The case report, carried out by researchers at UCL and Imperial College London, together with teams at the University of Cambridge and the University of Oxford, comes ten years after the first such case, known as the ‘Berlin Patient.’

Both patients were treated with stem cell transplants from donors carrying a genetic mutation that prevents expression of an HIV receptor CCR5.

The subject of the new study has been in remission for 18 months after his antiretroviral therapy (ARV) was discontinued. The authors say it is too early to say with certainty that he has been cured of HIV, and that they will continue to monitor his condition.

“At the moment the only way to treat HIV is with medications that suppress the virus, which people need to take for their entire lives, posing a particular challenge in developing countries,” said the study’s lead author, Professor Ravindra Gupta from the University of Cambridge, who led the study while at UCL.

“Finding a way to eliminate the virus entirely is an urgent global priority, but is particularly difficult because the virus integrates into the white blood cells of its host.”

According to the World Health Organization, there were approximately 36.9 million people worldwide living with HIV/AIDS in 2017 and only 59% of these are receiving ARV. Drug-resistant HIV is a growing concern. Almost one million people die annually from HIV-related causes.

The report describes a male patient in the UK, who prefers to remain anonymous, and was diagnosed with HIV infection in 2003 and on antiretroviral therapy since 2012.

Later in 2012, he was diagnosed with advanced Hodgkin’s Lymphoma. In addition to chemotherapy, in 2016 he underwent a haematopoietic stem cell transplant from a donor with two copies of the genetic mutation (or ‘allele’) that prevents expression of CCR5.

CCR5 is the most commonly used receptor by HIV-1, the most common and most harmful type of HIV. People who have two mutated copies of the CCR5 allele are resistant to the HIV-1 virus strain that uses this receptor, as the virus cannot enter host cells.

Chemotherapy can be effective against HIV as it kills cells that are dividing. Replacing immune cells with those that don’t have the CCR5 receptor appears to be key in preventing HIV from rebounding after the treatment.

The transplant was relatively uncomplicated, but with some side effects including mild graft-versus-host disease, a complication of transplants wherein the donor immune cells attack the recipient’s immune cells.

The patient remained on ARV for 16 months after the transplant, at which point the clinical team and the patient decided to interrupt ARV therapy to test if the patient was truly in HIV-1 remission.

Regular testing confirmed that the patient’s viral load remained undetectable, and he has been in remission for 18 months since ceasing ARV therapy (35 months post-transplant). The patient’s immune cells remain unable to express the CCR5 receptor.

Dr Hoi Ping Mok, and Dr Fanny Salasc from the Department of Medicine at the University of Cambridge tested for virus that is ‘latent’ and may not be found by conventional lab assays. The researchers are part of Professor Andrew Lever’s lab, which has developed a highly sensitive assay for latent virus.

“This is the most reliable assay there is to demonstrate that there really are no hidden reservoirs of HIV that might be temporarily ‘sleeping’ and might reactivate at a later date,” said Professor Lever. “Our Cambridge lab is unique in the UK in being able to carry out this assay.”  

The patient is only the second person documented to be in sustained remission without ARV. The first, the Berlin Patient, also received a stem cell transplant from a donor with two of the CCR5 alleles, but to treat leukaemia. Notable differences were that the Berlin Patient was given two transplants and underwent total body irradiation, while the UK patient received just one transplant and less intensive chemotherapy.

Both patients experienced mild graft-versus-host disease, which may also have played a role in the loss of HIV-infected cells.

“By achieving remission in a second patient using a similar approach, we have shown that the Berlin Patient was not an anomaly, and that it really was the treatment approaches that eliminated HIV in these two people,” said Professor Gupta.

The researchers caution that the approach is not appropriate as a standard HIV treatment due to the toxicity of chemotherapy, but it offers hope for new treatment strategies that might eliminate HIV altogether.

“We need to understand if we could knock out this receptor in people with HIV, which may be possible with gene therapy,” said Professor Gupta.

“While it is too early to say with certainty that our patient is now cured of HIV, and doctors will continue to monitor his condition, the apparent success of haematopoietic stem cell transplantation offers hope in the search for a long-awaited cure for HIV/AIDS,” said Professor Eduardo Olavarria from Imperial College Healthcare NHS Trust and Imperial College London.

The research was funded by Wellcome, the Medical Research Council, the Foundation for AIDS Research, and National Institute for Health Research (NIHR) Biomedical Research Centres at University College London Hospitals, Oxford, Cambridge and Imperial.

The research team is presenting the findings today at the annual Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle.

Reference
Gupta, R et al. HIV-1 remission following CCR5Δ32/Δ32 haematopoietic stem cell transplantation. Nature; 5 March 2019; DOI: 10.1038/s41586-019-1027-4

Adapted from a press release from UCL

Key University figures are also taking part in events in the city, and Cambridge University Press is throwing the spotlight on female writers by making a collection of books and journal articles freely accessible online throughout March.

The collection celebrates the significant contributions of women in the fields of Arts, Humanities, Social Sciences and STEM, and includes works written about leading literary figures such as Virginia Woolf, Jane Austen and Emily Dickinson. Click here to see the collection.

Mandy Hill, Managing Director for Academic Publishing at the Press, said: "We want to celebrate the achievements of some of the many brilliant women we have been privileged to work with, and to highlight work that explores the influential role of women in history, and tackles the issues faced by women around the world today."

Wednesday 6 March, 12pm-1pm - Unpacking the Gendered Consequences of Brexit - University Centre, Hicks Room
Women in the UK have benefited greatly from membership of the EU/EEC, and looking at Brexit as a process provides a unique opportunity to reflect on the relationship, and patterns of influence, between European and national legislation. For this year's lecture, we warmly welcome Roberta Guerrina, Professor of Politics at the University of Surrey and expert in EU gender politics and policies.
More information is available at this link.

Wednesday 6 March, 2pm-4pm - Balance for Better: A Women's Day Symposium - Old Library, Pembroke College
The event will feature discussions by the following accomplished women:
Dr Bina Agarwal - Professor of Development Economics and Environment at the Global Development Institute, University of Manchester
Ms Rebecca Ormond - Inclusive Workplace Leader, Price Waterhouse Coopers
Ms Evie Aspinall - Cambridge University Student Union President
Tickets are free and available at this Eventbrite link. 
Refreshments will be provided.
Please contact Jacqueline Gallo at jcg65@cam.ac.uk or Maya Tutton at mrt47@cam.ac.uk with questions.

Friday 8 March, 10am to 4pm - International Women's Day at the Museum of Zoology
Hear from female scientists and discover some of the amazing contributions by women to Zoology and Conservation Science with this feminist takeover of the Museum.
Free. No need to book. More information is available at this link.

Saturday 9 March, 9.30am to 5.30pm - Rising Festival 2019 celebrating International Women’s Day - St Barnabas Church, Mill Road, Cambridge
Professor Dame Carol Black, Dame Mary Archer, Dr Kamel Hothi OBE and Dr Helen Zhang will be among those taking part in the one-day event bringing together a diverse group of exceptional speakers for a programme of personal, practical and thought-provoking talks and workshops.
Tickets are £40-£50. More information is available at this link. 

Saturday 9 March, 11am to 5pm - International Women's Day at Kettle’s Yard
A day of free, drop-in activities for families - artist-led workshops, talks, tours and much more, celebrating women artists in the collection and the exhibitions.
Activities are suitable for all ages.
More information is available at this link. 

From this summer, the University is to participate in the UCAS system of ‘adjustment’ which provides students with a second chance of getting on to their first-choice course.

Adjustment is an optional process that allows students who have met and exceeded the terms of the conditional offer that they are holding to refer themselves for consideration by another institution.

Cambridge will be part of the system from August 2019. Students from under-represented backgrounds will be able to refer themselves for consideration on A-level results day (15 August).

It’s estimated up to 100 places will be offered under the scheme.

Dr Sam Lucy, Director of Admissions for the Cambridge Colleges, says: “Each year more than 14,000 students who apply to Cambridge are not made an offer.

"Students have to apply almost a year before they start their course, and some may be on an upward academic trajectory and not demonstrating their full academic potential at the point of interview.

"Adjustment provides those students who go on to achieve highly with an opportunity to be reconsidered as soon as they have their final results, rather than having to make a reapplication the following year.

"We hope this will have a positive impact, in enabling us to admit talented students from underrepresented groups who narrowly miss out in the first round.”

Access officer for the Cambridge University Students’ Union (CUSU), Shadab Ahmed, welcomed the announcement, saying: "This is a fantastic opportunity for students who exceed expectations and gives them a chance to gain a place at Cambridge.

"This will mean students will not be forced to take a gap year, which is often unfeasible for many students, especially for those from a widening participation background.

"This is vital in the current educational climate where there is increasing uncertainty and the admissions process is becoming more competitive.

"It also has the added benefit of allowing students increased flexibility, and I hope the pool that this is open to widens in the future."

Schools around the country welcomed the news.

Dan Taylor, Assistant Principal at Cardinal Newman College in Preston said: “Cardinal Newman College is very happy to hear about this news.

"Though we regularly send students to Cambridge, each year we have some students who just miss out on an offer even though they go on to achieve very high A-level grades.

"One of our students took a year out  and reapplied for Cambridge and received an offer but it will be so much more beneficial for such students if they could gain a place through adjustment.”

Matthew Joyce, Student Progression Manager at Harton Academy in South Shields commented: “This is a really positive development and one that could make a huge difference to the lives of individual students from Harton 6th Form or other schools and colleges in the north-east, enabling them to access the world class education that the University of Cambridge offers.”

Ian Udall, Head of High Achievers’ Unit at Loreto College in Manchester added: “We are delighted by the opportunity this represents for some of our most talented students. 

"Students from widening participation backgrounds who narrowly missed receiving an offer have often been obliged by their circumstances to accept places at other universities rather than re-apply. 

"Participation by the University of Cambridge in the UCAS adjustment process will give these students access to a second chance that was previously open only to those with access to parental means.”

Adjustment applications will only be considered for the subject a student originally applied for and are available to those who are resident in the UK and currently studying at a UK school.

Applicants who may become eligible when A-level results are published have been contacted by the Director of Admissions detailing the arrangements for the scheme.

