field – so I stopped writing up my PhD for a couple of months and instead wrote my first grant application. Like you do. And, in the autumn, we got it!”
The project, which ran through until May 2020, used ALSPAC data to study whether difficulties in regulating emotions in early childhood has an impact on self-harm and eating disorders in later childhood, and if there are links to issues understanding social situations, reading facial expressions or bullying.
As well as this, from November 2019, Helen was working with the local NHS trust as a consultant child and adolescent psychiatrist – the University and the NHS collaborated to create the post, which allowed her to spend part of her time as a clinician, and the remainder as an academic.
Into the virtual
Helen’s present work is very closely aligned to her Clinical Primer and PhD studies – in November 2022 she started a NIHR (National Institute for Health and Care Research) Advanced Fellowship titled ‘Using the Person Based Approach to Design Novel Virtual Reality Treatments for Eating Disorders’.
“This project is informed by the work that I did during my PhD – I was looking to move towards approaches that could potentially become a component of patient care – and I was fascinated by how we might be able to make use of virtual reality as a technology to enable people to experience things that aren’t necessarily possible to do in the real world”
The plan for the current research is to develop novel interventions – with another three years to go in the Fellowship, Helen and her team have a suite of three interventions at varying stages of development.
Feasibility trials
“One of the interventions will be feasibility trialed by the NHS as part of the fellowship. If that trial goes well, we will look to apply for follow-on funding for a randomised control trial. Should the other interventions look similarly promising, Helen would aim to get separate funding to spin them off from the same project in the same way.
But what is it about the application of VR that appeals, from a psychiatric perspective?
“I think there are definitely areas of psychiatry and mental health where virtual reality is making a real difference and really helping people. For patients with PTSD in particular, virtual reality enables people to relive experiences that they’ve had but with additional support from clinicians – and it seems to be quite effective. The other area which VR can help is with phobias – fear of heights, for example. Virtual Reality lets patients experience incremental stimuli in a controlled and gradual way and thus have exposure and response prevention work. Of course, it’s possible to do this without VR, but the technology makes it easier: it’s convenient and you can operate it within the clinic rather than having to go out into the world.
Cafe au fait
The aspect of Helen’s work that the team has progressed most to date is a cafe scenario, where patients with eating disorders, who often find cafes very challenging, can experience a much more controlled environment than they could in a cafe in real life.
“The patient and their clinician will be able to decide on the level of difficulty; how empty, busy, noisy or quiet the cafe should be, and what the interactions they have with other people are going to be like; what the menus are going to be like and so on. I envisage this being used as a sort of stepping stone to help people get back into real world cafes.”
The team is also working on some different VR experiences, focusing on body image interventions, as Helen explains:
“Virtual reality enables you to experience embodying a body that’s different to your own. We are in the process of analysing our first sets of focus groups and interviews with people with eating disorders about how they imagine that would be for them, and what therapeutic use we might be able to make of that experience. We’re working out how we can develop an intervention that is safe and that people would want to engage with, that might enable them to feel more positive about their own body and facilitate their journey to recovery.”
“One of the key things I have taken from my experiences in Bristol and working with Marcus and Ian is the importance of open science, and how having transparent and reproducible processes is key. If we work really carefully to discover the ways in which it can be useful, and involve end users throughout to ensure that patients in clinic will engage with what we develop, and use it as part of their treatment, then Virtual Reality has real potential.”
Reflections
Looking back on her journey in research to date, Helen said: “My career path was not without it obstacles and challenges, including several failures along the way (most notably four unsuccessful PhD Fellowship applications and an unsuccessful post-doctoral Fellowship application), and also a considerable amount of juggling around having children.”
“The Elizabeth Blackwell Institute supported me at a pivotal moment of my career, giving me the opportunity to move from working full time as a clinician to training as an academic too. There’s immense value in an institution that supports interdisciplinary research and facilitates collaboration in the way the Elizabeth Blackwell Institute does, helping new researchers explore new angles and consider different perspectives on their own work, and most importantly giving them time in which to do this.”
With support from the Franklin-Adams endowment, during 2024 we ran two funding calls to support research on children and young people’s health, with a focus on global health. The awards are named after Dr Joan Franklin-Adams who was a medical doctor who specialised in paediatrics.
Who was Joan Franklin-Adams?
Joan Franklin-Adams worked internationally, including as a medical officer for the Save the Children Fund. Her endowment, held at the University of Bristol, was designed to further the study of child health, both physical and mental, with an international focus, to make a difference to global knowledge and health.
