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Image of the Week: New homes for old laptops

28 Nov, 2014

malaptop

The Wellcome Trust is keen to ensure that we reduce the amount of waste that gets sent to landfill, and the Wellcome Trust Centre for Molecular Parasitology in Glasgow, has found an innovative way of recycling computer equipment that is no longer needed.

Working with Malaptop, a Scottish charity that was set up in 2012, their old laptops are being reformatted, loaded with educational materials, and then sent to schools in Malawi.

The Wellcome Trust has already donated a total of 116 laptops to the Malaptop project which aims to enable students and teachers to learn simple computer skills.

This month, the first batch of laptops was delivered to Malawian students at a school in Dowa, Malawi. The image above shows ten laptops that were given to students of Mponela CDSS school – so far a total of 76 have been delivered.

The donated laptops are set up to allow 1000s of free programmes to be quickly and easily installed, from basic programmes such as Libre Office to educational games. In addition, educational software, including the Malaria and Parasite comics developed by the Wellcome Trust Centre for Molecular Parasitology are pre-installed before the laptops are given out.

Malaptop aims to ensure that future generations in Malawi are in a good position to take full advantage of technologies as they become available, and we are delighted to see our surplus equipment being put to such good use.

At Trust headquarters we have sent over 334 tonnes of waste to composting, and 360 tonnes have been recycled over the past two years. John Spall is part of the team at the Wellcome Trust who have been working hard to improve our green credentials, he says “since September 2012 we’ve not sent any waste to landfill and we are now able to recycle over 65% of all our waste”.

Alternative impact: Can we track the impact of research outside of academia?

25 Nov, 2014

impact 2

A new type of metric purports to provide a means of measuring the ‘alternative’ impact of research among non-academic audiences such as clinicians, educators, policy makers, and the general public. Adam Dinsmore from the Wellcome Trust’s Evaluation Team explains how improvements to our understanding of the meaning and value of ‘altmetrics’ could expand the tools and techniques available to research evaluators in the research funding sector and beyond…

At any one time, the Wellcome Trust supports around 5000 active grants across biomedical research, developing medical technologies, public engagement with science, and medical humanities. An important part of the Trust’s operations is therefore to track, understand, and learn from the types of impact that this research has.

That job falls to the Trust’s Evaluation Team, who employ a wide range of tools and techniques to gather intelligence on the effects that Trust-funded research is having in academia and beyond. This can include case studies detailing the rich stories of research progression and breakthroughs associated with Wellcome Trust funding, longitudinal tracking surveys such as the Wellcome Trust Career Tracker, and the online system WT e-Val, which allows Trust-funded researchers to provide us with an on-going commentary on the work they do. All of this feeds back into the Trust’s strategic thinking.

C0021303 Tape measureIn addition, the team has long made use of quantitative indicators of scientific productivity. Conventional ‘bibliometric’ analysis can inform us about the use and re-use of the knowledge produced by research. This is typically measured by the frequency that scholarly published outputs are cited by peers in the academic literature.

These are important indicators of the production of new knowledge, but academics are not the only people who use and re-use research outputs such as articles, datasets, and software. Teachers may wish to integrate the latest research into their lesson plans. Policy makers may consult the academic literature to inform their thinking on social issues. Clinicians and patients are interested in reading about the conditions they must either treat or manage.

Metrics that allow us to gauge the ‘alternative’ impact of research away from the academic literature have conventionally been unavailable, but that may be changing.

The vast majority of research outputs are now accessed online, and so it is now possible to track the number of times an output is viewed, downloaded, or tweeted about (etc), and in some cases – by whom. Measures of this kind have come to be known as ‘altmetrics’, and are now provided in some form by most academic publishers and a number of online platforms (e.g. Altmetric.com, Plum Analytics, ImpactStory).