Further information can be found at: www.cam.ac.uk/adjustment

In a study featuring a miniature ‘gym’ for beetles (complete with beetle treadmills), researchers from the University of Cambridge found that beetles who consistently lose out to members of their own species have the most to gain by forming a mutually-beneficial cross-species partnership.

The researchers studied the relationship between the burying beetle and the tiny mites that hitch a ride on their backs. The researchers found that mites function like a warm jacket on smaller beetles, and cause them to heat up when the beetles exercise. This made them more successful in face-offs with larger opponents.

For larger beetles, the mites actually reduced their level of fitness. They needed no help from mites to win ownership of a dead body and then lost out because the beetle larvae had to compete with mites for food. The results are reported in the journal Evolution Letters.

Relationships between two species where both benefit – such as flowering plants pollinated by insects – is known as mutualism. These relationships are widespread and are key to maintaining biodiversity and ecosystem function, but they are highly variable.

“When the costs of a mutualistic relationship start to outweigh the benefits, it will break down,” said Syuan-Jyun Sun, a PhD candidate in Cambridge’s Department of Zoology and the paper’s first author. “We wanted to find out if competition within species might be one of the reasons why we see such variety in mutualistic relationships.”

In competitions for food or a mate, there will inevitably be winners and losers. The Cambridge researchers wanted to test whether ‘losers’ might be more likely to have a mutualistic relationship with another species in order to gain an advantage over their stronger rivals. At the same time, ‘winners’ may not need any help to win battles, so a mutualistic relationship wouldn’t bring any advantage and might even break down into a form of parasitism.

The researchers tested this idea with experiments on burying beetles and their mites. The mites Poecilochirus carabi are benign passengers on their host burying beetles Nicrophorus vespilloides. The beetle flies around, seeking out the bodies of freshly dead small animals like mice and birds. Both the beetle and the mites onboard use the dead body as food for their young.

However, beetles face fierce competition for the ownership of a carcass, such as a dead mouse, and smaller beetles often lose the territory to larger rivals. Since the beetles need the carcass to breed, how do smaller beetles manage to reproduce?

“We wondered whether mites could give these ‘losers’ a helping hand in fights over a carcass,” said Sun. In the lab of Professor Rebecca Kilner in Cambridge, the researchers staged contests over a dead mouse between two beetles that were matched in size. One carried mites, while the other did not. They filmed the fights with infrared thermography, and found that beetles with mites were hotter and more aggressive, and therefore more likely to win.

To investigate how such thermal benefits arose, the researchers built a ‘gym’ for beetles and exercised them on custom treadmills. Beetles either carried mites, or a weight that was equivalent to the mites, or they carried nothing.

“We found that carrying extra weight caused beetles to generate extra heat as they exercised,” said Sun. “We also discovered that this heat was trapped by the mites because the mites form an insulating layer when travelling on beetles.”

These effects were most pronounced for smaller beetles because mites covered a relatively larger surface area than on large beetles, suggesting that mites are likely to be disproportionally beneficial to smaller beetles.

To test this idea directly, the researchers again staged fights between two beetles over a dead mouse. This time, the two rivals differed in body size. They also let beetles lay their eggs on a mouse, with and without mites.

The researchers found that small beetles were much more likely to win a fight for a carcass when they were carrying mites. However, the mites slightly reduced the beetles’ reproductive success, because they competed with beetle larvae for carrion. Nevertheless, the huge benefits of acquiring a carcass for reproduction outweighed these small costs. For smaller ‘loser’ beetles, mites are mutualists because they increase beetle fitness.

The findings were different for larger beetles. They needed no help to win a carcass, so they gained nothing from associating with mites. To make matters worse, they then lost fitness to the mites when they bred alongside each together on the carcass. For larger ‘winner’ beetles, mites are antagonistic rather than mutualistic because they reduce beetle fitness.

The research was funded in part by the Cambridge Commonwealth Trust, the Royal Society and the European Research Council.

Reference:
Syuan-Jyun Sun et al. ‘Conflict within species determines the value of a mutualism between species.’ Evolution Letters (2019). DOI:10.1002/evl3.109

An international study involving researchers from the UK, Norway, Germany Australia, South Korea and the US has confirmed that changes in sea ice cover in the Norwegian Sea played a key role in driving abrupt climate change events between 32,000 and 40,000 years ago, where global temperatures shifted as much as 15 degrees Celsius.

The results, reported in the journal Science Advances, indicate that initial sea ice reduction started before the abrupt warming over Greenland, and that sea ice expansion started before the end of the warm periods in Greenland.

The Arctic sea ice is a key element of the global climate system and the strong ongoing warming of the Arctic Ocean can have major impacts on the stability of the Greenland Ice Sheet, first and foremost accelerated sea level rise.

The Nordic Sea system and its water column structure during the last glacial cycle is the closest analogue to the present-day Arctic Ocean, which makes it a perfect natural laboratory to understand the role of rapid disappearance of regional sea ice on abrupt warming on the Greenland Ice Sheet.

The last glacial period, 10,000–100,000 years ago, was marked by repeated abrupt climate changes with global implications. Within a matter of decades, temperature shifts of as much as 15 degrees Celsius occurred around Greenland, but the mechanisms driving these changes –known as Dansgaard-Oeschger events – are not fully understood.

“One of the most challenging aspects of palaeoclimatology is to precisely resolve and reconstruct the exact timing of the events that took place across the major climate transitions of the last glacial cycle,” said co-author Dr Francesco Muschitiello, from the University of Cambridge’s Department of Geography. “As a result, a detailed account of the temporal relationship between changes in sea-ice extent in the Nordic Seas, and North Atlantic ocean circulation and climate across Dansgaard-Oeschger events has been so far elusive.”

The researchers investigated specific organic molecules in a sediment core from the southern Norwegian Sea, one of which was produced by algae that live in sea ice and others that were produced by organisms living in open, ice-free waters thousands of years ago.

The new sea ice reconstruction based on organic molecules in marine sediments was also evaluated by means of results from a model simulation of past sea ice conditions.

“Our data suggest that there were substantial changes in the sea ice cover in the southern Norwegian Sea between 32,000 and 40,000 years ago,” said Henrik Sadatzki from the University of Bergen and the paper’s first author. “Most extensive sea ice conditions occurred at the onsets and early parts of cold periods over Greenland and the most pronounced open-ocean conditions occurred at the onsets of the abrupt changes to warm periods over Greenland.”

The results support that an enhanced sea ice cover contributed to insulation of the cold, high-latitude atmosphere from relatively warmer waters that were present in the Norwegian Sea beneath the sea ice lid.

In turn, sea ice reduction allowed for heat release from the exposed Norwegian Sea waters to the atmosphere, which was a prime ingredient in shaping the abrupt warming of the Dansgaard-Oeschger climate events in Greenland.

The Dansgaard–Oeschger climate events have stirred interest in documenting that the climate system contains mechanisms that may lead to abrupt and surprising climate changes.

These findings clarify the series of events taking place in the high-latitude North Atlantic across the abrupt Dansgaard–Oeschger cycles of the last glacial period. However, further work is needed to ultimately identify the physical mechanisms linking the current sudden demise of Arctic sea ice to abrupt Greenland Ice Sheet changes.

The research was funded in part by the European Research Council.

Reference:
Henrik Sadatzki et al. ‘Sea ice variability in the southern Norwegian Sea during glacial Dansgaard-Oeschger climate cycles.’ Science Advances (2019). DOI: 10.1126/sciadv.aau6174

Adapted from a University of Bergen press release. 

OCD is characterised by unwanted intrusive thoughts and repetitive rituals and causes pronounced impairment in everyday life. In very severe cases, OCD patients are unable to leave their house or flat due to fears of contamination. This repetitive and compulsive behavior is associated with cognitive rigidity or an impairment in cognitive flexibility – an inability to adapt to new situations or new rules.

One treatment for this type of OCD is a form of cognitive behavior therapy called "exposure and response prevention", which involves instructing OCD patients to touch contaminated surfaces, such as a toilet, but to refrain from then washing their hands. OCD is also treated with medicines known as selective serotonin reuptake inhibitors, or SSRIs, such as Prozac. But as many as 40% of OCD patients fail to respond to treatment.

Deep brain stimulation (DBS) is an emerging treatment for severe OCD when all other treatments fail. In a study by researchers at University College London and the University of Cambridge, together with several other UK-based centres, six patients with treatment-resistant OCD entered a controlled double-blind trial of DBS.

The study directly compared effects at two different brain locations – the subthalamic nucleus (STN) and ventral capsule (VC) – in the same patients. The two sites had both previously been identified as being important in OCD, but it had been unclear whether they were simply parts of the same brain network and if they worked on the same type of symptoms.

In an article published today in Biological Psychiatry, the researchers show that both sites were remarkably effective in reducing OCD symptoms, but on different aspects: VC stimulation improved mood, while STN stimulation improved cognitive flexibility.

These findings suggest that DBS at these two sites works on different brain circuits, one involving the medial prefrontal cortex and the other the lateral prefrontal cortex. This was also confirmed using brain imaging.

Lead author Professor Eileen Joyce from the UCL Queen Square Institute of Neurology says: “This is the first study to compare directly the effects of deep brain stimulation at two brain sites and has discovered important information about how the brain changes in severe OCD responsible for obsessions and compulsions, depressed mood and cognitive inflexibility might be alleviated.”

The researchers assessed OCD symptoms and mood using standardised scales. Cognitive flexibility was assessed with the CANTAB IED test, invented by Professors Barbara Sahakian and Trevor Robbins from the University of Cambridge. This test has been used previously by the Cambridge team to show that cognitive flexibility is a major deficit in patients with OCD and is related to the the lateral prefrontal cortex. The new research shows that OCD is also linked to medial prefrontal cortex abnormality.

"To our knowledge this is the first study with two sites which demonstrates that one site improves mood, while the other site improves cognitive flexibility, and that both sites reduce OCD symptoms,” says Professor Robbins.

"While DBS is only used when medication and specific psychological treatments have been tried and failed, for some patients it may provide them with the opportunity to regain well-being and quality of life,” adds Professor Sahakian.

One of the trial participants was first diagnosed at the age of 26 years with OCD but had symptoms since the age of seven. Prior to the trial, the participant had been ‘profoundly debilitated’ by OCD for 10 years and had been living continuously in psychiatric units for 6 years, receiving treatment from numerous specialist OCD services and specialists.

