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LifeLines 20 Apr 2016

This is the expansion of a project supporting volunteers aged 50 plus to run activities for vulnerable older people to improve health and well-being. These have previously included art classes, creative writing, yoga and computer club. The group will expand across the city, recruiting more volunteers, supporting more than 800 new people and establishing a Men’s Network to encourage older men to socialise regularly. It will also extend its HealthLink scheme to help older people get to medical appointments.

Kilkeel RBL - Saving Our Community Venue 22 Oct 2015

The group is a community and voluntary based organisation providing a range of services and activities to the local community. They received a grant of £10,000 to make improvements to their venue so that it can be used for more classes and activities.

Grant to Royal British Legion Tipton Branch 19 May 2016

Remembering Tipton's World War One Heroes

Grant awarded to The Royal British Legion (Forest Hall) Branch And Club (Tyne & Wear) 20 Nov 1998

Towards improving access and facilities for disabled people at the Forest Hall Ex-Servicemen's Institute.

Grant awarded to Community Service Volunteers (Training and Enterprise NE) (Tyne & Wear) 13 Jul 2004

To provide daycare services to older people living in high rise flats in Newcastle.

Karonga Prevention Study (KPS) : whole genome sequencing in a whole population: supplementary proposal for tuberculosis whole genome sequencing. 30 Nov 2011

HIV, tuberculosis and pneumococcal disease are leading causes of mortality and morbidity in Africa. They interact, and undermine development. Control measures exist but are inadequate (HIV, tuberculosis) or unproven (pneumococcus). By combining the established large-scale Karonga epidemiological studies and knowledge of long-term disease trends with detailed laboratory and genomic analysis we will: 1. measure pneumococcal carriage, transmission and serotype change at a household level fo llowing pneumococcal conjugate vaccine (PCV) introduction into the EPI schedule, trial alternate PCV schedules, and determine options to maximise vaccine benefits using modelling methods. 2. identify where M.tuberculosis is being transmitted by screening patients at antiretroviral clinics, by tuberculin testing and by defining transmission chains using whole genome sequencing, to target control efforts. 3. establish genomic determinants of virulence in M.tuberculosis by comparing s trains that have transmitted and caused disease with those that have not, and investigate long term non-progression of latent infection to better understand the host and pathogen determinants of M.tuberculosis natural history 4. assess the long-term direct and indirect benefits and limitations of antiretroviral therapy on adults and children. We will continue to develop the capacity of the site as a centre of excellence for research and training, relevant to Malawi.

m-WELLCARE: an integrated mhealth system for the prevention and care of chronic diseases 17 Jun 2011

Cardiovascular Diseases (CVDs) account for a third of total mortality in India and are projected to increase dramatically. Common modifiable risk factors for CVDs can be detected early and can be controlled by cost effective, widely available interventions. The major barriers to controlling these conditions in India and elsewhere are low detection rates, inadequate use of evidence based interventions and low adherence with these interventions. Common mental disorders such as anxiety and depression are frequently co-morbid with CVDs risk factors and often contribute to failure to follow treatment plans. Primary health care is the appropriate setting for improving the prevention and management of these chronic conditions. Public Health Foundation of India and the London School of Hygiene and Tropical Medicine will develop and evaluate an innovative mobile health (mhealth) software application, m-WELLCARE, which provides a patient health profile, decision support for clinical care, monitoring and feedback for use in Indian Community Health Centers (CHCs). This research will follow the steps proposed by the MRC for evaluation of complex interventions. Technical development of mwellcare will be conducted, user acceptability appraised and potential barriers overcome. m-WELLCARE will be evaluated in CHCs of Harayana and mini-primary health centers of Tamil Nadu. The use made of mwellcare, its impact on patterns of health care received and changes in risk factors achieved will be evaluated. In parallel a business plan will be established to enable the scaling up and sustainability of mwellcare.