Some research suggests that the online interactions measured by certain altmetrics may have some value as a predictor of subsequent academic impact, but the new metrics also hold much potential to inform the Trust and other funders about the wider impact of the work they support which can sometimes be invisible to conventional citation metrics. This could be especially helpful for early-career researchers who have not yet had the chance to accrue a large number of traditional citations, researchers who work in fields with little citation culture, or researchers whose specialist roles are rarely recognised in the authorship of academic papers. Altmetrics may also be useful as a discovery tool for researchers who wish to know what is being discussed and read about most in their field.

iamThe Wellcome Trust hosted a conference on altmetrics in late September (1:AM London) and an on-going HEFCE review is exploring whether altmetrics might contribute to the next Research Excellence Framework, likely to take place in 2020.

This wide interest in altmetrics represents a great opportunity to probe questions of the meaning and validity of altmetrics as proxies of research impact, which may provide us with new tools to help make science as efficient as possible.

Read more about the Wellcome Trust’s perspective on altmetrics in an editorial published this week in PLOS Biology. To read more about the work of the Wellcome Trust’s Evaluation Team please visit the WT e-Val webpage.

Prosopagnosia – a Common Problem, Commonly Overlooked

25 Nov, 2014

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Last month, Kate Széll was judged the winner of the Wellcome Trust’s science writing prize in category B for “anyone with a non-professional interest, including undergraduates”. More than 640 articles were submitted in total, with the top 20 judged by a panel consisting of neuroscientist Sophie Scott, materials scientist Mark Miodownik, science writer Anjana Ahuja, the Observer’s Nicola Davis, the Guardian’s Ian Sample and the director of the Wellcome Trust, Jeremy Farrar. A former partner in a law firm, Kate has now changed tack to pursue a career in science communication. Here is her piece in full, with minor edits.

Prosopagnosia – a Common Problem, Commonly Overlooked

“I once asked Clara who she was. It was so embarrassing, but she’d had a haircut, so how was I to know?” That’s Rachel, she’s 14 and counts Clara as one of her oldest and best friends. There’s nothing wrong with Rachel’s sight, yet she struggles to recognise others. Why? Rachel is face blind.

223937206_bf363648ef_zMost of us take for granted the fact that we recognise someone after a quick glance at their face. We don’t realise we’re doing something very different when we look at a face compared with when we look at anything else. To get a feeling of how peculiar facial recognition is, try recognising people by looking at their hands, instead of their faces. Tricky? That’s exactly how Rachel feels – only she’s not looking at hands, she’s looking straight into someone’s eyes.

Specific areas of the brain process facial information. Damage to those areas gives rise to prosopagnosia or “face blindness”: an inability or difficulty with recognising faces. While brain damage-induced prosopagnosia is rare, prosopagnosia itself is not. Studies suggest around 2% of the population could have some form of prosopagnosia. These “developmental” prosopagnosics seem to be born without the ability to recognise faces and don’t acquire it, relying instead on all manner of cues, from gait to hairstyles, to tell people apart.

Kirsten Dalrymple from the University of Minnesota is one of a handful of researchers looking into developmental prosopagnosia. Her particular interest is in prosopagnosic children. “Some seem to cope without much of a problem but, for others, it’s a totally different story,” she says. “They can become very socially withdrawn and can also be at risk of walking off with strangers.”

Dalrymple points out that lack of awareness of the condition among childcare specialists and the public, is a serious issue. Many parents of prosopagnosic children go through a number of specialists before realising what is causing their child’s peculiar behaviour. And it is usually seeing something about “face blindness” online or in the media, rather than a specialist’s deduction, that makes the penny drop.

What causes developmental prosopagnosia is a puzzle. It’s thought that the normal brain develops its facial recognition skill through innate knowledge and a learning ability.

N0026885 A Baby looking curiousWhen tested at less than an hour old, babies will track simple drawings of faces for longer than they will track anything else. They are born with a fascination for faces, but studies suggest they need experience, too, to develop normal face recognition. There are suggestions that individuals raised in orphanages have difficulty recognising new faces. If only a few faces are seen in childhood, it’s possible that the brain does not get enough information to optimise its facial-recognition abilities.

