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Globalisation is the increasing interdependence and interconnectedness of the markets, economies, societies and cultures of the world’s countries, and is causing profound changes in the global health landscape in ways which are not yet fully understood. Many factors, such as increasing migration, urbanisation, climate change and world-wide instability, call for an interdisciplinary approach to research and a need to develop international partnerships to tackle global human (and animal) health issues, from climate change to antibiotic resistance.

In 2024, with support from the Quality-Related (QR) Research England International Science Partnerships Fund (ISPF) award to the University of Bristol, the Elizabeth Blackwell Institute launched the International Research Partnership Awards. The scheme gave University of Bristol researchers access to short term funding to enable collaborative work with countries on the Development Assistance Committee (DAC) list for international partnerships that focused on research activities, policy issues or capacity strengthening.

Here, we give an overview of the four projects funded as part of this scheme to share their findings: 

Using Nanopore Sequencing for Rapid Antimicrobial Resistance Profiling of Non-typhoidal Salmonella in South Africa

Dr Sion Bayliss, Lecturer in Endemic, Enzootic and Emerging Infectious Diseases at the Bristol Veterinary School, partnered with Dr Ruan Marais from the Division of Medical Microbiology at the University of Cape Town on a project aimed at strengthening local diagnostic capabilities, improving disease management and antimicrobial stewardship, and promoting economic development and welfare in South Africa by addressing the growing public threat of antimicrobial-resistant non-typhoidal Salmonella.

Non-typhoidal Salmonella species are bacteria often associated with contaminated foodstuffs which cause a range of symptoms from gastroenteritis to more clinically serious infections such as bacteraemia — bloodstream infections. These infections are far more prevalent in patients with HIV, malnutrition, or sickle cell disease. Antimicrobial resistance (AMR), the ability of bacteria to evolve immunity to treatments, complicates disease management and is becoming increasingly prevalent in South African Salmonella cases.

In Bristol, Dr Bayliss’s team developed and optimised a method for concurrently identifying both the species and the AMR profile of different Salmonella species found in bloodstream infections directly from clinical samples. Researchers from South Africa then applied this technique to local cases, with ongoing work to sequence a full range of isolates over the coming months.

It is hoped that the project, alongside follow-on initiatives expanding the scope of the work, will improve mortality and morbidity rates, particularly among high-risk groups with HIV, malnutrition, or sickle cell disease. Consequently, there should be knock-on effects on societal healthcare costs, such as fewer workdays lost to sickness. The provision and training in sequencing technologies also enhance genomic research capability, research knowledge, and technology availability in South Africa.

“We anticipate benefits in clinical diagnostics and stewardship within a few years,” said Dr Bayliss. “Slightly longer term, the strengthened local capacity will enhance outbreak preparedness, surveillance, and health resilience — providing long-term economic and societal returns. These outcomes create a clear pathway to improved public health infrastructure and sustainable development, and are compatible with other ongoing projects and planned research activities to provide other synergistic benefits.”

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Kenyan Community One Health Guidelines for Antimicrobial Prescribing

Dr Judy Betteridge is Senior Research Associate at the Bristol Veterinary School. Her project partners with the Cambodian National Institute of Public Health for a project investigating the how new guidelines might help in the fight against antimicrobial resistance.

Antimicrobial resistance is an increasing threat to human health; many countries are taking action to reduce antimicrobial usage in both humans and animals. In Kenya, guidelines – which can help prescribing practices – are typically only available in paediatric hospital wards. The project applies existing intervention design frameworks to determine how to develop widespread guidelines for both humans and animal health practitioners in Kenyan communities.

Canvassing stakeholders

Dr Betteridge and her team canvassed a variety of stakeholders for opinions on how to implement and support guidelines for use in community settings by human and animal health practitioners.

The team identified a wide range of issues regarding the prescribing environment, communication and information sharing and economic pressures. They compared human and animal health approaches that helped to identify good practices, and champions who could provide useful lessons for implementing guidelines across sectors in the future.

National action plan

Kenya has adopted a National Action Plan to formulate and implement AMR policy, but there are still many hurdles to overcome, particularly at the community level, including a gap between the theoretical knowledge of AMR and its application in practice.

“Our project findings have identified areas which could be strengthened,” said Dr Betteridge. “Several of these relate to the social and legislative environments that prescribers are working within: elitism and limited legislation in the veterinary sector; a lack of information-sharing between public and private healthcare sectors, and lack of feedback from government surveillance to healthcare and veterinary professionals on the ground. These elements would need to be strengthened before effective universal prescribing guidelines could be implemented.”

