NIHRDataInsights/HRCSData huggingface dataset:
Title: Medical Encounters for Sports Injuries: patient's perceptions and social costs.
Funder: Wellcome Trust

Abstract: This research provides a preliminary assessment of the exercising public's sport-related illness experiences and interaction with medical care providers. While increased physical activity has been identified as a central tool in reducing the risks of developing, and in the rehabilitation from, a wide range of non-communicable diseases, epidemiological data suggest that physical activity also has significant health costs. Moreover, qualitative studies indicate that athletes' performance demands c reate a distinct cultural context for the practice of sports medicine (broadly defined), and that athletes frequently express dissatisfaction with the medical treatment they receive from public healthcare providers. Consequently, this research investigates the patient experience of various forms of treatment for sports injuries including ethnopharmacology, lay-guided medical treatment (sourced both interpersonally and online), general practice, emergency medicine and various private (e.g. sports physiotherapy) and complementary and alternative medicines (e.g. chiropractic, Ayurveda, acupuncture). In so doing it examines the impact of sport-related injury on daily living (work absenteeism, exercise withdrawal), social relationships, identity and sense of self. It therefore illustrates how engagements with medicine coalesce with social and environmental factors to mediate the health promoting lifestyle choice to exercise.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: INJURIES AND ACCIDENTS
Title: Stimulating recovery - can cognitive deficits after traumatic brain injury be improved by non-invasive brain stimulation?.
Funder: Wellcome Trust

Abstract: Traumatic Brain Injury (TBI) happens when the brain is damaged by physical injury, and is very common. TBI patients often have long-term concentration problems, which can result in serious consequences such as job loss. Despite the devastating impact of this condition, there is currently no effective treatment. My research aims to develop a new, effective treatment. In healthy brains, different brain regions communicate with each other, forming brain networks. TBI disrupts communication betwe en brain regions, which impairs brain network function and leads to patients concentration problems Studies show that transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique, can affect brain network function. I will investigate if tDCS can actually improve brain network function and, through this, alleviate concentration problems in TBI patients. My study will show whether and also how tDCS works. This is important because successful clinical application r equires an understanding of the way tDCS works. The use of tDCS in TBI has only been superficially studied. Its effects on brain networks in TBI have never been studied. Therefore, my research is highly original, with the potential to make a significant contribution to the clinical treatment of TBI patients.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: INJURIES AND ACCIDENTS
Title: Development of a clinical decision tool to aid in the identification of cases of major trauma from emergency calls to an Ambulance Service in the United Kingdom.
Funder: Department of Health (England)

Abstract: Patients with severe traumatic injuries may benefit from specialist interventions from physician-led teams before arrival at hospital. Limited availability of specialist Pre-hospital care resources necessitates early identification of appropriate cases to allow targeted deployment to incidents where they will have the greatest impact. This PhD will improve identification of incidents involving patients suffering severe injuries from 999 calls to a UK Ambulance Service. Ambulance Service and national trauma registry data will be analysed. Internationally accepted methodologies, supplemented by decision tree analysis, will be utilised to derive and validate a clinical decision tool to identify major trauma cases from 999 calls.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: INJURIES AND ACCIDENTS;DISPUTED AETIOLOGY AND OTHER
Title: Losing face? Living with disfigurement in medieval Europe.
Funder: Wellcome Trust

Abstract: This project will explore a substantial range of medieval text-based sources for incidents of deliberate cranio-facial mutilation in the period c. 500- c.1250. The first strand of the project asks how and when the face became a target for deliberate injury, why it did so and what happened to the victims of such injuries afterwards. Were their injuries survivable? Were they disabling? Would they need special care and where would this be found? The second strand of the project explores responses t o those who lived with disfigurement: were they marginalised because of their appearance or new impairment? Were those who had received injuries as judicial punishments treated differently from those accidentally maimed, or with congenital facial conditions? Or was facial impairment so common (e.g through leprosy or other disease) that it provoked little reaction from those among whom the maimed lived? As well as gathering data from the medieval sources, the project applies modern approaches fro m ENT clinicians, anthropological work on traditional societies and the insights provided by the aesthetics of visual culture to explore the possibilities of living with disfigurement in the Middle Ages.


Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION
Health categories: INJURIES AND ACCIDENTS;DISPUTED AETIOLOGY AND OTHER
Title: Encapsulated phage for treatment of burns and wound site infections
Funder: Engineering and Physical Sciences Research Council

Abstract: This project, in partnership with Biocontrol Ltd and the departments of Chemistry and Chemical Engineering at the University of Bath, will encapsulate specific lytic phages within phospholipid vesicles, and incorporate the vesicles into a prototype burn / wound dressing and a topical aqueous cream. The primary focus of the work is in the prevention of infection of paediatric burns, where our clinical partner, dr Amber Young at the South West Paediatric Burns Centre, Frenchay hospital will provide expertise. The vesicles will be designed such that they both will stabilize the phage over time i.e. when stored, but only release their contents following exposure to secreted toxins and enzymes from pathogenic bacteria. The aim of this project is to reduce the risk of infection from burns and other injuries by making a 'smart' dressing, based on phage therapeutics.38,000 children on average suffer burn injuries in England and Wales each year, of which 55% are scalds. Most are small in area, 80% are in children under five years and the majority are due to hot drink spillages. One of the primary problems in the treatment of burns is bacterial infection, which can delay healing, increase pain; increase the risk of scarring and in some cases cause death. In recent years there have been great improvements in the treatment of burns, particularly with biologically-derived dressings which actively promote cell growth. However, the problem of infection has not gone away, and there is evidence that silver treated antimicrobial dressings can delay burn healing.


Research activity codes: 5.1 PHARMACEUTICALS;5.3 MEDICAL DEVICES
Health categories: INJURIES AND ACCIDENTS;INFECTION
Title: Defining the pathophysiology of snakebite induced local tissue damage and evaluating tolerance of a repurposed orally administered venom inhibitor
Funder: Wellcome Trust

Abstract: Snakebite is a priority neglected tropical disease and has been under-researched, particularly in sub-Saharan Africa. The numbers who suffer snakebite are often under-appreciated, as many victims do not attend hospital. We will survey people in the community to identify the number of bites per year in Kilifi, Kenya. At Kilifi County Hopsital, relatively detailed information about snakebite cases has been collected, and this will be analysed to identify the burden of disease. All new cases of snakebite presenting to Kilifi County Hospital will be invited to enrol in an observational study. This observational study will aim to uncover the important biting species of snake, the rates of skin damage and to explore the underlying causes of skin damage. Many snake venoms contain “SVMP” toxins. These need zinc in order to function. SVMPs can damage blood vessels and interfere with normal blood clotting, and this can lead to bleeding. Unithiol has been used to treat heavy metal poisoning, but recently it has been shown to prevent death in mice following snakebite. We plan to give this drug to healthy volunteers in Kenya, in order to understand its safety, and to decide what dose is best to give in future research studies.


Research activity codes: 5.1 PHARMACEUTICALS
Health categories: INJURIES AND ACCIDENTS;INFECTION
Title: A Rapid and Substantial Increase in Supplies of an Effective, Safe and Affordable Antivenom to sub-Saharan Africa
Funder: Wellcome Trust

Abstract: The project will be directed by MicroPharm and will include contributions by scientists at the Liverpool School of Tropical Medicine. It is in direct response to the WHO's stated aim of reducing the mortality and morbidity of snake envenoming. The aim of the project is to re-establish supplies of Fav-Afrique in its current format as an equine F(ab’)2 based antivenom suitable for the treatment of Category 1 venomous African snakes. Sanofi-Pasteur will continue to supply large pools of plasma from horses immunised with venoms from Echis, Bitis, Naja or Dendroaspis species respectively. The manufacturing procedures will be modernised and simplified to increase yield and decrease cost. Initial supplies will be available for clinical use in Africa by 2023.


Research activity codes: 5.1 PHARMACEUTICALS
Health categories: INJURIES AND ACCIDENTS;INFECTION
Title: The Bacillosensor: A Bacillus subtilis whole-cell arsenic biosensor for field use.
Funder: Wellcome Trust

Abstract: Our aim is to construct a whole cell arsenic biosensor field kit for water testing based on the bacteria Bacillus subtilis. Using an engineering approach (iterative design cycle) we have three primary objectives: 1) to construct a genetic system for Bacillus subtilis that selectively detects bioavaliable arsenic at/below WHO safe levels 2) to construct a multiply disabled B. subtilis strain as a ?chassis? for the the genetic circuit and 3) to construct a low cost, simple, environmentally friendly container for the biosensor. Three main genetic circuit devices will be constructed. The first is an arsenic sensing device based on the B. subtilis arsenic operon, specificially the arsR repressor/promoter. The second device is a transcriptional amplifier to boost weak transcriptional signals to induce gene expression. The third device is a reporter based on the violacein operon. The VioABE enzymes make a green pigment from tryptophan and the VioC enyme converts the green pigment to violet. Two arsenic sensing systems will be constructed: the first responds to low levels of arsenic by signal amplification (below WHO level) and the second will be tuned to only respond to relatively high arsenic levels (just at or above WHO safe level). Thus green=safe and violet=unsafe.


