The researchers, from the University of Cambridge and Imperial College London, have clinically validated and tested the AI on large sets of CT scans and found that it was successfully able to detect, segment, quantify and differentiate different types of brain lesions.

Their results, reported in The Lancet Digital Health, could be useful in large-scale research studies, for developing more personalised treatments for head injuries and, with further validation, could be useful in certain clinical scenarios, such as those where radiological expertise is at a premium.

Head injury is a huge public health burden around the world and affects up to 60 million people each year. It is the leading cause of mortality in young adults. When a patient has had a head injury, they are usually sent for a CT scan to check for blood in or around the brain, and to help determine whether surgery is required.

“CT is an incredibly important diagnostic tool, but it’s rarely used quantitatively,” said co-senior author Professor David Menon, from Cambridge’s Department of Medicine. “Often, much of the rich information available in a CT scan is missed, and as researchers, we know that the type, volume and location of a lesion on the brain are important to patient outcomes.”

Different types of blood in or around the brain can lead to different patient outcomes, and radiologists will often make estimates in order to determine the best course of treatment.

“Detailed assessment of a CT scan with annotations can take hours, especially in patients with more severe injuries,” said co-first author Dr Virginia Newcombe, also from Cambridge’s Department of Medicine. “We wanted to design and develop a tool that could automatically identify and quantify the different types of brain lesions so that we could use it in research and explore its possible use in a hospital setting.”

The researchers developed a machine learning tool based on an artificial neural network. They trained the tool on more than 600 different CT scans, showing brain lesions of different sizes and types. They then validated the tool on an existing large dataset of CT scans.

The AI was able to classify individual parts of each image and tell whether it was normal or not. This could be useful for future studies in how head injuries progress, since the AI may be more consistent than a human at detecting subtle changes over time.

“This tool will allow us to answer research questions we couldn’t answer before,” said Newcombe. “We want to use it on large datasets to understand how much imaging can tell us about the prognosis of patients.”

“We hope it will help us identify which lesions get larger and progress, and understand why they progress so that we can develop more personalised treatment for patients in future,” said Menon.

While the researchers are currently planning to use the AI for research only, they say with proper validation, it could also be used in certain clinical scenarios, such as in resource-limited areas where there are few radiologists.

In addition, the researchers say that it could have a potential use in emergency rooms, helping get patients home sooner. Of all the patients who have a head injury, only between 10 and 15% have a lesion that can be seen on a CT scan. The AI could help identify these patients who need further treatment, so those without a brain lesion can be sent home, although any clinical use of the tool would need to be thoroughly validated.

The ability to analyse large datasets automatically will also enable the researchers to solve important clinical research questions that have previously been difficult to answer, including the determination of relevant features for prognosis which in turn may help target therapies.

The research was supported in part by the European Union, the European Research Council, the Engineering and Physical Sciences Research Council, Academy of Medical Sciences/The Health Foundation, and the National Institute for Health Research.

Reference:
Miguel Monteiro et al. ‘Multi-class semantic segmentation and quantification of traumatic brain injury lesions on head CT using deep learning: an algorithm development and multicentre validation study.’ The Lancet Digital Health (2020). DOI: 10.1016/S2589-7500(20)30085-6

I normally work in the Old Cavendish Laboratory, where I run the Cambridge Social Decision-Making lab. It’s a historic landmark where Watson and Crick discovered the structure of DNA. I never thought I’d say this, but I miss the tour groups pausing below my window every morning. I work from my home in Cambridge now, around the corner from Midsummer Common. The cows are out this time of year, so we often exchange theories about the pandemic when I go for a walk. They seem mostly skeptical, uninterested, and refuse to wear masks, but we get along well otherwise.

In my view, the pandemic is as much a behavioural as a biological problem. We need a vaccine, but we also need people around the world to coordinate their behaviours to help slow the spread of the virus. The required behavioural changes range from the relatively mundane, such as frequent hand washing, to making costly personal sacrifices by self-isolating at home. This necessitates knowledge about human cooperation as well as economic and social inequalities. Models that attempt to forecast the benefits of widespread social distancing and self-isolation also depend on accurate estimates of human behaviour under various conditions.

Behavioural science is also relevant in terms of how to communicate the science to the wider public, how to communicate uncertainty and risk, and how to protect people from the onslaught of fake news and misinformation about COVID-19. I am honoured to have been part of an effort to synthesize what behavioural science has to contribute to the pandemic, as part of a team of 40 international experts around the world. I hope that the article Using social and behavioural science to support COVID-19 pandemic response, published in the journal Nature Human Behaviour, will be useful to policy-makers.

My research looks at how humans make judgments and decisions. This could be about information, risk, societal issues, or other people. In collaboration with our partners we developed Bad News, an award-winning interactive online game. It helps inoculate players against fake news and misinformation, including fake news about COVID-19. We rely on the biomedical analogy: just as administering a weakened dose of a virus triggers the production of antibodies to confer immunity against future infection, the same can be achieved with information. By actively exposing people to severely weakened doses of the tactics used to produce fake news, people gain psychological immunity (or mental ‘antibodies’) against misinformation.

We use a large variety of methods to study human decision-making. We frequently test our interventions ‘in the wild’, for example, our study on the BBC news site tested how people react to uncertainty about scientific facts, and when ‘reality’ is not an option, we use virtual reality! So in a sense, our ability to do research has not been massively affected by the pandemic. A large chunk of it happens online using experimental and computational methods, online surveys, and ‘big data’.

Human behaviour is notoriously variable, and difficult to change and predict. I think it’s one of the biggest challenges of this pandemic. If we don’t get it right, there’s a chance the spread of the virus will pick up again as restrictions are relaxed. The constant stream of misinformation is also a major challenge. For example, concerted disinformation campaigns have the potential to undermine public willingness to vaccinate if people do not believe the vaccine is safe. In addition, several leading nations in the world have not adopted evidence-based strategies, which is a major hurdle.

I’ve been really impressed by the way the research community has come together so quickly. I’m on the management board of the Winton Centre for Risk and Evidence Communication, which has been able to track public opinion on COVID-19 around the world almost immediately. The Centre has pivoted many of their resources to help provide empirical data on how to best communicate evidence during the pandemic. The Cambridge press office has also been fantastic in helping researchers communicate their findings and expertise.

My own research programme has taught me the power of a proactive approach. Prevention is better than cure. People forget that this applies to psychology and communication too. For example, inoculation is all about pre-emptively protecting people from future harm, both in a biological as well as in a psychological sense. The same goes for communication of risk. Much of the response to COVID-19 was reactive, too late, and not well-prepared. One of the wonders of the human brain is our ability to simulate the future. We can start now.

When the pandemic is over, I’m looking forward to a cold beer with friends who are less than six feet away. I can’t wait to sit outside in the sun with colleagues, family, and friends, and have a good laugh again. It’s the little things in life. In the words of Sir Arthur Conan Doyle, “It has long been an axiom of mine that the little things are infinitely the most important.”

Sander van der Linden is Director of the Cambridge Social Decision-Making Lab in the Department of Psychology and a Fellow of Churchill College.

How you can support Cambridge’s COVID-19 research

Millions of UK lives have been changed significantly in the last few weeks, even those who have not been infected by the virus. Three of the most widespread changes for many working age adults have been:

1. The loss of a job or a large reduction in working hours
2. A shift in the place of work from the employer’s premises to homeworking
3. Living in social isolation alone or with other members of one’s household (adults and children) who are also spending more time at home.

We know from past research that any one of these can have negative mental health consequences, but the combined effects of these changes is unprecedented and unexplored. There are already media reports of the strain that this is putting on individuals and families. It is likely that many of these problems will be exacerbated over the coming months.

Deteriorating levels of mental health in the population will not just cause individual misery – for instance through increased symptoms of anxiety and depression – but the research to date on unemployment suggests that this will likely lead to knock on effects on the family, particularly a spouse. It may also lead to increased breaches of social distancing rules or civil unrest.

The Chancellor’s plans to save jobs through the furlough scheme are largely aimed at the financial fallout of the pandemic: the desire to avoid widespread hunger, destitution and financial insecurity, while also recognising the importance to society’s overall wellbeing of the ability for businesses to recover quickly.

Why employment matters beyond income

As social scientists have found repeatedly, in different countries and different demographic groups, the loss of the wage only explains a small fraction of the very large mental health deficit associated with unemployment and economic inactivity.

We now know that the ‘incidental’ aspects of having a job – e.g. time structure, social contact, shared goals, sense of achievement, enforced activity – are hugely important for our wellbeing. In our new short video, Lil Woods, a freelance arts charity worker, discusses how the lockdown has left her missing a sense of purpose: “When my work disappeared, I felt like part of my identity, my place in the world, went with it.”

It has proven almost impossible to find substitutes for jobs that fulfil the same functions: leisure activities, voluntary work or workfare just don’t provide us with the same levels of wellbeing through feeling valued. While some post-work utopians dream of a world where work is largely eliminated, there is little evidence that it could exist as a reality. In fact, recent ONS data shows work has become a coping mechanism in this crisis.

So, it seems, we have an impossible situation – for most people good mental health requires a job, but there simply aren’t enough jobs in the right sectors or with the right skill sets to go around, and this situation is likely to last for many more months of the current pandemic.

A possible solution: short-time working

Fortunately there’s a solution to this paradox, and one that’s being taken seriously in other countries: short-time working. The hastily-introduced measures to protect jobs in the UK encourage employers to retain some or all staff where:

• there is essential work to be done, for example health and emergency workers
• the work can be done at home, as with many office workers
• the work can be done while maintaining safe distancing, such as some agricultural jobs.

Other employees and self-employed workers will be stopped from working, and either be paid to stay at home or lose their wage too. How does it work? Other European countries, such as Germany and Austria, have traditionally used short-time work programmes to deal with economic crises. Employers can reduce the hours of employees, typically with some compensation from public funds to mitigate some of the loss of hours. This has several benefits over the all-or-nothing job shedding being used in the UK.

• Employees retain their attachment to an employer and have more certainty over their future.
• It is easier for employers to vary their volume and type of labour power as the pandemic peaks and then we start an exit strategy.
• Employees can be redeployed depending on their skills, adaptability of the job to homeworking or safe-distancing, or the pre-existing health conditions of the employee.

Recent research by economists from the universities of Cambridge, Oxford and Zurich suggest that, by early April 2020, 15% of people in the UK had lost their jobs due to the coronavirus outbreak compared to only 5% in Germany.

Turning back to the psychological functions of paid work, just how much employment is needed each week to preserve the mental health of employees, and at what point does their wellbeing drop to be closer to those who are unemployed?

Could it work in the UK?

The surprising finding from our research using UK and EU datasets is that increasing individuals’ hours of work from zero to just eight hours a week provides a large boost to their mental health, and there is little or no further psychological benefit as weekly hours are increased from eight to 40. The lesson for government strategy is clear: where possible (and with population health being the priority) keep everyone in paid work; even one day a week will keep more of us sane in these volatile times.