Differing needs

The work will continue, increasingly identifying the differing needs of medical and veterinary settings, as Dr Betteridge explains:

“For the veterinary sector, a key foundational element would be to establish trusted relationships between the regulatory bodies and groups of veterinarians and paraprofessionals that enable a system where legitimate prescribing practices can be followed. We are putting together a funding proposal to look at the political economy of antimicrobials in the Kenyan veterinary sector, to establish relationships between regulatory bodies and practitioners to facilitate prescribing practices.”

“For the human health sector,” Dr Betteridge continued, “one avenue is in the field of outbreak investigation and control, and how laboratory and genomic information can be better used in a hospital setting. Communication and information sharing needs be coordinated between the Ministry of Health, and public and private healthcare sectors.”

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One Health Approaches to understand Climate Impacts on Water Related Disease in South Africa and Ethiopia

Dr Josephine Walker is Senior Lecturer in Health Economic Modelling. Her project aimed to strengthen an international multi-disciplinary collaboration focused on one health approaches for water related disease, and to collect pilot data to identify the most impactful direction for future research.

A cross-disciplinary team of researchers from the University of Bristol, Haramaya University in Ethiopia and the University of Cape Town, South Africa, developed plans for focus groups discussions in Cape Town and Dire Dawa, Ethiopia. Preliminary analysis of these discussions enabled the researchers to identify areas in which people perceive there to be a disease risk, as well as areas the researchers expect a risk to be perceived that the communities did not consider as critical.

Interdisciplinary and international

“Our international core research team included researchers in engineering, environmental and public health, anthropology, and infectious disease modelling”, said Dr Walker. “We worked together to implement qualitative research which will inform future work linking disease modelling and health policy.”

The team is currently finalising the focus group discussion analysis and will build on the areas identified as a priority to develop plans for a research project which can reduce disease risks for communities in areas which they find to be important, as well as to raise awareness of risk and mitigation approaches which the communities may not already be considering.

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Building the Foundation for Hepatitis Modelling in Cambodia

Dr Aaron Lim of the Bristol Medical School and Dr Juliette Unwin of the School of Mathematics partnered with the Cambodian National Institute of Public Health for this project, which established a new international and cross-sectoral collaboration between the Cambodia National Institute of Public Health (NIPH) and the University of Bristol to spearhead key priority areas identified by NIPH.

The project identified and worked on two major priority areas identified by NIPH and emphasised by the NIPH Deputy Director: (i) Understanding Hepatitis B virus in Cambodia and its context in the wider Southeast Asia region, and (ii) developing in-house capacity in infectious disease modelling at NIPH.

Systematic review

Firstly, the team recruited a Cambodian Research Assistant at NIPH to investigate viral hepatitis infection prevalence in Cambodia and the wider Southeast Asian region. This led to a comprehensive systematic review, currently underway, to explore this topic in more detail – the team has identified 224 papers to extract data from.

Secondly, the team delivered a 5-day bespoke workshop at NIPH to 23 participants, including invited officials, team leaders, and researchers, to build capacity in infectious disease modelling.

Lastly, Dr Lim and Dr Unwin hosted a researcher from NIPH at the University of Bristol for two weeks to build connections with team members who have expertise in virology, epidemiology, programming, modelling, and health economics.

Addressing knowledge gaps

“Understanding HBV will help NIPH identify gaps in their current knowledge of their HBV burden,” said Dr Lim, “which will inform how they can develop ways to reduce the burden of the disease. The project also provided the necessary in-house skills to undertake advanced technical skills in mathematical modelling. Building in-country capacity in mathematical modelling skills will also enable Cambodia to develop better and more relevant models tailored to the Cambodian context. NIPH have already started using it to develop a Cambodian measles model.”

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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.”

Find out more about our Climate Change and Health Research

Blog by Hasini De Silva (pictured)

I’m Hasini De Silva, a Master’s Bioinformatics student passionate about the intersection of AI and biology, especially in fields of synthetic biology, protein design and drug discovery. I’m currently working on my dissertation, which focuses on engineering and optimising the redox properties of a de novo membrane protein under Associate Professor Paul Curnow. Through this project, I’ve developed a deep curiosity about how machine learning can be used not just to understand biology, but to reprogram it with precision and intent.