Research activity codes: 3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS;4.5 RESOURCES AND INFRASTRUCTURE (DETECTION)
Health categories: INJURIES AND ACCIDENTS;INFECTION
Title: Fractures in Sub-Saharan Africa: epidemiology, economic impact and ethnography
Funder: Wellcome Trust

Abstract: Sub-Saharan African (SSA) already has twice the number of older adults than northern Europe, with life expectancy rising rapidly. Ageing exponentially increases fracture risk. The WHO have called for action to prevent and manage fragility fractures in SSA in the next decade; there is an urgent and compelling need for research to inform actions to improve healthcare provision. We will establish vertebral fracture prevalence (the commonest fragility fracture), hip fracture incidence (the most life-challenging fragility fracture) and, over 12-months, their impact on survival, disability and health costs. We will examine the contribution of risk factors of importance in the context of SSA, e.g. HIV, body composition. Ethnographic research will inform understanding of fracture care pathways, patient’s beliefs, patterns of health service delivery and factors influencing implementation of fracture services. To ensure success, our collaboration encompasses international expertise in epidemiology, health economics, anthropology/qualitative methodology, HIV medicine, orthopaedic surgery, gerontology, skeletal imaging, and country-specific research experience within Gambia, Zimbabwe and South Africa. This application builds on our recently-completed South African hip fracture incidence study. The myth that fragility fractures are not an African problem is out-dated; high-quality research is needed, to enable a response to the WHO’s call to be realised.

Lay abstract: Background Africa is changing rapidly: people are living longer which brings risks e.g. fractures. Fractures cause pain, disability and sometimes death. HIV infection increases fracture risk and hampers recovery. Fractures strain healthcare services and are expensive. For countries to plan healthcare services they need to understand the scale of the problem and its costs and the resources currently in place. Approach In South Africa, Zimbabwe and The Gambia we will establish how frequently two key age-related fractures occur: spine fractures (the commonest) and hip fractures (the most life-challenging). We will assess recovery, disability and death rates following hip fracture, identifying factors that improve outcomes. We will calculate current and future health service costs for fractures. By talking with patients and healthcare workers we will learn of their experiences, understanding how future care can be improved. Impact Greater understanding of fracture care will inform health service policy and planning in Africa.

Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION
Health categories: INJURIES AND ACCIDENTS;INFECTION;MUSCULOSKELETAL
Title: The potential role of pro-resolving lipid mediators for the treatment of tendon inflammation.
Funder: Arthritis Research UK

Abstract: Recent research reveals that inflammation contributes to the pathogenesis of tendinopathy. I have shown that injured equine tendons mount a counter-response to inflammation known as resolution, producing the pro-resolving lipid (LXA4) and upregulating the pro-resolving receptor FPR2/ALX. The response to inflammation varies both with injury stage and with age. I hypothesise that the duration and magnitude of the resolution response after tendon injury can be insufficient and dysregulated; thus inflammation perpetuates and a fibrogenic repair ensues. Whilst resolution has been extensively studied in experimental models of systemic murine inflammation, it is not well characterised in diseased human connective tissues such as injured tendons. Pro-resolving lipids and proteins represent attractive potential therapeutic targets to treat tendinopathy due to their capacity to simultaneously modulate inflammation and potentiate resolution._x000D_ _x000D_ Key goals:_x000D_ _x000D_ 1) Investigate the resolution response of pathological human rotator cuff and Achilles tendons. Does resolution diminish with ageing as described in equine tendinopathy?_x000D_ _x000D_ 2) Determine if relationships exist between tendon inflammation, resolution and pain._x000D_ _x000D_ 3) Explore the therapeutic potential of pro-resolving mediators (immunoresolvants) to treat tendinopathy.


Research activity codes: 5.1 PHARMACEUTICALS;2.1 BIOLOGICAL AND ENDOGENOUS FACTORS
Health categories: INJURIES AND ACCIDENTS;INFLAMMATORY AND IMMUNE SYSTEM
Title: THE ALLOSTATIC LOAD MODEL AS A PREDICTOR OF OUTCOME FOLLOWING HEAD INJURY
Funder: Chief Scientist Office (Scotland)

Abstract: Head injury accounts for the majority of trauma deaths in young adults (Tagliaferri et al, 2006), and disability after head injury is common (Thornhill et al, 2000). There is also an increased risk of developing Alzheimer's Disease (Fleminger et al, 2003) and there is an association between head injury and an increased risk of death for at least 13 years after hospital admission, independent of age, gender and social deprivation (McMillan et al, 2011). It is also clear that late outcome after head injury is only partly explained by severity of injury and demographic factors (Whitnall et al 2006). A recent PET binding study suggested a chronic inflammatory response following head injury (Ramlackhansingh et al, 2011). However it is not yet understood whether or how inflammatory processes relate to health outcome. 'Allostatic Load' conceptualises the development of disease within the context of accumulated physiological stress, described as developing from cascades of physiological deregulations in response to stress (McEwen, 1998), and might explain the heterogeneity of outcome after head injury. The proposed research would calculate Allostatic Index (AI) scores at different time points following head injury in relation to health outcome. A chronically high AI following head injury might explain why some patients fail to recover, or die young. If AI at injury is a good predictor of later health outcome it could be used to focus interventions for at risk sub-groups in terms of education, rehabilitation, and support.


