Frequently need to pee? App-based therapy can help, finds research

Combining pelvic floor exercises with behavioral therapy could be more effective than current medical treatments at helping men with frequent urges to urinate, new research in men has found.

The initial results from the Bladder Emptying Disorder Therapy (BEST) Trial are presented today [Monday 8 April 2024] at the European Association of Urology Congress in Paris. They reveal that an app-based therapy leads to significant improvements in the lower urinary tract symptoms that many millions of men experience – hesitancy, straining, frequent urges to urinate and emptying the bladder effectively. Full results of the trial are expected to be published later this year.

Carried out in Germany, this is the world’s first randomised controlled trial to look at combining pelvic floor training, behavioural therapy and bladder control techniques for mild, moderate and severe bladder emptying disorders in men, all delivered as an app-based therapeutic.

Bladder emptying disorders can start to appear from the age of 30 and typically affect a large proportion of men aged over 50.

While clinical guidelines recommend physiotherapy, behavioural therapy and lifestyle changes as a first-line of treatment, they are often neglected by clinicians due to a lack of available evidence. Several unpleasant side effects are associated with the few drugs available, and surgery is only advised for those with severe symptoms.

Professor Christian Gratzke, from University Hospital Freiburg in Germany, who co-led the trial, explains: “Frequent urges to urinate and issues emptying the bladder are the most prevalent urinary conditions we see in men after urinary tract infections. While some drugs are available, they don’t tend to be effective, and up until now there’s been little data available to back physiotherapy. We’re confident that we now have that data, and making this form of therapy available digitally could be a game changer for the millions of men who struggle day-to-day with issues emptying their bladder.”

The researchers recruited 237 men aged over 18 from across Germany into their 12-week study. Half the men were randomised to receive standard medical care, while the other half were given access to the Kranus Lutera app-based therapy alongside standard care. These participants were asked to record a urination diary, which was used to inform their treatment, and complete questionnaires about the severity of their symptoms and their overall quality of life.

After 12 weeks, the trial found significant and clinically meaningful improvements in symptoms and quality of life measures from participants given the app-based therapy, who reported an average seven-point increase in symptom scores compared to those in the control group.

Crucially, the study found that the app-based therapy was more effective than medical therapy. No patients reported any side-effects or challenges accessing the smartphone app.

The findings challenge the dogma of the 1980’s and 1990’s, when prostrate surgery was the first line of treatment for an overactive bladder, and offer a welcome alternative to drugs, say the researchers.

“Many men with bladder emptying disorders are ageing and have other medical conditions that require drug treatments,” says Professor Gratzke. “The limited drugs we have available aren’t suitable for these patients due to their side effects. For those with mild-to-moderate urinary symptoms, this digital therapy is without side effects and improves symptoms by a magnitude we have not seen before. Simply strengthening the pelvic floor makes all the difference, it’s a no brainer.”

Jean-Nicolas Cornu, Professor of Urology at the Charles Nicolle Hospital in France and member of the EAU Scientific Congress Office, said: “There has been little to no evidence to support training men to better control their bladders, despite this being recommended in clinical guidelines. This is the first randomised controlled trial looking at physiotherapy and behavioural therapy for bladder emptying disorders, and it shows a very positive effect over conventional drug treatment.

“We now need a bigger trial looking at the longer-term effect of this app-based therapy after 12 weeks for different forms of bladder emptying disorders. If offered widely, this treatment could dramatically change clinical practice, and could relieve symptoms without exposing patients to drugs. We could save a lot of unnecessary prescriptions for drugs that tend to be of little benefit.”

The researchers compared data from men whose symptoms were due to overactive bladder with those whose symptoms were due to an enlarged prostate. They found that both groups benefited from the therapy. However, it did not compare the effect of therapy on different forms of bladder emptying disorder.

The research was funded by Kranus Health who was independent of the trial.

Oral vaccine for UTI is potential alternative to antibiotics, finds 9-year study

Recurrent Urinary Tract Infections (UTIs) can be prevented for up to nine years in more than half of people given an oral spray-based vaccine and is a potential alternative to antibiotic treatments, finds research.

Initial results from the first long-term follow-up study of the safety and effectiveness of the MV140 vaccine for recurrent UTIs are presented this weekend at the European Association of Urology (EAU) Congress in Paris.

They show that in both men and women with recurrent UTIs, 54% of study participants remained UTI-free for nine years after the vaccine, with no notable side effects reported. Full results of the study are expected to be published by the end of 2024.

UTIs are the most common bacterial infection. They are experienced by half of all women and one in five men and can be painful and uncomfortable. Recurrent infections, needing short-term antibiotic treatment, develop in between 20 to 30 per cent of cases. With antibiotic resistant UTIs now on the rise and drugs becoming less effective, new ways of preventing and treating these infections are needed.

Carried out by clinicians at the UK’s Royal Berkshire Hospital, this long-term follow-up looked at the safety and efficacy of the MV140 vaccine in 89 patients originally treated privately at The Urology Partnership Reading.

MV140 is a new vaccine for recurrent UTIs and is administered with two sprays of a pineapple-flavoured suspension under the tongue every day for three months. While researchers have previously studied MV140’s short-term safety and effectiveness, this is the first long-term follow-up study to report globally.

Dr Bob Yang, Consultant Urologist at the Royal Berkshire NHS Foundation Trust, who co-led the research, said “Before having the vaccine, all our participants suffered with recurrent UTIs, and for many women, these can be difficult to treat. Nine years after first receiving this new UTI vaccine, around half of participants remained infection free. Overall, this vaccine is safe in the long term and our participants reported having fewer UTIs that were less severe. Many of those who did get a UTI told us that simply drinking plenty of water was enough to treat it.”

“This is a very easy vaccine to administer and could be given by GPs as a 3-month course. Many of our participants told us that having the vaccine restored their quality of life. While we’re yet to look at the effect of this vaccine in different patient groups, this follow-up data suggests it could be a game changer for UTI prevention if it’s offered widely, reducing the need for antibiotic treatments.”

In their original trial, patients were initially followed-up for 12 months and data from the women in the cohort was published in BJU International in 2017. For their nine-year follow-up study, the researchers analysed data from the electronic health records of their original cohort. They interviewed participants about their experience of UTIs since receiving the vaccine and asked them about side effects.

Forty-eight participants remained entirely infection free during the nine-year follow-up. The average infection-free period across the cohort was 54.7 months (four and a half years) – 56.7 months for women and 44.3 months, one year less, for men. 40% of participants reported having repeat doses of the vaccine after one or two years.

Gernot Bonkat, Professor of Urology at the Alta Uro Medical Centre for Urology in Switzerland, and the EAU Chairman of Guidelines on Urological Infections, said: “These findings are promising. Recurrent UTIs are a substantial economic burden and the overuse of antibiotic treatments can lead to antibiotic-resistant infections. This follow-up study reveals encouraging data about the long-term safety and effectiveness of the MV140 vaccine. Further research into more complex UTIs is needed, as well as research looking at different groups of patients, so we can better optimise how to use this vaccine.

“While we need to be pragmatic, this vaccine is a potential breakthrough in preventing UTIs and could offer a safe and effective alternative to conventional treatments.”

Developed by the Spain-based pharmaceutical company Immunotek, MV140 contains four bacterial species in a suspension with water. It is available off-license in 26 countries.

Participants in the trial were all aged over 18 years and were UTI-free when they were initially offered the vaccine. None of the participants had other urinary abnormalities such as catheters, tumours or stones. The follow-up study included 72 women and 17 men and outcomes were self-reported.

Urine test halves painful procedures in bladder cancer follow up, new trial shows

A simple urine test can more than halve the number of cystoscopies necessary to follow up high-risk bladder cancer patients, new research has found.

Cystoscopies involve inserting a flexible probe through the urethra into the bladder, which allows a clinician to look at the bladder lining for signs of cancer. While they are predominantly safe procedures, cystoscopies do incur some risk of urinary infections and bleeding. They can also cause pain and discomfort.

Initial results from a two-year study, presented today [6 April 2024] at the European Association of Urology Congress in Paris, suggest that there is also no increased risk of recurrence in patients who had a urine biomarker test rather than a standard flexible cystoscopy. Full results on this aspect of the trial are expected in the summer.

The study was carried out in Denmark, where post-surgical follow up for high-risk bladder cancer recommends cystoscopies every four months for two years. In the UK, patients undergo even more frequent cystoscopies: every three months for two years.