I’m always looking for opportunities to work on projects that bring biology and computation together. That’s why I was so excited to attend two recent AI in Health workshops hosted by the Elizabeth Blackwell Institute, a hub for interdisciplinary health research at the University of Bristol, supporting collaboration across disciplines to drive innovation and tackle complex health challenges. The first workshop focused on Socio-Digital Transformation, Ethics and Governance in healthcare. The second explored Genomics, Protein Design and Drug Discovery. Each offered something rare, a space to explore cutting-edge science and engage in cross-disciplinary dialogue that was as critical as it was inspiring.

Artificial Intelligence in Health: socio-digital transformation, ethics and governance worksop, 6 May 2025

AI in health is not just about algorithms, it’s about systems

The first workshop opened with a clear message, AI in health does not succeed on technical performance alone. Its impact depends on context, on the systems into which it is introduced, and the people it is meant to serve.

We heard from ethicists, researchers, software engineers and policy experts who explored what it means to deploy AI responsibly within healthcare. These were not abstract concerns, they were grounded in real-world clinical and institutional challenges.

Three ideas resonated strongly with me:

1. Context is essential

Dr. Emanuele Ratti introduced the concept of interactional AI ethics. He emphasised that AI must be judged not only by accuracy or efficiency, but by how well it works in the specific settings where it is used. A model that performs well in development can still fail if it disrupts patient care or undermines trust in a hospital or GP practice.

2. Sustainability is part of governance

Professor Ruzanna Chitchyan raised the important issue of environmental and cognitive sustainability. As AI systems scale, so do their costs, from energy use to maintenance demands. Responsible AI must factor in these costs from the beginning, especially in resource-constrained healthcare environments.

3. Trust is an ecosystem, not a feature

Professor Jonathan Ives reminded us that trust is not something that can simply be added onto a system. It is built through legal accountability, professional standards and cultural readiness. In clinical settings, trust in AI depends as much on policy and communication as it does on interface design or technical reliability.

One of the most meaningful parts of this workshop was how interdisciplinary the conversations were. Between sessions, I had the chance to speak with clinicians, engineers, ethicists and researchers. Everyone brought questions, not just answers, and there was a real willingness to listen and learn across disciplines.

Artificial Intelligence in Health: genomics, protein design and drug discovery workshop, 22 May 2025

From decoding biology to designing it

The second workshop turned toward the molecular frontier, showing how AI is being used not just to understand life, but to redesign it.

I was particularly excited by the discussions on programmable biology. Researchers are moving beyond protein prediction to protein design, focusing on building molecules that can carry out specific, functional tasks.

Professor Dek Woolfson, Prof. Ross Anderson and Assoc. Prof. Paul Curnow presented work on de novo protein design, where the goal is not just to predict how proteins fold, but to engineer them to switch, catalyse and transport. This is the future of function-first biology, powered by computation.

Professor Lucia Marucci demonstrated how AI and control theory can be used to create cybergenetic systems, where living cells are steered in real time using microfluidics and feedback control. This is biology as computation, happening inside cells, not just on a screen.

Dr Daniel D’Andrea introduced spatial biology tools that combine transcriptomics and histology to create actionable maps of disease. These maps go beyond data layers, providing clinical insight that is grounded in real biological context.

Using high-performance computing infrastructure like Isambard-AI, researchers are now accelerating workflows that once took days. From protein simulation to real-time inference, AI is helping bring lab-scale design closer to clinical relevance.

For me, this was incredibly energising. As someone working at the intersection of machine learning and protein engineering, it was exciting to see the field moving with such purpose and speed.

Looking ahead

These workshops offered much more than updates on cutting-edge research. They were a reminder that AI in health is not just a technical advancement, but a systems-level challenge that brings together engineering, biology, ethics and governance.

I left feeling both inspired and grateful. Inspired by researchers who are designing biology with purpose, and by ethicists and policy leaders who are working to ensure that innovation remains responsible, equitable and grounded in real-world impact.

Huge thanks to the Elizabeth Blackwell Institute for creating space for these important conversations. I’m grateful to have been part of them and look forward to staying engaged with this vibrant and growing community.

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Watch the talks from the AI in Health: Socio-digital transformation, ethics and governance workshop.

Watch the talks from the AI in Health: Genomics, protein design and drug discovery workshop.

Explore our AI in Health workshop series 2024/25 via our YouTube playlists.