The Employment Dosage research team is led by Dr Brendan Burchell from the Department of Sociology, with co-investigators Dr Daiga Kamerade, Dr Adam Coutts, Dr Ursula Balderson and Dr Senhu Wang.  

How you can support Cambridge’s COVID-19 research effort

Donate to support COVID-19 research at Cambridge

Patients admitted to NHS hospitals are now routinely screened for the SARS-CoV-2 virus, and isolated if necessary. But NHS workers, including patient-facing staff on the front line, such as doctors, nurses and physiotherapists, are tested and excluded from work only if they develop symptoms of the illness. Many of them, however, may show no symptoms at all even if infected, as a new study published in the journal eLife demonstrates.

The Cambridge team pro-actively swabbed and tested over 1,200 NHS staff at Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, throughout April. The samples were analysed using a technique called PCR to copy and read the genetic information of material present on the swab, producing a colour change whenever the coronavirus was present in a specimen. At the same time, staff members were asked about relevant coronavirus symptoms.

Of the more than 1,000 staff members reporting fit for duty during the study period, 3% nevertheless tested positive for the coronavirus. On closer questioning, around one in five reported no symptoms, two in five had very mild symptoms that they had dismissed as inconsequential, and a further two in five reported COVID-19 symptoms that had stopped more than a week previously.

To probe routes of possible transmission of the virus through the hospital and among staff, the researchers also looked at whether rates of infection were greater among staff working in “red” areas of the hospital, those areas caring for COVID-19 patients. Despite wearing appropriate personal protective equipment (PPE), “red” area staff were three times more likely to tested positive than staff working in COVID-19 free “green” areas. It’s not clear whether this genuinely reflects greater rates of transmission from patients to staff in red areas. Staff may have instead transmitted the virus to each other or acquired it at home. Staff working in the “red” areas were also swabbed earlier in the study, closer to when the lockdown was first initiated, so the higher rates of infection in this group might just be a symptom of higher rates of virus circulating in the community at the time.

Nevertheless, extrapolating these results to the more than half a million patient-facing staff working across the NHS UK-wide suggests that as many as 15,000 workers may have been on duty and infected, with the potential to transmit the virus to co-workers, family members and patients, during the month of April. In fact, this figure could be even higher in settings where the supply of PPE has been very problematic.

The implications of the new study, say senior authors Dr Mike Weekes and Professor Stephen Baker from the Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), are that hospitals need to be vigilant and introduce screening programmes across their workforces.

“Test! Test! Test! And then test some more,” Dr Weekes explains. “All staff need to get tested regularly for COVID-19, regardless of whether they have any sort of symptoms – this will be vital to stop infection spreading within the hospital setting.”

The research was mainly funded by Wellcome and the Addenbrooke’s Charitable Trust.

Reference
Rivett, L, et al. Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission. eLife; 11 May 2020; DOI: 10.7554/eLife.58728

A team of researchers, led by the University of Cambridge and Simon Fraser University, designed a series of tests for medical image reconstruction algorithms based on AI and deep learning, and found that these techniques result in myriad artefacts, or unwanted alterations in the data, among other major errors in the final images. The effects were typically not present in non-AI based imaging techniques.

The phenomenon was widespread across different types of artificial neural networks, suggesting that the problem will not be easily remedied. The researchers caution that relying on AI-based image reconstruction techniques to make diagnoses and determine treatment could ultimately do harm to patients. Their results are reported in the Proceedings of the National Academy of Sciences.

“There’s been a lot of enthusiasm about AI in medical imaging, and it may well have the potential to revolutionise modern medicine: however, there are potential pitfalls that must not be ignored,” said Dr Anders Hansen from Cambridge’s Department of Applied Mathematics and Theoretical Physics, who led the research with Dr Ben Adcock from Simon Fraser University. “We’ve found that AI techniques are highly unstable in medical imaging, so that small changes in the input may result in big changes in the output.”

A typical MRI scan can take anywhere between 15 minutes and two hours, depending on the size of the area being scanned and the number of images being taken. The longer the patient spends inside the machine, the higher resolution the final image will be. However, limiting the amount of time patients spend inside the machine is desired, both to reduce the risk to individual patients and to increase the overall number of scans that can be performed.

Using AI techniques to improve the quality of images from MRI scans or other types of medical imaging is an attractive possibility for solving the problem of getting the highest quality image in the smallest amount of time: in theory, AI could take a low-resolution image and make it into a high-resolution version. AI algorithms ‘learn’ to reconstruct images based on training from previous data, and through this training procedure aim to optimise the quality of the reconstruction. This represents a radical change compared to classical reconstruction techniques that are solely based on mathematical theory without dependency on previous data. In particular, classical techniques do not learn.

Any AI algorithm needs two things to be reliable: accuracy and stability. An AI will usually classify an image of a cat as a cat, but tiny, almost invisible changes in the image might cause the algorithm to instead classify the cat as a truck or a table, for instance. In this example of image classification, the one thing that can go wrong is that the image is incorrectly classified. However, when it comes to image reconstruction, such as that used in medical imaging, there are several things that can go wrong. For example, details like a tumour may get lost or may falsely be added. Details can be obscured and unwanted artefacts may occur in the image.

“When it comes to critical decisions around human health, we can’t afford to have algorithms making mistakes,” said Hansen. “We found that the tiniest corruption, such as may be caused by a patient moving, can give a very different result if you’re using AI and deep learning to reconstruct medical images – meaning that these algorithms lack the stability they need.”

Hansen and his colleagues from Norway, Portugal, Canada and the UK designed a series of tests to find the flaws in AI-based medical imaging systems, including MRI, CT and NMR. They considered three crucial issues: instabilities associated with tiny perturbations, or movements; instabilities with respect to small structural changes, such as a brain image with or without a small tumour; and instabilities with respect to changes in the number of samples.

They found that certain tiny movements led to myriad artefacts in the final images, details were blurred or completely removed, and that the quality of image reconstruction would deteriorate with repeated subsampling. These errors were widespread across the different types of neural networks.

According to the researchers, the most worrying errors are the ones that radiologists might interpret as medical issues, as opposed to those that can easily be dismissed due to a technical error.

“We developed the test to verify our thesis that deep learning techniques would be universally unstable in medical imaging,” said Hansen. “The reasoning for our prediction was that there is a limit to how good a reconstruction can be given restricted scan time. In some sense, modern AI techniques break this barrier, and as a result become unstable. We’ve shown mathematically that there is a price to pay for these instabilities, or to put it simply: there is still no such thing as a free lunch.”

The researchers are now focusing on providing the fundamental limits to what can be done with AI techniques. Only when these limits are known will we be able to understand which problems can be solved. “Trial and error-based research would never discover that the alchemists could not make gold: we are in a similar situation with modern AI,” said Hansen. “These techniques will never discover their own limitations. Such limitations can only be shown mathematically.”

Reference:
Vegard Antun et al. ‘On instabilities of deep learning in image reconstruction and the potential costs of AI.’ Proceedings of the National Academy of Sciences (2020). DOI: 10.1073/pnas.1907377117

“For many people, adolescence – between the ages of 10 and 24 – is when you want to be making more social connections, not losing them. It’s also a time of increased risk-taking and sensitivity to peer influence,” said Jack Andrews at the UCL Institute of Cognitive Neuroscience, and first author of the paper. “For some adolescents it’s a challenge to stick to social distancing rules, particularly if their friends aren’t following the rules.”

Breaking social distancing rules is a risk-taking behaviour, putting at risk the health of the rule-breaker and of others – in many places with legal or financial consequences. But adolescents are particularly sensitive to the negative effects of social exclusion, and may prefer to risk breaking the rules rather than lose their friends, say the researchers of the paper published in the journal Trends in Cognitive Sciences.

Campaigns led by adults that try to influence adolescent behaviour often have mixed success. The COVID-19 pandemic has resulted in the widespread implementation of social distancing measures, led by governments, which are likely to be in place in some form for the foreseeable future. But media reports of large student gatherings in the US in March demonstrated the challenge of stopping young people from meeting their friends face-to-face.

Social distancing guidance could be more effective if adolescents are allowed to develop and deliver their own campaigns, focused on changing peer attitudes around the importance of social distancing. With the current restrictions on face-to-face interventions, social media is expected to be particularly effective in promoting social distancing behaviours amongst adolescents.

“Adolescents look to their peers to understand social norms, and align their behaviour with the group they want to belong to. The speed and extent of peer influence online is likely to amplified, because social media has such a wide and immediate reach,” said Professor Sarah-Jayne Blakemore at the University of Cambridge’s Department of Psychology, who led the report.

Previous studies have shown that adolescents are more likely to take certain risks, such as experimenting with drugs or posting sexual content online, when peers are present or doing the same things. Adolescents are also more likely to get involved in beneficial activities, such as volunteering in the community, if they know others who are doing them.

Young people’s capacity to encourage each other in a positive way has been demonstrated in previous studies, for example in a peer-led approach to reducing bullying in schools. This study identified highly-connected, well-liked students, and asked them to develop their own anti-bullying campaigns to share with their peers. Bullying dropped by 25% as a result, compared with other schools.

“The advantage of social media influencers is that the motivation for social distancing comes naturally from the young people themselves. Influencers could post videos or photos online, for example, showing how they are following social distancing rules by staying at home, and add tags to increase their visibility through sharing and Likes. Many YouTubers are already doing this. It’s really just presenting public health advice in a more accessible way that adolescents are more likely to listen to,” said Blakemore.

If social distancing can be established as a group norm amongst friends, it is more likely to be copied by others. Another advantage of targeting social media influencers is that they exist across many spheres of interest so have the potential to reach diverse groups of young people.

The researchers say that to create positive change, adolescents must be given the capacity to lead their own ideas. They hope that their proposals will be taken up by charities and public health bodies who can work with influencers to make sure the correct type of information is being shared.

Reference
Andrews, J.L. et al: ‘Peer influence in adolescence: Public-health implications for COVID-19.’ May 2020, Trends in Cognitive Sciences.DOI: 10.1016/j.tics.2020.05.001

How you can support Cambridge’s COVID-19 research

An analysis of possible COVID-19 economic recovery packages shows the potential for strong alignment between the economy and the environment. The direction of these measures over the next six months will largely determine whether the worst impacts of global warming can be avoided, and research published today reveals that climate-friendly policies can deliver a better result for the economy – and the environment.

Drawing on a global survey of senior central bank and finance ministry officials, as well as learnings from the 2008 financial crisis, economists found that green projects create more jobs, deliver higher short-term returns per dollar spent and lead to increased long-term cost savings, by comparison with traditional fiscal stimulus.

“The COVID-19-initiated emissions reduction could be short-lived,” said lead author Cameron Hepburn from the University of Oxford. “But this report shows we can choose to build back better, keeping many of the recent improvements we’ve seen in cleaner air, returning nature and reduced greenhouse gas emissions.”