High-risk patients with the most aggressive form of bladder cancer have a 60-70% likelihood of cancer returning within 5 years post-surgery, which is why follow up for these patients is so intensive.

The new research is the first time a urine biomarker test has been assessed in a randomised interventional controlled trial with high-risk patients. This trial design allowed the researchers to assess whether the test could reduce the number of cystoscopies patients had to undergo, as well as picking up any signs of returning cancer. Previous studies have only assessed biomarker tests observationally, adding the biomarker tests to existing standard of care.

Thomas Dreyer, a researcher at the Bladder Cancer Research Team, Dept of Urology, Aarhus University Hospital, who carried out the study for his PhD, explains: “There have been lots of studies of urine biomarker tests showing positive results, but no randomised trial to show what the impact would actually be in the clinic. We were confident the test was sensitive enough to not provide false negatives that put patients at risk. But would it provide false positives and actually result in equal or even higher numbers of cystoscopies being carried out? Our findings show that wasn’t the case.”

The researchers, from Aarhus University Hospital in Denmark, recruited 313 patients. Half were randomised to receive the standard three cystoscopies per year. The other half were randomised to receive just one cystoscopy per year, with their remaining two follow up cystoscopies replaced with the Xpert® Bladder Cancer Monitor test, a urine biomarker test. The test monitors for recurrence of bladder cancer by measuring levels of five target mRNAs, or genetic markers. The researchers chose to trial this particular biomarker test as it had previously shown promising results in high-risk bladder cancer patients.

Any patients who received a positive result on their urine test were called into hospital for a cystoscopy to check for evidence of the cancer returning. The urologists undertaking the cystoscopy were aware of the positive result, as they would be in normal practice.

After two years, for patients receiving primarily the urine test, just under 44% of follow up appointments involved a cystoscopy, compared to nearly 100% in those receiving standard treatment.

The researchers also found strong evidence that the urine test could pick up cancer recurrence before any disease was visible through the cystoscopy. For more than half of the patients who had a ‘false positive’ test – that is, the biomarker test showed positive but the cystoscopy was clear – the researchers found evidence of recurrence at a later visit.

“We know that many patients really dread their cystoscopy appointments, but are prepared to go through with them because they want to be sure they are free of the cancer,” said Thomas Dreyer. “However, if given the option of providing a urine sample instead of undergoing an uncomfortable medical procedure, most would choose that, so long as they were confident that it was just as effective.”

Joost Boormans, Professor of Urology at Erasmus University Medical Centre in Rotterdam and member of the EAU Scientific Congress Office said: “We know as urologists, we carry out too many cystoscopies, particularly during follow up of patients with non-muscle-invasive bladder cancer, so we need to find alternatives. Bladder cancer is a disease that particularly affects the elderly, and we foresee an increasing number of patients due to the ageing population, which could impact on the numbers able to access care.”

“This trial shows us a possible means of reducing cystoscopies. If the final results later this year do confirm that the urine test can pick up cancer recurrence as effectively as cystoscopies, then this is something we need to look at introducing into clinical practice as soon as possible, because it reduces demand on our resources and helps to make healthcare more accessible.”

The trial was funded by Cepheid, the company who make the Xpert® Bladder Cancer Monitor, but the trial was independently conceived and designed by the team at Aarhus University.

Five-year interval is safe for prostate cancer screening, research shows

A simple blood test every five years is sufficient to screen low risk men for prostate cancer, new research has shown.

The PSA blood test checks the level of prostate-specific antigen, a marker for prostate cancer. In Europe, only Lithuania routinely screens men for prostate cancer based on their PSA levels, as the test has historically been seen as insufficiently reliable.

The German study, presented at the European Association of Urology (EAU) Congress in Paris today [April 6, 2024], involved over 12,500 men aged between 45-50 taking part in the ongoing PROBASE trial, which is testing different prostate cancer screening protocols.

The research has also been accepted for publication in European Urology.

PROBASE is recruiting men aged 45 and splitting them into three groups based on their initial PSA test. Men with a PSA level of under 1.5 nanograms per millilitre (ng/ml) are deemed low risk and followed up with a second test after five years. Men with a PSA level between 1.5-3 ng/ml are deemed intermediate risk and followed up in two years. Those with a PSA level over 3 ng/ml are seen as high risk and given an MRI scan and biopsy.

Of over 20,000 men recruited to the trial and deemed low risk, 12,517 have now had their second PSA test at age 50. The researchers found that only 1.2% of these (146 in total) had high levels of PSA (over 3 ng/ml) and were referred for an MRI and biopsy. Only 16 of these men were subsequently found to have cancer – just 0.13% of the total cohort.

The EAU recommends that men should be offered a risk-adapted strategy (based on initial PSA level), with follow-up intervals of 2 years for those initially at risk, in which they include men with PSA over 1 ng/ml. The new findings suggest that the screening interval for those at low risk could be much longer with minimal additional risk.

Lead researcher, Professor Peter Albers, from the Department of Urology at Heinrich-Heine University Dsseldorf, explained: “By raising the bar for low risk from 1 ng/ml to 1.5, we enabled 20% more men within our cohort to have a longer gap between tests and very few contracted cancer in that time.  With nearly 14 million men aged between 45-50 in Europe, the numbers affected by such a change would be significant. Our study is still underway, and we may find that an even longer screening interval, of seven, eight or even ten years, is possible without additional risk.”

Prostate cancer screening has historically been a controversial subject, with concerns raised both around false positives leading to unnecessary invasive treatments and false negatives leading to cancers being missed. This is gradually changing due to MRI scans which can avoid unnecessary biopsies and the use of ‘active surveillance’, where men with early-stage cancer are monitored and only undergo treatment if their disease progresses.

Prostate cancer screening guidelines contradictory and unclear

Current guidelines and policies from European governments and health bodies remain contradictory and unclear, leading to high levels of opportunistic testing and inequality of access to early diagnosis, according to further research presented at the EAU Congress. The study reviewed early detection policies across the European Union and carried out focus groups with urologists to identify how guidelines were interpreted in clinical practice.

Dr Katharina Beyer, from the Department of Urology at the Erasmus MC Cancer Institute in Rotterdam, Netherlands carried out the research. She said: “Some country’s guidelines are actively against screening, others are non-committal and a few, such as Lithuania, have some form of screening. But in many countries, if you ask for a test, you can get one, sometimes free and sometimes not. This means that well-educated men, who know about PSA tests are more likely to be screened and get an early diagnosis, while others with less knowledge are at a disadvantage.”

This is also the situation in the UK, according to Professor Phillip Cornford, from Liverpool University Hospitals NHS Trust, who chairs the EAU Prostate Cancer Guidelines Committee.

Professor Cornford said: “The NICE guidelines here in the UK are incongruous. They say there’s no evidence that PSA screening is worthwhile, but at the same time say any man can ask for a PSA test if they want it. The result is that well-educated, driven men ask and others, including many Afro-Caribbean men who are actually at higher risk, don’t ask and so prostate cancers get missed.

“There is clearly a need for more organised prostate cancer screening and last November, the UK government and the charity, Prostate UK, announced a £42m research programme to look at this. The details of that should soon be made public. Each country will need to design a screening programme that fits their health system and the resources they have available. But there is still plenty we can learn from other countries and the work underway in the EU. New findings, such as those from the PROBASE trial, can help us design an appropriate screening programme both in the UK and elsewhere.”

Bladder cancer treatment can be better targeted and more effective, trials show

Testing for tumour DNA in the blood can successfully identify advanced bladder cancer patients who will not relapse following surgery, new research shows.

This could allow doctors to target treatments more effectively to those who need it, and spare those patients for whom further treatment is unnecessary, researchers say.

The findings from the screening phase of the IMvigor011 Phase III trial are presented today [Friday 5 April] at the European Association of Urology Congress in Paris.

They show that just over 90% of muscle invasive bladder cancer (MIBC) patients with a negative circulating DNA (ctDNA) test following surgery, which remained negative on follow up, did not relapse. The findings mean that use of a ctDNA test could allow some patients to be spared further treatment with minimal risk.

MIBC is an advanced form of bladder cancer, where the tumour has spread into the bladder wall. The disease is usually treated by surgery to remove the bladder. Around half of patients see cancer return, often in the lungs and usually within two-to-three years. All patients are currently offered follow-up treatment such as chemotherapy or immunotherapy to prevent recurrence, for which the side effects can be serious and lifechanging.