Following surgery, the patient said: “I didn’t feel anything for a few days but then… I felt inexplicably excited and happy with the great sense of looking forward to life. I recognised the feeling from 20 years before when I had been completely well.

“The surgery has transformed my life. I am living completely independently and doing volunteer work.”

The study was funded by the Medical Research Council, Wellcome and the NIHR Biomedical Research Centre.

Reference
Tyagi, H et al. A randomised trial directly comparing ventral capsule and anteromedial sub thalamic nucleus stimulation in obsessive compulsive disorder: Clinical and Imaging evidence for dissociable effects. Biological Psychiatry; 7 March 2019; DOI: 10.1016/j.biopsych.2019.01.017

The EU Referendum of June 2016 shone a light upon some of the deep fault lines contained within British society, throwing up profound and uncomfortable questions about what underpinned the differences in people’s perspectives that were revealed in the vote. Evidence suggests that you were much more likely to have voted to Leave if you had not been to university, were over the age of 45 and lived in a town or the countryside rather than a city.

This seismic event, along with the other political earthquakes currently shaking democratic politics throughout the Western world, reveals societies that are profoundly divergent in terms of political values and cultural outlook. Life chances are often contingent on where you are born, where you grow up and what access you have to educational opportunity. ‘Place’, in other words, has a profound influence on our sense of where we belong and the values we prefer.

For politicians and policymakers who came of age during years of sustained economic growth, and who assumed the financially driven economy would generate opportunities for all, these deeply structural patterns of inequality must come as a shock. Anger and frustration underpinned the revolts by the disenchanted against democracy’s political establishments, sentiments which powered new waves of popular protest and support for populist challenger parties.

These responses highlight the inadequacies of a policy paradigm rooted in assumptions about stable economic growth, the unalloyed merits of urban expansion, and the capacity and political will of states to redistribute public goods across poorer regions.

Government is not alone in bearing responsibility for these issues. Academic experts could also have done more to highlight the major inequalities that are opening up across our democratic lives. These inequalities have helped fuel the very different responses to Brexit that have been apparent in our own ‘place’.

The city of Cambridge was very clearly in favour of Remain in the Referendum – with 73.8% voting in favour. But drive for 30 minutes in almost any direction from the centre and you will find yourself in villages or towns that voted overwhelmingly for Leave. They may be geographically close, but, in relation to Brexit, a chasm of outlook and experience divides Cambridge from the places around it.

A new Combined Authority now links Cambridge, Cambridgeshire and Peterborough – one of a number of innovations in administrative devolution introduced in England in recent years. This single jurisdiction has a limited set of powers conferred upon its elected Mayor. These new arrangements have had the effect of formally linking Cambridge and its world-class university to districts and towns from which it is, in many ways, a world away. This has created a kind of natural experiment on our doorstep, a smaller-scale replica of some of the geographical divides that are apparent across the country. Some of the social inequalities that exist in the eastern region are ingrained – and are one reason why this area lacks a sense of shared geographical identity. Divides of this sort will require both political will and policy ingenuity to solve.

If we compare Cambridge and Peterborough, for instance, the latter’s inhabitants have a significantly lower standard of living, on average, than their counterparts in Cambridge. On a range of public health measures, from obesity to physical activity levels and avoidable mortalities, there is an entrenched difference between these towns. 

More of Peterborough’s children receive free school meals, and a much lower proportion of its residents have access to further and higher education. Most Cambridge full-time residents can expect to earn £120 more per week than their Peterborough equivalent; and the latter’s inhabitants can expect, on average, to live two years fewer than their Cambridge counterparts.

There are significant disparities within each of these places, as well as between them. In 2018, for instance, the think tank Centre for Cities ranked Cambridge the most unequal city in the UK – for the second year in a row – which should give us pause for thought. Cambridge is home to an extraordinary concentration of academic expertise, innovation and knowledge-intensive industries. How can the economic and societal benefits of these assets be more evenly distributed?

The University has a key role to play in addressing these issues. At Cambridge’s newly established Bennett Institute for Public Policy, we are committed to a deeper understanding of them, and to helping policymakers think through different potential responses.

For instance, we are currently examining some of the main differences in economic opportunity and social provision that characterise life in different kinds of town within England, looking at whether the ‘footprint’ of public services is receding more dramatically in, for instance, post-industrial towns than elsewhere. And we are exploring ways in which the newly created tier of Combined Authorities, including that in Cambridgeshire and Peterborough, can improve in terms of their political accountability to their citizens.  

Cambridge is, in relative terms, one of the wealthiest parts of the country. The city is one of the strongest sources of economic growth in the UK, and a provider of employment for many residents from Cambridgeshire – though relatively few from Fenland or Peterborough. The most widely aired solution to the region’s imbalances is to do more to improve its connectivity to the areas that lie beyond its boundaries. To get to the root of the economic disparity in the Cambridgeshire and Peterborough region, we need to understand the underlying factors that make ‘place’ so important both to the innovation industries that have flourished in Cambridge and to the other kinds of business – notably agriculture –  in the landscape that surrounds it.  

The University houses a range of individuals and groups with considerable academic expertise on the social and policy issues facing the region, and the importance of place. Several of these have made important contributions to policy debates, for instance as advisors to, and members of, the Cambridgeshire and Peterborough Independent Economic Review, the Greater Cambridge Partnership and the Combined Authority’s Business Board.

Understanding the importance of place to public policy does not just mean thinking locally, however. There are many different kinds of community – institutional, cultural, or voluntary – which matter to people, and also to policymakers, and some of these extend beyond national borders while others reside within them. In policy circles, the notion of place is a more recent discovery in the wake of events like Brexit. Our conclusion is that bringing intellectual depth and a richer evidence base to this emergent issue is one of the major contributions which the University can make to public policy in our region.

By Ben Goodair, a Research Assistant at the Bennett Institute for Public Policy, and Professor Michael Kenny, the Institute's inaugural Director.

Read more about Cambridge University research in the East of England in a special issue of Research Horizons magazine: pdf; on Issuu.

Forty thousand pages of former Prime Minister Margaret Thatcher’s personal and political papers from 1989 are being opened to the public at the Churchill Archives Centre and online at the website of the Margaret Thatcher Foundation.

In 1989, the arrival of Alan Walters had an incendiary effect. Chancellor of the Exchequer Nigel Lawson's fundamental disagreements with the views and actions of Walters, Margaret Thatcher’s economics adviser, led to the watershed resignation of both men on 26 October 1989.

Lawson’s decision to resign after over six years as a key figure in Thatcher’s government was a pivotal moment in the events which would lead to the downfall of the Prime Minister.
For the first time, Thatcher’s extraordinary handwritten letter to Walters – written in the aftermath of both their resignations – gives profound insight and confirms Thatcher’s true sentiment and affiliation to Walters over Lawson as her Chancellor, a split that divided the Conservative party.

Across four pages Thatcher underlines her words and states she was "truly appalled" at Lawson’s request to sack Walters for undermining his authority and regarded it as "totally unjust and shocking". Her gratitude to Walters is evident saying “the work you did during our first administration was the foundation of our later success’ adding “I fervently believe you’re right”.  
Thatcher bemoans the legacy of her longstanding Chancellor in a way she could not do in public. “As you know he has left us with high inflation, a very high trade deficit, not to mention the very high interest rate”. 

Contained in an off the record interview with Kelvin McKenzie Editor of the Sun, released for the first time, her emotional reaction to events is powerfully present. She recalls her children’s consoling phone calls on the evening of the Lawson resignation – “Mum are you alright? don’t worry, you know we love you”. She describes their support as “meaning more than anything in the world”. 

This event, combined with the highlights of the previously unseen material, opened the door to the end of Thatcherism before another year was out. Documents released for the first time include:

• Startling confidential reports on the effects of the poll tax – some only sent to the Prime Minister – forewarning her of its unfairness and adverse impact on Tory marginal seats, including Thatcher’s own Finchley constituency. Thatcher was clearly warned from numerous sources about the ratio of losers to winners amongst Conservative voters and the consequent likely political damage, yet despite all this, pressed ahead. This flagship Thatcherite policy, would not be possible to abolish while Thatcher was still Prime Minister;
• Thatcher’s private notes on the 'Madrid ambush',  the ultimatum from Nigel Lawson and Geoffrey Howe that she issue a date to join the ERM goes to the very heart of the story of the Thatcher government in its last years – both men had once been among her closes political allies;
• Mrs Thatcher’s personal fondness for health cures in the form of her correspondence with the novelist Barbara Cartland offering her “golden acorns”, perhaps nutrimental supplements she might have taken in combination with living off black coffee and describing eggs and bacon as “quite the best thing, British peoples culinary gift to the world”;
• The first use of the ‘royal we' in Thatcher's statement to the press on the birth of her first grandchild, Mark Thatcher's son Michael caused huge negative public reaction. The term had previously been restricted to royalty. Its use by a mere prime minister alongside Thatcher's imperious personal manner were the source of considerable disdain at the time. Thatcher's apparent conceit led to her being described as “a legend in her own imagination”.

Allen Packwood, Director of the Churchill Archives Centre, said: “Whatever our politics we have to recognise Margaret Thatcher as a major historical figure. The material released today will further inform our understanding of these historic events during 1989. There is huge research interest in her as a political figure and in the events of her life and premiership, the material will inform further study, discussion and debate.”

The Churchill Archives Centre is open to researchers five days a week for about fifty weeks each year. The Centre provides free access for all potential visitors, subject only to prior booking of a space in its reading room.

The archive can be viewed at the Margaret Thatcher Foundation website and will be made available to view at the Churchill Archives Centre from Monday 11 March. 

The exhibition will be opened today (11 March) by the Russian physicist Professor Yuri Oganessian, who has the unique distinction of being the only living person with an element (oganesson) named after him. The free event, part of the Cambridge Science Festival, opens to the public tomorrow and runs until 5 April.

One hundred and fifty years ago this month, Russian chemist Dmitri Mendeleev first came up with his periodic system of the chemical elements – what we now think of as the periodic table. In celebration of this event, the United Nations have proclaimed 2019 to be the International Year of the Periodic Table of Chemical Elements.

