Up to 1 in 5 patients hospitalised by COVID-19 have evidence of heart muscle injury as measured from a blood test. This is associated with a high death rate. Using an MRI scan of the heart we aim to investigate how often, and in what way, the heart becomes damaged, and how the heart recovers 6 months later. We need to know how heart muscle damage and recovery is affected by age, sex, ethnicity and other medical conditions (such as diabetes, high blood pressure, heart disease and narrowing of blood vessels), as these are also known to be associated with high death rates. We also want to see if we can improve the diagnosis of viral heart damage from a simple ECG, which may save patients having invasive heart tests which can be uncomfortable, are expensive and carry a small risk of serious complications and may put healthcare staff at increased risk of exposure to COVID-19.

Additive manufacture, also known as 3D printing, offers many benefits to industry and medicine such as reductions in weight, material costs and medical implants personalised to the patient. Currently additive manufacture has a relatively low uptake due to a series of technical barriers that are preventing its progression into end-use parts. One of these barriers is design. Design for additive manufacture (DfAM) requires the engineer to think in a different way, one that is the completely opposite to design for traditional manufacturing methods such as milling. Similarly, the majority of software on the market is computer aided design (CAD) which has been developed to support the design of parts using traditional manufacturing methods. This research approaches this challenge, from a radically different perspective. Growth in animals and plants involves the expansion and multiplication of cells, to incrementally increase the volume of the form. In this way additive manufacture, which bonds material point by point, is analogous to growth. Two novel design techniques will be developed in this project. They are drawn from concepts seen in the development of the fetus and the plant root, and integrated into a software called GrowCAD. The development of GrowCAD will create a software interface which is more intuitive to DfAM. The platform will also incorporate Temporal Design, which will increase creativity in the design of additively manufactured materials. The design approaches will be confirmed against the AM and testing of biomaterials for cardiovascular implants and three industrial applications proposed by the project partners. This project offers a solution to the challenges that face DfAM, across industrial and medical applications. This research offers benefits to the UK economy by increasing the uptake of additive manufacture, and the inherent upskilling of design engineers through use of the software. In addition, there will be benefits to society through increased creativity in the design of cardiovascular implants, and thus enhanced levels of personalisation in healthcare.

The COVID-19 pandemic has exposed how significant a role the indoor environment plays in the transmission of infection. The virus has highlighted how there are substantial gaps in knowledge relating to how microorganisms in aerosols and droplets are generated and dispersed in our buildings, how effectively we can measure and monitor risks in indoor environments, and how the design of the environment and the technologies within it can be used to control exposure to pathogens. While there is an immediate focus on respiratory infections, this challenge applies to a very wide range of microorganisms including gastroenteric pathogens and environmental microorganisms where exposure risks are driven by human interactions with the building layout, ventilation, heating and water systems. Understanding and tackling these challengers requires new knowledge about the interactions between microorganisms and the physical environment. Microbial aerosols in buildings are known to be released from human sources (respiratory aerosols, skin squame), building systems (aerosols from water, drainage and ventilation systems), industry processes (waste and waste water treatment, agricultural activities), the natural environment (sea, animals, plant pathogens) and medical procedures (dentistry, intubation). However we know very little about how the engineering design of the environment determines the generation, transport, deposition and control of microorganisms. Beyond microorganisms, there is growing awareness that human health is significantly affected by exposure to pollutants in indoor spaces and that many buildings are inadequately ventilated to provide healthy conditions for occupants. The CECAM (Chamber for Environmental Control of Airborne Microorganisms) facility will provide a new, multi-user research environment that can enable controlled experiments with aerosolised microorganisms under different indoor environmental conditions. The facility will enable key research questions to be addressed relating to sources and survival of microbial aerosols, methods for measuring and monitoring microbial aerosols and pollutants, the role of ventilation and room layouts on the dispersion and deposition of microbial aerosols and other pollutants, the development of effective engineering solutions including personal protective equipment, air cleaning and disinfection devices, and better designs of key components such as showers, hot air dryers, air conditioning units and drainage systems. The facility will enable research at the interfaces of fluid dynamics and aerosol sciences with microbiology and indoor air chemistry that is driven by clinical challenges and the need for improved indoor environmental quality in buildings across just about every sector of society. The CECAM facility will provide an integrated user environment that combines a controlled biocontainment chamber with dedicated air handling systems with a suite of environmental sensors and bioaerosol samplers including real-time bioaerosol sampling. Through location within a well-equipped microbiology laboratory and managed by a dedicated experimental officer, the CECAM facility will enable robust and safe experiments to be carried out by academic users, research organisations, NHS users and industry. This will include the ability for experiments to be carried out using human participants.

