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Agency: GTR | Branch: EPSRC | Program: | Phase: Training Grant | Award Amount: 4.93M | Year: 2014

The global Robotics and Autonomous Systems (RAS) market was $25.5bn in 2001 and is growing. The market potential for future robotics and autonomous systems is of huge value to the UK. The need for expansion in this important sector is well recognised, as evidenced by the Chancellor of the Exchequers announcement of £35m investment in the sector in 2012, the highlighting of this sector in the 2012 BIS Foresight report Technology and Innovation Futures and the identification of robotics and autonomous systems by the Minister for Universities and Science in 2013 as one of the 8 great technologies that will drive future growth. This expansion will be fuelled by a step change in RAS capability, the key to which is their increased adaptability. For example, a home care robot must adapt safely to its owners unpredictable behaviour; micro air vehicles will be sent into damaged buildings without knowing the layout or obstructions; a high value manufacturing robot will need to manufacture small batches of different components. The key to achieving increased adaptability is that the innovators who develop them must, themselves, be very adaptable people. FARSCOPE, the Future Autonomous and Robotic Systems Centre for PhD Education, aims to meet the need for a new generation of innovators who will drive the robotics and autonomous systems sector in the coming decade and beyond. The Centre will train over 50 students in the essential RAS technical underpinning skills, the ability to integrate RAS knowledge and technologies to address real-world problems, and the understanding of wider implications and applications of RAS and the ability to innovate within, and beyond, this sector. FARSCOPE will be delivered by a partnership between the University of Bristol (UoB) and the University of the West of England (UWE). It will bring together the dedicated 3000 square metre Bristol Robotics Laboratory (BRL), one of the largest robotics laboratories in Europe, with a trainin and supervising team drawn from UoB and UWE offering a wide breadth of experience and depth of expertise in autonomous systems and related topics. The FARSCOPE centre will exploit the strengths of BRL, including medical and healthcare robotics, energy autonomous robotics, safe human-robot interactions, soft robotics, unconventional computing, experimental psychology, biomimicry, machine vision including vision-based navigation and medical imaging and an extensive aerial robotics portfolio including unmanned air vehicles and autonomous flight control. Throughout the four-year training programme industry and stakeholder partners will actively engage with the CDT, helping to deliver the programme and sharing both their domain expertise and their commercial experience with FARSCOPE students. This includes regular seminar series, industrial placements, group grand challenge project, enterprise training and the three-year individual research project. Engaged partners include BAE Systems, DSTL, Blue Bear Systems, SciSys, National Composites Centre, Rolls Royce, Toshiba, NHS SouthWest and OC Robotics. FARSCOPE also has commitment from a range of international partners from across Europe, the Americas and Asia who are offering student exchange placements and who will enhance the global perspective of the programme.