Mendeleev’s original publication from March 1869 will be on display at St Catharine’s, both in the form of his textbook, in which the table was hastily appended to the already-printed first volume, and in the form of the longer article which appeared in the first volume of the journal of the newly-formed Russian Chemical Society and in which Mendeleev fully discusses his system. It is said only 80 copies of this latter volume were printed and the St Catharine’s copy is the only one available in the UK.

Despite this year’s anniversary, Mendeleev’s periodic table was not the first to be published. The exhibition compares Mendeleev’s table with the remarkably similar version published in October 1864 by British chemist William Odling, along with versions by his fellow countryman John Alexander Newlands from the same time.

Perhaps the most remarkable item on display is what is regarded as the very first periodic table published in 1862 – seven years before Mendeleev’s. The French mineralogist Alexandre-Émile Béguyer de Chancourtois first arranged the known elements by atomic weight and properties in 1862, in what can be considered the first periodic table. The form of his table is quite different: instead of plotting the elements in rows and columns, it is designed to be wrapped around a cylinder in order to align the elements into groups with similar properties.

However, Béguyer’s attempt was almost completely overlooked at the time. Since he was primarily concerned in trying to classify the elements from a mineralogical perspective, his system was largely ignored by chemists. But more importantly, his paper failed to include any diagram and without it, his text was incomprehensible.

However, while his first description initially appeared as one of many articles in one of the leading chemical journals of the day, the author also received a few ‘offprints’ – separately-printed, re-paginated, standalone extracts containing just his article. These were intended to be given out as presentation copies by the author to other leading scientists of the day. To accompany these offprints, Béguyer had a five-foot-long chart printed to accompany the text, which is also part of the exhibition.

In addition to the historic versions of the periodic table, the exhibition also includes several new artworks created to mark the 150th anniversary, including one of laser-etched glass, and a macramé version of the table containing more than 180,000 knots.

Professor Oganessian will formally complete a third work of art, a sculpture by Kent-based silversmiths Padgham and Putland based on a 1920 German design, when he adds the personalised tile representing his element. Today’s event will also feature the St Catharine’s College Girls Choir, who will perform a new work on the periodic table composed by Christopher Fox.

The exhibition has been curated by Dr Peter Wothers, who presented the 2012 Royal Institution Christmas Lectures entitled ‘The Modern Alchemist’.

The exhibition runs from March 12 to April 5, including weekends, and is open 9:00 am to 5:00 pm. 

The Cambridge Centre for Data-Driven Discovery (C2D3) will harness the knowledge of academics in data science, ethics, and from a wide range of disciplines, to research all aspects of this complex and expanding area.

The Centre will be truly interdisciplinary, allowing experts in technical, mathematical and topic knowledge to work together on tackling the methodological and practical challenges presented by handling big data.

The Centre is to be funded by a series of collaborations with partners in business and industry which have an interest in using big data for the benefit of their customers and their organisations.

The first founding partner is to be Aviva, Britain’s biggest insurer. Aviva will sponsor a research fellowship and support PhD students to help investigate some of the ethical, political and operational questions surrounding the use of big data.

The relationship will combine world-class research with frontline practice. It will help Aviva develop new ethical approaches to advising customers through evidence-based science. It will enable University researchers to develop methods and tools to address real-world problems and to influence the wider debate about how organisations address the difficult methodological, practical and ethical challenges of big data.

Professor Anna Vignoles, co-chair of the Cambridge Centre for Data-Driven Discovery, said: “The University is constantly looking for innovative ways for our research to make a difference to the wider world, as well as opportunities for our students to gain valuable experience of industry.

“Working with Aviva will give our researchers the opportunity to solve some ‘real world’ challenges, ranging from how to securely, ethically, efficiently and effectively store and use their customers’ data and to identify what health interventions are most likely to help their customers live a longer and healthier life.”

Owen Morris, Managing Director of Aviva Quantum, Aviva’s Global Data Science Practice, said:

“Aviva is on a mission to create a world-class data science capability – and this ground-breaking partnership with the University of Cambridge will equip us with unparalleled access to knowledge and research in this area.”

Aviva is expected to be the first of ten organisations in C2D3’s Industry Club, which will underwrite the cost of research and provide companies with:

• access to existing research
• the opportunity to commission new areas of research
• practical guidance, tools and techniques to use data in the commercial world.

Other partners will be announced in due course.

Paragraf is producing graphene ‘wafers’ and graphene-based electronic devices, which could be used in transistors, where graphene-based chips could deliver speeds more than ten times faster than silicon chips; and in chemical and electrical sensors, where graphene could increase sensitivity by a factor of more than 30. The company’s first device will be available in the next few months.

Graphene’s remarkable properties – stronger than steel, more conductive than copper, highly flexible and transparent – make it ideal for a range of applications. However, its widespread commercial application in electronic devices has been held back by the difficulties associated with producing it at high quality and at high volume. The conventional way of making large-area graphene involves using copper as a catalyst which contaminates the graphene, making it unsuitable for electronic applications.

Professor Sir Colin Humphreys from the Centre for Gallium Nitride in Cambridge’s Department of Materials Science and Metallurgy, along with his former postdoctoral researchers Dr Simon Thomas and Dr Ivor Guiney, developed a new way to make large-area graphene in 2015.

Using their method, the researchers were able form high-quality graphene wafers up to eight inches in diameter, beating not only other university research groups worldwide, but also companies like IBM, Intel and Samsung.

The three researchers spun out Paragraf in early 2018. Thomas is currently the company’s CEO and Guiney is its Chief Technology Officer, while Humphreys, who has recently moved to Queen Mary University of London, serves as Chair.

Paragraf has received £2.9 million in funding to support the development of its first commercial products and moved into premises in February 2018. The funding round was led by Cambridge Enterprise, the University’s commercialisation arm. Paragraf already employs 16 people and has filed eight patents.

“Paragraf has the potential to transform a wide range of industries, including electronics, energy and healthcare,” said Humphreys. “It will enable the basic science results achieved in laboratories worldwide using small graphene flakes to be commercially exploited in graphene-based devices and to realise the potential and benefits to society of graphene, the wonder material.”

The original research was funded by the Engineering and Physical Sciences Research Council (EPSRC). 

Every day, on the streets of cities, towns and even villages across the East of England, young people take decisions that can – in a moment – alter the course of their life and the lives of others.

These events do not occur in a vacuum: the wrong combinations of environment, timing, people and experience can result in decades lost to crime and addiction – damaging communities and draining the resources of criminal justice services under increasing pressure.

This year, the University’s Institute of Criminology celebrates its 60th anniversary. Researchers from the Institute have spent years in the local region engaging with people at different points of these adverse cycles – from police and prison officers to kids on street corners – to build an evidence base for effective ways to reduce harm caused by criminality.

While providing prevention lessons for the UK and indeed the world, research that was kick-started and, in many cases, continues to run in the eastern region means that local policymakers have an opportunity to build on projects and findings uniquely relevant to their patch.

Perhaps none more so than the Peterborough Adolescent and Young Adult Development Study (PADS+): a large longitudinal study that has followed more than 700 young residents of Peterborough from the age of 12 to now over 24, as they navigate school, work, family and the law.

Streets of Peterborough 

Led by Professor Per-Olof Wikström, Director of the Centre for Analytic Criminology, the study uses waves of surveys conducted across 13 years that take a singular approach to data gathering. For a given day, the participants are asked to give hour-by-hour detail of where, when, how and with whom they have spent their time. This has been combined with psychological and genetic data, plus two huge surveys each of around 7,000 city residents, to create an extraordinary cross-section of young lives and communities in early 21st-century Britain.

“There is nothing else like this study,” says Wikström. “We have the kind of detail other studies simply don’t have. We can demonstrate not just where ‘hot spots’ of crime occur, but why – which can help us predict future crime-prone areas.”

In a major book, Breaking Rules, the research team showed how certain environments trigger crime, the central importance of personal morality and self-control in “crime-averse” youngsters, and how a third of teens never even consider breaking the law while just 16% commit more than 60% of all adolescent crime.

The researchers are currently finishing off their next book, which will take the study findings up to the present day. “We still have a huge retention rate of 91% for our cohort, many of whom are now back in Peterborough after university and some are now becoming parents themselves,” says senior PADS+ researcher Dr Kyle Treiber. “This data has the potential to reach far beyond criminological contexts. There’s so much information on everything from education and lifestyle to social mobility,” she says.

For Wikström, Peterborough is an ideal city to research the role of people and environment in crime causation. “It’s a diverse place of manageable size, with neighbourhoods at both ends of the socioeconomic spectrum. Itʼs big enough but not too big, so we could cover the whole urban area – and the surrounding Fenland means people tend to live their lives within the city.”

He suggests that the research, now being replicated (and its findings supported) in countries from Sweden to China, could prove useful for city planners in the eastern region, as well as police and social services. “Peterborough is an expanding city, and our data could help developers understand what creates crime-prone people and criminogenic situations.”

Cops and 'hot spots'

Like all cities, Peterborough has its hot spots: streets or intersections where there is a concentration of theft, violence and criminal damage. These are the areas that some of Wikström’s young people know all too well – and policing them is a challenge for a force that works with tightening budgets. To find the most effective ways of reducing crime in neighbourhoods across Peterborough, University criminologists partnered with Cambridgeshire Constabulary to conduct major experimental trials of police deployment.

By randomly allocating 21 extra minutes of daily foot patrol by Police Community Support Officers to some of the cities hottest hot spots, researchers showed an average drop in reported crime of 39%. They worked out that every £10 spent on patrols would ultimately save £56 in prison costs.

“In working with us to conduct experiments, Cambridgeshire Constabulary has set the standard for cost-effectiveness in policing,” says Professor Lawrence Sherman, Director of the Jerry Lee Centre for Experimental Criminology. “The results from Peterborough provide an important benchmark for evaluating police time – challenging those who would rather see patrols in safer neighbourhoods or high traffic areas.”

Fen life

Outside Peterborough, those brought up in the fens can feel their opportunities are limited, and rural life presents its own challenges to those working in the justice system.

A new project led by Cambridge criminologist Dr Caroline Lanskey and King’s College London psychologist Dr Joel Harvey is exploring how the unique Fenland environment stretching east from Peterborough contributes to youth offending. “There are pockets of the fens where isolation, poor transport links and often high levels of deprivation feed into the types of crime young people commit,” she says.