TB fast track: effect of a point-of-care TB test-and-treat algorithm on early mortality in people with HIV accessing ART. 16 May 2011

Background: Early mortality remains high among adults with HIV accessing antiretroviral therapy (ART) in resource-constrained settings, with tuberculosis (TB) a leading cause of death. 20% people accessing ART in South Africa have undiagnosed TB. However, due to insensitivity of sputum microscopy, and a complex diagnostic pathway for smear negative TB, the time to TB diagnosis is protracted, delaying both TB treatment (among those diagnosed with TB) and ART (among all investigated, whether or not TB is diagnosed). We hypothesise that a care pathway using point-of-care technology to rapidly identify individuals presenting for ART at high risk of TB and ensure they start TB treatment, then ART, will markedly reduce early mortality. Objective: To compare 6-month mortality among patients with HIV disease and CD4 150 cells/mul referred to start ART between intervention clinics implementing a point-of-care algorithm to identify individuals with a high probability of active TB, and facilitate rapid initiation of TB treatment, followed by ART; vs. control clinics delivering standard of care management according to South African TB/HIV care guidelines. Methods: This is a cluster-randomised trial, randomising 20 primary health clinics in Gauteng and Limpopo provinces, South Africa. ART-eligible patients (CD4 150, ambulant, no recent TB treatment) at intervention clinics will be assessed using simple point-of-care assays. Patients with any of: positive urine lipoarabinomannan (LAM), haemoglobin (Hb) 10, body mass index (BMI) 18.5 will be considered high probability TB, and start TB treatment immediately, then ART. Asymptomatic patients with negative LAM, Hb 10, BMI 18.5 will be low probability and will start ART. Others ( medium probability ) will be investigated for smear-negative TB as per South African guidelines with review after one week to re-categorise into high or low probability. In control clinics we will recruit similar patients and obtain permission for follow-up; management will be as per national guidelines. The primary outcome is mortality at 6 months after recruitment; secondary outcomes include severe morbidity, measured by duration of hospitalisation. Diagnostic cost per TB case detected, and cost per DALY, will be estimated. We estimate mortality conservatively at 25/100 person years in the control arm; with 10 clusters per arm, 175 patients per cluster, and 95% ascertainment of vital status at 6 months, using between-cluster coefficients of variation of 0.2 and 0.25, there will be 91% and 85% power to assess 40% reduction in mortality,respectively.

The HAEM (Haemorrhage and Antifibrinolytics in Emergency Medicine) Project 08 Oct 2010

Sudden severe bleeding is an important medical problem in the UK and worldwide. Recent results from a large international clinical trial in bleeding accident victims show that a cheap drug called tranexamic acid reduces the chances of dying from the injuries and improves other patient outcomes without any increase in side effects. Tranexamic acid is not a new drug. It has been used to control bleeding during major surgical operations for many years. The realisation that this drug could be used to treat a much wider range of bleeding conditions holds the promise of important benefits for patients at low cost The research team, lead by Professor Ian Roberts at the London School of Hygiene and Tropical Medicine, responsible for the accident victim research are now conducting a trial to see if this drug improves outcome in post-partum bleeding.

Amount: £1,792,456
Funder: The Wellcome Trust
Recipient: London School of Hygiene & Tropical M...

Fieldworkers, ethics and the medical research process in developing countries. 30 Nov 2010

The research project proposed is an ethnographic examination of the role of medical research fieldworkers in the ethics debate, with a particular focus on HIV research. The aims are to examine the role played by fieldworkers in the delivery of ethical research and to inform the debate with a fresh perspective from the field. There are substantial limitations to the current bioethical research guidelines, which are challenged when applied to developing countries. These limitations have been highlighted by the ongoing ethics debate of medical research in developing countries and in particular in the field of HIV/AIDs. The current debate represents a largely theoretical and academic discussion of ethics, rather than the challenges and ethical dilemmas faced at the point at which the data are collected or produced. In recognition of the limitations of theoretical examination, social scientists emphasise a focus on the 'everyday' practicalities of conducting research in order to improve the existing guidelines. Examining the role of the fieldworker has emerged as a key component in gaining a greater understanding the ethics of medical research. As the 'intermediaries' in the research process they occupy a role between the Principal investigators and the participants. As fieldworkers are at the frontline of research, they are also at the point where potential ethical challenges are most likely to occur.

The immunological determinants of protective immunity and immunopathology in human Chlamydia trachomatis infection. 05 Oct 2010

The goal of this programme is to determine the immunological and molecular basis of protection and pathology following exposure to ocular Chlamydia trachomatis (Ct) infection in humans. We aim to test the relevance of hypotheses concerning interactions between Ct and the host, generated in vitro and in animal models, in naturally infected human subjects. This will enable us to define rational strategies for vaccine development and delivery, and to determine whether immune responses to candidate vaccines are likely to be protective or damaging. We hypothesise that the resolution of chlamydial infection without associated tissue damage depends on the balance between pro-inflammatory innate immune responses, host responses that act to limit chlamydial replication, and those homeostatic mechanisms induced in parallel which limit inflammation, thereby reducing the potential for tissue damage, but which may be more permissive to chlamydial replication and persistence. We will study the rel ationship between immune responses (in the peripheral blood and at the site of infection) and the clinical and microbiological outcomes of infection in a cohort study, and identify genetic polymorphisms associated with adverse outcomes by case-control and family-based association studies in trachoma endemic populations.