Franklin-Adams Research Award
The successful candidate for the Franklin-Adams Research Award call was Nick Townsend, Professor in Public Health, School for Policy Studies. He will act as supervisor to a post-doctoral researcher to carry out a project titled: ‘Community Participatory Research for Adolescent Health Promotion in Diverse Communities in Bangladesh’.
We’re pleased to announce that the successful researcher who will lead on this project under the supervision of Nick Townsend is Dr Nuzhat Choudhury, who will join the team shortly from Durham University. She will be based at the University of Bristol for this project, but will also undertake work in Bangladesh.
Bangladesh is experiencing a rapid economic, demographic, and epidemiological transition, leading to an increasing burden from non-communicable disease (NCD). Research led by Nick Townsend, and the partner organisation for this proposal, the Asian University for Women (AUW), found that more than one third of those aged 10-19 years had four or more NCD risk factors. Improvements in health throughout adolescence can bring a triple dividend of immediate benefits, benefits into future adult life and benefits for the next generation of children.
Challenges have been found with adolescent health promotion in Bangladesh, leading the Bangladesh World Health Organisation (WHO) office to call for a review of the recent implementation challenges related to the Health Promoting School (HPS) approach within the country. However, contexts vary enormously across Bangladesh, with variations between urban and rural populations.
This project will use participatory research approaches to engage with communities and adolescents within urban, rural and tea plantations within Bangladesh, to examine the current NCD risk factor prevalence and the sectors involved in tackling them, including HPSs. The project will employ community members that are now based at AUW for data collection, to ensure the research is relevant to their needs. It will link to WHO and other relevant stakeholders to ensure that the research informs approaches within the country and will act as a pilot and feasibility study for a larger grant application, to support the researcher after study completion.
Franklin-Adams Project Award
The successful candidate for the Franklin-Adams Project Award was Dr Emma Anderson, based in the Bristol Medical School, for her project titled: ‘Training Azerbaijani paediatricians in communicating about vaccinations with caregivers – AzPIC Study’.
Childhood vaccination rates in Azerbaijan suffered during the pandemic and have not returned to pre-pandemic levels (e.g. Diphtheria tetanus toxoid and pertussis uptake is 88.9% down from 94.5% in 2019). Disease outbreaks affecting Azerbaijan and neighbouring countries are putting children at risk.
Health workers are the most trusted information providers for caregivers. Their recommendations and ability to navigate conversations with hesitant parents plays a vital role in childhood vaccine uptake. There is evidence that effective communication techniques for conversations about vaccines improves trust and vaccine acceptance. While these techniques are teachable, health workers lack such training so are ill-equipped to address vaccine hesitancy and misinformation held by caregivers. Children miss out on life-preserving vaccines as a result.
Emma Anderson has been working on research in paediatrician training and evaluation is underway to assess training feasibility and acceptability and effectiveness. The next phase is designed to support and evaluate initiatives to embed communication training into medical education and in-service training of health workers. This will involve working with the Ministry of Health, medical educators, paediatricians and other key stakeholders in Azerbaijan. The aim is to support key stakeholders in Azerbaijan to become self-sufficient in training paediatricians and other healthcare professionals to communicate effectively about vaccination with caregivers in order to improve childhood vaccination rates and reduce inequity of coverage.
Further information
We aim to run an annual Franklin-Adams funding call from this endowment, so watch this space for further opportunities.
There is a major need to understand the changing global health landscape due to the social and economic effects of globalisation. Many factors, including increases in migration, urbanisation, climate change and world-wide instability, call for an interdisciplinary approach to research and a need to develop international partnerships to tackle the many issues of human health that can only be addressed in a global context.
From climate change to antibiotic resistance, the health challenges facing the human race, intertwined with that of the animal and plant world and the effect on our food chains, are complex and interconnected. Elizabeth Blackwell Institute Director, Pat Kehoe, explains the importance of establishing international research partnerships:
“Complex problems sometimes require complex solutions but innovative and equitable partnerships that facilitate meaningful engagement with people and communities with relevant lived experiences, as well as relevant public agencies and other partners in a position to bring about change, is really the only way to be able to truly get to grips researching the problems to hopefully help create solutions that have impact. A lot of this fuels our interest to support research related to Climate Change and Health that we are doing in partnership with Cabot Institute for the Environment, and where we are working to grow a new cohort of interdisciplinary trained PhD students.”
This also is the backdrop against which we launched a scheme in June 2024 to provide University of Bristol researchers with access to short-term funding for activities and partnerships that focus on research activities, policy issues or capacity strengthening in health research areas in countries that are on the Development Assistance Committee (DAC) list of recipients of official development assistance (ODA). Below we introduce the successful awardees and explain what they will be researching.