“The markets are not unduly worried about UK public debt and neither should we be,” said co-author Dimitri Zenghelis, Special Advisor to the Wealth Economy Project, Bennett Institute, University of Cambridge. “The key is that new borrowing is invested wisely to generate productivity-enhancing innovation, resilient output and a sustainable expansion of capacity. We cannot go back to the old model of business as usual, instead we should confront the economic threat posed by ‘fear’ through investment in building back better.”

A team of internationally-recognised experts came together to assess the economic and climate impact of taking a green route out of the crisis. They catalogued more than 700 stimulus policies into 25 broad groups, and conducted a global survey of 231 experts from 53 countries, including from finance ministries and central banks.

Noting that ‘green’ policies could be widely defined, the study focused on the reduction of greenhouse gas emissions as the key environmentally-beneficial criteria. The paper, to be published in the Oxford Review of Economic Policy, observes that desirable policies have a large return on investment, can be enacted quickly and have a strongly positive impact on climate. Examples include investment in renewable energy production, such as wind or solar. As previous research has shown, in the short term, clean energy infrastructure construction is particularly labour intensive, creating twice as many jobs per dollar as fossil fuel investments, as well as being less susceptible to off-shoring.

Other desirable policies included building efficiency retrofit spending, clean research and development spending, natural capital investment for ecosystem resilience and regeneration, and investment in education and training to address immediate unemployment from COVID-19 alongside unemployment from decarbonisation. For developing countries, rural support scheme spending, such as on sustainable agriculture, was also highly ranked. Meanwhile, non-conditional airline bailouts performed the most poorly on both economic impact and climate metrics.

Most G20 governments have implemented significant relief measures as a result of the pandemic. But, as yet, none has introduced any significant fiscal recovery measures. The study authors hope that countries will seize this generational opportunity to take account of these criteria into national plans – for their economies and the environment.

In addition, the COP26 Universities Network has drawn on this research and other analyses to create a briefing for policymakers outlining a path to net-zero emissions economic recovery from COVID-19. The network, a growing group of more than 30 UK-based universities, including the University of Cambridge, was formed to help deliver climate change outcomes at the UN Climate Summit in Glasgow and beyond.

They have put together a briefing that identifies nine fiscal recovery policies that promise to bring both short-term high economic impact and long-term structural change to ensure the UK meets its 2050 climate goals.

“Shaping the national and global recovery from the coronavirus pandemic in a way that supports the response to climate change and other environmental threats simply makes sense – not only does analysis suggest that green recovery packages deliver greater economic benefit, but investing appropriately in research, innovation, infrastructure and skills training, and matching that with robust institutional structures, will help create a fairer, more resilient, sustainable world with benefits for all,” said Dr Emily Shuckburgh, Director of Cambridge Zero. “As ever, good can be extracted from even the darkest hour, but it requires clear thinking, imagination and bold leadership.”

Among the policies emphasised are: renewable energy, reducing industrial emissions through carbon capture and storage, investment in broadband internet to increase coverage, electric vehicles and nature-based solutions. The group further called for the Cabinet Committee on Climate Change to be renamed the Climate Change Emergency Committee to reflect the urgent need for action.

“Currently, the UK directs €10.5bn in subsidies to fossil fuels. Reallocating this capital to jobs-rich renewable energy projects would be a win-win for the economy and environment,” said Brian O’Callaghan, economist at the Institute for New Economic Thinking, University of Oxford.

The briefing highlights the leadership role of the UK in the leadup to COP26, as well as the opportunity to lead by example with a green recovery package. But the universities warned that the specific designs of any policy would ultimately determine its effectiveness.

References: 
Hepburn, C., O’Callaghan, B., Stern, N., Stiglitz, J., and Zenghelis, D. 2020. “Will COVID-19 fiscal recovery packages accelerate or retard progress on climate change? (PDF)” Oxford Review of Economic Policy, 36(S1), forthcoming.
Allan, J., Donovan, C., Ekins, P., Gambhir, A., Hepburn, C., Reay, D., Robins, N., Shuckburgh E., and Zenghelis, D. (2020). A net-zero emissions economic recovery from COVID-19. COP26 Universities Network Briefing.

Adapted from a University of Oxford press release.

How you can support Cambridge’s COVID-19 research effort

Donate to support COVID-19 research at Cambridge

The flexible method of parenting, known as ‘autonomy support’, places emphasis on the child taking the lead. As the child engages in tasks, parents should watch and adjust how they respond according to how the child is managing, say the researchers. They acknowledge that this method of helping the child to be in control is not necessarily easy.

“It’s not about doing everything for your child, or directing their actions. It’s more of a to-and-fro between parent and child. Parents who do best at this can sit back and watch when they see their child succeeding with something, but increase support or adapt the task when they see the child struggling,” said Professor Claire Hughes, Deputy Director of the Centre for Family Research at the University of Cambridge, and joint first author of the study with Dr Rory Devine at the University of Birmingham’s School of Psychology.

The study, published in the journal Developmental Science, found a link between parental autonomy support in 14-month-old children, and reduced behavioural problems ten months later. But this link only applied to children who had been rated as ‘easy babies’- those in a generally happy mood, who adapted easily to new experiences and quickly established routines. Children who demonstrated high levels of self-control at 14 months were less likely than their peers to have behaviour problems at 24 months.

“If you’re blessed with a happy baby, then you can get them through the ‘terrible twos’ without things getting too bad or lasting too long, by being flexible about the way you play with your child between the age of 14 and 24 months. A puzzle game, for example, can turn into quite a different game if you allow your child to take the lead,” said Hughes.

Many toddlers have temper tantrums and exhibit frustration and defiant behaviour, in what is commonly known as the ‘terrible twos’. Unfortunately, the autonomy support strategy isn’t equally effective for all children: those born with a more irritable temperament are still more likely to be difficult toddlers.

Parenting must be tailored according to the child, say the researchers. Parents who don’t remember their baby having an easy temperament should let go of the idea of achieving specific goals during play, and allow their children to develop at their own pace.

“As we cope with the upheavals of being in lockdown, we’re having to be patient with ourselves in so many ways. Parents particularly need to be more patient with the toddlers who found life a bit more challenging, even in ordinary times,” said Hughes.

Over 400 expectant couples were recruited for the study from the East of England, New York State and the Netherlands. Each couple was visited when their new baby was 4 months, 14 months and 24 months old, and filmed interacting as their young children carried out a range of specific tasks. The research team carefully rated the level of parental support for each interaction. In addition, parents rated their child’s temperament as a baby, and behavioural problems at 14 and 24 months.

Simple tasks were used to test the level of autonomy support parents gave to their child. In one, each child was given farm animal pieces that fitted into cut-out shapes on a board. Some of the parents appeared quite anxious for their child to put the pieces in the right places, and gave them a lot of help. Others spotted that the task was too difficult for their child, and let the game evolve by following the child’s lead.

“We had some children who took two animal pieces from a wooden farm puzzle and started clapping them together, and making a game out of the fact that they made a clapping noise. Here, parents might respond by encouraging the child to make animal noises that match the animals being clapped together,” said Devine. ”Autonomy supportive parenting is about being flexible, following a child’s lead, and providing just the right amount of challenge.”

During lockdown, many parents are having to look after young children at home rather than leaving them in nursery care during working hours. Trying to keep children motivated and engaged all day can be a daunting task. Yet having more time to spend with young children can also be seen as a rare opportunity to explore new ways of engaging with them, say the researchers.

“Rather than trying to make a child achieve a rigidly defined task, autonomy support is more of a playful interaction. It promotes the child’s problem solving and their ability to learn, by letting games or tasks evolve into experiences that engage them,” said Hughes.

Previous studies have looked at links between executive function and antisocial behaviour, and separately at family influences on conduct problems. This study is unique in its direct observational measures of parent-child interactions, in combination with a group of executive function tasks.

The researchers found the link between executive function at 14 months and reduced problem behaviours at 24 months held up even when controlling for other factors like a child’s language skills, and the quality of mother-child interactions.

This research was funded by the Economic and Social Research Council, the National Science Foundation and the Dutch Research Council (NWO).

Reference
Hughes, C., Devine, R.T., Mesman, J., & Blair, C.; ‘Understanding the Terrible Twos: A longitudinal investigation of the impact of early executive function and parent-child interactions.’ Developmental Science, April 2020. DOI: 10.1111/desc.12979 

Inactive participants in the study spent just over four days more in hospital over the next ten years than those who did at least some physical activity, whether for work or leisure. And similar results were observed ten years later when the same participants were 50–90 years old.

The study, by researchers at the University of Cambridge’s Department of Public Health and Primary Care and MRC Epidemiology Unit, calculates that for every inactive person who started to take at least some exercise, the NHS could save around £247 per year. This would equate to around 7% of the UK’s per capita health expenditure.

The findings, published in BMC Geriatrics, are based on a general British population cohort study of 25,639 men and women aged 40–79 living in Norfolk and recruited from general practices between 1993 and 1997 (The European Prospective Investigation into Cancer in Norfolk).

The researchers found that in the first ten years active participants were 25–27% less likely than inactive participants to have more than twenty hospital days or more than seven admissions per year with similar results over the subsequent ten years. They also reported that in 9,827 study participants with repeated measurements, those who remained physically active or increased their activity were 34% less likely to spend twenty days in hospital.

Lead author Robert Luben from the Institute of Public Health says:

“Our study provides some of the clearest evidence yet that small, feasible increases in usual physical activity substantially reduce the future hospital usage of middle-aged and older people, and would significantly ease pressure on the NHS.”

The study is one of relatively few to examine the physical activity (both occupational and leisure-time) of middle-aged and older men and women – validated against heart rate monitoring with individual calibration – and their subsequent healthcare use. As well as studying a large cohort over a long follow-up period, the researchers used record linkage to hospital data and took a range of demographic and lifestyle factors into account.

When recruited, participants completed a lifestyle questionnaire where they were asked about their physical activity. Occupational activity was assessed using a four category question (“sedentary”, “standing”, “moderate physical work” and “heavy manual work”) with examples such as office worker, shop assistant, plumber and construction worker respectively.

Leisure activity in both summer and winter was assessed from the number of hours per week spent cycling, attending keep fit classes or aerobics and swimming or jogging. Estimated average hours of leisure activity was calculated as the mean of summer and winter activities. Based on a score (validated using heart rate monitoring with individual calibration) combining leisure and occupational elements, individuals were categorised as “inactive”, “moderately inactive”, “moderately active” and “active”.

The study found that those with a physical activity score of at least “moderately inactive” had fewer hospital admissions and fewer days in hospital, than those who were “inactive”.

While previous studies have suggested that pre-admission physical activity programmes may lower duration of hospital stay, these are short term, require funding and are targeted at a limited number of individuals. But these new findings indicate that usual physical activity patterns in the general population predict hospital usage over the next two decades.