Lanskey and Harvey, with the support of PhD student Hannah Marshall, are working to develop an “explanatory framework” for rural rule-breaking. They are currently conducting interviews, as well as analysing risk assessment data for hundreds of young people from across Cambridgeshire.

“The fens can feel defined by distance: geographically, but also socially and culturally,” says Lanskey. “Youth justice workers struggle to gain the trust of secluded communities – and struggle to reach them. It can take a whole day to see two or three people.” The project is aiming to report back findings later this year.

Prison and beyond 

When the decisions young people make end badly, it can result in imprisonment. Life inside can be harsh – many of the region’s prisons have suffered extensive funding cuts, as in the rest of Britain – and, once a sentence is completed, opportunities on the outside can be scant.

For Drs Ruth Armstrong and Amy Ludlow (who, like Lanskey, are in the Centre for Community, Gender and Social Justice), the secure estate holds a vast amount of talent and potential that risks being wasted. Four years ago, they started an initiative called Learning Together: partnering universities with prisons and probation organisations to build “transformative communities”, in which students from both inside and out are taught at the same time by some of the best lecturers in the UK.

The Learning Together team has worked in several prisons in the eastern region, including Peterborough and Warren Hill near the Suffolk coast. It is with Whitemoor, the high security prison that sits just outside the Fenland town of March, that the team has one of their longest-standing partnerships.

“We started courses in Whitemoor three years ago, and the prison has bought into this work in really exciting ways,” says Ludlow. Bespoke courses on everything from philosophy to creative writing have been taught in Whitemoor; in most cases university students were taken into the prison to learn alongside students currently serving sentences.

“When we move ideas from the learning environment into criminal justice, we show people in prison that they are not defined by their offending, but that there are avenues for them to progress,” says Armstrong.

Learning Together has now instigated over 20 university–prison partnerships nationally. “The relationships of trust built with prisons such as Whitemoor have allowed us to create models of working for partnerships across the country. By engaging locally with research, you can end up pushing national agendas.”

The tool, PREDICT Prostate, launches today to coincide with publication in the journal PLOS Medicine of the research that underpins it. It brings together the latest evidence and mathematical models to give a personalised prognosis, which the researchers say will empower patients as they discuss treatment options with their consultant.

According to Cancer Research UK, there were 47,151 new cases of prostate cancer in 2015. Progression of the disease, which usually presents in later life, is very variable: in most cases, the disease progresses slowly and is not fatal. It is often said that more men die with prostate cancer than from it. However, it is still the case that in a significant number of men, the tumour will metastasise and spread to other organs, threatening their health.

When a patient is diagnosed with prostate cancer, they are currently classified as low, intermediate or high risk. Depending on the patient’s risk group, clinicians will recommend either an ‘active monitoring’ approach or treatment. Treatment options include radiotherapy or surgery and can have potentially significant side-effects, including erectile dysfunction and urinary incontinence.

However, evidence suggests that these classifications, which are in the current guidelines provided by the National Institute for Health and Care Excellence (NICE), are only 60-70% accurate. This means that many men may elect for treatment when it is not necessary. In fact, a recent study carried out in the UK showed that for early prostate cancer (low and intermediate risk), treatment is no more beneficial in terms of ten year survival compared to no treatment.

Cambridge researchers have already shown that it is possible to improve the accuracy of the NICE-endorsed model to more than 80% by stratifying patients into five rather than three groups. Their next challenge was to use this information to give a more individual prediction of outcome to patients at no extra cost. The result is PREDICT Prostate.

PREDICT Prostate takes routinely available information including PSA test results, the cancer grade and stage, the proportion of biopsies with cancerous cells, and details about the patient including his age and other illnesses. It then gives a 10-15 year survival estimate. Importantly, the tool also estimates how his chance of survival differs depending on whether he opts for monitoring or treatment, providing context of the likelihood of success of treatment and risk of side effects.

“As far as we are aware, this is the first personalised tool to give an overall survival estimate for men following a prostate cancer diagnosis,” says first author Dr David Thurtle, Academic Clinical Fellow in Urology at the University of Cambridge and Addenbrooke’s Hospital, which is part of Cambridge University Hospital NHS Foundation Trust (CUH).

“PREDICT Prostate is designed for men who are considering whether to choose to monitor or to opt for treatment. This is the choice that faces nearly half of all men who are diagnosed with prostate cancer. We hope it will provide a more accurate and objective estimate to help men reach an informed decision in discussion with their consultant.”

The research was led by Dr Vincent Gnanapragasam, University Lecturer and Honorary Consultant at CUH, and undertaken by Dr Thurtle, both of the Academic Urology Group in Cambridge, and in collaboration with Professor Paul Pharoah of the Department of Cancer Epidemiology.

“We believe this tool could significantly reduce the number of unnecessary – and potentially harmful – treatments that patients receive and save the NHS millions every year,” says Dr Gnanapragasam.

“This isn’t about rationing treatments – it’s about empowering patients and their clinicians to make decisions based on better evidence. In some cases, treatment will be the right option, but in many others, patients will want to weigh up the treatment benefits versus the risks of side effects. It will also show men who do need treatment a realistic estimate of their survival after treatment.”

Data from the National Prostate Cancer Audit has shown that rates of treatment for low risk prostate cancer vary across different hospitals between 2-25%. ‘Radical’ treatment – surgery or radiotherapy, for example – costs on average around £7,000 per patient and treating these men unnecessarily wastes considerable resources as well as causing significant side-effects.

Dr Thurtle and Dr Gnanapragasam have since carried out a randomised study of almost 200 prostate cancer specialists in which they gave some clinicians access to the tool and a series of patient vignettes, while others received the vignettes only. In most cases, the clinician overestimated the risk of the patient dying from the cancer, compared to the estimate given by PREDICT, going on to recommended treatment in many cases and overestimate how successful this treatment would be. When given access to the tool, the clinicians were less likely to recommend treatment in good prognosis cancers.

Dr Gnanapragasam says that the development of PREDICT Prostate has only been possible because of the intactness of records available through Public Health England – the tool was developed using data from over 10,000 UK men recorded in the East of England. This regional registry, he says, is one of the highest quality and most comprehensive data sets available both in the UK and internationally. The data was then validated externally in a sample of 2,500 prostate cancer patients in Singapore. The web tool was developed in collaboration with the Winton Centre for Risk and Evidence Communication

The researchers caution that the tool is strongly recommended for use only in consultation with a clinician. It is also not suitable for men with very aggressive disease or who have evidence of disease spread at the time of diagnosis.

The research was funded by the Evelyn Trust and the Urology Foundation.

Reference
Thurtle, DR et al. Individual prognosis at diagnosis in non-metastatic prostate cancer: Development and external validation of the PREDICT Prostate multivariable model. PLOS Medicine; 12 March 2019; DOI: 10.1371/journal.pmed.1002758

Making prostate biopsies safer

Dr Gnanapragasam recently announced the start of clinical trials of CamProbe, a device to make prostate biopsies safer.

The current method to retrieve samples from the prostate uses a transrectal ultrasound probe inserted into the anus to allow the biopsy to be taken. Patients who undergo this procedure are at risk of urinary infections or sepsis as the needle has to pass through the bowel wall to reach the prostate.  Around 30-40,000 prostate biopsies are done every year using this method in the UK alone.

The CamProbe, invented and developed in Cambridge, has been designed so the biopsies can be taken more safely through the skin under the scrotum (transperineal) and avoid the bowel.

“The design of the CamProbe is a needle within a needle and allows us to collect tissue from the prostate through a more sterile part of the body,” says Dr Gnanapragasam, who co-leads the Urological Malignancies Programme at the CRUK Cambridge Centre.

“Most importantly it can be done under local anaesthetic in the out-patient department. Previously this kind of approach was only possible if a general anaesthetic was used with very significant additional costs.”

The trial for the CamProbe is now underway using funding from the National Institute for Health Research (NIHR). It will run for a year at several hospitals around the UK including at the Cambridge Clinical Research Centre. If the trial is successful, the CamProbe could be adopted into mainstream use within two years.

“Our goal is to show that the CamProbe is a simple alternative for taking prostate biopsies which eliminates infection risks to patients and drastically reduces the need for antibiotics,” added Dr Gnanapragasam. “Its simplicity also means it will be a very low-cost device, and, in addition to reducing infections, the need for antibiotics and sepsis related admissions, could potentially save the NHS an estimated £7-11 million pounds every year.”

The report was funded by the Nuffield Foundation, with additional support from the James S McDonnell Foundation.

The UK is facing a maths crisis: according to a 2014 report from National Numeracy, four out of five adults have low functional mathematics skills compared to fewer than half of UK adults having low functional literacy levels.

While mathematics is often considered a hard subject, not all difficulties with the subject result from cognitive difficulties. Many children and adults experience feelings of anxiety, apprehension, tension or discomfort when confronted by a maths problem.

A report published today by the Centre for Neuroscience in Education at the University of Cambridge explores the nature and resolution of so-called ‘mathematics anxiety’.

Origins of maths anxiety

In a sample of 1,000 Italian students, the researchers found that girls in both primary and secondary school had higher levels of both maths anxiety and general anxiety.

More detailed investigation in 1,700 UK schoolchildren found that a general feeling that maths was more difficult than other subjects often contributed to maths anxiety, leading to a lack or loss of confidence. Students pointed to poor marks or test results, or negative comparisons to peers or siblings as reasons for feeling anxious.

“While every child’s maths anxiety may be different, with unique origins and triggers, we found several common issues among both the primary and secondary school students that we interviewed,” says Dr Denes Szucs from the Department of Psychology, the study’s lead author.

Students often discussed the role that their teachers and parents played in their development of maths anxiety. Primary-aged children referred to instances where they had been confused by different teaching methods, while secondary students commented on poor interpersonal relations.

Secondary students indicated that the transition from primary to secondary school had been a cause of maths anxiety, as the work seemed harder and they couldn’t cope. There was also greater pressure from tests – in particular, SATS – and an increased homework load.

Relationship between maths anxiety and performance

In a study published in 2018, the researchers showed that it is not only children with low maths ability who experience maths anxiety – more than three-quarters (77%) of children with high maths anxiety are normal to high achievers on curriculum maths tests.