Learning facial recognition might take place, or at least start, very soon after birth: People born with cataracts have abnormal facial recognition abilities in later life, even if the cataracts were removed at the age of two months. That ties in with indications that newborns’ innate interest in faces trails off after the age of one month.

Despite the importance of infant brain development, there may be processes that can be harnessed to help a face-blind child become a non face-blind adult. The brain needs to perceive a face and to remember it; it must identify a face as a face, then realise that it has seen that particular face before. Evidence suggests that facial perception and facial memory are dissociable processes; one can function without the other and the existence of one without the other can be probed. Dalrymple finds that children with developmental prosopagnosia seem to have problems with perception and memory processes. Some prosopagnosic adults, however, only have problems with face memory. If there are adults – but not children – with impaired face memory and unimpaired face perception, it may be that the face perception element can improve.

lego facesTreatment of prosopagnosia is a long way off, but raising awareness of the condition would be a huge help to those affected. Understanding that someone isn’t ignoring you deliberately lessens the likelihood of offence; understanding a child’s behaviour enables you to help them. When a child like Rachel fails to recognise a classmate – again – it might be time to recognise the face of prosopagnosia.

 

The Wellcome Trust Science Writing Prize is run in conjunction with The Guardian and The Observer. Kate Széll’s winning piece was published in the Observer Tech Monthly this weekend and she can be found on Twitter as @KateSzéll.

Image credits: Some faces – Dan Morelle on Flickr, CC BY-NC-SA 2.0,  25 Smiles: Festival faces mosaic – Strolloerdos on Flickr, CC BY 2.0, Curious baby – Anthea Sieveking , Wellcome Images,

Wellcome Trust Research Round-up: 24.11.14

24 Nov, 2014

Our fortnightly round-up of research news from the Wellcome Trust community…

Discovery of gene variant leading to natural typhoid resistance

B0004685 DNAPeople who carry a particular gene have natural resistance against typhoid, according to a new study that examined the genetic material of hundreds of people in Vietnam and Nepal.

The study, published in Nature Genetics, involved screening the human genome to look for genes associated with susceptibility to, or resistance from, typhoid. Also known as enteric fever, typhoid affects more than 25 million people annually.

According to lead researcher Dr Sarah Dunstan, from the Oxford University Clinical Research Units in Vietnam and Nepal, a Wellcome Trust Major Overseas Programme, said: “We found that carrying a particular form of the HLA-DRB1 gene provides natural resistance against typhoid fever. This gene codes for a receptor that is important in the immune response, by recognising proteins from invading bacteria.”

The study’s findings are important because the gene that gives rise to protection against typhoid is one of the most widespread instances of natural resistance to an infectious disease. Other examples of genetic variation that leads to natural immunity include the gene for sickle cell that protects carriers from malaria, and the CCR5 and HLA genes that provide protection from HIV AIDS.

New frontiers in paediatric pain

The research of Wellcome Trust Career Development Fellow Dr Rebeccah Slater, who studies paediatric and infant pain, is explored in a film produced by the University of Oxford.

Dr Slater’s most recent paper investigated how the new-born brain is activated by sensory stimulation of the skin. This was a pilot study of a small group of infants, testing the feasibility of using fMRI studies to look at how infant brains react to mechanical stimulation of their skin. Initial results showed distinct patterns of brain activation in response to varying intensities and types of stimulation, indicating potential for future studies to explore this further.

Understanding the infant sensory experience and pain is key to developing ethical treatments and providing effective pain relief for the very young. For example, Dr Slater’s previous work has challenged a common practice of doctors giving sugar as pain relief to new-borns, for example during heel-prick blood sampling.

International E. Coli study raises hope for vaccine

B0003279 E.coli on agar - colour-enhancedWellcome Trust supported researchers have conducted the largest ever study of the bacterium enterotoxigenic Escherichia coli, providing hope that a single global vaccine can be developed.

This bacterium causes 400,000 deaths and 400 million cases of diarrhoea each year in low-and-middle-income countries as well as affecting many travellers to these regions.