The researchers acknowledge that participants may be physically inactive because of known or preclinical illness which may also predispose them to increased later hospitalisation. But sensitivity analyses excluding those with a self-reported chronic disease at baseline (heart attack, stroke or cancer), and excluding hospital admissions occurring in the first five years of follow-up, did not differ materially from the main findings.

Reference

R. Luben, S. Hayat, N. Wareham, P. Pharoah, K-T. Khaw, ‘Usual physical activity and subsequent hospital usage over 20 years in a general population: the EPIC-Norfolk cohort’. BMC Geriatrics, 6 May 2020). DOI: 10.1186/s12877-020-01573-0.10.1186/s12877-020-01573-0.

Since the emergence of the SARS-CoV-2 virus in late 2019, more than 3.5 million people are known to have been infected, leading to over 240,000 deaths worldwide from COVID-19, the disease caused by the novel coronavirus. The race is on to find new drugs to treat COVID-19 patients and to develop a vaccine to prevent infection in the first place.

A team of researchers representing the International Union of Basic and Clinical Pharmacology today say there will be no ‘magic bullet’ to treat the disease and argue that a multi-pronged approach is needed to find new drugs. They caution that an effective and scalable vaccine is likely to take over a year before it can used to tackle the global pandemic.

When a virus enters our body, unless we have already developed immunity from previous infection or vaccination, it will break into our cells, hijacking their machinery and using it to replicate and spread throughout the body. Often, the symptoms we see are a result of our immune system fighting back in an attempt to clear the infection. In severe cases, this immune response can become overactive, potentially leading to a so-called cytokine storm, causing collateral damage to organs along the way.

“Any drug to treat COVID-19 will need to focus on the three key stages of infection: preventing the virus entering our cells in the first place, stopping it replicating if it gets inside the cells, and reducing the damage that occurs to our tissues, in this case, the lungs and heart,” said Professor Anthony Davenport from the University of Cambridge, one of the authors of the review.

The review looks at potential therapeutic drug targets – the chinks in the virus’s own armour or weak spots in the body’s defences. Two key targets appear to be proteins on the surface of our cells, to which SARS-CoV-2 binds allowing it entry – ACE2 and TMPRSS2. TMPRSS2 appears to be very common on cells, whereas ACE2 is usually present at low levels that increase depending on sex, age, and smoking history.

“As we know these two proteins play a role in this coronavirus infection, we can focus on repurposing drugs that already have regulatory approval or are in the late stages of clinical trials,” said Professor Davenport. “These treatments will have already been shown to be safe and so, if they can now be shown to be effective in COVID-19, they could be brought to clinical use relatively quickly.”

One promising candidate is remdesivir, a drug originally developed for Ebola. Although clinical trials found it to be insufficiently effective at treating Ebola, clinical trials in the USA have suggested the drug may be beneficial for treating patients hospitalised with COVID-19, and the FDA has now approved it for emergency use. There have also been promising findings from studies of monoclonal antibodies, but this type of drug is expensive to produce and therefore less likely to be scalable.

“While we’re waiting for a vaccine, drugs currently being used to treat other illnesses can be investigated as treatments for COVID-19 – in other words repurposed,” said Dr Steve Alexander from the University of Nottingham.

“There’s unlikely to be a single magic bullet – we will probably need several drugs in our armoury, some that will need be used in combination with others. The important thing is that these drugs are cheap to produce and easy to manufacture. That way, we can ensure access to affordable drugs across the globe, not just for wealthier nations.”

The team say that we need to move quickly to identify existing drugs that are effective in clinical trials so that we can begin treating patients as rapidly as possible, but also because cases are likely to fall during the summer meaning there will be fewer people who can be recruited to clinical trials ahead of an anticipated second wave of the disease in autumn. They estimate there are currently more than 300 clinical trials taking place worldwide, though many of these investigational drugs are unlikely to be effective for widespread use because either it is not clear which part of the disease pathway they are targeting or they cause unpleasant side-effects.

They also advise patience for the promise of developing an effective vaccine against the virus anytime soon. Even after a new vaccine candidate has been shown to offer immunity against the coronavirus in humans, it needs to be tested in larger numbers of people to ensure it is safe to use. Manufacturing and distributing a vaccine at the scale needed to tackle this pandemic will also present significant challenges.

“Although there are a lot of vaccines being developed around the world, which we hope will be successful, it’s still going to take a long time before those vaccines are shown to be effective and can be manufactured at the scale needed to make an impact,” said Dr Steve Alexander.

“Some of the vaccines may not work, so the more drugs that can be tested and the more we know about the targets, the more likely we are to get something which is effective. The very specificity of vaccines means they are limited in which viruses they can neutralise. The lessons we learn and the drugs we generate will hopefully provide a greater degree of protection, not just against the COVID-19 virus, but also against the next viral threat.”

Professor Davenport is a member of the Department of Medicine, University of Cambridge, and a Fellow at St Catharine’s College.

Reference
Alexander, SPH, et al. A rational roadmap for SARS-CoV-2/COVID-19 pharmacotherapeutic research and development. British Journal of Pharmacology; 1 May 2020; DOI: 10.1111/bph.15094 

A new study of public attitudes across Europe, America and Asia has found that people in the UK have the highest overall levels of concern about coronavirus – more than Italy or Spain – while those in South Korea are the least concerned.

Researchers from the University of Cambridge conducted surveys on how people feel and think about the risk of the virus between mid-March and mid-April, across ten different countries with varying approaches to tackling the pandemic.

The study, co-authored by Dr Sarah Dryhurst and Dr Claudia Schneider from the Winton Centre for Risk and Evidence Communication, measured risk perception by combining people’s ratings of how prevalent, how life-threatening, and how worrying they thought the virus was.

The Cambridge team also set out to uncover some of the key psychological factors behind people’s concern. The findings, based on data from 6,991 participants, are published today in the Journal of Risk Research.

“Without pharmaceutical treatment, we are relying on people changing their behaviour to put the brakes on this pandemic,” said Dr Sander van der Linden, study lead and Director of the Cambridge Social Decision-Making Lab.

“The willingness to adopt protective behaviours such as frequent hand-washing or physical distancing is likely to be influenced, in part, by how risky people perceive the virus to be.”

“We think this is the first comparative evidence of how people perceive the risk of COVID-19 around the world,” he said.

In the study’s sample, Spain followed the UK for greatest public concern about coronavirus, with the US in third place. Although remaining differences were smaller, Germany came in fourth above Sweden – where the government has been less proscriptive about lockdowns – followed by Australia then Japan.

Perhaps surprisingly, Italy – the pandemic’s first European epicentre – ranked fairly low out of the ten nations, with only Mexico and South Korea having lower average risk perception scores.

However, there was little difference between many of the countries, with risk perception generally high in all nations.

The researchers also found that greater concern about the virus did indeed correlate with taking a number of preventative public health measures such as increased hand washing or wearing facemasks.

Men typically had lower levels of concern about the virus than women, despite the fact that, on average, COVID-19 appears to be considerably more dangerous to men if contracted.

The significance of different psychological factors varied between countries. However, some attitudes and traits consistently indicated increased perception of risk in people across several countries.

For example, across all nations, those who suspected they had already contracted the virus perceived a higher risk from it. In several countries, people who got information on the virus from friends or family also perceived higher risk.

“Prosociality”, or a belief in the importance of doing things for the benefit of others, related to heightened concern about the virus in nine of the ten countries. In fact, it emerged as one of the most important psychological factors of risk perception internationally.

“Appealing to prosocial motives can be an important part of solving social dilemmas during pandemics,” said Dr Claudia Schneider, co-author of the study. “For example, ‘clap for our carers’ campaigns help us to publicly signal prosocial intentions through shared sentiment and the spread of positive emotions.”

By contrast, what the researchers term an “individualistic worldview” – inferred from a belief that governments meddle too much in our lives – related to lower levels of concern about the risks of coronavirus.

While this worldview is famously associated with certain US states, it was also significantly related to risk perception in several other countries, such as Germany, Sweden, Spain, Japan and the UK.

“The perception that the government is restricting people’s freedom might cause psychological pushback among some people with strong individualistic worldviews,” said Dr Sarah Dryhurst, co-author of the study. “We see this expressed in anti-lockdown protests in the US and Germany, for example.”

Political ideology was less significant for risk perception overall, although a more conservative outlook was associated with lower levels of concern in the UK and the US.

“Governments are asking people to stay inside and give up their livelihoods in order to protect their societies. It’s important we understand how people react to the information and instructions they receive about the virus,” said Dr Alexandra Freeman, Director of the Winton Centre.

“We’ve made all our data publicly available to help institutions and journalists communicate better. We hope that this work can help the global effort to react appropriately to this threat,” she said.

Prof Sir David Spiegelhalter, co-author and Chairman of the Winton Centre, added: “As we move towards relaxing the lockdown, it is important to understand both the overall levels of concern, and the variability between people in their attitudes to the virus and the counter-measures taken. This evidence suggests that different worldviews need to be taken into account.”

How you can support Cambridge’s COVID-19 research effort

Donate to support COVID-19 research at Cambridge

My research is focused on viruses in bats that can be transmitted to people or domestic animals. We call these zoonotic viruses. The work is important in helping to understand where and how pandemics may emerge, and can help reduce people’s exposure to diseases. However, once a pandemic is underway it becomes a public health issue and other colleagues are better placed than me to respond. Like many scientists, I’ve offered to help assess new evidence relating to the coronavirus, for example by responding to requests from the teams of modellers who advise the UK Government.

I’m quite lucky that my work is mainly office-based, so working from home hasn’t caused too much disruption apart from having to cancel a few trips and conferences. Obviously, staying in touch with everyone in my team requires a bit more organisation, but they’re all doing well. On the plus side I get to spend more time with my three year-old son.

I’m part of a large international consortium, called Bat One Health, studying zoonotic viruses in bats in Africa, Asia and Australia. Using years of field data, we develop models to investigate how bat ecology affects the spread of viruses. We have come to realise that human activities, by disrupting wildlife, increase the risk of diseases spreading to humans in multiple ways. Working with academics and communities in affected countries, our goal is to come up with practical and sustainable solutions to preserve biodiversity while reducing threats to human health.

The UK and other high-income countries are experiencing unprecedented challenges in responding to the outbreak. But I think the biggest crisis is just beginning to hit many African and Asian countries. Many have recorded very low numbers of cases so far and some have imposed drastic social distancing measures. However, the virus has likely been spreading through those countries for weeks due to the lack of detection capacity. If severe cases increase exponentially in poor communities that lack access to health care, we could soon be witnessing a new humanitarian crisis.

The reaction of the University’s research community has been quite extraordinary. Online forums have been set up to exchange information and coordinate action, to ensure that the necessary resources and expertise can be found and employed very quickly. Even though it’s often claimed that researchers work in silos, that’s not my experience at all: interdisciplinary research is thriving.

