Diagnosis is a difficult process. A patient who presents to their doctor ill will often undergo a process which involves being asked questions, observed, examined and perhaps even having blood or imaging 'tests'. Each question asked or observation made is either a diagnostic test in its own right or part of one and is a necessary part of arriving at a diagnosis. But some tests are better than others and importantly probably no test is 100% accurate. Sometimes a test result may suggest a patient has normal health when they actually have disease or have disease when they have normal health. This happens to all tests and diagnostic test accuracy research is aimed at evaluating how often this happens, in other words, determining how accurate tests are. Essentially when a clinician decides upon a diagnosis they are consciously or otherwise invoking a probabilistic process where multiple tests are combined and the patient's diagnosis should be the one most probable given the combination of all the test results. However, for this process to be truly beneficial to the patient the clinician needs to know the accuracy of each of these tests and how likely the patient has disease before the diagnostic process has even started. This is where the difficulty lies for those who practise evidence-based medicine. Although the accuracy of many tests has been estimated by research studies, for individual tests the accuracy may vary significantly between studies. This variation may depend on who is applying the test, how it is being applied, which patient it is being applied to and most significantly of all, how the accuracy was measured in the study. When there are several studies there are methods which allow us to combine their results. These methods may also help determine the real reasons why the test's accuracy varies. However, in general, the studies report insufficient data of sufficient quality to enable such analyses to be either possible or comprehensive. Furthermore, from previous work, we have been able to demonstrate that in some cases the test accuracy reported by a study may be virtually impossible in some patient settings. This creates a problem for the doctor. How do they know which estimate of a test's accuracy to use if it varies greatly between studies and risks being nearly impossible for their own practice? We have already begun to develop methods which make it possible to determine whether results from a test study are likely to accurately represent a doctor's practice in general. This would mean that a doctor could confidently apply the research to their own practice without reservation. However, sometimes the research is not reflective of the different clinical settings seen in practice and a more specific solution is required. This may be done by collecting routine data from the doctor's own setting and using it to determine a feasible range of values for the test's accuracy. This method, in its current form, is used to exclude the studies 'least likely' to derive a plausible estimate of a test's accuracy for the doctor in their own practice. At the moment both methods are in development but potentially could be implemented into the real-world and used to improve diagnosis. There are clear patient benefits to improving diagnostic performance including reducing the number of patients treated unnecessarily and increasing the number treated appropriately. One of the aims of this research is to pilot integrating this method into General Practice to help diagnose infection. This could also help reduce the potential for antibiotic resistance by reducing the number of antibiotics prescribed inappropriately. However, before this is done the methods need to be fully investigated to determine their utility and limitations. It may be that other approaches afford greater patient benefit, and an evaluation of these with the methods already described, will be the focus of the proposed research.

When teenagers get a good night's sleep, they are more likely to be able to concentrate, regulate their emotions and behaviours, problem-solve, learn and succeed at school, and avoid difficulties with anxiety and depression. Teenagers are naturally vulnerable to problems with sleep, because of multiple biological, psychological, and social changes. Although some teenagers will be lucky to avoid problems with their sleep, up to two thirds do not receive the recommended 8-10 hours sleep. Furthermore, many teenagers experience several unpleasant consequences of this lack of sleep. For some young people, the experience of disturbed sleep as a teenager can lead to long-term difficulties with mental health, particularly depression. Experiencing depression is not uncommon during the teenage years, with an estimated 154,000 10-19 year olds meeting diagnostic criteria for depression. Difficulties with depression can lead to difficulties at school and with friendships, as well as commonly presenting with self-harm and suicidal behaviours. Negative thinking patterns, or 'cognitions', have long been theorised to play a key role in the maintenance of various mental health problems, triggering unhelpful cycles of behaviour as well as causing distress. There is evidence that this may be the case for both insomnia and depression. There is also preliminary evidence that negative cognitions may explain why sleep problems can lead to depression, with it being theorised that sleep-specific cognitions can trigger more generalised negative thoughts about the world. Psychological treatments for sleep problems have been found to improve both sleep and mood in adults and young people, and adult psychological models of insomnia propose that these treatments help generate positive and helpful thoughts about sleep, which may generalise to positive and helpful thoughts more broadly. However, this has rarely been tested, and it is not currently known if this theory can be applied to depression or teenagers. We would like to find out: The proposed research uses an intervention design to better understand 1) how sleep and depression are linked in teenagers, 2) why improving sleep can also reduce depression, and 3) whether negative thoughts about sleep can be changed and interrupt other negative thoughts. Workshops using evidence-based techniques for improving sleep will be delivered in schools by external mental health practitioners. Workshop content will include how to create a good sleep environment and setting optimal bedtimes and waketimes as well as follow-up sessions to check in and help problem-solve. Sleep, mood and cognition will be measured pre- and post-intervention, and at a follow-up, to measure change. The study design will also allow us to examine whether offering sleep interventions in schools could improve both sleep and depression, and whether it is a scalable solution that should be tested and evaluated on a larger scale. Why this matters: This research is important because it will help us to understand how and why teenagers' sleep is crucially linked to their mood and wellbeing. The findings will provide evidence of how best to support teenagers to improve their sleep quality and quantity, with potential short- and long-term improvements in their wellbeing. To ensure that the research has long-term benefits for society, the work is being conducted within one of the recently provisioned services providing school-based mental health support, meaning that it could be scaled up nationally. The research has the potential to dramatically affect the way that schools and parents can support young people's wellbeing and to significantly decrease problems with sleep and depression as a consequence. This would improve the quality of life of teenagers across the UK and decrease the substantial societal costs associated with long-term mental health problems.