“Because these children perform well at tests, their maths anxiety is at high risk of going unnoticed by their teachers and parents, who may only look at performance but not at emotional factors,” says Dr Amy Devine, the 2018 study’s first author, who now works for Cambridge Assessment English. “But their anxiety may keep these students away from STEM fields for life when in fact they would be perfectly able to perform well in these fields.”

However, it is almost certainly the case that in the long term, people with greater maths anxiety perform worse than their true maths ability. Today’s report includes a review of existing research literature that shows that this can lead to a vicious circle: maths anxiety leading to poorer performance and poorer performance increasing maths anxiety.

Recommendations

The researchers set out a number of recommendations in the report. These include the need for teachers to be conscious that an individual’s maths anxiety likely affects their mathematics performance. Teachers and parents also need to be aware that their own maths anxiety might influence their students’ or child’s maths anxiety and that gendered stereotypes about mathematics suitability and ability might contribute to the gender gap in maths performance.

“Teachers, parents, brothers and sisters and classmates can all play a role in shaping a child’s maths anxiety,” adds co-author Dr Ros McLellan from the Faculty of Education. “Parents and teachers should also be mindful of how they may unwittingly contribute to a child’s maths anxiety. Tackling their own anxieties and belief systems in maths might be the first step to helping their children or students.”

The researchers say that as maths anxiety is present from a young age but may develop as the child grows, further research should be focused on how maths anxiety can be best remediated before any strong link with performance begins to emerge.

“Our findings should be of real concern for educators. We should be tackling the problem of maths anxiety now to enable these young people to stop feeling anxious about learning mathematics and give them the opportunity to flourish,” says Dr Szucs. “If we can improve a student’s experience within their maths lessons, we can help lessen their maths anxiety, and in turn this may increase their overall maths performance.”

Josh Hillman, Director of Education at the Nuffield Foundation, said: “Mathematical achievement is valuable in its own right, as a foundation for many other subjects and as an important predictor of future academic outcomes, employment opportunities and even health. Maths anxiety can severely disrupt students’ performance in the subject in both primary and secondary school. But importantly - and surprisingly - this new research suggests that the majority of students experiencing maths anxiety have normal to high maths ability. We hope that the report’s recommendations will inform the design of school and home-based interventions and approaches to prevent maths anxiety developing in the first place.”

Background

Researchers worked with more than 2,700 primary and secondary students in the UK and Italy to examine both maths anxiety and general anxiety, and gain a measure of mathematics performance. They then worked one-to-one with the children to gain a deeper understanding of their cognitive abilities and feelings towards mathematics.

This is the first interview-based study of its kind to compare the mathematics learning experiences of a relatively large sample of students identified as mathematics anxious with similar children that are not mathematics anxious. Although further in-depth studies are needed to substantiate and expand upon this work, the findings indicate that the mathematics classroom is a very different world for children that are mathematics anxious compared to those that are not.

Reference
Understanding Mathematics Anxiety: Investigating the experiences of UK primary and secondary school students. 14 March 2019

In the first study of its kind, scientists at the Cancer Research UK Cambridge Institute at the University of Cambridge, in collaboration with Professor Christina Curtis at Stanford University, examined the patterns of genetic changes within tumours from nearly 2,000 women with breast cancer and followed their progress over 20 years – including whether their cancer returned. They used this information to create a statistical tool that can better predict if, and when a women’s breast cancer could come back.

While the genetic analyses used in the study are too detailed for everyday use, the team are now working on a routine test that could one day help doctors offer women a more accurate prediction of if, and when, their disease may return. Although not available to patients yet, this means that in the future, treatments and follow-up can be tailored, improving women’s chances of survival.

Professor Carlos Caldas, lead researcher at the Institute, said: “Treatments for breast cancer have improved dramatically in recent years, but unfortunately for some women, their breast cancer returns and spreads, becoming incurable. For some, this can be many years later – but it’s been impossible to accurately predict who is at risk of recurrence and who is all clear.

“In this study, we’ve delved deeper into breast cancer molecular subtypes, so we can more accurately identify who might be at risk of relapsing and uncover new ways of treating them.”

Previous results from this group of researchers had already revealed that breast cancer isn’t just one disease, but instead could be classified into one of eleven different molecular subgroups.

The latest findings highlight how these molecular subtypes have distinct clinical ‘trajectories’, which can’t be predicted by looking at commonly used characteristics (such as size, stage, oestrogen receptor (ER), or Her2 status) alone.

These clinical trajectories vary considerably, even between tumours that seem similar. For example, the team found, among women with a form of the disease called triple-negative breast cancer, there was a distinct subgroup whose outlook is initially poor, but for whom the disease is unlikely to come back in those who survived 5 years.

They also identified subgroups of women with oestrogen receptor-positive (ER+) tumours, who were at a higher risk of their cancer coming back up to 20 years after they were first diagnosed.  Around 12,300 women in the UK could belong to one of these late relapse subgroups and therefore might benefit from longer courses of treatments such as tamoxifen, or more frequent check-ups

 “We’ve shown that the molecular nature of a woman’s breast cancer determines how their disease could progress, not just for the first 5 years, but also later, even if it comes back.” said Dr Oscar Rueda, first author of the paper and senior research associate at the Cancer Research UK Cambridge Institute. “We hope that our research tool can be turned into a test doctors can easily use to guide treatment recommendations.”

The model also revealed how molecular subgroups could behave very differently if a patient’s cancer returns. They commonly spread to different parts of the body and some are more aggressive than others, affecting how much time women survive for following a relapse

Professor Karen Vousden, Cancer Research UK’s chief scientist, said: “This study provides some valuable new insights into how we might identify women whose breast cancer is likely to return.

“We’re still a way off being able to offer this type of detailed molecular testing to all women and we need more research to understand how we can tailor treatments to a patient’s individual tumour biology. But this is incredibly encouraging progress. One in seven women will get breast cancer in their lifetime in the UK, and we hope that research like this will mean that if faced with the disease, even more of our daughters and granddaughters will survive.”

In addition to developing an affordable test for future use in hospitals, Caldas’ team are also already investigating personalised treatment options for different breast cancer subtypes. The next steps will be to recruit patients onto different clinical trials depending on the molecular makeup of their tumour.

Catharine Scott, 51, from Cambridge, was diagnosed with triple negative breast cancer in 2016. She had the molecular biology of her tumour analysed as part of the Personalised Breast Cancer Programme at Addenbrooke’s Hospital, which is part of Cambridge University Hospital NHS Foundation Trust. This programme aims to confirm whether women are receiving the best treatment for their tumour type, and if they might be eligible for a clinical trial should they relapse in the future.

Since finishing treatment, Catharine had one scare in the summer of 2018, but it was not a recurrence. She has annual check-ups and mammograms.

Catharine said: “I finished my treatment and found it very strange knowing I wouldn’t see anyone for a year. I was at the hospital every week, then every three, then suddenly that’s it. It’s quite scary and definitely a worry. I spoke to my consultant at the time and asked, ‘How likely am I to get this again?’

“They can tell you the risks and likelihood, and how things have been in the past. If they were able to make it more personalised that would be more reassuring. It would definitely be better than feeling you have to cross your fingers.

“I feel lucky to have been on the trials and I’m glad to be helping with research. Women in the past contributed to get treatment where it is today and I’m glad to be doing my bit for my daughter, for other women and for the future generations.” 

Adapted from a press release from Cancer Research UK.

Reference:
Rueda, O., et al. Dynamics of breast cancer relapse reveal late recurring ER-positive genomic subgroups. Nature; 13 March 2019; DOI: 10.1038/s41586-019-1007-8

The annual Cambridge and Oxford Student Conferences series is taking place across the UK this month (March) - and will give accurate, up-to-date information to potential applicants and offer them the opportunity to meet current students at both universities.

The Conferences will take place in Edinburgh, Swansea, Birmingham, Aintree, Newcastle, Lisburn and Epsom between 15-28 March. 

Cambridge students are actively involved as volunteers in initiatives to increase the number of applicants from state schools and other under-represented groups, and they are keen to return to their home areas to talk to and encourage potential applicants.

Blane Jones, 19, is a former pupil at Coleg Gwent at Crosskeys near Newport. He is in his first year studying English at Robinson College and will be attending the Liberty Stadium event in Swansea on Monday 18 March.

He said: “These conferences are such a good idea – the background information you can get is priceless when it comes to applying. I applied to Cambridge because, for me, the course content was the best in the country.

“My advice for those applying would be to enjoy the process. The interview is intellectually challenging, but essentially just a really interesting conversation. You need to grab the whole process by the collar and just go with it.”

Juliette Thomas, 19, is a former pupil of Bishop Vesey’s Grammar School in Sutton Coldfield. She is studying Modern and Medieval Languages at Jesus College and will be helping at the Conference in Birmingham on Tuesday 19 March.

She said: “When I was at school I went to the Conference in Birmingham and I met loads of people from the area that seemed really normal and didn’t fit the ‘Cambridge stereotype’ I had in my mind.

“My biggest tip for getting into Cambridge is to do as much research as you can. Read both the prospectus and the alternative prospectus, and the University website, and if you have any specific admissions queries, email Cambridge Admissions Office. Cambridge University Student Union’s (CUSU) website also features an ‘Ask a Student’ email address run by student volunteers.

“Also, don’t believe the myth that Cambridge is more expensive than other universities - there is funding for students that might find themselves in financial difficulty.”

Matthew Coombes, 20, is a former pupil of Lord Lawson of Beamish Academy in Gateshead who will be at the Newcastle event at St James' Park on Thursday 21 March. He is in his second year studying Land Economy at Homerton College.

He said: “It’s great to go back home to speak to students who are in the same position I was a couple of years ago. I want to tell them about my own experience and encourage them to apply. 

“My tip for applying to Cambridge is to make sure you can talk knowledgeably about your subject. And be resourceful if needs be. I wasn’t able to find suitable work experience in my field of study, so instead I read as much as I could in the journals I could find in Newcastle – it meant I was able to discuss the ideas with confidence during my interview.”

Ruth Augarde, 21, is a former pupil of Durham Johnston Comprehensive School. She is in her second year studying engineering at Peterhouse and will also be at the St James' Park event.