Other Phase III trial results, also presented at the EAU Congress today, show that patients given immunotherapy, nivolumab, as a follow up to surgery have an average survival of nearly six years, compared to four for patients on placebo.

The CheckMate 274 trial has already shown that nivolumab can reduce recurrence of disease, but these interim results are the first to show the potential benefit in overall survival for MIBC patients.

Joost Boormans, Professor of Urology at Erasmus University Medical Centre in Rotterdam, and member of the EAU Scientific Congress Office, is chairing the session where both trials will present their findings. He said:

“Although we already knew that nivolumab improved disease-free survival in MIUC patients who received radical surgery, overall survival is what really matters following local treatment, such as radical surgery. These interim findings, which show that overall survival also improves, are very encouraging, particularly as this hasn’t been the case in other recent immunotherapy trials.

“The question for regulators and healthcare authorities is whether the improvement in overall survival is enough to justify licensing or prescribing the drug for all patients, in the knowledge that some of these patients would have been cured of their cancer by surgery alone. This is where the findings from the IMvigor011 trial could really make a difference, by allowing us to select patients at highest risk who will benefit the most from treatment while sparing others for whom it isn’t needed.

“At a time when healthcare resources are under pressure, this kind of innovation is really needed.”

IMvigor011

IMvigor011 is a global, double-blind, randomised Phase III trial looking at the efficacy of the immunotherapy atezolizumab vs placebo in patients with high-risk MIBC.

The trial is recruiting MIBC patients post-surgery and testing their blood for circulating tumour DNA. Those with a positive ctDNA result are randomised to receive either atezolizumab or placebo. Those with a negative result are given no further treatment, but were followed up with scans and further ctDNA tests for up to two years. For the analysis presented at the EAU Congress today, 171 patients with a negative ctDNA test were included, with follow up continuing on a further 115.

Just 17 patients of the 171 patients (9.9%) saw their cancer return within two years. These outcomes were irrespective of the stage their tumour was at or whether it showed elevated levels of PD-L1, a protein biomarker that plays a role in cancer.

Professor Thomas Powles of Barts Cancer Institute leads the IMvigor011 trial. He said: “These results are even better than we were hoping. The risk of relapse in this ctDNA group of patients is just 1 in 10. It appears this test can effectively filter patients into two groups: those who are likely to relapse and those at much lower risk. Focusing treatment on those at risk and sparing the very low risk group potentially life-altering treatment-related side effects is attractive. Hopefully these data will allow patients to remain treatment free with the reassurance they need, that they’re unlikely to see their cancer return.”

The study is sponsored by F. Hoffmann-La Roche Ltd.

CheckMate 274

CheckMate 274 is a global, Phase III, randomised, double-blind trial of nivolumab vs placebo in high-risk MIBC after surgery.

The trial recruited just over 700 patients, with half given nivolumab and the other half given a placebo every two weeks for 12 months following an operation to remove the bladder. Patients were also tested to see if their cancer had elevated levels of the biomarker PD-L1, which nivolumab specifically targets.

The trial has already reported positive results in preventing recurrence, particularly for PD-L1 patients. Across all patients, those on nivolumab had an average of 22 months before recurrence, compared to 10 months for those on placebo. However, of the PD-L1 group, those on nivolumab had an average of over four years without recurrence, compared to just over eight months for those on placebo.

The latest results, although still early stage, show a similar benefit in overall survival. For all patients, those on nivolumab survive on average for nearly six years (69.5 months) compared to just over four years (50.1 months) for those on placebo. The researchers do not yet have enough follow-up data to separate out the PD-L1 patients, but the analysis so far shows that overall survival is likely to also be even better for this group when treated with nivolumab versus placebo.

Professor Matthew Galsky from the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai in New York, leads the CheckMate 274 trial. He said: “We know that patients with high-risk urothelial cancer are at highest risk for recurrence within the first three years after surgery. We’ve now followed a substantial subset of patients for longer than that on this study without recurrence. It looks as if the improvement in disease free survival is ultimately going to translate into improvement in overall survival. And that’s for all patients, but particularly patients with the PD-L1 biomarker. Our hope is that this improvement will then translate into an increased likelihood of curing cancer in these patients.”

The trial is funded by Bristol Myers Squibb and Ono Pharmaceutical. Dr. Matthew D. Galsky is a paid consultant to Bristol Myers Squibb.

Careful who you believe: University of Oxford leads celebration of hoaxes for April Fools’ Day

April Fakes Day 2024 explores the potential for fakes to reveal hidden truths, as several museums display well known and obscure fakes.

 In our age of misinformation there is rising concern about fact vs fiction, but this April Fools’ Day a celebration of hoaxes, forgeries and fakes will take place as University of Oxford researcher Professor Patricia Kingori encourages us to consider what is real.

From mysterious 16th Century monsters to fake ivory and infamous forged manuscripts, museums across London and Oxford will display objects and host activities that challenge audiences to consider the ethics of using fakes to determine truth, and whether some domains are more important than others when it comes to authenticity.

April Fakes Day is organised by The Oxford Research Centre in the Humanities (TORCH) and will challenge audiences to consider the ethics of using fakes to judge what is real. Across museums in Oxford and London, objects and activities will take place including gallery displays of mysterious 16th century monsters, fake ivory, and infamous forged manuscripts.

Patricia Kingori, Professor of Global Health Ethics at Oxford Population Health, explains: “Fakes are often dismissed as rubbish. But in a world where it’s increasingly hard to tell what’s real, they can help us to understand what we value and raise other important questions - such as who gets to say that something is real or fake? Are some copies ‘better’ than others? And how can a fake help us understand the reality of the world in which we live?”

London’s Natural History Museum will display a mysterious monster from the 1500s, known as a Jenny Haniver and thought to have magical powers – but are they real? The Bodleian will showcase fake books, documents and art in the Weston Library and the Pitt Rivers Museum will allow visitors to hold fake ivory and learn how or why it is made.

Professor Kingori’s research explores different kinds of fakes, from seemingly harmless animals, relics and paintings in museums to more damaging deepfake videos, fake medicines and misinformation that have harmful consequences in the modern world.

Her ongoing project, Wellcome-funded Fakes, Fabrications and Falsehoods in Global Health, explores how uncertainty and ambiguity around the authenticity of products are reconciled in practice. Professor Kingori is interested in knowledge production and (mis)information: who produces ‘real’ knowledge in academic journals and social media, including the growth of shadow scholars and essay mills in STEM subjects and what they produce.

She also looks at access to high-quality drugs and medicines and how healthcare professionals reconcile issues around real and fake in contexts where medicine quality is a concern. As part of April Fakes Day, the History of Science Museum in Oxford will exhibit fake medicines hidden among real ones in their displays and educate visitors on the history of vaccine misinformation.

Highlights of exhibits and activities include:

• Oxford University Museum of Natural History has specimens that aren't quite as real as they first seem.

• The Ashmolean Museum will teach visitors about fakes and forgeries throughout history and learn how to tell if something is a 'real' fake.

• The Story Museum will tell stories of tricksters and shapeshifters who appear in tales across cultures and generations.

• Orson Welles’ F for Fake will be screened at Oxford’s Ultimate Picture Palace followed by a panel discussion with April Fakes Day Curator Professor Patricia Kingori, and Dr Andrew Dunning (Curator of Medieval Manuscripts at the Bodleian Library), chaired by Dr JC Niala (Head of Research, Teaching and Collections, Museum of The History of Science). 3 April

• The British Museum, Culture& and Uncomfortable Oxford will host blogs about the authenticity of gold, the first 3D printed replica of the bust of Egyptian Queen Nefertiti and the story of how a replica Zimbabwe Bird ended up on Rhodes’ House in Oxford.

As well as objects on display, events will take place to engage museum visitors and a series of online articles encourage the curious to find out more. 

Patricia Kingori says: “Oscar Wilde wrote in The Importance of Being Earnest that: “the truth is rarely pure and never simple”. April Fakes Day celebrates this sentiment and underlines the impact that fakes have on our everyday reality.”

For more information: www.torch.ox.ac.uk/fakes  

Winners of £50K Franklin research residencies announced

Three of the UK’s brightest life science companies have been awarded research prizes by the Rosalind Franklin Institute in collaboration with the Science and Technology Facilities Council (STFC), a part of UKRI. These research prizes will enable the winners to benefit from the Franklin’s top-level technologies and support to move their work forward.