Groups that experience the worst health outcomes include people in coastal communities (like in the North East and North Cumbria), experiencing homelessness, dependent on drugs or alcohol, vulnerable migrants, people in contact with the justice system and other socially excluded groups. In the North East, 32% of people live in the most deprived 20% of the national population. The recent Levelling up White paper (2022), the White paper on health and social care integration (2022) and the NHS's Core20PLUS5 framework (2022) all highlight the role of housing as a key determinant of health. This consortium will investigate and co-produce integrated, community led, asset-based approaches to supporting people with multiple and complex needs who have been homeless, to improve individual and community wellbeing and address health disparities in the North East North Cumbria Integrated Care System (NENC ICS). The project will: (1) Provide training for and work closely with a group of Experts by Experience (who have been homeless), who will support evidence development and decision making into practice, policy and research in this area. They will: share their experiences and views on how services might best support people with multiple and complex needs; make use of an 'innovation budget' to improve a service and evaluate their innovations; help with mapping existing services. They will be an integral part of the project, leading many aspects of it. (2) Identify all the research evidence in the area of community support for people who experience homelessness, and identify the data being held by relevant stakeholders (local authorities, health services, voluntary sector) and how it might be shared to gain a better understanding of regional needs and monitor progress. (3) Identify one integrated care service (integrating, health, social care and housing), which will be improved and evaluated by experts by experience. (4) Identify and map all local community assets and services supporting people with multiple and complex needs, particularly in relation to housing, in the NENC. The mapping will create a directory of all services, statutory or otherwise, which community members can access for support. This will form the basis of a digital dynamic data sharing platform accessed by all relevant stakeholders, which will become a virtual consortium, directly connecting research on community assets with health and social care integration efforts, and community members, to reduce health disparities. For this bid we have brought together an interdisciplinary team of experts across academia (covering expertise in housing; health inequalities; humanities; health economics; mental health; addictions; participatory research), service (housing; NHS) and policy (ICS) partners. The project is supported by Tyne Housing, a third sector organisation working with people experiencing precarious housing and homelessness; the NIHR NENC Applied Research Collaboration (a a partnership bringing together six regional universities, the NHS, health and social care providers, local authorities, the voluntary sector, community groups and members of the public); and the NENC Deep End network (a network of GP surgeries working in the most deprived areas regionally).