News Article | February 15, 2017

Gay men who defied medical advice seem to have changed the course of the HIV epidemic in the UK – for the better. Four London sexual health clinics saw dramatic falls in new HIV infections among gay men of around 40 per cent last year, compared with 2015, new figures show. This decline may be mostly due to thousands of people buying medicines called pre-exposure prophylaxis (PrEP), which cut the chance of catching the virus, online. “We need to be very cautious at this stage, but I can’t see what else it can be,” says Will Nutland at the London School of Hygiene and Tropical Medicine, who has set up PrEPster, a website that gives people information on how to give themselves PrEP. “Something extraordinary has happened in the last 12 months because of a bunch of DIY activists working off our kitchen tables.” The medicine has been approved in the UK as a drug for preventing HIV infection in both men and women, but it isn’t yet available on the National Health Service. “People say, ‘Why don’t gay men just use condoms?’,” says Mags Portman of the Mortimer Market Centre in London, one of the clinics that has seen large declines in diagnoses. “They do, but not all the time. Straight people don’t use condoms all the time either.” To avoid paying £400 a month for private prescriptions of the brand-name drug Truvada, growing numbers are buying generic versions from online pharmacies in India and Swaziland for £40 a month, through a UK website called I Want PrEP Now. Until recently, most doctors would have advised against buying any medicines online, warning that the process could be illegal or the drugs may not be safe. While it is legal to buy up to a three-month personal supply, it can seem shady as the medicines are sent through several countries to get around custom laws. But attitudes are changing. Some sexual health doctors now help people who source PrEP online by providing blood tests to check the pills are real and urine tests to ensure people aren’t getting kidney damage as a side effect. So far no pills have turned out to be fake. These doctors were also reassured when the regulatory body, the General Medical Council, told them its ethical guidelines say clinicians should give patients information about treatments they cannot offer themselves, says Portman. PrEP use has been rising in other countries, and some cities have also seen drops in new HIV diagnoses. San Francisco saw a 17 per cent fall in infection rates in 2015. But this decline has generally been attributed to a mix of better prevention, diagnosis and treatment methods, without singling out PrEP. Higher rates of diagnosis and treatment cut new infections because HIV drugs slash the amount of virus in people’s genital fluids, lowering the risk of passing it on to almost zero. In the UK, however, the use of PrEP was low until it suddenly surged over the past year. This increase coincided with the launch of I Want PrEP Now and PrEPster, and ongoing publicity over an attempt to sue NHS England to provide the medication on the NHS. Greg Owen, who runs I Want PrEP Now, estimates that more than 2000 people buy it through his non-profit site. Doctors mainly recommend that people use his site rather than finding a manufacturer to buy from directly because Owen works with NHS clinics to check the medicines are genuine. Some people also manage to get free PrEP through the NHS by claiming they were exposed to HIV through unprotected sex in the past few days. This gets them a month’s worth of pills and the supply can be continued by “clinic hopping”: attending different hospitals every month using false names. The falls in new HIV diagnoses among gay men at the four London health centres were announced last month. While it is unknown how much of this is thanks to PrEP, several doctors say it is probably the main factor. “We are convinced that PrEP is responsible for the large decreases in new diagnoses,” Portman said in a tweet about the announcement. While a similar drop is unlikely to be seen in total HIV infections across men and women, the decline among gay men is important. Just over half of new UK infections are in gay men, so such a drastic drop could significantly slow the epidemic. Sheena McCormack of the London clinic 56 Dean Street says the fall in infection rates is unlikely to be due to more condom use, as rates of other sexually transmitted diseases such as syphilis were about the same in 2016 as the year before. Matthew Hodson of the HIV information charity NAM says that while the drop could in theory be down to the preventative impact of wider testing and treatment, that is unlikely because of the timing and steep decline in incidence. The best argument for using PrEP is that it works so well at reducing new infections, says Jason Domino, who has been using the medicine for two years, after a scare when a partner turned out to be HIV-positive. “You’re tackling an infection that’s hugely expensive to address,” he says. “It saves the NHS money.” But a Public Health England spokesperson told New Scientist that a range of other factors could have caused the fall in new HIV diagnoses. After NHS England lost a court case in November, Public Health England said it would make PrEP available, but only as part of a 10,000-person trial to answer outstanding questions about how the drug should be rolled out. “The NHS needs to pull its finger out and make sure there’s a contingency plan for what to do when its 10,000 places fill up,” says Nutland. “The cat is out of the bag that PrEP really works.”