The irony is that we have been expecting a pandemic like this for nearly twenty years. We learned a lot from recent international outbreaks of SARS, Ebola and swine flu in particular, and contingency plans had been drafted by some of the best experts. The research was shared with governments and also with the general public, for example in David Quammen’s excellent book Spillover (2012) and in the Hollywood film Contagion (2011). So why didn’t this knowledge translate into better preparedness? This is yet another example of short-term political priorities getting in the way of planning for extreme events.

From an academic perspective, better collaborations between natural scientists and economists would certainly help. The coronavirus outbreak definitely highlights the importance of research on zoonotic viruses in wildlife ‘upstream’ of pandemics. In addition to continuing our work on viruses in bats, we’ll be looking for new opportunities to collaborate with public health scientists and policy makers. More than ever, our emphasis will be on capacity-building in Africa.

When the pandemic is over, I’m most looking forward to meeting up with relatives and friends. I’m also conscious that the current restrictions are causing major disruptions for our students, who will need additional support to catch up. Hopefully the experience will inspire more students to work on pandemics and appreciate the importance of interdisciplinary research.

Dr Olivier Restif is Alborada Lecturer in Epidemiology, based in the University’s Department of Veterinary Medicine.  Read his recent opinion piece for The Conversation.

How you can support Cambridge’s COVID-19 research

There is much debate over the economic costs of our lockdown lives: whether the mitigation of disease spread is worth the deepening financial crisis.

New research from the University of Cambridge suggests that there is no absolute trade-off between the economy and human health – and that the price of inaction could be twice as high as that of a ‘structured lockdown’.

A Cambridge economist, together with researchers at the US Federal Reserve Board, has combined macroeconomics with aspects of epidemiology to develop a model for the economic consequences of social distancing.

The study uses US economic and population data, but the researchers say their findings have implications for most developed economies.

It divides the working population into ‘core workers’ – those in healthcare as well as food and transportation, sanitation and energy supply, among others – and then everyone else, and models the spread of the virus if no action is taken.

“Without public health restrictions, the random spread of the disease will inevitably hit sectors and industries that are essential for the economy to run,” said co-author Prof Giancarlo Corsetti, from Cambridge’s Faculty of Economics.

“Labour shortfalls among core workers in particular strip more value from the economy. As essential team members within this core sector drop out of the workforce, it impairs production far more than losing those in other areas of the economy.”

By separating the core and non-core workers, the study suggests that the economy would shrink by 30% or more without lockdown and social distancing. “By ignoring this division in the workforce, we may badly underestimate the true depth of economic damage,” Corsetti said.

Using data from the US Bureau of Labour Statistics, the researchers then quantified the share of workers who could ‘reasonably keep performing occupational tasks at home’: 15% of those in core sectors, and 40% of everyone else currently working – along with 30% of all non-working age people, from children to the retired. This puts a third of the entire population on lockdown.

In this scenario, the infection curve is smoothed out through social distancing, and the rate of loss in economic output is around 15%, just half the level of damage if no action is taken to prevent disease spread.

Sickness rates for core workers would be the same as the rest of the population, the high levels of social distancing elsewhere act as a shield.

“This overarching policy flattens the curve,” said Corsetti. “The peak of the infected share of the population drops from 40% to about 15%. However, this is still far too high given the capacities of healthcare systems.”

So the researchers also modelled a scenario where infection rates are kept to a manageable level for healthcare services of under 1.5% of the population for 18 months – the length of time many believe it will take for a vaccine to arrive.

This would mean lockdown shares of 25% of core workers, 60% of workers outside of core, and 47% of non-working age people. Under this scenario, the economy contracts by 20%.

The study also looked at a very strict lockdown – 40% of core workers and 90% each of non-working age and everyone else – that lasts for just three months. Such a scenario simply delays the infection rates but prevents ‘herd immunity’, creating an economic drop comparable to that of taking no action in the first place.

“As well as containing the loss of life, committing to long-term social distancing structured to keep core workers active can significantly smooth the economic costs of the disease,” said Corsetti.

“The more we can target lockdown policies toward sections of the population who are not active in the labour market, or who work outside of the core sector, the greater the benefit to the economy,” he said.

“What seems clear to us is that taking no action is unacceptable from public health perspective, and extremely risky from an economic perspective.”

However, Corsetti and colleagues caution that the lingering uncertainties around just how the coronavirus spreads means their scenarios are not forecasts, but should be taken as a ‘blueprint’ for further analysis.

The research is published as a Cambridge-INET working paper [PDF].

The Cambridge-INET Institute has a dedicated website for research relating to the pandemic: covid.econ.cam.ac.uk.

How you can support Cambridge’s COVID-19 research effort

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Published on 29 April in the journal Nature, the study involved brain-injured patients showing very minimal or no signs of awareness of the external world. It found that 100% of patients who reacted to the sniff test went on to regain consciousness, and over 91% of these patients were still alive three and a half years after injury.

“The accuracy of the sniff test is remarkable – I hope it will help in the treatment of severely brain injured patients around the world,” said Anat Arzi, a researcher in the University of Cambridge’s Department of Psychology and the Weizmann Institute of Science Israel, who led the research, together with Professor Noam Sobel from the Weizmann Institute of Science Israel and Dr Yaron Sacher from the Loewenstein Rehabilitation Hospital Israel.

It is often difficult for doctors to determine a patient’s state of consciousness after a severe brain injury. Errors in diagnosis are made in up to 40% of cases. A patient that is minimally conscious differs from one in a vegetative state, and their future outcomes differ. An accurate diagnosis is critical because it informs treatment strategies such as pain management, and can underlie end-of-life decisions.

Our sense of smell is a very basic mechanism and relies on structures deep within the brain. The brain automatically changes the way we sniff in response to different smells – for example, when presented with an unpleasant smell we automatically take shorter, shallower breaths. In healthy humans the sniff-response happens in both waking and sleeping states of consciousness.

Research was conducted on 43 severely brain-injured patients. The experimenter first explained to each patient that different smells would be presented to them in jars, and the breathing through their nose would be monitored using a small tube called a nasal cannula. There was no indication that the patients heard or understood.

Next, a jar containing either a pleasant smell of shampoo, an unpleasant smell of rotten fish, or no smell at all was presented to each patient for five seconds. Each jar was presented ten times in a random order, and a measurement was made of the volume of air sniffed by the patient.

The researchers found that minimally conscious patients inhaled significantly less in response to smells, but did not discriminate between nice and nasty smells. These patients also modified their nasal airflow in response to the jar with no smell. This implies awareness of the jar or a learned anticipation of a smell. Vegetative state patients varied – some did not change their breathing in response to either of the smells, but others did.

A follow-up investigation three and a half years later found that over 91% of the patients who had a sniff response shortly after injury were still alive, but 63% of those who had showed no response had died.

By measuring the sniff-response in severely brain injured patients, the researchers could measure the functioning of deep-seated brain structures. Across the patient group they found that sniff-responses differed consistently between those in a vegetative state and those in a minimally conscious state – providing further evidence for an accurate diagnostic.

“We found that if patients in a vegetative state had a sniff response, they later transitioned to at least a minimally conscious state. In some cases, this was the only sign that their brain was going to recover – and we saw it days, weeks and even months before any other signs,” said Arzi.

In a vegetative state the patient may open their eyes, wake up and fall asleep regularly and have basic reflexes, but they don’t show any meaningful responses or signs of awareness. A minimally conscious state differs because the patient may have periods where they can show signs of awareness or respond to commands.

“When the sniff response is functioning normally it shows that the patient might still have some level of consciousness even when all other signs are absent,” said Dr Tristan Bekinschtein in the University of Cambridge’s Department of Psychology, who was involved in the study. “This new and simple method to assess the likelihood of recovery should be immediately incorporated in the diagnostic tools for patients with disorders of consciousness.”

This research was funded by the Rob and Cheryl McEwen Fund for Brain Research, the Blavatnik family Foundation, the Royal Society and the European Molecular Biology Organisation.

Reference
Arzi, A. et al: ‘Olfactory Sniffing Signals Consciousness in Unresponsive Patients with Brain Injuries.’ Nature, April 2020. DOI: 10.1038/s41586-020-2245-5 

Fellows are chosen for their outstanding contributions to scientific understanding. The 62 newly elected Fellows embody the global nature of science, and are elected for life through a peer review process based on excellence in science. Past Fellows and Foreign Members include Isaac Newton, Charles Darwin, Dorothy Hodgkin and Stephen Hawking.

The Royal Society is a self-governing Fellowship made up of the most eminent scientists, engineers and technologists from the UK and the Commonwealth. Its Foreign Members are drawn from the rest of the world. The Society’s fundamental purpose is to recognise, promote and support excellence in science and to encourage the development and use of science for the benefit of humanity.

Sir Venki Ramakrishnan, President of the Royal Society, said: “At this time of global crisis, the importance of scientific thinking, and the medicines, technologies and insights it delivers, has never been clearer. Our Fellows and Foreign Members are central to the mission of the Royal Society, to use science for the benefit of humanity.

“While election to the Fellowship is a recognition of exceptional individual contributions to the sciences, it is also a network of expertise that can be drawn on to address issues of societal, and global significance. This year’s Fellows and Foreign Members have helped shape the 21st century through their work at the cutting-edge of fields from human genomics, to climate science and machine learning.

“It gives me great pleasure to celebrate these achievements, and those yet to come, and welcome them into the ranks of the Royal Society.”

The Cambridge scientists announced today as Royal Society Fellows are:

Professor Kevin Brindle FMedSci, Department of Biochemistry and Cancer Research UK Cambridge Institute. His current research is focused on novel imaging methods for detecting cancer progression and to monitor early tumour responses to treatment, with an emphasis on translating these techniques to the clinic.

Professor Vikram Deshpande, Department of Engineering, for his seminal contributions in microstructural mechanics. His works include developing ‘metallic wood’, sheets of nickel as strong as titanium, but four-times lighter thanks to their plant-like nanoscale pores.

Professor Marian Holness, Department of Earth Sciences. She has created a new approach to decoding rock history, and concentrates on understanding the evolution of bodies of magma trapped in the crust, which ultimately controls the eruptive behaviour of any overlying volcano.

Professor Giles Oldroyd, Russell R Geiger Professor of Crop Science, Crop Science Centre and Group Leader, Sainsbury Laboratory. He is leading an international research programme attempting to achieve more equitable and sustainable agriculture through the enhanced use of beneficial microbial associations.

Professor Hugh Osborn, Department of Applied Mathematics and Theoretical Physics for work in theoretical physics on quantum field theory and in particular conformal field theory.

Professor Didier Queloz, Cavendish Laboratory, for his part in the discovery of the first planet beyond our solar system, for which he shared the Nobel Prize in Physics last year. Hundreds more exoplanets have since been revealed by his pioneering observational techniques.