In the UK, musculoskeletal disorders (joint and back problems) affect one in five people long term. While joint replacements are successful, they are challenged by demands of an active and younger population presenting with disorders due to trauma, obesity, or other lifestyle choices. One of the causes for joint and back pain is the deterioration of the different soft tissues acting as cushions in the joints. New surgical interventions are being developed to repair or locally replace those soft tissues in order to delay or prevent a total joint replacement. There is no clear indication yet on which patients benefit the most from them. There is an urgent need to define the type of patients for which new and existing interventions are most beneficial. The local anatomy or level of tissue deterioration differs greatly between patients, and there is currently a lack of biomechanical evidence that takes into account these large variations to help matching patients to interventions. To tackle these issues, this Fellowship, MSKDamage, will develop novel testing methods and tools combining laboratory simulation with computer modelling and imaging. MSKDamage methods will be used to predict the variation in the mechanical performance of a series of treatments at various levels of joint deterioration. This will enable the different interventions to be matched to different patient's characteristics. I will focus on three musculoskeletal disorders and associated repairs: 1. Emerging treatments involving the injection of biomaterials in the intervertebral disc: I will produce realistic testing conditions that can be personalised to a specific patient, assessing each patient's chance of success and identifying areas for treatment optimisation. 2. Evaluation of meniscus repairs in the knee and their interaction with cartilage defects: I will provide new information on the type of cartilage defect that reduces the chances of success of a meniscus replacement in the knee. The research will develop guidance on the type of cartilage defects that need repair for a meniscus replacement to be successful. 3. Optimisation of custom wrist repair: I will help optimise patient-specific wrist repairs so that they reduce the damage in tendons and ligaments in the wrist. MSKDamage builds on my strong track-record in the field and network of industry, clinical and academic collaborators, as well as my recent work that demonstrates the specific information which need to be included in models of degraded tissues in the spine and the knee. MSKDamage aims to (1) develop a methodology to test interventions for a specific patient and its specific tissue degradation, (2) carry out a series of case studies which demonstrate the capacity to test a range tissues disorders and repairs. This work is a particularly suitable for a Fellowship, as it will allow me to develop fundamental engineering tools and methods while engaging with end users for significant economic and societal impact. I will also develop as a leader in the field, leading a growing research group and taking actions for the research community, directly related to the research, with advocacy on sharing more research outcomes openly for creation of more impact, and indirectly related to act as an ambassador for public and patient involvement for research related to computer simulations in healthcare.

During the twentieth century, Britain experienced several radical transformations of its sexual-health policies and services. These developments brought huge benefits and helped to break down the stigma and inequalities that impeded access to care. Yet fundamental problems remain. Compounding these problems, sexual-health services are threatened by a looming crisis of antibiotic resistance and funding cuts to Local Authorities. History has much to teach us as we face such challenges. Understanding the historical impact of clinical practices, social conditions, cultural attitudes and policy interventions enables us to recognise long-term trends and patterns. And it makes us better equipped to tackle persistent and emerging challenges in sexual-health outcomes, service delivery and service-user experiences. I am heading an interdisciplinary project that arms us with this knowledge, tracing sexual health in Britain from the end of the First World War to the beginning of the AIDS epidemic. Today, sexual health is defined as the ability to lead a pleasurable and safe sex life and is recognised as a vital component of overall health and wellbeing. Historically, its definition was much narrower. In clinical practice, it meant combating syphilis and gonorrhoea, the principle 'venereal' diseases (VDs) preoccupying health authorities. In the public imagination, it meant remaining morally and eugenically 'fit' to ensure the future health of the race and nation. Gradually, sexual health ballooned, becoming its own clinical field and encompassing a variety of other, newly identified VDs like chlamydia as well as diverse provisions for maternal welfare and family planning. Key to this project is Britain's state-funded VD Service. Established in 1918 and integrated into the NHS after 1948, it was a vital part of Britain's shift towards socialised medicine. Millions of patients passed through its nationwide network of clinics. Yet the entire scheme has been overlooked by all but a handful of scholars. Building on their work, we employ new methods and underused archives to push into understudied time periods, places and themes. We take inspiration from a growing collection of transnational sexual-heath histories, exploring Britain's involvement in initiatives set up by the League of Nations and, later, the WHO to understand how regional politics and culture has influenced responses to global challenges. And because the project prioritises service-user experiences, an important focus is on oral histories that we will conduct with people who accessed or staffed clinics between 1948 and 1980. The project addresses major gaps in the history of sexual health and provides vital context for current problems. But in exploring historical sexual health, it also foregrounds a range of themes in British history. For example, the VD Service was intended to help overcome gender, class and racial inequalities in access to healthcare. Certainly, this government initiative went a long way towards correcting a variety of social injustices and endemic health challenges. But in practice, within the clinics and wider society, prejudices and stigma persisted for decades and continue even into the present. Women and the working classes continued to be viewed as 'vectors' of contagion, in need of management and surveillance. The structural violence faced historically by LGBTQ+ communities within healthcare continues today to undermine their wellbeing and health outcomes. Similarly, institutional racism continues to have a damaging impact on BAME sexual-health experiences. With its robust research, policy and engagement programme, the project will enrich humanities and health research, build public understandings of sexual health, inform policy, augment clinical training and create more reflexive practices among health workers. In so doing, it will have long-term benefits in improved sexual-health outcomes and service-user experiences.