She said: “My advice would be to research your course thoroughly. Find out about the content, how the supervision works. Engineering obviously isn't something you can study at A-level, so when I was in Year 12 I was able to find out more about the Cambridge course by attending this Conference.

“I was so keen on my course and studying at Cambridge that the distance between home and Cambridge wasn't a big concern for me. I'm so glad I applied - there are so many people from so many different backgrounds here."

Sessions for students will give an overview of courses available at Cambridge, how to make an application, student life and finance, and the interview process. Admissions tutors will be available to talk to both pupils and teachers.

Rachel Lister, Head of Student Recruitment and Widening Participation at the University of Cambridge, said: “Each year, staff and students from both Cambridge and Oxford Universities hit the road and head out to all corners of the UK to try to encourage more teenagers to consider applying for the range of courses they offer.

“At each venue we go to, we invite schools from the area to bring their pupils along to ask questions and learn more about life at two of the country’s leading Universities. It’s always satisfying to inspire young people to apply, who may have previously thought a place at Cambridge or Oxford was beyond their reach.”

The conferences will take place at seven large venues in the UK. For directions to each location and detailed schedules go to www.undergraduate.study.cam.ac.uk/events/student-conferences

• Edinburgh - Friday 15 March 2019, Corn Exchange – 9.30am to 3.30pm
• Swansea - Monday 18 March 2019, Liberty Stadium – 9.30am to 3.30pm            
• Birmingham - Tuesday 19 March 2019, Edgbaston Cricket Ground - 9.30am to 3.30pm
• Aintree - Wednesday 20 March 2019, Aintree Racecourse - 9.30am to 3.30pm
• Newcastle - Thursday 21 March 2019, St James’ Park - 9.30am to 3.30pm
• Lisburn, NI - Tuesday 26 March 2019, Lagan Valley Island - 9.30am to 3.30pm
• Epsom - Wednesday 27 March 2019 & Thursday 28 March 2019  - Epsom Downs Racecourse - 9.30am to 3.30pm

Latest research on hundreds of new green technology companies in the US shows the patenting activity of a startup climbs by over 73% on average every time they collaborate with a government agency on “cleantech” development – from next-generation solar cells to new energy storage materials.

The study also found that every time a cleantech startup licensed a technology developed by a government agency, the company secured – on average – more than double the amount of financing deals when compared to similar startups: a 155% increase one year after taking out a licence.    

Collaboration with universities and private firms are a familiar path for many startups, yet government partnerships are significantly undervalued when it comes to green technologies, say researchers.

While the role of public-private partnerships in sectors such as biotech and IT is well known, they say that – until now – there has been a lack of data on the effectiveness of these alliances in cleantech. The study is published in the journal Research Policy. 

“Our findings suggest that some of the signs commonly used to track innovation and business success, such as patents and financing, increase when new cleantech companies partner with US government departments or labs,” said study co-author Laura Diaz Anadon, Professor of Climate Change Policy at the University of Cambridge.

Prof Claudia Doblinger, study first author from the Technical University of Munich, said: “Government research laboratories have a major role to play in the climate challenge but also the growth of small businesses – twin objectives at the heart of many policy discussions, such as the Green New Deal in the United States.”

The researchers built a new dataset of 657 US cleantech startups and the more than 2,000 partnerships those companies established between 2008 and 2012, to gauge the different outcomes for private and public alliances.

Around 66% of the startups were less than five years old in 2008, with the remaining 34% commencing during the selected study period. The research included companies across the sustainable sector: from wind to marine power, and recycling to batteries.

In addition to the benefits seen in patenting and investment, researchers also found that alliances with some of the stronger innovation outcomes were outside of major tech hubs such as Silicon Valley – suggesting the potential for building “regional ecosystems”. 

The National Renewable Energy Laboratory (NREL), for example, part of the US Department of Energy and situated in Colorado, is a “prominent example of government organisations in the US partnering with cleantech startups”, say researchers.

A major player in the development of green technologies, NREL it worked throughout the 2000s with startup companies in “thin film” such as First Solar, which in 2009 became the largest producer of Cadmium Telluride solar technology.

Researchers point out that NREL has granted more than 260 licenses since 2000, and this study shows the value of government agencies such as this have on startups in particular.

The study’s authors argue that the scale, facilities, and longer-term perspective of state agencies, such as the US Department of Energy and its seventeen national laboratories, naturally complement the nimble startups that can sniff out and adapt technological developments to market opportunities at a faster rate.

“Governments can and should have longer-term perspectives when compared to the private sector, and thus play a critical role in energy innovation,” said study co-author Prof Kavita Surana, from the University of Maryland.

“Beyond grants and supporting the early markets, it is the joint development and transfer of knowledge that government agencies are able to foster with startups that makes a difference.

“As the US Congress and civil society prepare to debate the substance of the policies like the Green New Deal, facilitating public-private partnerships could well be an important, and relatively inexpensive, part of any forward-looking policy package,” said Surana.

Doblinger says that to forge lasting partnerships with emerging businesses, government agencies should test out incentives that support collaborative projects.

“Initiatives such as investing more in technology transfer capabilities, starting entrepreneurs in residence programs, or allowing government scientists to take temporary leave to work with a private firm, could reduce information asymmetry and provide incentives to researchers,” she said.

Anadon believes that the lessons from the study are worth considering in national contexts beyond the US. “For the agencies of any government to successfully work with startups, sufficient and stable funding is vital – along with technology transfer and communication support.”

“Our findings should be taken into consideration whenever funding for public research into sustainable energy is being debated. Cleantech that comes from public-private partnerships will be essential for meeting global climate and sustainability goals,” she said.  

While inflammation is a natural response necessary to fight off infection, chronic inflammation – which may result from psychological stress as well as lifestyle factors such as smoking, excessive alcohol intake, physical inactivity and obesity – is harmful.

The link between heart disease and depression is well documented. People who have a heart attack are at a significantly higher risk of experiencing depression. Yet scientists have been unable to determine whether this is due to the two conditions sharing common genetic factors or whether shared environmental factors provide the link.

“It is possible that heart disease and depression share common underlying biological mechanisms, which manifest as two different conditions in two different organs – the cardiovascular system and the brain,” says Dr Golam Khandaker, a Wellcome Trust Intermediate Clinical Fellow at the University of Cambridge. “Our work suggests that inflammation could be a shared mechanism for these conditions.”

In a study published today in the journal Molecular Psychiatry, Dr Khandaker and colleague Dr Stephen Burgess led a team of researchers from Cambridge who examined this link by studying data relating to almost 370,000 middle-aged participants of UK Biobank.

First, the team looked at whether family history of coronary heart disease was associated with risk of major depression. They found that people who reported at least one parent having died of heart disease were 20% more likely to develop depression at some point in their life.

Next, the researchers calculated a genetic risk score for coronary heart disease – a measure of the contribution made by the various genes known to increase the risk of heart disease. Heart disease is a so-called ‘polygenic’ disease – in other words, it is caused not by a single genetic variant, but rather by a large number of genes, each increasing an individual’s chances of developing heart disease by a small amount. Unlike for family history, however, the researchers found no strong association between the genetic predisposition for heart disease and the likelihood of experiencing depression.

Together, these results suggest that the link between heart disease and depression cannot be explained by a common genetic predisposition to the two diseases. Instead, it implies that something about an individual’s environment – such as the risk factors they are exposed to – not only increases their risk of heart disease, but at the same time increases their risk of depression.

This finding was given further support by the next stage of the team’s research. They used a technique known as Mendelian randomisation to investigate 15 biomarkers – biological ‘red flags’ –  associated with increased risk of coronary heart disease. Mendelian randomisation is a statistical technique that allows researchers to rule out the influence of factors that otherwise confuse, or confound, a study, such as social status.

Of these common biomarkers, they found that triglycerides (a type of fat found in the blood) and the inflammation-related proteins IL-6 and CRP were also risk factors for depression.

Both IL-6 and CRP are inflammatory markers that are produced in response to damaging stimuli, such as infection, stress or smoking. Studies by Dr Khandaker and others have previously shown that people with elevated levels of IL-6 and CRP in the blood are more prone to develop  depression, and that levels of these biomarkers are high in some patients during acute depressive episode. Elevated markers of inflammation are also seen in people with treatment resistant depression. This has raised the prospect that anti-inflammatory drugs might be used to treat some patients with depression. Dr Khandaker is currently involved in a clinical trial to test tocilizumab, an anti-inflammatory drug used for the treatment of rheumatoid arthritis that inhibits IL-6, to see if reducing inflammation leads to improvement in mood and cognitive function in patients with depression.

While the link between triglycerides and coronary heart disease is well documented, it is not clear why they, too, should contribute to depression. The link is unlikely to be related by obesity, for example, as this study has found no evidence for a causal link between body mass index (BMI) and depression.

“Although we don’t know what the shared mechanisms between these diseases are, we now have clues to work with that point towards the involvement of the immune system,” says Dr Burgess. “Identifying genetic variants that regulate modifiable risk factors helps to find what is actually driving disease risk.”

The research was funded by Wellcome and MQ: Transforming Mental Health.

Dr Sophie Dix, Director of Research at MQ, says: “This study adds important new insight into the emergence and risk of depression, a significantly under researched area.

“Taking a holistic view of a person’s health – such as looking at heart disease and depression together – enables us to understand how factors like traumatic experiences and the environment impact on both our physical and mental health. 

“This research shows clearly the shared biological changes that are involved. This not only opens opportunities for earlier diagnosis, but also create a solid foundation for exploring new treatments or using existing treatments differently. We need to stop thinking about mental and physical health in isolation and continue this example of bringing sciences together to create real change.”

Reference
Khandaker, GM et al. Shared mechanisms between coronary heart disease and depression: findings from a large UK general population-based cohort. Molecular Psychiatry; 19 March 2019; DOI: 10.1038/s41380-019-0395-3

Alongside the Chinese People’s Liberation Army, Indian Railways and Walmart, the NHS ranks among the world’s largest employers. In England, it treats more than 1.4 million patients every 24 hours and will this year spend £126 billion. But as communities gathered to celebrate the NHS’s 70th birthday in 2018, reports continued to emerge on the ailing health of this much-loved national institution.