Winning biotech companies Neuro-Bio, Oxford Target Therapeutics and Hypha Discovery will each spend a residency of 12 weeks at the Rosalind Franklin Institute, allowing them to investigate, respectively, a potential early diagnostic test for Alzheimer’s disease, a promising therapy for Triple Negative Breast Cancer, and new technologies for determining the chemical structures of small drug metabolites.

Oxford Target Therapeutics plans to use the Franklin’s serial focused ion beam scanning electron microscopy to find out for the first time exactly how its treatment acts on a micromolecular level on both breast cancer cells and healthy cells.  Victor Bolanos-Garcia, Founder and Chief Scientific Officer, said: “Without this opportunity, we wouldn’t be able to fund the cost of this work ourselves as we have too many competing priorities. But it is instrumental for us, so the Franklin’s offer of funding and expertise will really fill a vital gap.” The results of the research will help the company plan more effective strategies to treat Triple Negative Breast Cancer, one of the most aggressive and deadly forms of the disease. 

Neuro-Bio aims to measure how a peptide biomarker that may indicate pre-symptomatic Alzheimer’s Disease can be accurately detected from saliva samples. The company will use the Franklin’s liquid chromatography-mass spectrometry (LC-MS) technology to analyse the biomarker, known as T-14. The project will allow them to see how the amounts of the peptide biomarker in saliva correspond to the different stages of the disease, by analysing hundreds of samples donated by patients living with Alzheimer’s.  Sara Garcia Rates, Chief Scientific Officer of Neuro-Bio, said: “We’ve previously done a very limited  pilot study in-house, but this work with the Franklin will allow us to validate the test, greatly increase our throughput and enable the quantification of T14. This transformational step will enable us to progress from a very lab-based project into something that doctors will be able to access, very much faster than we’d have been able to do otherwise.” 

Professor Ben Davis, Interim Director of the Rosalind Franklin Institute, said: “The Franklin is tasked with creating advances which push forward life science. The creative challenges posed by these SMEs are a great testbed for our technologies – this creates a golden opportunity to explore new areas together and so provide the companies with the leaps in results they need to take their products to the next stage.”

The Franklin is the national institute developing disruptive new technologies designed to tackle major challenges in health and life sciences. Their inaugural SME (small and medium enterprise) competition aimed to make these technologies – and the expertise of the Franklin’s own scientists – available to smaller life science companies in the UK, to help them overcome a specific research challenge. The residency prizes, which include bench space, consumables and instrument time, are valued at between £30,000-£50,000. All intellectual property generated during the residency will remain with the individual companies.

The UKRI-STFC part funded the awards. Dr Barbara Ghinelli, Director, Innovation Clusters and Harwell Campus, UKRI-STFC, said:  “We are delighted to support this programme at the Rosalind Franklin Institute, a core partner within the Health Tech Cluster at Harwell. Fostering collaboration and partnerships between world leading institutes and innovative businesses helps to drive forward science and innovation that will have a real impact. These exciting projects at the Franklin will nurture the development of tools and technologies in business that will have far-reaching impacts on people’s health and wellbeing in the UK and around the world.”

Mental health costs of lockdown compliance still being felt, research shows

The more strictly people complied with Covid restrictions during the pandemic, the worse their mental health today, new research has found.

The analysis by researchers from Bangor University looked at the behaviour of around 1700 people during the Covid restrictions in relation to their personality traits and their post-pandemic recovery. The study aimed to answer three broad questions: who follows health advice, what can be done to improve compliance; and what are the costs for those who comply?

The team found that those who were more sensitive to the needs of others were more likely to have complied with lockdown rules and health advice, compared to those who were more focused on their own needs and priorities.

However, they also found that those who reported high levels of compliance with Covid restrictions and were most worried about infection during the pandemic are least likely to have resumed normal behaviour and more likely to be experiencing stress, anxiety and depression now.

Dr Marley Willegers, from the Institute for the Psychology of Elite Performance (IPEP) at Bangor University, said: “There was naturally a lot of focus on getting public health messages out when Covid first emerged, to change people’s behaviour. Similarly, throughout the pandemic, messaging campaigns were designed to ensure people continued to follow the rules. But there was no messaging campaign as we came out of the pandemic to help everyone safely transition back to normality. Without this, certain personality types have retained infection prevention behaviour and anxiety that undermines their mental wellbeing.”

The study involved over 1700 people, recruited through Healthwise Wales, who were asked earlier this year to answer questions about their personality traits and their attitudes to Covid and behaviour during the first lockdown (March-September 2020). The researchers also questioned 230 people who were friends or family of those involved in the study, to cross check respondents’ recollections of their behaviour with others who knew them well.

The team followed up with 850 of those who’d taken part, asking them to report their levels of well-being, stress, anxiety, depression and infection prevention every two weeks over a three-month period between February and May 2023.

They categorised each person in relation to two types of personality trait – those who are more focused on what affects them (agentic personalities) and those who are more focused on what affects others (communal personalities). In general, the former were less likely to have complied with Covid rules, except where they felt under personal threat of infection. Conversely, communal personalities were less likely to improve their compliance with health advice as the threat of infection increased, possibly due to them taking personal risks to help others.

The researchers found, regardless of personality, higher levels of compliance with Covid rules during the pandemic (March-September 2020) predicted lower current levels of well-being (Feb-March 2023). In other words, the more people complied with Covid rules during the pandemic, the worse their wellbeing emerged in the aftermath.  

Dr Willegers said: “It’s clear from our research that if government advertising campaigns want to change the public’s behaviour, they need to take both personality types into account. Campaigns need to highlight the personal costs and benefits involved not just people’s responsibility to others.”

One example the researchers point to is the introduction of the 20mph limit in Wales. The existing campaign to inform the public of the speed limit change, which focuses primarily on the lives potentially saved by driving slower is unlikely to encourage compliance from more agentic personalities. A broader campaign, which also focuses on personal costs and benefits of compliance with the change would target a wider range of personality types more effectively, the researchers say.

The full report ‘The effect of agency and communion on pandemic response and post-lockdown recovery’ is published by Bangor University

Left-handers aren’t better spatially, gaming research proves

It’s been debated for decades, but now researchers at the University of York and University College London have demonstrated conclusively that left-handedness is not linked to better spatial skills.

By asking participants to download and play a videogame that captured user information and tracked navigational challenges, researchers were able to measure demographic data – including hand preference - and activity from 422,772 international participants, across 41 different countries. They found that left handers were neither better nor worse than right handers at the tasks, clarifying a long-running debate about the links between handedness and spatial skills.

The brain has two hemispheres, controlling the opposite sides of the body; so in right handers, the left hemisphere controls the dominant right hand, whereas the situation is reversed in left-handers. Many cognitive abilities are also dominated by one of the two brain hemispheres, while right and left handers also show different patterns of lateralisation – the specialisation of a particular area. As a result, many debates about cognitive differences related to handedness are also debates about the effects of brain lateralisation on cognitive abilities.

Spatial cognition, the ability of humans to perceive and navigate our physical environment, is a fundamental set of brain-based skills.  It is also not clearly dominated by either hemisphere, leaving scientists unclear as to whether it has any link to handedness.

Some, inconclusive, research has suggested that left-handers might be better at navigating virtual and real games and left-handed athletes are known to be over-represented in the in professional sports requiring rapid and accurate responses. However, it’s been a tricky issue to research, partly because handedness prevalence changes from culture to culture, and partly because testing for handedness effects requires a large number of participants. Using the videogame Sea Hero Quest, the researchers were able to overcome both challenges.

Dr Pablo Fernandez-Velasco, a researcher at the Department of Philosophy at the University of York, who co-led the study, said: “Recruiting participants in our study through a videogame is a new approach, which allowed us to standardise a test across a very large sample. We found no reliable evidence for any difference in spatial ability between left and right handers, across all countries. Moreover, that large data sample allowed us to confirm that factors like age, gender and education don’t play a part in the relationship between hand preference and spatial ability.”

The users in the study downloaded and played Sea Hero Quest, a free app that measures spatial navigational ability and was originally designed to contribute to research on dementia. It asks participants to view a map featuring both their current position and their goal locations, and they are then asked to navigate a boat as quickly as possible towards goal locations in a specified order. Only participants reaching level 11 of the game were included. Informed in-app consent was obtained from all participants.