Meet the researchers
Sion Bayliss, Bristol Veterinary School Partnering with Division of Medical Microbiology, University of Cape Town
Using nanopore sequencing for rapid antimicrobial resistance profiling of Non-typhoidal Salmonella in South Africa
In Sub-Saharan Africa, salmonellosis caused by non-typhoidal S. enterica (NTS) can cause invasive disease in individuals with HIV, malnutrition or sickle cell disease. Emerging antimicrobial resistance (AMR) is a major concern for NTS treatment, with multi-drug resistant (MDR) Salmonella Typhi underpinning a large proportion of NTS cases. This project will explore the application of the ONT MinION genome sequencer for rapid whole genome sequencing (WGS) serotyping and AMR detection on South Africa (SA) NTS blood culture isolates. SA researchers will be trained at the University of Bristol, with subsequent analysis of clinical isolates performed in SA, strengthening local diagnostic capacity and improving AMR stewardship.
Aiming for impact
This research will contribute to better health outcomes, particularly for vulnerable populations, reducing morbidity and mortality associated with AMR infections. Through long-term enhancement of workforce productivity, there will be economic impacts by lowering healthcare costs. Academically the project will help to build local research capacity and foster knowledge transfer in genomic technologies, contributing to policy development on AMR and strengthening future research. It will also empower local researchers and healthcare professionals, ensuring sustainable benefits beyond the project’s timeframe and aligning with ODA’s emphasis on capacity building and knowledge sharing.
Judy Bettridge, Bristol Veterinary School Partnering with KEMRI Wellcome Trust Research Programme
Kenyan Community One Health Guidelines for Antimicrobial Prescribing
Antimicrobial resistance is an increasing threat to human health, and many countries have adopted National Action Plans to address antimicrobial usage in both humans and animals. Antimicrobial prescribing practices can be improved by encouraging use of evidence-based guidelines; in Kenya, such guidelines are absent outside of large hospitals. This project applies an existing intervention design framework to scope out an approach to develop guidelines for application by human and animal health practitioners in Kenyan communities. This approach will include establishing desirable content; identifying support required to enable guidelines to be widely applied; and ways to monitor and evaluate intervention success.
Aiming for impact
The Global Action Plan for AMR has recognised the need for stronger systems that monitor resistance, enhance accountability and support best practice around antimicrobial usage. Kenya has made considerable progress in formulating and implementing AMR policy in the form of a National Action Plan. There exist sustained multisector and One Health co-ordination, national treatment guidelines for hospitals and AMR awareness campaigns. However, there are still many gaps to address, particularly at the community level, including a gap between theoretical knowledge of AMR and suppliers and users of antimicrobials applying such knowledge to their everyday practices.
With the data from this project, we will formulate further funding applications with African partners to move the project through co-design, implementation and evaluation stages within five years. Academic impacts can also inform current Kenyan initiatives, including the establishment of a national platform to monitor antimicrobial usage and expanding stewardship programmes to more facilities.
Aaron Lim, Bristol Medical School (PHS) Partnering with the Cambodian National Institute of Public Health
Building the foundation for hepatitis B virus modelling in Cambodia
Our proposal, in collaboration with the Cambodian National Institute of Public Health (NIPH), lays the foundations for modelling Hepatitis B virus (HBV) in Cambodia. It comprises three primary activities: 1) a scoping review of existing studies on HBV in Cambodia; 2) investigating if these data are amenable for adapting and parameterising existing HBV mathematical models; and 3) developing modelling capacity within Cambodia. Modelling capacity is a high priority for NIPH and will have wider scope than just HBV. The crucial preliminary work in this proposal will position us to develop a partnership, and apply for larger grant funding next year.
Aiming for impact
The modelling group at the University of Bristol has world-class expertise in modelling the epidemiological impact and cost-effectiveness of interventions to reduce the burden of blood-borne viruses, including country-level analyses of HBV (e.g. Rwanda). The immediate activities are academic and will provide a starting point for partnership building and skills development with Cambodia, as well as evaluating which data are missing to develop a bespoke HBV model for the country. Next year the researchers propose to seek additional funding to collect the data we are missing to parameterise the model and, alongside the person we have trained up, explore the potential impact of intervention strategies to reduce the burden of HBV in Cambodia. This will then be used to inform local policy.