Analysis by another national treasure, the BBC, revealed that nearly one in five hospital trusts were failing to hit any of their key waiting-time targets. Hospitals seemed to be lurching towards over-crowded A&Es, bed shortages and queuing ambulances unable to hand over their patients.

Two University of Cambridge researchers have a grand vision to rethink the system to make it fit for the next 70 years – a vision that’s rooted in research with local patients and doctors.

Professor Stefan Scholtes works at Cambridge Judge Business School and Dr Alexander Komashie is at the University’s Engineering Design Centre. Both are engineers by training, both have spent the past 10 years studying different parts of the local healthcare system and both are passionate believers that, as researchers, they can help make the NHS better.

System design

The NHS faces numerous challenges but the real test, says Komashie, is understanding how to design better delivery systems by working with patients. “That’s where engineering comes in,” he says. “Engineers excel in designing large systems that work well, from worldwide telecommunications networks to the Airbus A380. What motivates me is translating the engineering practice of a systems approach into healthcare.”

The first step is understanding the system requirements. “It sounds obvious, but to design a system to do something you need to understand what it is you want,” Komashie explains. “In engineering, a lot of effort goes into defining what the system should do. When you understand that, you can ask how the system is set up to deliver it.”

Komashie has applied this systems engineering approach to adult mental health services within the Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), and ran a series of workshops for patients and clinicians. Patients’ stories allow him to unpack each component of the delivery system and represent them in visual diagrams so that services can be improved in a systematic way. The project was funded and supported by the National Institute for Health Research (NIHR) East of England Collaboration for Leadership in Applied Health Research and Care (CLAHRC), hosted by CPFT.

“My goal is developing a new way of describing the system, and hearing people talk about their experience of care helps me understand it. If through patient and public involvement, we can get rich enough stories, it gives us a window into the system behind the story,” says Komashie, who has recently been awarded an interdisciplinary fellowship for research into health systems visualisation at The Healthcare Improvement Studies Institute (THIS Institute). “Hearing patients’ accounts of what matters most helps to ensure the system designs and delivers the support they need.”

Sarah Rae, CPFT Expert by Experience, worked closely with Komashie in bridging the gap between the academic researcher and the patient participants. “As workshop co-facilitator I gave the participants a better understanding of the research by helping them to make the connection between systems engineering and mental health,” she says. “Sharing my own lived experience of mental health also helped the participants feel more comfortable about describing their experiences authentically.”

Komashie is now taking the tools he developed in mental health and applying them to vascular surgery and spinal cord injuries at Addenbrooke’s Hospital in Cambridge and holistic neuropsychological rehabilitation at The Princess of Wales Hospital’s Oliver Zangwill Centre in Ely.

Working with GP practices

Headlines about NHS waiting times, bed shortages and ambulance queues invariably focus on capacity, which Scholtes argues is a misdiagnosis. “People say we’ve got a capacity problem but that’s wrong. We have a complexity problem. There are so many things going on simultaneously but pulling in different directions. Complexity is killing hospitals.”

At Addenbrooke’s, for example, where Scholtes spent three sabbaticals over the past 10 years, the hospital does everything from pulling wisdom teeth to multiple organ transplants. He argues that delivering this breadth of services in a system already at full stretch is impossible. Instead, hospitals need to be “decomplexified” by delivering most of their routine services in community settings.

It sounds simple, but it’s not. “The problem is that there’s no landing space. We have 92 GP practices locally, so how can you move work currently centralised in a large hospital to 92 small businesses? It’s impossible. The only way to make headway is to scale up primary care so that it can take on more responsibility,” says Scholtes.

This is exactly what he’s doing with Granta Medical Practices, a large Cambridgeshire GP practice where he spent his most recent sabbatical evaluating the practice’s innovative operational and business model.

A critical barrier to change in primary care is the traditional GP partnership model, he says. By leaving GP partners with unlimited liability, the model creates risk aversion and hampers transformative change. In response, Granta is developing an innovative business model – an employee-owned trust akin to the John Lewis Partnership – which could enable it to deliver 70% of routine outpatient activity in the community and cut by 25% the number of emergency bed days among its patients.

Dr James Morrow, CEO of Granta Medical Practices, describes how Granta Medical Practices has gained enormously from working closely with Sholtes and his colleagues at the Cambridge Judge Business School: “Several of our senior clinicians have participated in formal educational programmes through the Judge and have brought back insights and skills from other sectors. Stefan’s sabbatical with the practice has refined and clarified our thinking around not just service delivery and user-experience but also helped with developing our longer term strategic goals as we embark on a period of rapid health system reform.”  

But how can transforming Granta help the NHS as a whole? This is where the University comes in, says Scholtes, who hopes to establish a Primary Care Innovation Academy, drawing on research expertise from across the University.

The Academy would provide leadership and management training for GPs, practice managers and lead nurses, and also ensure that interventions taken to transform the local primary care system are robustly evaluated. As such, it would add to the University’s increasing capacity in creating the evidence base for improving healthcare. For instance, THIS Institute is focusing on how to improve quality and safety across the system.

A “radically different” NHS

Addenbrooke’s Hospital itself has been transformed over the past three decades with a major emphasis on recruiting clinical academics in partnership with the University, who split their time between practising medicine and carrying out research.

Professor Patrick Maxwell, Head of the School of Clinical Medicine, explains: “Clinical academics have been central to the development of tertiary referral services and a major trauma centre. This has helped to create an excellent district and regional hospital with outcomes that are among the best in the country. Currently our priorities include improving prevention and early diagnosis of diseases, so that fewer patients need hospital services.”

Meanwhile, in January 2019, the NHS released its new 10-year plan, which included aims to boost ‘out-of-hospital’ care through increased investment in primary medical and community health services.

All in all, Scholtes believes that, by the time the NHS reaches its 80th birthday, it could look radically different: hospitals could be doing 60% of what they do now by focusing on cases that can only be treated in hospital and on cutting-edge treatments and research, while more integrated, scaled-up primary care practices will be taking full responsibility for out-of-hospital care.

“If this work is successful, it has the potential to bring the local health economy back onto a sustainable path by establishing a new model of primary care that can be scaled throughout the NHS,” he concludes. “It’s ambitious – but we can do it.”

Read more about our research linked with the East of England in the University's research magazine; download a pdf; view on Issuu.

In the Atlantic Ocean, a giant ‘conveyor belt’ carries warm waters from the tropics into the North Atlantic, where they cool and sink and then return southwards in the deep ocean. This circulation pattern is known as the Atlantic Meridional Overturning Circulation (AMOC) and it’s an important player in the global climate, regulating weather patterns in the Arctic, Europe, and around the world.

Evidence increasingly suggests that this oceanic current system is slowing down, and some scientists fear it could have major effects, such as causing temperatures to dive in Europe and warming the waters off the eastern coast of the U.S., potentially harming fisheries and exacerbating hurricanes.

A new study published in Nature Communications provides insight into how quickly these changes could take effect if the ocean current system continues weakening.

An international team of scientists studied one of the key sections of the AMOC –where North Atlantic water sinks from the surface to the bottom of the ocean. They confirmed that changes in the ocean conveyor belt preceded abrupt and major climatic changes during the transition out of the last ice age, referred to as the last deglaciation. The study is the first to determine the time lags between past changes to the AMOC and major climate changes.

“Our reconstructions indicate that there are clear climate precursors provided by the ocean state — like warning signs, so to speak,” said lead author Francesco Muschitiello from the University of Cambridge’s Department of Geography, who completed the work while a postdoc at Columbia University.

Until now, it has been difficult to resolve whether past changes in the ocean conveyor belt occurred before or after the abrupt climate shifts that punctuated the last deglaciation in the Northern Hemisphere. To overcome the usual challenges, the team pieced together data from a sediment core drilled from the bottom of the Nordic Seas, a lake sediment core from southern Scandinavia, and ice cores from Greenland.

Scientists typically rely on radioactive carbon (carbon 14) dating to determine the ages of sediments. This relationship is tricky in ocean sediments, though, because carbon 14 is created in the atmosphere, and it takes time for the carbon to make its way through the ocean. By the time it reaches the organisms at the bottom of the water column, the carbon 14 could already be hundreds or thousands of years old. So the team needed a different way to date the sediment layers in the marine core.

The researchers solved this puzzle by measuring carbon 14 levels from a nearby lake sediment core and matching it to the marine core layers. Next, they compared the real age of the marine sediments to the deep ocean carbon 14 measurement, giving them a record of ocean circulation patterns in this region over time. The final piece of the puzzle was to analyse ice cores from Greenland, to study changes in temperature and climate over the same time period.

Comparing the data from the three cores revealed that the AMOC weakened in the time leading up to the planet’s last major cold snap around 13,000 years ago. The ocean circulation began slowing down about 400 years before the cold snap, but once the climate started changing, temperatures over Greenland plunged quickly by about 6 degrees.

A similar pattern emerged near the end of that cold snap, transitioning out of the ice age; the current started strengthening roughly 400 years before the atmosphere began to heat up dramatically, when Greenland warmed up rapidly — its average temperature climbed by about 8 degrees over just a few decades, causing glaciers to melt and sea ice to drop off considerably in the North Atlantic.

For now it’s not fully clear why there was such a long delay between the AMOC changes and climatic changes over the North Atlantic.

It’s also difficult to pinpoint what these patterns from the past could signify for Earth’s future. Recent evidence suggests that the AMOC began weakening again 150 years ago. However, current conditions are quite different from the last time around, says Muschitiello: the global thermostat was much lower back then, winter sea ice stretched farther south than New York Harbour, and the ocean structure would have been much different. In addition, the past weakening of the AMOC was much more dramatic than today’s trend so far.

“It is clear that there are some precursors in the ocean, so we should be watching the ocean. The mere fact that AMOC has been slowing down, that should be a concern based on what we have found,” said Muschitiello.

The study should also help to improve the physics behind climate models, which generally assume the climate alters abruptly at the same time as AMOC intensity changes. The model refinements, in turn, could make climate predictions more accurate. As Svensson puts it: “As long as we do not understand the climate of the past, it is very difficult to constrain the climate models needed to make realistic future scenarios.”

Reference:
Francesco Muschitiello et al. 'Deep-water circulation changes lead North Atlantic climate during deglaciation.' Nature Communications (2019). DOI: 10.1038/s41467-019-09237-3

Adapted from Columbia University story.