Plus de 100 exposants venant de 20 pays se retrouveront sur le site de l’exposition, plus de la moitié lanceront leurs nouveaux produits et prototypes en présence de 200 journalistes. La liste des exposants comprend aussi bien des compagnies de renom comme Epson que les nouvelles initiatives du Launch Pad et des start-ups comme Real Wear et E-Senses, qui étaient présentes au salon CES en janvier. Le salon présente six différents secteurs : technologie portable, IOT Connect, AR & VR Show, MXR Summit, Smart Home Show et le tout nouveau salon Digital Health Technology Show. Ce dernier permettra aux visiteurs de s’imprégner du futur des soins de santé et d’en savoir plus sur les dernières technologies de rupture transformant le secteur médical. Plus de 50 produits seront lancés pour la première fois sur le marché britannique et en présence des médias. Les visiteurs découvriront par exemple des technologies médicales et sanitaires permettant de sauver des vies, les nouvelles lunettes connectées à la réalité augmentée Moverio BT-350 d’Epson, le dispositif de conduite de réalité augmentée de Navdy, qui permet de garder les yeux sur la route tout en restant connecté, le ‘Netflix pour la musculation’ de MYZONE, Kerv, la première bague au monde permettant d’effectuer des paiements sans contact, ainsi que le premier casque de course du monde, créé par Cognisess, qui diffuse en direct à l’équipe de course les réactions cérébrales du conducteur. Une conférence sur sept différents thèmes aura lieu parallèlement au salon. Elle se targue de plus de 200 intervenants délégués par des organisations comme BBC, Microsoft HoloLens, Google Daydream, Princess Cruises, HTC Europe, TEAM Sky, British Cycling et l'ECB, Red Bull, Dixons Carphone, NHS Digital et NHS England. « 2017 va être une année fascinante pour la technologie connectée, en particulier dans les domaines de la santé et de la médecine, et le salon Wearable Technology Show présentera tout ce qui est révolutionnaire et qui nous aidera à améliorer notre travail et à vivre nos vies de façon plus agréable », a déclaré John Weir, le chef des opérations du salon.

Agency: GTR | Branch: EPSRC | Program: | Phase: Research Grant | Award Amount: 573.84K | Year: 2015

By 2018, it is estimated that the number of people in the UK with three or more long-term conditions, also known as multimorbidity , will have grown from 1.9 million to 2.9 million. Various chronic diseases develop simultaneously in response to common risk factors such as smoking, diet, ageing and inactivity. The four most common chronic diseases are cancer, chronic obstructive pulmonary disease (COPD), coronary heart disease and diabetes. A recent study found that over 97% of patients with moderate to severe COPD had at least one concomitant chronic disease. In clinical settings processes are complex and are influenced by a number of social, technical and organisational factors. This complexity can result in variation in how physicians practice, appropriate care is documented, and healthcare costs managed. To reduce inconsistencies, clinical guidelines have emerged based on the best existing evidence, with the aim to support clinical staff and improve the quality of healthcare. Current guidelines almost entirely focus on single conditions. As a result, applying multiple guidelines to a patient may potentially result in conflicting recommendations for care. In software system design and development, we create computer systems capable to support diverse interactions between the environment/users and the system. These interactions often reflect different and possibly conflicting viewpoints, such as those presented by different users or stakeholders. Although software system specification and patient care guidelines seem different, inherently they have something in common. In both cases we have procedures and executions of (partially) ordered sequence of actions (aka activities or tasks) called traces of execution in computer science or pathways in clinical practice. In the case of computer-based systems, actions are carried out by users or computers (more specifically individual components or objects in the system). In the case of care guidelines, actions are carried out by physicians, patients and carers. In both cases, conflict may arise when individual executions and pathways are incompatible. In this proposal, we investigate automated methods of detection of conflicts in clinical pathways for multimorbidities and propose solutions that resolve them .

Dwan K.,NHS England
Cochrane database of systematic reviews (Online) | Year: 2011

Publication of complete trial results is essential if people are to be able to make well-informed decisions about health care. Selective reporting of randomised controlled trials (RCTs) is a common problem. To systematically review studies of cohorts of RCTs to compare the content of trial reports with the information contained in their protocols, or entries in a trial registry. We conducted electronic searches in Ovid MEDLINE (1950 to August 2010); Ovid EMBASE (1980 to August 2010); ISI Web of Science (1900 to August 2010) and the Cochrane Methodology Register (Issue 3, 2010), checked reference lists, and asked authors of eligible studies to identify further studies. Studies were not excluded based on language of publication or our assessment of their quality. Published or unpublished cohort studies comparing the content of protocols or trial registry entries with published trial reports. Data were extracted by two authors independently. Risk of bias in the cohort studies was assessed in relation to follow up and selective reporting of outcomes. Results are presented separately for the comparison of published reports to protocols and trial registry entries. We included 16 studies assessing a median of 54 RCTs (range: 2 to 362). Twelve studies compared protocols to published reports and four compared trial registry entries to published reports. In two studies, eligibility criteria differed between the protocol and publication in 19% and 100% RCTs. In one study, 16% (9/58) of the reports included the same sample size calculation as the protocol. In one study, 6% (4/63) of protocol-report pairs gave conflicting information regarding the method of allocation concealment, and 67% (49/73) of blinded studies reported discrepant information on who was blinded. In one study unacknowledged discrepancies were found for methods of handling protocol deviations (44%; 19/43), missing data (80%; 39/49), primary outcome analyses (60%; 25/42) and adjusted analyses (82%; 23/28). One study found that of 13 protocols specifying subgroup analyses, 12 of these 13 trials reported only some, or none, of these. Two studies found that statistically significant outcomes had a higher odds of being fully reported compared to nonsignificant outcomes (range of odds ratios: 2.4 to 4.7). Across the studies, at least one primary outcome was changed, introduced, or omitted in 4-50% of trial reports. Discrepancies between protocols or trial registry entries and trial reports were common, although reasons for these were not discussed in the reports. Full transparency will be possible only when protocols are made publicly available or the quality and extent of information included in trial registries is improved, and trialists explain substantial changes in their reports.