The study, published in Nature Genetics, looked at 362 different strains of E. Coli from 20 countries and found that strains clustered into closely related groups. The bacteria sampled from Asia, Africa and Latin America were more closely related than previously thought, with some strains of E. coli found to have spread from a single source. The discovery of large genetic similarities in the strains add support to the idea that one vaccine may effective for treating patients around the world.

“This research strengthens our belief that it is possible to target a broad range of enterotoxigenic E. coli groups with one vaccine,” says Professor Gordon Dougan, senior author from the Wellcome Trust Sanger Institute. “By targeting the most prevalent colonisation factors in these lineages, we stand a chance of developing a vaccine that will reduce the disease burden caused by this bacterium. This work is now underway at the Sanger Institute.”

In other news…

Genomics England has opened applications for clinicians and researchers to join a new Clinical Interpretation Partnership, working with data from the 100,000 Genomes Project. The Wellcome Trust provided £27m funding for a sequencing hub that will house the project, which aims to sequence 100,000 genomes from NHS patients by 2017.

Dame Kay Davies, Wellcome Trust Deputy Chair, has been awarded a WISE Lifetime Achievement Award for her career researching Duchenne muscular dystrophy (DMD) and championing women in science.

The Mental health research charity MQ: Transforming Mental Health has announced £1.5 million in funding awards to support innovative ways of providing more effective and accessible psychological treatments for conditions such as anxiety, depression and ADHD.

Image credit: DNA sequencing – Neil Leslie, Wellcome Images ,E. Coli –  David Gregory&Debbie Marshall, Wellcome Images

Image of the Week: Freud’s Porcupine

21 Nov, 2014

L0077373 Porcupine model, bronze

In honour of The Institute of Sexology opening yesterday at Wellcome Collection, we’ve decided to showcase a very special object from the exhibition. This little porcupine has been gaining quite a bit of attention recently, but we feel that it is well deserved.

What is the link between porcupines and sexology you may wonder? Whilst many objects in the exhibition have an obvious link to the study of sex and sexuality, this innocent looking porcupine may seem a little out of place amongst the phallic amulets and Wilhelm Reich’s Orgone Accumulator, parodied by Woody Allen as the “Orgasmatron”.

This bronze porcupine was kept on Sigmund Freud’s desk. He thought it represented the prickliness of human relationships. Porcupines crowd together when cold; however their sharp quills cause them to move away from each other when they get too close. This forces them to shift closer and then further apart until a balance of proximity is found. Freud used this to illustrate how people can both benefit from and be harmed by those they are most intimate with. The porcupine, on loan from the Freud Museum, was a gift to Freud from James Jackson Putnam, a neurologist and psychologist.

This isn’t the only porcupine to feature in the Institute of Sexology – they are also featured in footage of the mating practices of animals, from the archives of the Kinsey Institute. Originally an entomologist, Alfred Kinsey was interested in animal mating rituals as well as those of humans. The practices of porcupines were of particular interest to Kinsey and his colleagues. When perceptive to mating, the female lays her quills flat and curves her tail over her back so that she doesn’t impale the male. In other words, porcupines mate carefully.

The Wellcome Collection invites you to “undress your mind” with their free exhibition, The Institute of Sexology – now open (running until 20th September 2015).

Image Credit: ©Freud Museum, London

Director’s Update: Simple, flexible funding

18 Nov, 2014

Dr Jeremy Farrar, Wellcome TrustHaving listened to our grantholders, colleagues at the Wellcome Trust and others in the UK and international research communities, Wellcome Trust director Jeremy Farrar now introduces a new way of understanding the Trust’s funding framework.

At our best, funders of medical research provide support that brings the right people together in the right places with the right resources, and enables them to make discoveries and develop inventions that will improve human and animal health. We’ve seen this in the last few months as the research community has come together in response to the outbreak of Ebola virus in West Africa.

It’s too soon to claim that we have got to grips with the virus. People are still dying, communities are devastated and in many areas the epidemic continues to expand. But I am extremely proud that the Wellcome Trust and others have been able to join together to catalyse and fund research that will identify and deliver effective therapies, vaccines, communication strategies and classic public health measures. Partnership, flexibility and collaboration have been central to our response – whether it’s supporting clinical trials or scrutinising the ethics of how research is done in an epidemic, the work we’ve funded has required a huge amount of teamwork between scientists and funders alike.