Dr Sarah Teichmann FMedSci, Director of Research, Cavendish Laboratory and Senior Research Fellow, Churchill College, for her contributions to computational biology and genomics, including her role in founding and leading the Human Cell Atlas international consortium to map all cell types in the human body.

Professor Stephen Young, Department of Engineering, for pioneering the statistical approach to language processing – namely, treating conversation as a reinforcement learning problem – that made the speech-recognition products in millions of homes a reality.

Professor Jack Thorne, Department of Pure Maths and Mathematical Statistics for multiple breakthroughs in diverse areas of algebraic number theory. At age 32, he becomes the youngest living member of the Fellowship.

In addition, Dr William Schafer at the MRC Laboratory of Molecular Biology, based at the Cambridge Biomedical Campus, has been elected as a Fellow.

I work in the Department of Pathology at Addenbrooke’s Hospital. Although it’s now closed I’m still here, along with others from the Division of Virology and volunteers from the Department of Medicine. We’re supported by two great Lab Managers, who take it in turns to come in and keep the labs operational. Without them, and the staff working from home placing urgent orders, we’d be in a very difficult position.

I gained experience in setting up rapid diagnostics and in viral genetic sequencing when working on the Ebola epidemic in West Africa, and the recent Ebola outbreak in the Democratic Republic of the Congo. I’m lucky to have a great team of people here in Cambridge, including Dr Luke Meredith who has recently returned from a very stressful six months in South Sudan where he was a World Health Organisation Coordinator for Ebola and COVID-19 testing.

During the COVID-19 pandemic we are sequencing the coronavirus in real time. We collect samples from the Addenbrooke’s diagnostic team, sequence them, piece together the genomes and upload the data to a national server for analysis. The process is similar to many molecular methods we use routinely in the lab. We’ve been able to go from a standing start to producing viral sequences within 24 hours. This work is part a large national consortium headed by Professor Sharon Peacock in the Department of Medicine.

Revealing the genetic sequence of the virus can improve knowledge about COVID-19, and can provide invaluable information about the size of the epidemic and potential sources of infections. As highlighted by Dr Mike Ryan from the WHO, preparedness is important, but moving fast is essential. If you don’t make decisions quickly then you get behind the epidemic curve. Responding rapidly is more important than making sure everything is 100% correct.

I’ve also been coordinating local volunteers to enable them to support the national response. Working with Rhys Grant in the University’s Department of Biochemistry, we’ve set up a website to capture volunteers with skills relevant to COVID-19 testing. Our database now has over 1200 people from Cambridge signed up. We’ve used it to get Cambridge staff engaged in the establishment of the national testing lab in Milton Keynes, and are feeding into local efforts to establish the fourth national testing centre here in Cambridge.

Rapid wide-spread testing of the community is the biggest challenge we face relating to this pandemic. It will be key to stamping out clusters of the infection in the coming months.

The Cambridge research community has really come together. Everyone is keen to help in the response efforts, and the heads of institutes have been very supportive of anyone wanting to engage. Our staff have a real ‘can do’ attitude and a drive to overcome practical challenges. We’ve been able to engage people from many departments in various aspects of the work very quickly. Trying to wade through regulatory issues is more of a challenge.

We are also involved in developing a programme of research on COVID-19. A new initiative in the Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), led by Professor Ken Smith, has been set up to enable university-wide research on COVID-19. This draws together people from across the University, with various skills and interests in different aspects of COVID-19, to engage in collaborative studies. It makes use of the excellent facilities in the new Jeffrey Cheah Biomedical Centre, including a state of the art containment level 3 laboratory that enables work with live COVID-19.

After the pandemic is over I’m really looking forward to taking a well-deserved holiday with my family. Everyday life as an academic is challenging at the best of times, but when you layer on top the pressure of working in a pandemic, trying to support the efforts in multiple ways and trying to juggle so many things, it can really take its toll.

Goodfellow in the lab at Addenbrooke’s Hospital with his team

How you can support Cambridge’s COVID-19 research effort

Nations with high rates of coronavirus testing such as South Korea and Germany are also leading the world in commercialising COVID-19 diagnostic tests – far outstripping the domestic UK and US diagnostic industries, new research shows.

Researchers also argue that lax EU regulations for diagnostic devices could make the region a “dumping ground for poor quality tests”.

A team from the University of Cambridge’s Department of Sociology has produced what they say may be the most comprehensive global dataset of companies developing molecular diagnostic tests for COVID-19.

They found that 88% of South Korean firms working on COVID-19, and 80% of those in Germany, now have tests either on the market or ready to be rolled out. In the UK, just 54% of firms developing COVID-19 tests have a commercialised product. The US also lags behind at 67%.

China has 93 diagnostic firms working on COVID-19, the overall highest number, 90% of which have commercialised tests.

The latest analysis is available on a website set up by CancerScreen, a Cambridge research project funded by the European Research Council on the political economy of diagnostic innovation.

“The COVID-19 testing strategies adopted by different countries are now under intense public scrutiny,” said Dr Stuart Hogarth, who leads the research.

“The UK and US have been criticised for failing to ramp up capacity compared to places such as Germany and South Korea. We can see this playing out in the global molecular diagnostics industry.”

Building on previous work, the CancerScreen team have trawled media coverage and drawn on lists of COVID-19 tests from organisations such as the Foundation for Innovative Diagnostics (FIND) and the UK National Institutes for Health Research (NIHR) Innovation Lab.

They now have 303 firms in their dataset of COVID-19 molecular diagnostics firms and their main database has increased to 830 firms.

The Asia Pacific region already dominated the global industry, with 40% of all molecular diagnostics manufacturers, compared to 29% in the US and 28% in Europe. In terms of the COVID-19 market, Asia Pacific is even more dominant, with 55% of all firms.

The region is also ahead when it comes to commercialising COVID-19 tests. In Asia Pacific 90% of firms have a test on the market, compared to 78% in Europe and 67% in the US.

“The lag is striking because it mirrors the spread of the pandemic, starting in Asia Pacific and then moving to Europe and North America,” said Hogarth. “It suggests that firms in the US and Europe could have responded more quickly when the pandemic began.”

He points out that some of the countries with an effective commercialisation response to COVID-19 diagnostic testing needs are those where there is a strong relationship between the state and manufacturing sector.

“A country like South Korea exemplifies a pattern of industrialisation in which the state directs economic development,” said Hogarth.

“Our data suggests that strong leadership by the national government plays a role in industry responsiveness, at least at the extremes of leaders and laggards,” he said.

There are also important distinctions between regions and nations when it comes to the pace and nature of regulatory approval, says Hogarth: “Although most countries have put in place fast-track emergency approval mechanisms, the European Union already had a very low barrier to market entry.”

He points out that the ‘CE-mark’ – indicating a test complies with EU regulations – is self-certified by nearly all types of diagnostic tests manufacturers: the firm simply awards itself a CE-mark.

“The lack of regulatory scrutiny makes the EU an attractive market for firms,” said Hogarth. The CancerScreen research shows there are 50% more Chinese firms with CE-marks for the EU market than actually have approval in China itself, a pattern that is almost identical in South Korea.

Some 62 firms across China, South Korea and Singapore, as well as the US, currently export CE-marked COVID-19 tests to the EU. In China, South Korea and the US, the position is reversed: most firms with approved tests are domestic.

Meanwhile, only South Korean firms have approval in South Korea, very few firms that are not Chinese have approval in China, and this trend is replicated in the US.

Last week, the New York Times reported that the UK government bought two million kits for detecting antibodies for the coronavirus from two Chinese companies, only to find them ineffective.

“If the EU is to avoid becoming a dumping ground for poor quality tests, then further action must be taken,” said Hogarth. “That is already happening at a national level, as individual member states are forced to undertake post-market evaluation to assess the quality of tests to inform their procurement decisions.”

“Over the last few days the European Commission has begun to establish a more active role as a coordinating body and I welcome that very important development.”

The CancerScreen team is now working in collaboration with FIND to gather more data on the industry response to COVID-19 and Hogarth hopes to build links with the NIHR Innovation Lab for future work.

Added Hogarth: “It is important to share resources and expertise. FIND and NIHR have the definitive lists because they have data on immunoassays, as well as molecular diagnostics, but our strength is our broader understanding of the molecular diagnostics sector that we have developed over many years.”

The most affected group were young people aged 18-24 years, with more than four in ten (44 per cent) saying they felt lonely, according to the research study. The next most affected group were adults aged 25–34, with more than one third (35 per cent) saying they had experienced loneliness as a result of coronavirus.

One in six older people aged over 55 said they had felt lonely as a result of coronavirus, according to the study.

The survey data, from 2,221 UK adults aged 18 and over, were collected as part of Coronavirus: Mental Health and the Pandemic, a UK-wide longitudinal research project.

The survey was carried out on 2-3 April and asked people whether they had felt loneliness in the “previous two weeks”.

The UK-wide project is being led by the Mental Health Foundation in partnership with the University of Cambridge, Swansea University, University of Strathclyde and Queen’s University Belfast. The charity is seeking to track changes in the UK’s mental health in real time and target issues as they emerge.

The research also revealed a major surge in feelings of loneliness, which more than doubled across the lockdown period. When the researchers carried out the first round of the survey in March, shortly before lockdown started, 10 percent of UK adults said they had felt lonely. This figure rose to 24 per cent of all UK adults by the beginning of April.

Similarly, shortly before lockdown, 16 percent of young people aged 18-24 said they had felt loneliness because of coronavirus. This figure rose to 44 percent of young people after lockdown had been in force for almost two weeks.

Professor Tine Van Bortel from the Cambridge Institute of Public Health at the University of Cambridge said: “It might feel surprising but what our research shows is that the group most likely to be experiencing these feelings are young people.

“It is worrying that close to half of them said they are concerned about feeling lonely, and special attention should be given to young people. However, we shouldn’t forget that loneliness is also clearly affecting very large numbers of people of all ages.”

The Coronavirus: Mental Health and the Pandemic research project is carrying out ongoing analysis of the data, which cover approximately 20 topics including the unequal impact on the mental health of at-risk groups, the key drivers of risk to mental health and how people in the UK are coping. Qualitative data is to be added via a Citizen’s Jury and regular detailed briefings will be produced.

Dr Antonis Kousoulis, Director at the Mental Health Foundation: “Our data reveal that millions of people in the UK are experiencing feelings of loneliness – which is a key risk factor for developing or worsening mental health problems.

“The concern is that the longer the pandemic goes on, the more feelings become long-term. The impact of long-term loneliness on mental health can be very hard to manage.

“While the initial priority must be to prevent loss of life, we fear that we may be living with the mental health impacts of the coronavirus situation for many years to come. This is especially true of vulnerable groups and it is critical that governments and others are mindful of this in developing policy as we go forward.”

For the latest wave of data-gathering, total sample size was 2,221 UK adults aged 18 and above. Fieldwork to gather the new data was undertaken between 2 and 3 April 2020.  The survey was carried out online. The figures have been weighted and are representative of all UK adults (aged 18 and above).