In people with type 2 diabetes mellitus (T2DM), the incretin effect is reduced, but the recent advent of dipeptidyl peptidase-4 inhibitors and glucagon-like peptide (GLP)-1 agonists/analogues has enabled restoration of at least some of the function of the incretin system, with accompanying improvements in glycaemic control. Two GLP-1 receptor agonists/analogues are currently approved for the treatment of T2DM-exenatide (Byetta®, Eli Lilly & Co., Indianapolis, IN, US) and liraglutide (Victoza®, Novo Nordisk, Bagsvaerd, Denmark); a once-weekly formulation of exenatide (Bydureon®, Eli Lilly & Co.) has also been approved by the European Medicines Agency. The National Institute for Health and Clinical Excellence (NICE) has recently published guidance on the use of liraglutide in T2DM, based on evidence from the Liraglutide Effect and Action in Diabetes (LEAD) Phase III trial programme, which compared liraglutide with existing glucose-lowering therapies, such as exenatide and insulin glargine. The LEAD programme reported HbA1c reductions from 0.8 to 1.5% with liraglutide (1.2 and 1.8 mg), accompanied by low rates of hypoglycaemia and some weight loss; side effects were primarily gastrointestinal in nature (e.g. nausea and diarrhoea). Based on the findings of the LEAD studies and the NICE recommendation, liraglutide now represents an important therapy widely available in the UK for certain patient groups, including those with a body mass index (BMI) ≥35.0 kg/m2, and patients with a BMI <35 kg/m2 who are considered unsuitable for insulin and are failing to meet targets for glycaemic control with oral agents. NICE guidelines still suggest that most patients without considerable obesity (BMI <35 kg/m2) are probably best managed using insulin therapy. Evidence also suggests a future role for GLP-1 mimetics in combination with basal insulin. © 2011 Blackwell Publishing Ltd.

Barnett A.H.,NHS England
Expert Opinion on Drug Safety | Year: 2015

Introduction: Established treatments for type 2 diabetes mellitus (T2DM) have side effects that limit their use in specific populations. New therapies with improved safety profiles are needed, especially because of the chronic and progressive nature of T2DM.Areas covered: This review describes the overall safety and tolerability of linagliptin-a dipeptidyl peptidase-4 inhibitor that improves glycemic control without increasing risk for hypoglycemia and without weight gain. Specifically, the safety of linagliptin is evaluated in difficult-to-treat patients with T2DM, in relation to risk of cardiovascular (CV) events and acute pancreatitis, and in comparison with other antihyperglycemic drugs.Expert opinion: Linagliptin is generally well tolerated in a broad range of patient populations. It can be used in patients with renal impairment without dose titration and may be a rational alternative treatment in this vulnerable population. Ongoing long-term trials are fully evaluating the CV and renal safety profile of linagliptin. © 2015 Informa UK, Ltd.