Left handers in the sample made up an average of 9.94% of the participants, with more males using their left hand compared with women, similar to what had previously been found in the general population.

Dr Fernandez-Velasco adds: “We’re still finding out so much about cognition, and although we’ve shown that large-scale spatial skills aren’t affected by left and right handedness, perhaps further research will find some differences based on handedness when it comes to navigation styles, or to preferences for different types of environments.”

Families already in crisis facing real terms drop in income, research shows

The cost of living crisis is hitting hardest on low-income families with children, with benefits failing to keep up, says new research from the University of York.

Drawing on the testimonies of over 100 families and analysis by the Resolution Foundation, the researchers show how the crisis is far from over for low-income families as winter approaches.

The new report is published by the Changing Realities project, a collaboration between parents and carers, researchers at the universities of Salford and York, and Child Poverty Action Group.

It calls on the Chancellor to address the crisis facing families in his forthcoming autumn statement, by increasing benefits in line with inflation and ending the freeze on the Local Housing Allowance. The report also calls for an end to one-off, flat rate, emergency payments and for these to be replaced with long-term investment and support.

Ruth Patrick, Professor of Social Policy at the University of York, who leads the Changing Realities project, said: “Our new analysis makes clear just how vulnerable the poorest households are to continued high prices. Those with the least spend the greatest proportion of their income on food, energy and housing, and have completely run out of places to cut back. Families face a constant, daily crisis as they struggle to make ends meet, and are terrified of how they will survive this winter. The Government must act, and uprating benefits in line with inflation is a vital first step to providing families with more security this winter.”

The report shows why low-income families are especially vulnerable to the high prices of essential items and how the cost of living payments paid to date have left them at a disadvantage.

In the year preceding the pandemic, the lowest-income families with children spent nearly half their income on areas where it is almost impossible and detrimental to cut back on spending, such as food, housing, water and electricity. Food costs alone accounted for a fifth of their household income. These areas are also where prices have remained high, with food inflation in September 2023 at 12.2%.

The cost-of-living payments from government to help low-income households have mainly been through one-off, flat rate payments. This means that a single person receives the same as a family of five. Single-person households saw their income rise by 6% thanks to these payments, whereas for families with two or three children, the increase was just 3.3%. Although this enabled the lowest-income families to avoid catastrophic falls in their income in real terms, with no further cost of living payments planned, they are now set to see a real-term fall in income of around 3% this year.

University of York researchers spoke to over 100 parents and carers through the Changing Realities project, funded by the abrdn Financial Fairness Trust. Their testimony underscores the ongoing reality of the cost of living crisis for these families: rising prices, static incomes and the anxiety they feel as they approach another winter, with no remaining areas left to cut in their spending.

Sadie, a mother of three involved in the project, said: “Things are still creeping up.... there are fewer options for making any more cuts now. And as my children get older, there are bigger costs associated with them. It still feels very overwhelming.”

Roxy, another parent taking part in the project agreed: “No bills have come down...Food shopping hasn't come down. We're just having to survive any way we can. It's definitely not getting any better, if not worse.”

The Changing Realities project team worked with the families to develop recommendations for government, including:

• Increase benefits at least by inflation

• Restore Local Housing Allowance, frozen since April 2020, to better reflect market rents

• Replace flat rate and one-off payments with longer-term investments

• Abolish policies such as the two-child limit and benefit cap which punish families with children

Alison Garnhan, Chief Executive of Child Poverty Action Group, said: “On a graph the inflation line is dipping but on the ground there is absolutely no let-up for low-income families and 4.2 million children are living in poverty.  Prices are still rising.   People are deciding now how best to deal with the hunger and cold to come.  A real-terms income cut next April would be unmanageable for these families. The Chancellor must do right by children and commit to an inflation-based benefit increase. To do otherwise would be reckless.”

Invertebrate biodiversity is improving in England’s rivers, long-term trends show

Rivers across England have seen a significant improvement in river invertebrate biodiversity since 1989, shows a study led by UK Centre for Ecology & Hydrology (UKCEH) researchers.

The study, which involved one of the largest and most wide-ranging analyses of long-term monitoring data in the world – spanning over 30 years, found improvements in invertebrate biodiversity across all regions and river types in England.

This improvement is all the more surprising given English rivers are amongst the most highly exposed to wastewater and other pressures in Europe. The recent State of Nature report shows that the overall abundance of species in Great Britain has declined on average by 19%. For terrestrial invertebrates the decline is unequivocal, but this is not the case for freshwater invertebrates.

Published in Science of the Total Environment, this latest analysis adds weight to a growing body of evidence showing that freshwater invertebrate species have been moving towards recovery across England and Europe since the 1990s.

The study analysed data from up to 223,300 routinely collected freshwater records from the Environment Agency across England between 1989 and 2018. The researchers looked at the presence of invertebrate families like dragonflies, snails, mayflies, shrimp and worms which respond to changes in water quality. They examined how the presence and numbers of each family changed over time at each location.

Nationally, the long-term trend is positive. The average number of families of freshwater invertebrates found at each site increased from 15 to 25 between 1989 and 2018. Overall, this is an average 66% increase in the number of invertebrate species observed in England’s rivers over the past 30 years. However, this rate of improvement began to slow for some groups from 2003 onwards.

These trends are seen across every river type, from upland to lowland, from rural to urban, and in areas with low to high levels of arable farming. Rivers with higher exposure to wastewater or pesticides were less rich in invertebrates, yet these sites also showed improvement. Given the universality of this improvement and its timing, which coincide with declines in some key chemical pollutants, these trends across England’s rivers may be linked.

Crucially, the data shows that families that are particularly sensitive to river pollution, like mayflies, stoneflies and caddisflies, are recovering most strongly of all. The diversity of these species improved by 300% overall, rising from an average of 3 families recorded at each site in 1989 to 10 families in 2018. This recovery continued until 2003 when the rate of biodiversity improvement for some other families started to level off.

While there is still room for improvements and there are many local issues still to tackle, at the national scale England’s rivers now provide far better habitats for invertebrates than they did 30 years ago. To an extent where, for some invertebrate species, England’s rivers have reached the target ecological standard for populations to thrive.

Lead author Professor Andrew Johnson, Principal Scientific Officer at UKCEH, said: “Long-term monitoring has shown us a dramatic improvement in the biodiversity of freshwater invertebrates over the past 30 years across all river types at the national scale. Similar trends are also observed across Europe, and in the decades during which changes in legislation around water treatments and restoration projects have been introduced driven by EU policies. This suggests that water quality improvements have been effective at allowing freshwater biodiversity to recover. Since these trends are also observed across Europe, it suggests that water quality improvements, consistent with changes in legislation around wastewater treatments and associated restoration projects, have been effective at improving freshwater biodiversity. The implication is that given good legislation, resources and regulation, we can reverse biodiversity decline.

“We now need to understand more about the role chemical changes or conservation measures have had in achieving this recovery in England’s freshwater invertebrates, and to what degree current levels of pollution affect wildlife in relation to other issues.”

The analysis accounted for geographical factors like latitude, altitude and the slope of the waterway, alongside wastewater exposure and the type of land each river flowed through. It also considered the effect of invasive species, finding the increase in the distribution of such species across the sample sites was only modest and could not on its own account for the overall trend in biodiversity.

The study included researchers from UKCEH and Brunel University London. It was funded by the National Environment Research Council, part of UK Research and Innovation.

Research significantly reduces HIV-linked meningitis deaths in African hospitals

A research project studying how best to implement ‘back to basics’ clinical and laboratory care in public hospitals in three African countries has halved the number of deaths from HIV-linked meningitis. The results are reported in The Lancet HIV today.

A joint European and African research partnership, the DREAMM project worked with local health leaders and healthcare workers, empowering them to design and implement changes to routine care for patients with HIV-related central nervous system conditions: cryptococcal meningitis, tuberculous meningitis, bacterial meningitis and cerebral toxoplasmosis.

DREAMM (Driving Reduced AIDS-associated Meningo-encephalitis Mortality) was funded by the European and Developing Countries Clinical Trials Partnership and by ANRS – IED (ANRS Emerging Infectious Diseases).

The DREAMM project aimed to ensure that all HIV patients with symptoms of meningitis or cerebral toxoplasmosis were diagnosed and treated rapidly and effectively.