Amount: £1,360,178
Funder: The Wellcome Trust
Recipient: London School of Hygiene & Tropical M...

Perceptions of scientific collaboration in transnational HIV research -- an emergent bioethical issue. 04 Nov 2010

The growth of collaborative global health research networks presents a number of ethical issues not previously encountered such as community engagement, global ethics governance, and the ethics of global research collaboration. Recently, researchers and bioethicists have observed that the protections that medical and research ethics aim for are modeled on a western tradition which often prove limited in effect and inadequate in scope especially when cast against a wider backdrop of global healt h, economic inequalities and cultural diversity. These discussions have not been a preserve for researchers and bioethicists. They do take place amongst the public through debates in the media, by politicians and policy makers as well as the general public, including the communities where research is conducted (discussing power relations among scientists, control of research agenda, trusting or mistrusting certain agencies). The proposed project will focus on the experiences of scientists workin g in collaborative global health research initiatives and the public perception of collaboration between local and international scientists as a measure of the way in which the public engages with health research in the broadest sense. The role of the media in informing and shaping this public opinion on collaborations is investigated as part of this inquiry.

An investigation on community-level influences on mental health amongst internally displaced persons and returnees in Georgia using innovative methodological and analytical techniques. 20 Oct 2010

Evidence shows how persons forcibly displaced from their homes by armed conflict are subject to many negative influences on their mental health. There is far less evidence on what factors may promote their mental health such as community-based factors of housing conditions, security, mobility, social networks, and sources of support. Georgia has approximately 250,000 internally displaced persons (IDPs) who live in a variety of types of settlements in rural and urban areas. No reliable data could be identified on the mental health status of these IDPs or those who have recently returned to their home areas (returnees). We firstly propose to conduct a cross-sectional survey with a representative sample of Georgian IDPs and returnees to collect individual-level data on their mental health and investigate the influence of community factors on their mental health. Secondly, we propose to collect community-level data using an innovative community profiling method to help quantify the extent to which the communities in which IDPs and returnees live may promote their mental health. Data analysis will include multivariate analysis and multi-level modelling; and the validity, reliability and feasibility of the community profiling method. The project will include activities to strengthen epidemiological research capacity on mental health Georgia.

Assembly of infectious rotavirus from cDNA clones: its application to determine the roles of non-structural proteins in virus replication. 05 Oct 2010

Rotavirus is a member of the Reoviridae family of viruses; it has a multilayered capsid and a segmented double-stranded RNA (dsRNA) genome. Like other members of this family it has proven difficult to develop reverse genetics (RG) approaches for this virus. The major aim of this project is to develop a RG system for Rotavirus with a systematic approach. This will be built on a RG method established in our laboratory with Bluetongue virus (BTV), a related dsRNA virus, and further facilitated by t he knowledge and reagents that are already generated for this project application (see preliminary data). Although challenging, it is quite feasible for us to transfer the novel approach that has been highly successful for BTV, and developed a similar RG systems based entirely on T7 RNA transcripts for RV synthesized in vitro. We will generate targeted mutant viruses focussing on three functionally related non-structural proteins that are involved either in rotavirus replication platform or intr acellular trafficking, egress and pathogenesis. Complementing stable cell lines expressing these proteins will be generated to rescue mutant viruses. Together, it will be possible to address some of the outstanding fundamental questions regarding virus replication and pathogenesis of this human (and animal) pathogen.

African historical demography using parish registers. 29 Mar 2011

Little is known about the historical demography of sub-Saharan Africa before the 1960s because of the lack of data. This hampers understanding about population development in the region, making it difficult to predict future change. Without demographic knowledge we cannot document the true impact of colonialism on African health or fully understand the relationship between health and environment in Africa. I propose to adapt the sources and methods of European historical demography to produc e a comparative historical demography of Africa using micro-data from parish registers. Parish registers of baptism, marriage and burial from seven research sites in five countries during 1900-2000 will be digitised. A longitudinal dataset will be constructed (for c.300,000 individuals) using family reconstitution. Event history analysis will be used to estimate trends in fertility, mortality and marriage age during the 20th Century. At the national-level, indirect techniques have been applie d to post-1970 censuses and surveys in Africa to reconstruct trends in child mortality and fertility from the 1950s onwards. I will apply indirect methods to censuses of the 1940s-1960s (adjusted on the basis of later data), to establish national-level trends dating from the 1920s. I will compare these national estimates with the micro-level estimates from parish data.