Daniels R.,NHS England
Journal of Antimicrobial Chemotherapy | Year: 2011

Severe sepsis is a major cause of morbidity and mortality, claiming between 36000 and 64000 lives annually in the UK, with a mortality rate of 35%. International guidelines for the management of severe sepsis were published in 2004 by the Surviving Sepsis Campaign and condensed into two Care Bundles. In 2010, the Campaign published results from its improvement programme showing that, although an absolute mortality reduction of 5.4% was seen over a 2 year period in line with increasing compliance with the Bundles, reliability was not achieved and Bundle compliance reached only 31%. This article explores current challenges in sepsis care and opportunities for further improvements. Basic care tasks [microbiological sampling and antibiotic delivery within 1 h, fluid resuscitation, and risk stratification using serum lactate (or alternative)] are likely to benefit patients most, yet are unreliably performed. Barriers include lack of awareness and robust process, the lack of supporting controlled trials, and complex diagnostic criteria leading to recognition delays. Reliable, timely delivery of more complex life-saving tasks (such as early goal-directed therapy) demands greater awareness, faster recognition and initiation of basic care, and more effective collaboration between clinicians and nurses on the front line, in critical care and in specialist support services, such as microbiology and infectious diseases. Organizations such as Survive Sepsis, the Surviving Sepsis Campaign and the Global Sepsis Alliance are working to raise awareness and promote further improvement initiatives. Future developments will focus on sepsis biomarkers and microarray techniques to rapidly screen for pathogens, risk stratification using genetic profiling, and the development of novel therapeutic agents targeting immunomodulation. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

Background: Patients with type 2 diabetes appear to be at relatively low risk of severe hypoglycaemia and hypoglycaemia unawareness in the early stages of disease. However, declining endogenous insulin secretory capacity due to β-cell dysfunction/failure eventually produces vulnerability similar to type 1 diabetes. Severe hypoglycaemia itself is associated with serious morbidity and sometimes mortality, and represents an important barrier to achieving glycaemic goals and thus may reduce the protection from diabetes-related morbidity provided by good glycaemic control. Achieving an optimal balance of good glycaemic control and low risk of hypoglycaemia is key to providing optimum care in individuals with type 2 diabetes. This article discusses the issues related specifically to hypoglycaemia associated with oral agent therapy and how these agents may be best employed to provide an optimal balance between hypoglycaemia and good glycaemic control. Methods: Embase and Medline searches from 1998 to 2009 using the search terms DPP-4 inhibitors, metformin, oral agents, sulphonylureas, thiazolidinediones AND hypoglycaemia were conducted to identify relevant articles. The limitations inherent in this retrospective, narrative review of previously published publications chosen at the authors discretion are acknowledged. Findings: Failure to address even mild hypoglycaemia and glycaemic control early in the course of the disease may compromise the success of treatment in the longer term. Metformin, thiazolidinediones and DPP-4 inhibitors, either as monotherapy or in combination with each other, have a well-characterised low propensity to cause hypoglycaemia compared with other therapies. Conclusions: Metformin, thiazolidinediones and DPP-4 inhibitors appear to be the most appropriate oral options for minimising the risk of hypoglycaemia. Early and ongoing attention to hypoglycaemia should form an integral part of any long-term glucose control strategy. © 2010 Informa UK Ltd All rights reserved.

Most patients with type 2 diabetes mellitus (T2DM) are overweight or obese. Both T2DM and overweight/obesity are associated with increased patient risk of cardiovascular events and mortality. Despite being the recognized cornerstone of treatment, weight loss and maintenance of weight loss are difficult for patients with T2DM, particularly as treatments for T2DM may cause weight gain. Sodium glucose cotransporter 2 (SGLT2) inhibitors, a new class of drug for the treatment of patients with T2DM, reduce renal glucose reabsorption, resulting in urinary glucose excretion. Due to the caloric loss associated with decreased glucose in urine, treatment with SGLT2 agents offers the benefit of weight loss to patients, as well as reduction in hyperglycemia. Clinical trials of SGLT2 inhibitors in patients with T2DM, ranging in length from 4 to 90 weeks, have shown patient weight reductions from baseline of up to 4.7 kg. Such weight loss may have beneficial effects on adherence to medication, glycemic control, and cardiovascular risk in patients with T2DM.

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