Josephine Walker, Bristol Medical School Partnering with University of Cape Town Future Water Institute
One Health Approaches to Understand Climate Impacts on Water-Related Disease in South Africa and Ethiopia
This project aims to build and strengthen a multi-disciplinary collaborative relationship between University of Bristol, University of Cape Town (South Africa), and Haramaya University (Ethiopia), focused on One Health approaches to predict and mitigate climate-change impacts on water-related diseases in South Africa and Ethiopia. It will build cross-disciplinary understanding by attending the One Health conference in Cape Town, followed by a 3 day collaborative workshop in which will (1) plan pilot focus groups to identify the most impactful direction for future research, aligning with the Africa Charter, and (2) develop a grant application to the NIHR Global Health Research call.
Aiming for impact
The research will have an academic impact in terms of health policy and capacity strengthening. It is the first step in which aims to develop feasible, realistic, community-led interventions which can reduce the risk of water-related diseases while building the resilience of urban and rural communities to climate change. The process will engage local stakeholders from the outset, bringing lived experience directly into research design and delivery through our pilot focus groups. The time frame to achieve impact starts with this project, from which pilot data will support our application to a research project to last approximately 5 years.
In the longer term there are plans for further impact on health outcomes, policy and practice, and strengthening research capacity at partner institutions. Haramaya University has partnerships with federal and regional health bureaus to co-create and identify interventions that work in local communities, and leverage policy changes.
Further information
This scheme was enabled through the University of Bristol’s International Science Partnerships Fund (ISPF) Institutional Support Grant (ODA), funding provided by Research England (grant reference RE-CL-2023-09).
Could there be connections between having cancer and a reduction in dementia risk? This is something various studies are currently looking into.
There is growing interest, from studying patterns of disease in the population, in the potential connection between the development of cancer and a reduced risk of dementia, with several studies exploring this idea. What is of particular interest now, with seemingly similar observations from several population studies is to try and understand what might be possible biological mechanisms that might explain this.
Members of the Cancer Endocrinology Group (Dr Claire Perks and Prostate Cancer UK supported early career researcher, Dr Rachel Barker) are investigating the role of the PI3K signalling pathway in hormone responsive cancers, including prostate and breast. This pathway helps to regulate cell growth and in cancer, PI3K is highly active, aiding tumour growth, but in dementia patients without cancer, its activity is lower. ¹ ²
Pat Kehoe, Professor of Translational Dementia Research and Director of the Elizabeth Blackwell Institute, has teamed up with Elizabeth Blackwell Institute-supported Cancer Network members, Dr Perks and Barker as biomedical cancer specialists, and Professor Richard Martin with vast experience of the study of the epidemiology of cancer to take a multi-disciplinary approach to understanding the biological mechanisms underpinning this puzzling connection between cancer and AD.
Professor Pat Kehoe notes that “one can see a plausibility around how some of the functions of systems driving cancer and uncontrolled cell growth and how they might also contribute to mechanisms that might shield cells against some types of dementia, like Alzheimer’s disease, where cell damage occurs due to their exposure to various damaging proteins like give rise to amyloid plaques. The question now is to try and find those pathways that might be shared in both diseases to try and focus in on what might be the most relevant.”
Some studies suggest that the potential links between the diseases go both ways, and that having some types of dementia may reduce the risk of developing some types of cancer. This might be due to some of the degenerative processes associated with dementia, like some inflammatory processes etc potentially suppressing cancer-promoting enzymes.
Professor Pat Kehoe, believes there is no smoke without fire. “Based on what I have seen so far from various studies and how the same patterns of association keep coming up across the two diseases time and again, I’m quite convinced that there is something is going on here that is worth investigating further. Of course this benefits both diseases as well. Looking at these disease from the different vantage points of researchers with different experiences can provide new insights that might otherwise have been overlooked. In this case, there is also a bigger consideration, not only could this work help identify other mechanisms by which we can effectively target these diseases, the new knowledge will also help us to identify ways to do so that can carefully negotiate what might be some shared mechanisms and avoid inadvertently changing the dynamics of the other disease.”
However, not everyone agrees about the idea that cancer has a protective role against dementia and vice versa. While promising, more research is needed to explore these potential links and their implications for treatment.
In his role as Director of the Elizabeth Blackwell Institute for Health Research at the University of Bristol, Professor Kehoe explains the importance of interdisciplinary research: “Getting researchers together, like in this instance, with a shared interest in exploring a really curious intellectual puzzle involving diseases that have huge societal impact is fantastically exciting, and importantly, really fun. Working together in such a multi-disciplinary way benefits us all as we learn from each other how different ways of approaching their research questions, providing opportunities to learn new methodologies as well, but also the whole collaborative effort truly extols the virtues of the adage ‘many hands make light work’.”