Despite the roll-out of antiretroviral therapy, there are still over half a million HIV-related deaths annually in Africa, of which a third are caused by conditions like meningitis that attack the central nervous system. These conditions should be treatable, but lack of diagnosis, the correct drugs and training on how to use these safely mean that many are fatal.

The project consortium researchers worked with the local Ministries of Health and empowered local health leaders, including hospital staff, to put in place rapid diagnostic testing and to ensure that the WHO cryptococcal meningitis treatment guidelines for confirmed cases were followed. Diagnosis involved both bedside point-of-care tests carried out by clinical staff and more detailed laboratory tests.

The project was led by Dr Angela Loyse, a global health expert based at St George’s, University of London, and African health researchers (Drs Cecilia Kanyama, Charles Kouanfack, Saulos Nyirenda & Prof Sayoki Mfinanga). It involved public hospitals in Malawi (Lilongwe and Zomba), Tanzania (Dar es Salaam) and Cameroon (Yaoundé). From Institut Pasteur, Professor Olivier Lortholary (Necker Pasteur Center for Infectious Diseases and Tropical Medicine) was the ‘Principal Investigator Nord’ for the DREAMM Cameroon site, while Research Engineer Aude Sturny-Leclere developed and led the delivery of the DREAMM laboratory training programme.

Dr Loyse said: “By performing diagnostic tests such as lumbar punctures, on admission, the hospitals could get a rapid diagnosis, and then start treatment while the patient was still in the emergency area. This meant that ward care could become more about monitoring than chasing diagnostics. We also had in-parallel lab testing for quality control and to determine diagnoses not immediately clear by the bedside.”

Local healthcare leaders provided training – with support from the St George’s and Institut Pasteur teams – for both frontline healthcare workers and laboratory technicians. The team set up ‘communities of practice’ in each hospital, so experience could be shared between staff and ongoing support provided from healthcare leaders. Virtual ward rounds enabled doctors to discuss difficult cases with a mentorship community of senior doctors, laboratory experts and researchers online.

Dr Cecilia Kanyama, an expert on HIV-related conditions, led the project in Lilongwe, Malawi. She said: “It was really encouraging to see the local leadership so involved and keen to take this on, particularly around the point of care testing. We were just facilitating, but there was excellent involvement of local key players, nurses and clinicians. That is really important to make this kind of intervention sustainable.”

Before the training was provided and the new procedures put in place, the team followed the progress of patients presenting at the hospitals with symptoms of HIV-related meningitis, and found that within two weeks of admission to hospital, nearly half (49%) of these patients had died.

The new, co-designed procedures for dealing with HIV-related meningitis and cerebral toxoplasmosis were put into practice at each site for around 10 months, between January 2018 and March 2021.

The project recruited a total of 365 adults living with HIV who were admitted to hospital with a suspected first episode of CNS infection. Just under a quarter of these patients died (24%) within two weeks of admission, half the rate before the new procedures were put in place.

The researchers are now calling for the project to be urgently scaled up to reduce unnecessary deaths from HIV-related central nervous system infections. This is echoed by African health leaders on the ground.

Dr Kanyama said: “Accessibility to point of care testing is really crucial and every hospital in Malawi should have it. Similarly with medication; tertiary level hospitals have it, but the district hospitals typically won’t. We still have a very long way to go, but we’ve seen what is possible if these resources are made available.”

Dr Loyse added: “We’ve shown that optimising the pathways for diagnosis and treatment of HIV-related central nervous system infections has a high potential to save lives, and that this is feasible in resource-limited settings. Access to essential tests and medicines in public facilities needs to be urgently ensured.”

‘Reduction in mortality from HIV-related central nervous system infections in routine care in Africa (DREAMM): A before-and after- implementation study’ is published today in The Lancet HIV.

Government reneging on food policy plans, say experts

A year after publication of the UK’s 2022 Food Strategy, the Government has abandoned promises to transform the national food system and crucial targets on health, climate and nature will be difficult to meet, a group of eminent food system experts warn.

Writing in Nature Food, five academics from the Universities of York, Sheffield, Reading and Cambridge argue that the Government’s U-turns and lack of ambition on food policy leave the nation increasingly vulnerable to rising food prices, diet-related health conditions, and a decline in biodiversity.

The academics call on the UK’s next government to develop a more coherent, coordinated and collaborative approach to food policy. They propose a new five-point plan to support the UK to transition towards a more sustainable, healthier food system.

The Government’s wide-ranging 2022 Food Strategy focused on long-term measures to support a resilient, healthier, more affordable and sustainable food supply. It was a response to the recommendations set out in the previous year’s National Food Strategy Independent Review, authored by Henry Dimbleby.

In their commentary, the academics note that there have been a series of shelved government policies and reversed decisions since the 2022 Food Strategy was published, despite what they see as a collective will for change across the UK agri-food sector.

Grounded in recommendations from the Dimbleby Review, as well as evidence from several UK Government funded policy research programmes, the five-point plan proposes:

• Setting up a cross-government commission that joins up population and planetary health to make policy decisions about future systems.

• A full economic analysis of the recommendations evidenced in Dimbleby’s review.

• Free school meals made available to all primary school children in England, revolutionising catering in schools.

• Integrating mandatory health and environmental metrics into the Food Data Transparency Partnership. This partnership promotes the use of data when making decisions about the production and sale of healthier and more sustainable food and drink.

• A comprehensive framework for how land should be used for food production, which would help to reverse the UK’s status as the worst-performing G7 country in terms of species depletion.

Lead author Professor Bob Doherty, Dean of the School for Business and Society at the University of York, said: “Although the Government’s 2022 Food Strategy was not as robust as the Dimbleby Review, it was a critical step in the right direction. Just one year later, Government have reneged on their responsibility to implement change across the whole agri-food sector. We are now seeing a gradual decline in food security, diet, soil health and biodiversity. To prevent the UK falling further behind other G7 nations, we need action to tackle diet-related health, improve school meals for the 800,000 children in poverty, increase the consumption of fibre, fruit and vegetables, and to better measure the environmental impacts of food production so the UN goals on Net Zero greenhouse gas emissions can be met.

“Rather than stalling and making U-turns, if the UK Government implemented their own food strategy it would boost our agri-food sector and save the country a lot of money in terms of GDP, as well as improve the health of soil and make a valuable and long-term contribution to human and planetary health.”

Benchtop NMR spectroscopy can accurately analyse pyrolysis oils

A team of researchers at Aston University has demonstrated that benchtop spectrometers are capable of analysing pyrolysis bio-oils just as well as far more expensive, high-field spectrometers.

Bio-oils resulting from the intense heating (pyrolysis) of industrial or agricultural by-products, are increasingly seen as potential alternatives to fossil fuels. But the stability and consequent treatment of these bio-oils depends entirely on their composition; and since they are often mixtures of many dozens, or hundreds, of different compounds, analysing such complex mixtures is not simple – or cheap.

Dr Robert Evans, Senior Lecturer in Physical Chemistry at Aston University, explains: “The composition of any pyrolysis bio-oil is absolutely key to future use. For example if there are oxygen-containing chemicals in the oil, that will make the oil more corrosive and it will be more unstable. So in particular we need to know if carbonyl groups are present – where oxygen and carbon atoms are bonded together – as these can have a major impact.”

A leading method of analysis is high-field nuclear magnetic resonance (NMR) spectroscopy, which gives a detailed breakdown of the identity and concentration of chemical species present in any sample. However these large high-field NMR spectrometry machines cost in the range of £600,000-£10million and require a supply of expensive cryogens and solvents, so are generally only found in the very biggest research facilities.

The team at Aston, led by Dr Evans, set out to see if ‘low-field’, or benchtop, NMR spectrometers, could analyse pyrolysis oils well enough to produce the necessary detailed information. Benchtop NMR spectrometers use permanent magnets, which don’t require cryogenic cooling, so cost much less to purchase and maintain. However, using lower strength magnets comes at the cost of lower sensitivity and poorer resolution. While they can find some use as research instruments, they are also commonly found in teaching laboratories.

The study, carried out with collaborators at the University of Tennessee, tested pyrolysis oils produced from a number of different plants, and compared the results from benchtop spectrometers to both high-field spectrometers and other methods of analysis. They found that the benchtop machine estimates compared favourably with titration analysis for overall carbonyl content, as well as matching high-field spectrometry for the specific identification of carbonyl groups such as ketones, aldehydes and quinones.