David Hettle continues his Elizabeth Blackwell Institute Global Health Fellowship based in Harare, Zimbabwe. He’s mainly working on a study improving the usefulness of blood cultures in managing (neonatal) sepsis in Sally Mugabe Central Hospital (SMCH), a central government hospital in Harare. This project addresses the whole blood culture process, from clinical settings to lab and back again, to support patient care in context of widespread antimicrobial resistance and challenges accessing appropriate antibiotics. This blog explores lab and clinical staff perspectives on changes that David and the study team have implemented over the last 8 months.

Image: David Hettle presenting work at the ReAct Africa Network Annual AMR conference (2025) in Lusaka, Zambia.

Developing changes

After a few months taking stock of how blood cultures were used and processed in clinical and lab settings at SMCH, our study team designed a package of practical improvements to improve the process. The aim was simple but critical: helping to deliver blood culture results to clinicians quickly enough to impact clinical care. Five years ago, only 1 in 25 positive blood cultures made it back quickly enough, so lots of scope for improvement.

We developed four major changes, all trying to improve accuracy of results and reduce the time for blood cultures to be processed from start to finish. Shown in the diagram below, each change addressed training or practical factors which needed improvement and were built with lab and clinical teams to make sure they were practical and worked for them and their practice.

Improving lab-clinician communication

The final change, ‘Rapid result communication to clinicians’, I’ll give a bit more context for. In this hospital and across Zimbabwe, results from labs are written on the paper request forms that arrived when samples first make it to the lab. Rather than providing any guidance to clinicians, issued results go back to the ward with minimal interpretation alongside the result reported as lab staff would read it. So, for the very early-career doctors it may be difficult to interpret microbiology results or antibiotic resistance patterns, especially for the tiny babies they’re looking after. So, we wanted to not only provide more rapid, accurate results, but also guide clinicians to use antibiotics as well as possible to help patients.

What difference has it made: A clinician and lab staff perspective

Over 100 samples go through the improved blood culture system, and it’s having a big impact – over two-thirds of results now make it to the clinicians in time to alter care – a big jump from the 1 in 25 from the previous study in our setting.

In practice, this can mean advice to switch to appropriate antibiotics which will treat the multi-drug-resistant organisms which cause most of the infections underlying neonatal sepsis, or advising further investigations to explore the cause of infection further.

Since the work started, we’ve also found out what difference this has made to lab and clinical practice and the staff in each place. For clinical staff, this has included early-years doctors and consultants on the neonatal unit. So far, we’ve found that 76% of them have never received any clinical advice alongside lab results. They’ve also highlighted that the guidance provided now has helped them to provide effective care much quicker than they previously could, which they feel is making a difference to their patient outcomes (although our formal analysis on this is still to follow). They also feel that guidance has supported their learning about the antibiotics that they use and which organisms each antibiotic can treat. Though this might seem simple, these rotating junior staff will often end up practising in more rural settings, so the hope would be that this learning gives a foundation for their future use of antibiotics, some of the most used medicines across Zimbabwe.

In the lab, our study has trained staff in using molecular diagnostics and offered a longitudinal Gram stain training program. Training here is often delivered through single point-in-time workshops, with little focus on ongoing professional development, so by ‘longitudinal’ we mean that our approach includes regular reviews of the Gram stains performed during routine practice, and then training can be delivered when problems are identified, reflecting on real-life samples and challenges. Finally, regular discussion about the results identified in the lab has been hosted online, with the thinking behind the questions, issues and steps in result analysis (i.e. does the bug we’ve found, match up to the antibiotic results which we’ve found?) made explicit to enable lab staff understanding to develop. Such a routine approach to feedback, training and advice to support lab practice has been highlighted as supporting lab staff to learn more about and enable development of their day-to-day practice.

Looking forward

As the study continues, we’ll carry on collecting data on clinical impact and outcomes for patients but are also looking deeper into how staff experience these changes – what’s working, what’s not and what’s it doing for staff learning, as all of these will support sustained improvement once our study finishes.

So far, the study results seem promising in both clinical and staff development perspectives, so the next stages are to consider how we can translate this into sustainable change which stretches beyond the duration of this work – keep an eye out for a future blog telling you how we got on!

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.

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

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

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.

Image: L-r: Jeff Clark and Raul Santos-Rodrıguez

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

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 44^th.

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.

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?

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.” 

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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
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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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