Capabilities theory and global population-level bioethics. 18 Nov 2010

This philosophical and normative research proposes to extend the Capabilities Approach (CA) to population-level bioethics. A range of ethical questions and reasonable disagreements have arisen at the level of population health in areas such as priority-setting in health care resource allocation, equity considerations of cost-effective analysis, health measurements, social group health inequalities, global health inequalities, and so forth. As an alternative to the utilitarian philosophy which pervades both health care policy and health economics, the proposed research aims to extend the CA to population-level health ethics. The hypothesis or moral intuition is that the CA can help produce and guide health care policy that does more justice than current health maximization approaches. The CA is also likely to be more coherent in identifying social action to address population-level bioethical issues outside of health care. The research seeks to compare and contrast the CA with cost -effective analysis and health maximization; see how the CA would pursue aggregation and efficiency in health policy; see how it would measure health; and see how it would delineate societal versus individual responsibility for health. The research would be supervised by a international health economist, a social epidemiologist, and a moral and political philosopher.

Performance bias in behaviour change trials: what is the problem and how should it be studied? 20 Nov 2008

This project consists of a series of studies which make linked contributions to the achievement of the overarching aim of better understanding the nature of performance bias in behaviour change trials. There are seven project objectives, one for each study component, as follows: 1. To systematically review and summarise what is known about this issue. 2. To develop a coherent conceptual framework which integrates existing ideas and work done in different scientific disciplines. 3. T o explore research participant views on the nature of performance bias. 4. To consider the ethical issues raised by the use of deception and blinding in the study of performance bias and in behaviour change trials. 5. To establish consensus as widely as possible on the implications of study findings across targeted scientific sub-communities by Delphi study. 6. To undertake a prospective experimental study of the nature of performance bias. This will provide a direct measure of effect f or one possible component of performance bias in a university student population whose alcohol consumption is under study. 7. To develop a research programme which both addresses implications for the interpretation of the existing evidence-base and will identify any required alterations to the design of behaviour change trials.

The epidemiology, spatial ecology and transmission dynamics of co-infection with plasmodium falciparum and hookworm in East Africa 29 May 2009

The epidemiology of plasmodia-helminth co-infection is poorly understood. This is despite increasing evidence that co-infection may enhance individual susceptibility to clinical malaria and recent advocacy for the logistical and economic benefits of integrated disease control targeting multiple parasites. This proposal details a range of field and modelling studies aimed at understanding the epidemiology, geography and transmission dynamics of co-infection with Plasmodium falciparum and hookworm in East African children. The proposed field studies will provide better descriptions of the patterns of transmission and the risk factors for co-infection in a variety of environmental and socio-economic settings. This information will be used to develop innovative geostatistical models to predict the spatial range of co-infection. Mathematical models will be developed of the dynamics of co-infection within communities in relation to key geographic heterogeneities and augmented with geostatistical models to determine the paediatric population at the risk of co-infection in East Africa. The resulting products will provide decision-makers with better information with which to design integrated disease control strategies in the region. They will also provide a credible academic framework for future work on the individual, population and thus public health consequences of co-infection.

Intensified tuberculosis case finding and rapid detection of drug resistant disease in patients accessing antiretroviral treatment in South Africa. 30 Apr 2009

This research will be conducted within a well characterised ART cohort in a township in Cape Town. Eligible patients (n=600) without a current TB diagnosis will be screened for TB at enrolment and again after 4 months of ART. On each occasion, two sputum samples from each patient will be subjected to fluorescence microscopy and automated liquid culture. Culture of Mycobacterium tuberculosis (MTB) will be used as the gold-standard for TB diagnosis and isolates will undergo culture-based drug susc eptibility testing. All sputum samples will also be tested with two rapid nucleic acid amplification tests (NAATs) - MTBDRplus and Xpert MTB assays. These are able to detect MTB complex and resistance mutations to rifampicin +/- isoniazid. The sensitivity, specificity, and predictive values of these tests for TB will be determined. The impact of the NAATs on the mean time to TB diagnosis and to detection of drug resistance will be determined. The diagnostic yield of screening for TB after 4 months ART in addition to screening at programme entry will also be determined. The cost-effectiveness of different strategies to screen for TB and TB drug resistance will be formally evaluated.