He goes on to explain how Cancer and Poor Mental Health Outcomes are included in the six new Grand Challenge Research Clusters of the University of Bristol’s Faculty of Health and Life Sciences strategy, which Elizabeth Blackwell Institute supports. He said: “Clearly there is an opportunity across the University to make major contributions against some of society’s major health challenges and we at the Institute now wish to build on the previous historical support we have provided to some of these priority areas.
He continues: “In this time of rapid change in the University we are steadfast in our intention to continue to build and support research ecosystems that can help deliver on the health research priorities, across the whole University, but also support and champion the surfacing of new emerging research needs, such as our AI in Health community. Ultimately we will continue to help the health research conducted at the University of Bristol to be to the forefront, as an International research leader, and in doing so support the University’s strategic ambitions to be a steadfast World Top 50/UK top 10 ranked University ”
Elizabeth Blackwell Institute for Health Research and Cabot Institute for the Environment recruited a cohort of Climate Change and Health PhD students in 2023, supported by a cross-disciplinary team of academic staff who are experts in their fields. We caught up with the students a year into their projects for an update on how their research projects are going.
Climate change and local public health: how are local climate change strategies developed and are they effective?
Leticia Marca
“In the first year of my PhD I analysed climate change action plans or strategies from Unitary authorities in South West England and Brazilian state capitals. I identified that all the areas investigated have plans related to transport; land use; energy efficiency; renewable energy; communication and education; natural resources; and built environment. However, some differences in planning were also identified. For example, almost all the documents from South West England have actions related to heat and cooling, which was observed in only half of Brazilian documents. These planning differences may be associated with local characteristics and the challenges faced by each local area and can indicate how different areas can learn from each other to enhance their preparedness for climate change impacts.
“Following on from this I will interview local authority professionals involved in local climate change plans to get a deeper comprehension of their strategies. In the next phase of my PhD, I will use mixed methods to evaluate the effectiveness of a decision-making tool used by a local council in South West England. This tool aims to predict the environmental and social impacts of local projects, and reduce any possible negative consequences.”
Assessing the impact of heat adaptation strategies on reducing indoor temperatures in low-income communities in Africa; A case study of South Africa and Ghana
Ritah Pavin Nakanjako
“I am now focusing on assessing the impact of structural heat adaptation strategies on reducing indoor temperatures in low-income houses in South Africa and Ghana. The study intends to analyse the sensitivity of structural components to changes in diurnal temperatures and assess the impact of cool roofs on reducing indoor temperatures as a heat adaptation strategy.
“I have visited three of my sites, two in Ghana and one in South Africa. I am currently conducting exploratory analysis with the indoor ‘ibutton’ temperature data and outdoor station data. Preliminary explorations indicate that different house structures have different diurnal temperature patterns and different temperature time lags of heat exchange.
“I am yet to analyse the non-linear empirical relationship between indoor and outdoor temperature as a result of the different building materials. I will also analyse the impact of cool roofs on indoor temperatures before and after intervention and its impact on indoor thermal comfort conditions.
“This [data] will provide evidence-based research to explore passive heat adaptation strategies in African communities to improve thermal comfort conditions.”
Heat impacts on pregnancy outcomes: an interdisciplinary and cross-species approach
Sofia Samoylova
“My project takes an interspecies approach to looking at the effects of heat stress on preterm births using data from both Diploptera punctata, a species of live-birthing pacific beetle cockroaches, and humans. This will allow to improve our knowledge of pregnancy processes and potentially establish new clinical approaches concerning heat stress and pregnancy care.
“So far, I have completed a CTmax analysis which tells us the thermal/heat tolerance of the individual and therefore allows us to determine what a heat wave would be for said inidividual, and simulated heat wave conditions with pregnant Diploptera punctata mothers. I’ve also sequenced the RNA from the mothers from these heat wave simulations and am currently in the data analysis stage. I’m still collecting data from one more birth to finalize this part of the study.
“On the human data side, I haven’t yet begun analysis but plan to start soon. Additionally, I attended a couple of conferences where I presented some preliminary findings.”
New PhD opportunity
Urban green space as refuge for people and disease vectors under climate change: a double-edged sword.
With heatwaves becoming increasingly frequent and intense under climate change, people are relying on urban green spaces as a refuge particularly as cities can be worse impacted by heat (the urban heat island effect). These green spaces also offer a refuge to vectors of disease by providing suitable habitat for breeding and survival.
Some individuals and communities face considerable inequities associated with socioeconomic or environmental disadvantage that limit their access to green spaces; and in awareness of disease risk and strategies taken to mitigate these.
This project will focus on the issue of public use of urban green space by contrasting two variable contexts, Ghana and the UK – where vector borne disease is an endemic or emerging threat respectively; and where urban green space is either declining or being more accessible and managed to promote biodiversity.