The previous wave of data-gathering was as follows: Total sample size was 2,126 UK adults. Fieldwork was undertaken between 17 and 18 March 2020. The survey was carried out online. The figures have been weighted and are representative of all UK adults (aged 18 and above).

Advice on tackling loneliness.

All figures, unless otherwise stated, are from YouGov Plc.

Adapted from a press release by the Mental Health Foundation.

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Women on both sides of the Atlantic are more likely to have lost their jobs or suffered a fall in earnings since the coronavirus pandemic took hold – even after accounting for differences in types of occupation, a new study suggests.

Economists from the universities of Cambridge, Oxford and Zurich have collected two waves of data in the UK and the US – the first toward the end of March and then again in the middle of April – from almost 15,000 people.

The second wave of data from mid-April suggests that – across gender, age and occupation – a total of 15% of the UK population have lost their jobs due to the economic impact of coronavirus. In the US it’s even higher: a total of 18%.

However, significantly higher rates of women and workers without a degree had experienced job loss or wage drops in the four weeks prior to questioning, compared to men and those with a university education.

In the UK, 13% of workers with a degree lost their job compared to 18% without a university education. In the US, the rate of job loss was 22% for those without a college degree compared to 15% of college-educated workers.

Women in the UK are four percentage points more likely to have lost their job than men, with 17% of women newly unemployed compared to 13% of men. The gap in the US was even wider: 21% of women compared to 14% of men.

The researchers found that this gender gap in job loss due to coronavirus persisted even after controlling for education, occupation and regional location within each nation.

“We found that people without university degrees are more likely to be working in jobs with tasks that just can’t be done from home, making them more vulnerable to loss of employment,” said Dr Christopher Rauh, a report author from the University of Cambridge’s Faculty of Economics.

“While we can fully explain the education gap for job loss probabilities by differences in the types of work, the same is simply not true for the gender gap we see in job loss,” he said.

Despite this, the survey study found that – on average across both countries – women are more optimistic than men about their chances of keeping their job going forward.

The researchers suggest that one potential reason for the gender gap they identify might be found in hours spent homeschooling and caring for children.

Data gathered from 9-14 April show that, on average during a typical working day, men in the UK spend under 2.5 hours on childcare, and do under two hours of homeschooling.

Women in the UK, however, spend over 3.5 hours on childcare, and do over two hours of homeschooling. In the US this childcare and homeschool gender gap is very similar, although slightly smaller.

The type of occupation makes a massive difference to whether the coronavirus economic shock had taken your job in the last month. In the US, food serving and preparation was by far the worst hit type of occupation with 40% losing their jobs, followed by transportation and then production.

In the UK, the cleaners and maintenance workers have fared worst with 33% losing their jobs, closely followed by personal care services, then food workers and construction. In both countries, those who work in computing and occupations such as architects and engineers were least affected by loss of employment.

The research also found a stark difference in job or earnings loss across the board between those on permanent contracts compared with temporary contracts, and those who can fully work from home compared with those who cannot do any. However, these inequalities were far greater in the US than the UK.

The latest research builds on the first wave of survey work conducted near the end of March, which showed that those under the age of thirty and on lower incomes were more likely to have seen wage and job losses.

Added Rauh: “In general, younger individuals across the board, as well as women and those without university education, were significantly more likely to report experiencing drops in income.”

“The outlook on the future is bleak. Of all those still employed, 32% of people in the UK and 37% of people in the US believe they will lose their jobs in the next few months,” he said.

“Our findings highlight the need for immediate policy responses that target those most affected by the economic crisis.”

The findings by the research team, composed of Rauh along with the University of Oxford’s Abi Adams-Prassl and Marta Golin and the University of Zurich’s Teodora Boneva, are published as a working paper through the University of Cambridge Institute for New Economic Thinking: https://www.inet.econ.cam.ac.uk/working-paper-pdfs/wp2018.pdf.

The Cambridge-INET Institute has now launched a dedicated website for all their coronavirus-related research: http://covid.econ.cam.ac.uk.

How you can support Cambridge’s COVID-19 research effort

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Because of the urgent need to share information relating to the pandemic, the researchers have published their report on MedRXiv. It has not yet been peer-reviewed. However, the preliminary data is supported by data in other countries.

While the initial symptoms of COVID-19 include fever but do not always include breathing difficulties, some patients go on to develop very serious respiratory problems. Although most patients only experience mild illness, around a quarter of hospital-admitted cases require intensive care treatment because of viral pneumonia with respiratory complications. While research suggests that COVID-19 likely stems from an overactive immune response, it is not clear why some patients are at greater risk of severe disease.

Previous studies suggested that individuals over the age of 60 or with underlying health conditions, including cardiovascular disease, diabetes, chronic respiratory disease and cancer, are at highest risk of severe disease or death. Long-term exposure to air pollutants, including nitrogen oxides and ground level ozone from car exhaust fumes or burning fossil fuels, is a known risk factor for these health conditions. Such pollutants can also cause a persistent inflammatory response and increase the risk of infection by viruses that target the respiratory tract.

In this new study, researchers at the MRC Toxicology Unit at the University of Cambridge report an association between certain air pollutants and COVID-19 in England.

The team analysed the data on total COVID-19 cases and deaths, against the levels of three major air pollutants, collected between the years 2018 and 2019, when no COVID-19 case was reported. Their study used publicly available data from seven regions in England, where a minimum of 2,000 SARS-CoV-2 infections and 200 deaths are reported in the period from February to the 8 April 2020.

The largest number of COVID-19 deaths in England occurred across London and the Midlands, reflecting the geographical distribution of COVID-19 related cases. Previous studies have shown that the annual average of nitrogen dioxide concentrations are largest in these two regions.

When the team compared the annual average of daily nitrogen oxide and nitrogen dioxide levels to the total number of COVID-19 cases in each region, they found these to be positively correlated – in other words, the higher the pollutant levels, the greater the number of COVID-19 cases and deaths. Both nitrogen oxide and nitrogen dioxide result from a chemical reaction between nitrogen and oxygen during combustion of fossil fuels, and therefore represent a significant source of air pollution in areas with high traffic

Marco Travaglio, a PhD student at the MRC Toxicology Unit, said: “Our results provide the first evidence that SARS-CoV-2 case fatality is associated with increased nitrogen oxide and nitrogen dioxide levels in England. London, the Midlands and the North West show the largest concentration of these air pollutants, with Southern regions displaying the lowest levels in the country, and the number of COVID-19 deaths follows a similar trend.”

The team found a negative association between ambient ground levels of ozone and the number of COVID-19 cases and deaths in each region – in other words, reduced ozone levels are associated with a greater number of COVID-19 cases and deaths.

Ozone is a secondary by-product of traffic-related air pollution and is generated through sunlight-driven reactions between motor-vehicle emissions and volatile organic compounds. The lowest levels of ozone were found in highly urbanised regions, such London or the Midlands. This is likely to be due to the highly reactive nature of ozone, which results in the gas being converted to other chemicals, a phenomenon previously reported for areas of heavy traffic. The researchers suggest that the detrimental effects of low ozone concentration observed in this study could be linked to increased generation of ozone oxidation products.

Dr Miguel Martins, senior author on the study, added: “Our study adds to growing evidence from Northern Italy and the USA that high levels of air pollution are linked to deadlier cases of COVID-19. This is something we saw during the previous SARS outbreak back in 2003, where long-term exposure to air pollutants had a detrimental effect on the prognosis of SARS patients in China. This highlights the importance of reducing air pollution for the protection of human health, both in relation to the COVID-19 pandemic and beyond.”

The researchers say that their findings only show a correlation and that further research is needed to confirm that air pollution makes COVID-19 worse.

The research was supported by the Medical Research Council.

Reference
Travaglio, M et al. Links between air pollution and COVID-19 in England. MedRXiv; 17 April 2020; DOI: 10.1101/2020.04.16.20067405

Built primarily for use in low- and middle-income countries, the OVSI ventilator can be cheaply and quickly manufactured from readily available components. Current ventilators are expensive and difficult to fix, but an open-source design will allow users to adapt and fix the ventilators according to their needs and, by using readily available components, the machines can be built quickly across Africa in large numbers. The cost per device is estimated to be around one-tenth of currently available commercial systems.

The first ventilators will be delivered in May by a team of South Africa-based companies led by Defy, a leading southern African manufacturer of domestic appliances, and Denel, a major state-owned company.

Recent tentative estimates published by the WHO have suggested that there could be as many as 10 million cases of COVID-19 in Africa within three to six months, resulting in anywhere between 300,000 and 3.3 million deaths. There are 10 countries in Africa that do not have any ventilators at all and according to the WHO, it is estimated that there are fewer than 2,000 working ventilators across 41 countries in Africa.

“Fulfilling the unique requirements of local clinicians was key to this project,” said Professor Axel Zeitler from the Department of Chemical Engineering and Biotechnology, and OVSI team lead. “Clinicians told us the ventilator needed to cover the wide spectrum of patient ventilation requirements, and therefore work in three modes – non-invasive, mandatory or patient-triggered ventilation.

“We also know that oxygen availability varies within countries, hospitals and wards. The system must use the smallest amount of oxygen possible, but include the potential to add an oxygen concentrator.”

The Open Ventilator System Initiative is a consortium of academics, engineers, intensive care medics, innovators and industry partners across the UK and Africa. Formed in March this year, the initiative has grown quickly from an initial idea at the University of Cambridge to a team of 60 individuals contributing remotely.

The team is being advised by a panel of clinical experts including physicians in Uganda, Kenya, the DRC, South Africa and the UK. The clinical partnerships were established with the support of the Cambridge-Africa programme and Cambridge Global Health Partnerships. The ventilator was designed and built by a team based at the University of Cambridge’s Whittle Laboratory.

“Critical to this project has been the speed of technology development,” said Professor Robert Miller, Director of the Whittle Laboratory. “In recent years, the primary focus of the Whittle Laboratory has been to accelerate the process of technology development. By merging the digital and physical systems integral to the technology development process and by using Formula One-style teams, we’ve cut the amount of time this takes by a factor of 10 to 100. This capability has been key to delivering the OVSI ventilator.”

The prototype is currently being developed further into a version that can be easily mass-produced by Prodrive Ltd, a British motorsport and advanced engineering group based in Banbury, Oxfordshire. It has been thoroughly tested at the National Physical Laboratory in Teddington and passed the MHRA test specifications with flying colours. The OVSI team is currently working on securing regulatory approval for the device.

The first manufacture will be led by Defy Ltd and Denel Ltd in South Africa. Evren Albas, CEO of Defy Appliances in South Africa said, “Defy’s flexible manufacturing capabilities in Africa, together with the design and development expertise of the consortium with whom we are partnering, will allow us to fast-track ventilator production and distribution. Teams are working around the clock to start production by May.”