Research activity codes: 4.1 DISCOVERY AND PRECLINICAL TESTING OF MARKERS AND TECHNOLOGIES;2.1 BIOLOGICAL AND ENDOGENOUS FACTORS
Health categories: INJURIES AND ACCIDENTS;INFLAMMATORY AND IMMUNE SYSTEM
Title: The efficacy and cost effectiveness of a falling prediction and prevention programme in older patients with rheumatoid arthritis
Funder: Department of Health (England)

Abstract: Background Rheumatoid arthritis (RA) affects 0.8% of the UK adult population and results in significant morbidity and increased healthcare costs. Older people with RA are uniquely prone to osteoporosis and osteoporotic fractures resulting from falls, which have a sizeable contribution to both morbidity and mortality from the disease. No falling prevention programme that is tailored to the needs of older people with RA has been developed or tested. This study aims to identify risk factors that contribute to falls in RA and develop a care package to reduce the risk of falling in these patients. Aims The study aims: • To provide the first detailed prospective assessment of fall-related risk factors in older patients with RA; • To develop a falling prevention strategy that is tailored to the needs of older people with RA, taking into account their experiences and self-perceived healthcare needs; • To perform a pilot study in older patients with RA to assess the acceptability and feasibility of the intervention package and refine it; • To design a protocol of randomised control clinical trial (RCT) for the further assessment of the clinical- and cost-effectiveness of the package. Plan of Investigation This will be carried out in a cohort of older patients (? 65 years) with RA attending outpatient clinics in Norfolk & Norwich University Hospital (NNUH). 1. Longitudinal data on the risk factors and incidence of falls will be collected by questionnaires and postcard surveillance to determine the chief predictors of falls in RA. 2. A sample of fallers and non-fallers will undergo a full clinical and neuro-physiological assessment. A qualitative study will explore their experiences and views on falls and the associated preventive measures. 3. Based on above findings, a structured falling prevention package will be developed and pilot tested in older patients with RA. The study will produce a protocol for a RCT to assess the clinical- and cost-effectiveness of the care package. Potential Impact The objective knowledge of fall-related risk factors in older patients with RA and a tailored intervention package based on these findings will provide unique guidance on falling prevention for these patients. This will be of direct and tangible benefit to older patients with RA for whom the incidence of fractures will be reduced. The results of this study will have the potential to change clinicians’ attitudes towards falling prevention in these patients and lead to better and cost-effective clinical care for those who have the condition. A key output will be a protocol for a RCT.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: INJURIES AND ACCIDENTS;INFLAMMATORY AND IMMUNE SYSTEM
Title: What is the burden of alcohol-related problems on Accident and Emergency Departments (AED)?: An epidemiological analysis of the prevalence of alcohol use disorders (AUDs) within the AED setting and the impact of clinical interventions in reducing this burden
Funder: Department of Health (England)

Abstract: Alcohol Use Disorders (AUD) are linked to health problems and currently cost the NHS £2.7bn per year. The Government is committed to reducing alcohol related harm and reduce the rate of alcohol related hospital admissions, yet there is no reliable national information on the burden of alcohol problems in Accident and Emergency Departments (AED). This research will estimate of the burden of AUD on AED through secondary analysis of existing data sets. This should have relevance for the development of alcohol policy in England. As many alcohol interventions are nurse delivered, this will have implications for the nursing role within AED.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: INJURIES AND ACCIDENTS;MENTAL HEALTH
Title: Improving quality of life after spinal cord injury: design and evaluation of an intervention
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Previous research, including a systematic literature review by the PhD applicant has revealed that the quality of life among people with spinal cord injuries (SCI) who have left rehabilitation centres in Wales and across the UK can be very low and depression and anxiety are frequently high. Based on the literature and in response to communication with members of the Spinal Cord Injuries Association (SIA) and individuals with SCI, there appears to be a consensus that a peer support group could be beneficial to the quality of life of those with SCI and reduce social care needs.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: INJURIES AND ACCIDENTS;MENTAL HEALTH