Over 80 million patients worldwide suffer from hip osteoarthritis, and increasing numbers of patients are requiring total hip replacement surgery. This is considered to be a successful intervention, however, an ageing population with increasing orthopaedic treatment needs, greater levels of obesity and patient expectations, and reducing healthcare budgets and surgical training are conspiring to challenge this success. There is also increasing demand for surgical treatments in younger patients that will delay the need for hip replacement surgery, these interventions reshape bone and repair soft tissue. One of the major causes of failure in the natural hip and in hip replacements is impingement, where there is a mechanical abutment between bone on the femoral side and hip socket or hip replacement components. In the natural hip, surgery reshaping the bone can reduce this impingement and soft tissue damage can be repaired; however, the effects of the amount of bone that is removed is not well understood nor is the best way to repair soft tissue. The number of hip replacements needing to be removed from patients and replaced with a new one in revision surgery is increasing; damage to the cup rim because of impingement is often implicated. It is known that this is more likely if the components are not well aligned relative to each another, or relative to the load direction experienced in the body. In this proposal, I seek to ensure long term outcomes of early intervention and hip replacement surgery are always optimum by negating concerns about impingement. To do this, I will develop an experimental anatomical hip simulator. The simulator will apply loads and motions to the hip similar to those observed clinically, and include high fidelity phantoms that mimic the natural hip, into which hip replacement components can also be implanted. This anatomical simulator will be used to assess how variables such as those associated with the patient (e.g. their bony geometry), the extent of early intervention surgery (e.g. the amount of bone removed) or the design of the prosthesis and how the hip is aligned in the body will affect the likelihood of impingement. This improved understanding of factors affecting the likelihood and severity of impingement will enable better guidance on how the surgery should be performed to optimise outcomes to be provided. I will work with orthopaedic surgeons to integrate this improved understanding into their clinical practice and with an orthopaedic company to integrate the findings into new product development processes; so that future interventions and devices can be designed to provide better outcomes for all patients.

A growing proportion of the population living with and beyond cancer are working-age cancer survivors, and 300,000 are estimated to be teenagers and young adults (TYAs) aged 16 to 39. With advances in medical treatments, up to 90% of TYAs now live beyond their treatment, a growing population. A cancer diagnosis will disrupt anybody's life, their personal biography, resulting in a significant impact on their physical, emotional, social, and economic well-being. This will be even more challenging for young people, diagnosed at a vulnerable time of multiple transitions and emerging adulthood (e.g. completing education, leaving home, becoming financially independent, forging relationships/marrying, having children). Our project aims to understand how the social integration of TYAs is impacted by a cancer diagnosis. We will describe their social reintegration (SR) through outcomes relating to: employment (income, type of employment); educational attainment (level of education and satisfaction); social development (quantity and quality of social support, connections, and participation); and subjective well-being (how people feel about their life, including satisfaction with key life domains such as health, family, income, social relationships, leisure time, work, and sex life). We want to understand which factors contribute (together or independently) to enable or disable TYAs' SR trajectories following treatment. This will be facilitated by linking knowledge and methods from multiple fields such as medical and psychosocial oncology, sociology, and developmental psychology. We will explore how social science perspectives and methodologies can inform the development of health and social care support that minimises the impact of cancer on TYAs' lives. Through 3 interconnected strands including a qualitative sub-study we will explore, in turn, several sets of factors that may influence TYAs' SR trajectories: socio-demographic factors (e.g. age, gender, geographical area); clinical factors (e.g. cancer type, time since diagnosis); psychosocial factors (e.g. extraversion, self-efficacy); patient-reported outcomes ('PROs', e.g. ongoing symptoms, health-related quality of life). Other factors, potentially unaccounted in existing literature, may emerge from our qualitative patient interviews. This will enable the development of stratified, evidence-based knowledge to improve the educational, employment, and social development opportunities of TYA cancer patients. To evaluate the influence of socio-demographic and clinical factors we will analyse and compare 2 existing databases. These databases include information on our planned outcomes in the general population and a nation-wide cancer group. To evaluate the influence of psychosocial factors and patient-reported outcomes we will run a longitudinal study with 2 patient groups (one during and one after treatment) across 2 centres. To explore wider potential factors we will run interviews with TYAs in the socio-demographic and clinical strata defined by the secondary data analyses. Our ambition is that TYAs should have the same or better opportunities and socio-economic outcomes as their peers or as they would have expected if they were not diagnosed with cancer. To develop the support to achieve this, we require the evidence this project will deliver. Within 3 years, the 3 strands of our project will come together to offer a comprehensive description of the 'biographical disruption' and inequality of opportunity and outcomes brought about by a cancer diagnosis in the lives of TYAs. This will be summarised in the Multidimensional Stratification Model of Social Reintegration Outcomes, which will be relevant to many health and social care policies addressing patients' future socio-economic outcomes.