Dr Evans said: “Despite the known limitations of benchtop spectrometers, a very similar quality of NMR data could be obtained for these samples, enough to accurately estimate concentrations of different classes of carbonyl-containing species. Using benchtop spectrometers will make NMR analysis of pyrolysis oils much simpler, cheaper, and more accessible to a wider range of different users.”

Quantitative Low-Field 19F NMR Analysis of Carbonyl Groups in Pyrolysis Oils is published online today in ChemSusChem, a journal of Chemistry Europe.

Cautious welcome to UK’s new Biomass Strategy

A group of bioenergy experts have welcomed the Government’s new UK Biomass Strategy, but say urgent action is now vital to shape its ambitions into deliverable policies.

Researchers at the Supergen Bioenergy Hub – led by Aston University – worked closely with government departments to provide scientific evidence to inform the strategy, which outlines the role biomass will play in supporting the UK’s transition to net zero and how this will be achieved.

Professor Patricia Thornley, who leads the Hub, says: “This is a comprehensive and considered biomass strategy that, rightly, places sustainability at the heart of UK bioenergy development. The challenge is now to produce actions that can deliver the sustainable system of biomass required to achieve net zero.”

Sustainability is a major theme within the new strategy. It includes a review of how existing sustainability policies could be improved, as well as a commitment to developing a cross-sectoral sustainability framework (subject to consultation) to ensure sustainability across the many different applications of biomass. This follows previous work led by Dr Mirjam Rӧder, Systems Topic Group Lead in the Supergen Bioenergy Hub, calling for harmonised sustainability standards across different biomass applications, which is referenced in the strategy.

Dr Rӧder says: “We need rigorous approaches to sustainability governance that go beyond emissions. Considering wider environmental, social and economic trade-offs is essential for true sustainability and building trust in bioenergy projects.”

The strategy considers the amount of biomass resource that might be available to the UK in the future, highlighting the importance of both imported and domestically produced biomass resources. Professor Thornley comments: “It is important that the strategy recognises the potential of imported as well as indigenous biomass in achieving global greenhouse gas reductions. Sustainable systems should grow, convert and use biomass in the locations where they can deliver most impact, ensuring we take account of all supply chain emissions. We shouldn’t shy away from imports where the source is sustainable and the overall system makes environmental, economic and social sense.”

The strategy also considers how biomass should be prioritised across a variety of applications to best support the transition to net zero. Biomass applications ranging from transport fuels and hydrogen to domestic and industrial heating are recognised as important, but in the medium to long term the focus is on integration of bioenergy with carbon capture and storage (BECCS).

BECCS is an emerging technology where the CO2 that may be released during the production and use of electricity, fuels or products derived from biomass is captured and stored, potentially resulting in negative emissions.

Professor Thornley comments: “The priority use framework outlined in the Biomass Strategy makes eminent sense. The UK (and the global energy system) needs carbon dioxide removals to deliver net zero. BECCS has an absolutely key role to play, as reflected in the strategy. Again, while this is encouraging to see, we must not underestimate the challenges of moving towards such a radically different system at scale.”

“Relying on future BECCS deployment alone to counterbalance the current excess of greenhouse gas emissions would not enable the full potential and benefits of BECCS. BECCS should be deployed alongside measures to transition away from the use of fossil fuels, not instead of them,” adds Dr Joanna Sparks, Biomass Policy Fellow at the Supergen Bioenergy Hub, who engaged closely with government departments as they developed the strategy.

Dr Sparks led an extensive policy engagement and knowledge transfer process to ensure that those developing the strategy had full access to the breadth and depth of UK scientific and engineering academic expertise, ensuring a robust, independent scientific base.

Professor Thornley believes continued engagement between policymakers, academics and the wider sector is vital in achieving the next steps in the delivery of the Government’s strategy. She says: “The key to successful long-term results is a close partnership between academia, industry and policy stakeholders so that we can anticipate problems and plan the pathways to success.”

ChatGPT could free doctors to spend more time with patients

Artificial intelligence could be used to free up hospital doctors and surgeons from repetitive paperwork so they can spend more time with patients, according to a new trial.

Doctors have used the online AI programme ChatGPT to write detailed surgical discharge letters that give information to patients and their GP about their care after procedures.

The AI-written letters were deemed to be almost indistinguishable, and in some cases were classed as better in terms of the medical information they contained, than real hospital letters written by humans.

It raises the potential for discharge letters, which NHS doctors tend to write out individually for each patient in many hospitals, to be automatically generated using AI.

The study is being presented today (12 July 2023) at the first ever Health and Care Analytics Conference, which is taking place in Birmingham on 11-12 July.

Dr Chris Bodimeade, a Core Surgical Trainee in South East England, who led the work, said: “I am half way through my core surgical training and one of the frustrations I have with the NHS is the amount of time I have to spend on a computer.

“Doctors are increasingly becoming tethered to a computer doing mundane and repetitive paperwork tasks rather than spending time with patients. But at the same time I’ve been excited by the development of AI technologies like ChatGPT, so I wondered if there was a way of using it to make some of these tasks easier.”

Surgical discharge letters for routine operations usually contain a summary of the treatment a patient has received during their stay in hospital, alongside any potential complications and how their care should be managed after they leave hospital.

Dr Bodimeade decided to ask ChatGPT to write a surgical discharge letter for two hypothetical patients who had undergone an elective tonsillectomy. To generate the letters, he gave the AI chatbot the simple instruction: “Please write a hospital discharge letter for patient undergone a tonsillectomy.” No patient information was included.

He then showed the resulting letters to 19 other consultants and doctors at his current hospital alongside two real letters written for patients that had been anonymised. The doctors and surgeons found the letters indistinguishable and one of the letters was on average rated to contain better medical information and was easier to read than the real discharge letters.

Dr Bodimeade said that while his study was small, he hopes it might lead to greater exploration of how artificial intelligence might lighten the workload of NHS staff.

He stressed that any letters would all still need to be checked by a doctor before being sent and said colleagues in other surgical departments were already conducting their own experiments to use ChatGPT to write discharge letters.

He said: “I’m hoping this work can open up a discussion about how technology that is freely available can be used within the confines of confidentiality and patient safety to make our jobs much more efficient and improve a service that is under tremendous stress.”

Machine learning helps manage demand for emergency beds

New machine learning technology can use real-time A&E data to predict how many patients will need an emergency bed later that day, in which part of the hospital.

The technology is being presented today (11 July 2023) at the inaugural Health and Care Analytics (HACA) conference.

The tool was developed by a team of analysts and hospital staff at UCL and UCLH. It is now being used by operational staff at UCLH to forecast how many emergency beds will be needed within the next eight hours, and where: surgical, medical, haematology and oncology, or paediatric departments. Early tests suggest the tool is better at predicting bed demand than standard methods.

Many UK hospitals are currently operating at capacity, which means planned surgeries can be cancelled last-minute if the demand for emergency beds is high. By predicting short-term fluctuations in capacity across the hospital, the tool can help operational staff ensure there are enough beds in each department to minimise impact on patients.

Dr Zella King (Clinical Operational Research Unit at UCL), who co-developed the technology, said: “Our research demonstrates the potential of machine learning and data in the day-to-day operation of hospitals by looking for patterns in real-time patient data and supporting hospital staff to plan accordingly. Hospital capacity is affected by many systemic factors and we’re not suggesting machine learning is a magic bullet to fix this complex challenge. But it’s fantastic that our tool is making a meaningful difference to the day-to-day running of UCLH.”

Co-author Craig Wood (Clinical Operations Manager at University College London Hospitals NHS Foundation Trust (UCLH)) said: “Managing the flow of patients around the hospital is the continuous, careful balance of patients who are in for elective treatment with people in A&E who need a bed as an emergency. Since implementing the tool at UCLH, we’ve been able to make targeted actions to free up beds in specific areas of the hospital, improving our ability to manage hospital capacity.”

As patients move through A&E, the machine learning tool incorporates additional data – like vital signs, blood test results and whether a patient is to be examined by specialist doctors – and updates its forecast every 30 minutes. It also predicts how many people will enter the emergency department and need a bed within 8 hours, assuming the A&E department is meeting its targets for wait times. The team trained the tool to do this using electronic health records from more than 166,000 patients who visited A&E between August 2021 and August 2022.