“While the immediate need is to save lives in the context of the COVID-19 pandemic, we wanted something that will be useful to healthcare workers around the world going forward,” said Dr Lara Allen, CEO of the Centre for Global Equality and a founding member of the OVSI team. “It’s often the case that those living on less than $4 per day are excluded from the innovation process. As a result, many well-meaning innovations are not what is needed or wanted by the intended beneficiaries and end up not being used. This is disappointing for designers, a waste of humanitarian resources, and low-resource communities continue to go without the support they desperately need. This is why taking an inclusive innovation approach is vital for sustainable impact.”

Present efforts to adapt the design for low- and middle-income countries include collaboration with the long-term inclusive innovation partners at the Bahir Dar Institute of Technology, at Bahir Dar University in Ethiopia, and the Science & Technology Park at the University of Nairobi in Kenya.

OVSI will work with partner countries in Africa and elsewhere to enable local manufacturing and maintenance of the ventilator, and to design, prototype and gain regulatory approval for system upgrades.

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The centres, which include the Cancer Research UK Cambridge Cancer Centre, form an alliance known as Cancer Core Europe (CCE), and together represent around 60,000 newly diagnosed cancer patients each year and conduct more than 1,500 clinical trials.

In a Perspective published in Nature Medicine, CCE researchers describe how their centres have been forced by the current pandemic to drastically revise and reorganise their patient care and scientific research, while maintaining the same high quality of care.

The specialist centres not only want to prevent the spread of the virus in general, but also to protect patients with cancer whose disease and treatment make them especially vulnerable to complications if infected.

“COVID-19 has created a unique challenge: how to adjust cancer management to minimise the disruption caused to cancer care by the pandemic,” said Professor Carlos Caldas, co-lead author of the article, member of the senior management team of the Cancer Research UK Cambridge Centre, and Group Leader at the Cancer Research UK Cambridge Institute.

“Our medical staff across all disciplines have been truly amazing at very quickly producing COVID-19-adjusted treatment guidelines.”

The researchers have identified several factors that medical institutions need to consider to ensure continuity in cancer care as the COVID-19 pandemic unfolds. These include:

• Clinical activities
  Given the high transmissibility rate of SARS-Cov2, it is the responsibility of all health care professionals to make sure patients are not exposed to COVID-19. For CCE centres, this means that face-to-face consultations are now, whenever possible, taking place via web consulting or by telephone calls, and non-urgent appointments are postponed.
• Adaptation of standard-of-care treatment regimens
  Across all centres, standard-of-care treatment regimens have been adapted to minimize the number of hospital visits and hospitalizations, and to prevent complications of COVID-19 caused by anticancer treatments.
• Patient information and psychosocial care
  Addressing patients’ concerns relating to their treatment and how it may be affected by COVID-19 poses a challenge to CCE centres and has required urgent attention.
• Support of qualified personnel
  In order to ensure the continuity of cancer care, the presence of sufficient qualified personnel to treat cancer patients is essential. This involves the whole chain of hospital caregivers, from the operating theatre, to the ward, day clinic, and intensive care unit (ICU). Every CCE has faced a similar problem: the absence of a rapid diagnostic system for COVID-19 for caregivers. This frequently leads to unnecessary self-isolation of health professionals, further reducing the health workforce in a time when demand is peaking.
• Capacity of cancer care facilities
  In many hospitals, the COVID-19 pandemic is a major stress test for the capacity of the various treatment or support units: radiation, medical oncology, imaging, surgery and ICUs. With increasing severity of the pandemic, health care systems will become overwhelmed and prioritization will be necessary. To prepare for this, CCE centres have established decision rules to categorize and prioritize patients for anticancer therapies or surgery.
• Research activities​
  CCE centres have large research facilities and together employ thousands of preclinical scientists. One of the first measures taken was to downscale these preclinical research activities to a minimum in accordance with social distancing guidelines and the ‘lockdown’ local policy. Clinically trained scientists and research fellows are frequently going back to clinical work to support their healthcare system.

  The authors acknowledge that the current crisis will have major ramifications to the progress of cancer research. However, public health measures in place to curtail the COVID-19 pandemic have to be prioritized at the moment, and the damage to the scientific enterprise will be repairable in time if safeguards and resources are put in place.

The team outline a set of practical measures that have been implemented in their respective centres and could be considered by other medical centres. These range from instructing patients where possible not to visit the hospital if they have possible symptoms of COVID-19 to reducing preclinical research activities to a bare minimum, and from informing patients about a possibly increased risk associated with anticancer therapy during the pandemic through to considering non-surgery-based treatments, such as radiation for prostate cancer.

Professor Caldas added: “We hope that our collective experiences will help guide others and will also reassure cancer patients that we are doing everything we can to avoid compromising their care.

“This COVID-19 crisis is making us rethink care, and some of the changes might in the long run have positive effects, for example minimising hospital visits and face-to-face consultations or delivering care using telemedicine.”

The Cancer Core Europe (CCE) alliance of seven leading European cancer centres was founded in 2014 to accelerate the development of innovative cancer therapies through close collaboration in translational and clinical research. Its seven member centres collectively treat approximately 350,000 patients annually.

The Cancer Research UK Cambridge Centre acknowledges funding from Cancer Research UK, the National Institute for Health Research Cambridge Biomedical Research Centre, and The Mark Foundation for Cancer Research. Its clinical cancer services are provided by Cambridge University Hospitals (CUH) and Royal Papworth Hospital.

Reference
Caring for patients with cancer in the COVID-19 era. Nat Med; 16 Apr 202; DOI: 10.1038/s41591-020-0874-8

A multi-institutional collaboration, co-led by scientists at the University of Cambridge and Okinawa Institute of Science and Technology Graduate University (OIST), has identified the source of efficiency-limiting defects in potential materials for next-generation solar cells and LEDs.

In the last decade, perovskites – a diverse range of materials with a specific crystal structure – have emerged as promising alternatives to silicon solar cells, as they are cheaper and greener to manufacture, while achieving a comparable level of efficiency.

More and more evidence suggests that SARS-CoV2, the virus that causes COVID-19, may be commonly transmitted before individuals show symptoms.

Professor Babak Javid, a consultant in infectious diseases at Cambridge University Hospitals NHS Trust, as well as a professor at Tsinghua University in Beijing, China, said: “We know that a lot of transmission of the coronavirus occurs before people show any symptoms. Wearing masks is primarily to protect others, as well as offering some degree of protection to the wearer.”

Writing in an editorial for the BMJ, the team argue that the potential benefits vastly outweigh the possible downsides associated with mask use. Studies performed prior to the current emergency were of variable quality, and didn’t take into account how likely individuals were to comply with wearing a mask. The authors argue that in the midst of a pandemic, people are much more likely to follow guidelines.

The evidence for masks is no worse than other widely adopted and promoted behaviours, such as handwashing, they say. Even if masks are only 20% effective at reducing transmission, previous models for an influenza pandemic suggested that substantial numbers of cases may still be prevented. Widespread education campaigns, such as those promoting handwashing at present, could help ensure the masks are used properly and mitigate some of the concerns over their proper use.

Due to shortages of medical masks for our healthcare workers, the researchers recommend cloth masks for the public. Dr Michael Weekes from the Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID) said: “The evidence to support the use of masks in non-clinical settings may be limited, but the mass manufacture and use of cloth masks is cheap and easy, compared to the societal economic costs associated with isolation and social distancing measures.”

Dr Nicholas Matheson, also from CITIID, and a consultant at Cambridge University Hospitals NHS Trust and NHS Blood and Transplant added: “As we prepare to enter a ‘new normal’, wearing a mask in public may become the face of our unified action in the fight against this common threat, and reinforce the importance of social distancing measures.

Reference
Covid-19: should the public wear face masks? BMJ; 9 Apr 2020; DOI: 10.1136/bmj.m1442 

Since adult hearts cannot usually repair themselves once damaged, harnessing the power of this gene represents major progress towards the first curative treatment for heart disease.

“This is really exciting because scientists have been trying to make heart cells proliferate for a long time. None of the current heart disease treatments are able to reverse degeneration of the heart tissue – they only slow progression of the disease. Now we’ve found a way to do it in a mouse model,” said Dr Catherine Wilson, a researcher in the University of Cambridge’s Department of Pharmacology, who led the study.

The cell cycle – through which cells make copies of themselves – is tightly controlled in mammalian cells. Cancer develops when cells start to replicate themselves uncontrollably, and the Myc gene plays a key role in the process. Myc is known to be overactive in the vast majority of cancers, so targeting this gene is one of the highest priorities in cancer research. Much recent research has focused on trying to take control of Myc as a means of cancer therapy.

When the researchers made Myc overactive in a mouse model, they saw its cancerous effects in organs including the liver and lungs: huge amount of cells started replicating over the course of a few days. But in the heart, nothing much happened.

They found that Myc-driven activity in heart muscle cells is critically dependent on the level of another protein called Cyclin T1, made by a gene called Ccnt1, within the cells. When the Ccnt1 and Myc genes are expressed together, the heart switches into a regenerative state and its cells start to replicate. The results are published today in the journal Nature Communications.

“When these two genes were overexpressed together in the heart muscle cells of adult mice we saw extensive cell replication, leading to a large increase in the number of heart muscle cells,” said Wilson.

Heart failure affects around 23 million people worldwide each year, and there is currently no cure. After a heart attack, an adult human heart can lose up to one billion heart muscle cells – called cardiomyocytes. Unlike many other organs in the body, the adult heart can’t regenerate itself, so these cells are never replaced. Their loss reduces the strength of the heart and causes scar formation, heart failure and ultimately death.

Using a next generation sequencing technology called ChIP, the researchers were able to watch the action of Myc in the heart cells. Myc produces a protein – called a transcription factor – that binds to the DNA in specific cells and activates gene expression. But despite the protein binding successfully, the heart cells didn’t start to replicate themselves because the protein could not activate gene expression. Another protein vital to gene expression, Cyclin T1, was deficient in the heart. Adding it to the cells with the overactive Myc caused the cells to start proliferating.

“None of the current treatment options can reverse the degeneration of heart tissue. The inability of the heart to regenerate itself is a significant unmet clinical need,” said Wilson. “We found that even when Myc is switched on in a heart, the other tools aren’t there to make it work, which may be one of the reasons heart cancer is so extremely rare. Now we know what’s missing, we can add it and make the cells replicate.”

As the world’s population grows and the prevalence of heart failure increases, the cost of patient care is anticipated to increase dramatically. The researchers hope to develop their finding into a genetic therapy for the treatment of heart disease. “We want to use short-term, switchable technologies to turn on Myc and Cyclin T1 in the heart. That way we won’t leave any genetic footprint that might inadvertently lead to cancer formation,” said Wilson.

This research was funded by Cancer Research UK.

Reference
Bywater, M. J. et al: ‘Reactivation of Myc transcription in the mouse heart unlocks its proliferative capacity.’ Nature Communications, April 2020. DOI: 10.1038/s41467-020-15552-x