“Machine learning could be a powerful tool to support hospital operational staff, but its outputs have to be both actionable and aspirational,” said Dr King. “At HACA, we’re sharing what we’ve learned from working as a close team of analysts and hospital staff. We hope our insights will be helpful for others thinking about adopting similar approaches at their hospitals.”

The research builds on the team’s previous work, published in the open access journal npj Digital Medicine in 2022, when the tool could predict the total number of emergency beds needed in the next 8 hours, but couldn’t yet break this number down by department.

Mental health of children suffered during pandemic

The scale of the mental health crisis among children during the Covid-19 pandemic has been revealed by new analysis of NHS data.

Prescriptions for mental health conditions among children in the north-east of Scotland were 59% higher in 2021 compared to six years earlier, according to the research. Prescriptions rose by 24% between 2020 and 2021 alone.

Referrals of children to see outpatient mental health specialists increased by 9% between 2015 and 2021, but rose steeply since the pandemic. The most pronounced rise in referrals was among teenage girls which were 35% higher in 2021.

The results are due to be presented at the first ever Health and Care Analytics Conference, which is taking place in Birmingham on 11-12 July.

While the study examined data from mental health services for children aged 2-17 years old in the Grampian region of NHS Scotland, the researchers say the findings reflect similar trends in other parts of the UK.

“There has been a lot of concern about children’s wellbeing post-pandemic and the data does seem to reflect this,” said Dr Jessica Butler, Lead Data Scientist for NHS Grampian and a Senior Research Fellow at the University of Aberdeen, who led the study.

“The rate of referrals of children to specialists was steady pre-pandemic, but we see a rise post-lockdown. It’s clear that it is steepest among the older children, and particularly older girls, where we see the biggest rise in referrals.”

The research also highlighted other differences between the sexes, ages and residential areas. For example, the rate of prescribing and referrals to specialists in the most deprived areas was double that in the least deprived. Prescriptions of mental health drugs to boys were twice as high as those for girls, with the majority of the drugs being given to young boys to treat ADHD. The prescription rate to girls, however, rose steeply after puberty, mainly to treat depression.

The study highlights just how useful information within NHS databases can be to identify potential changes in patient need and help health services allocate resources, but also reveals its limitations.

Dr Butler and her team were able to examine anonymised data contained within NHS Scotland databases in the Grampian region for their research. But they said this only reflects one side of those dealing with children who are struggling with their mental health. Local authorities, social workers, teachers and police will also support children.

Butler and her team have created software that is freely available to allow other NHS services to carry out their own analysis.

The research was conducted as part of a project by the Health Foundation’s Networked Data Lab examining children and young people’s mental health in England, Scotland and Wales. Five teams around the country used anonymised, high security data held in their local NHS databases.

The full research being presented at the conference was published earlier this year in BMC Psychiatry: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-04438-5

NHS geospatial app saves vital staff time

NHS Trusts could help staff plan their journeys more efficiently and cut their impact on the climate with software that can help district nurses and health visitors plan their journeys more efficiently.

Data scientists from NHS England’s Digital Analytics & Research Team and engineers from Google Health collaborated to develop a web app that can optimise routes between locations. This can help to reduce the amount of fuel used when making health visits or by ambulances that have a series of patient drop offs to do. As well as saving money and cutting carbon emissions, it can also mean health workers spend less time travelling between visits, giving them more time to spend with patients.

It is due to be presented at the first ever Health and Care Analytics Conference, which is taking place in Birmingham on 11-12 July.

“District nurses can be visiting multiple patients in their homes each day, so we wanted to find a way for them to plan the most efficient route to get to the patients,” said Paul Carroll, senior data scientist at NHS England’s Digital Analytics Research Team, who led the project.

“If they have 10 appointments in a day, there could be 3.6 million different routes they could take. If there are 12 addresses to visit, that becomes 479 million permutations. These are difficult problems to solve and we wanted to be able to do it in a way that could be done an average laptop computer.”

Currently, many NHS trusts rely on third party companies to provide routing information.

Mr Carroll and his team, who were working as part of programming community called NHS-pycom, developed the code in an open-source app framework called Streamlit so that analysts at NHS trusts could adapt it to their requirements. This could help to overcome potential data privacy issues as the patient information would not have to be sent to a third party or uploaded to a server.

In the case of district nurses, they could use the app to plot routes between up to 12 addresses and display them on a map, taking into account the distance between each one, driving times at peak and off-peak hours, walking time and cycling time.

“The idea is they can spend less time travelling and more time with patients,” said Mr Carroll.

The app has two additional functions which were developed in response to unmet needs identified by NHS Trusts. One suggests the shortest route that staff and patients might be able to take to reach a hospital or other health service. This could be used to help reduce the climate emissions as they travel to work or to help patients find which service is closest to them. Although this initially used driving and walking data, Mr Carroll said it could be expanded in the future to include public transport and cycle routes.

The second tool was designed to show the best location for services such as a vaccination centre or mobile blood test unit to ensure they can cover as much of the population in an area as possible. This took into account travel time and local authority population data and was a simplified version of something that many retailers already use to find the best place to locate a new store that is accessible by as many people as possible and away from competitors.

“Geospatial needs within the NHS are everywhere, from ambulance patient drop-offs to where to site a new GP practice within your community,” said Mr Carroll.

Multiple factors delay timely endometriosis diagnosis, study shows

New research from Aston University has uncovered reasons why endometriosis, one of the most common and debilitating gynaecological conditions, takes an average of 8 years to be diagnosed by medical professionals.

Reviewing qualitative studies from the past 20 years, the researchers found a range of contributing factors including: a continuing stigma around periods; society’s normalisation of menstrual pain; and a lack of medical training about the condition.

Endometriosis, which affects 10% of women globally and 1.5 million women in the UK alone, is caused by endometrial (womb) tissue growing outside the womb. It’s extremely painful, exhausting, interferes with daily life and can lead to infertility if untreated.

The researchers found that women in the studies often weren’t sure if their pain was unusual or severe enough to seek treatment. When they did, some found that their GP was doubtful, or even dismissive of their symptoms. GPs in two of the studies themselves admitted that they found it difficult to differentiate problematic pain from ordinary menstrual symptoms.

Dr Sophie Davenport, who led the research and is now working as a doctor in the NHS, says: “Society has traditionally normalised period pain, so we need to rethink what constitutes ‘non-normal’ periods. If symptoms are affecting daily life, where the woman is not going to work or school, or unable to carry on a social life, that’s a clear sign that medical intervention is needed”.

Many GPs in the studies reviewed mentioned a lack of knowledge about endometriosis, with some saying they’d had scant training in medical school about it. Endometriosis symptoms can vary widely and overlap with other common conditions, so the signs can be difficult to spot.

Dr Davenport says: “Given the numbers of women affected, we think there should be additional, mandatory training about menstrual conditions during medical school. At present, as little as 4 weeks out of 5 years of medical training may be spent on gynaecology; and during that time, endometriosis may barely be mentioned. Given that 1.5 million women in the UK are affected, we think it’s time to prioritise this.”

Even if suspected, the definitive method of diagnosis has been by laparoscopy under general anaesthetic, so some practitioners have been reluctant to order such an invasive procedure. However recent ESHRE guidelines now recommend a two-step approach in which treatment is started more quickly, based on clinical suspicion and MRI/ultrasound imaging, rather than waiting for laparoscopic findings. Supervising author Dr Dan Green, Senior Teaching Fellow at Aston University’s College of Health and Life Sciences, adds: “It will be interesting to see if these new ESHRE guidelines affect the existing time to diagnosis, and can improve patients’ experiences in future.”

Emma Cox, CEO of Endometriosis UK, comments: “We hear many stories at Endometriosis UK evidencing the points this research highlights. The study underlines once more that those with suspected and diagnosed endometriosis are being consistently let down. I urge Government to use these findings to drive forward real action towards ensuring greater, faster and easier access to medical professionals with a specialist interest in endometriosis across England, Scotland, Wales and Northern Ireland.”

She continues: “It’s important that women experiencing chronic pelvic pain or other symptoms of endometriosis speak to their GP, and when they do they should expect to be listened to, believed and understood. We have heard many stories of such symptoms being shrugged off as ‘normal’, ‘not serious’ or ‘just part of being a woman’. These attitudes are changing, but sadly we still have some way to go.”

‘Barriers to a Timely Diagnosis of Endometriosis: A Systematic Review and Qualitative Synthesis’ will be published in ‘Obstetrics & Gynaecology’ on July 6 2023.