We face many different kinds of health challenge but they all share the need for a diverse range of activities to understand and respond to them. However, that doesn’t mean we funders have to devise a new scheme for every possible permutation of person, discipline, location, career stage, scale and duration of project. Rather, it requires a simple, flexible framework that everyone can easily engage with, and that allows us to respond quickly, creatively and confidently without unnecessary process.

This is an issue that chimes with me from when I was on the other side of the funding relationship. It is also something I have heard a lot about this past year from listening to people we fund and people we don’t, in the UK and around the world, as well as from colleagues within the Trust. So I want the Trust’s funding framework to be clear and simple, in order that people can come to us with an idea and quickly understand what we can offer and what we will expect.

For all the areas that we fund – science, innovations, medical humanities, society and ethics, and public engagement – we now have five broad categories of response mode funding. These categories are people, seeds, teams, places and resources. They are consistent across the Trust, but remain flexible enough to encompass everything from clinical studies in stroke to a science-inspired film by Björk, from the Wellcome Trust Sanger Institute to Pathfinder awards for early-stage applied research in biotech, from individual fellowships in cell biology or the history of medicine or screenwriting to a multinational collaboration on urbanisation and health.

People

This is what science boils down to: people. Talented people with curiosity, ideas and ambition wanting to ask questions and find answers. We could probably have called all our categories ‘People’ but as it is, this refers specifically to personal awards like our Fellowships and Investigator Awards.

Seeds

Seeds_Web thumbnail_2A new kind of funding to support the generation of new ideas. These are small awards for developing original, innovative and risky ideas or for generating preliminary data or resources towards a larger research application.

Teams

Collaborative_Web thumbnail_2Another new kind of funding that recognises the key importance of collaboration in research and public engagement, bringing together people from within or across disciplines to inspire new ideas and new ways of thinking.

Places

Long-term support in the UK and in low- and middle-income countries for centres of excellence in research, innovation or engaging the public with science.

Resources

Funding for shared equipment, facilities and research resources, including support for longitudinal studies.

In addition to this framework, strategic funding is available in areas of particular importance to us. It has not always been clear to everyone else what these areas are, however, so to improve transparency, our strategic areas will be identified and developed in dialogue with our researchers and the wider community.

This is how the Trust works at its best. We want to engage in an ongoing discussion about opportunities and demands for research and public engagement. We have big ambitions, but the only way we can achieve them is in partnership with creative, innovative and ambitious people. So I really hope that our refreshed, simple and clear framework will encourage you to look at the website, identify opportunities relevant to you, come and talk with us, and consider applying for funding.

- Dr Jeremy Farrar, Director of the Wellcome Trust

Find out more about our updated grant schemes in this press release and on the grants pages of the Wellcome Trust website. If you are working in biomedical science and public health, we are hosting a webinar to outline the key changes for our science portfolio. Register for our webinar, taking place on 12th December at 11.00am (GMT).

Researcher Spotlight: Dr Lucy Blake

17 Nov, 2014

Lucy BlakeOur Researcher Spotlight shines on Dr Lucy Blake this week. Dr Blake is a research associate at the Centre for Family Research at the University of Cambridge, conducting some fascinating research into family relationships – especially those within “non-traditional” families. Her work helps give a voice to those people who can get overlooked by assumptions about what families consist of…

What are you working on? 

I’m working on a number of different studies at the moment, all of which are about family relationships and psychological well-being in families created by assisted reproduction. I’m currently coordinating a study based in the US looking at families in which gay couples have become parents through the use of surrogacy, a process in which a woman carries a child to term for the intending parent/s.

I am also working on a UK study of families in which heterosexual couples have started their families through the use of donated sperm, donated eggs or surrogacy. In addition to these large-scale studies, I’m conducting a smaller scale, qualitative study of men’s experiences of genetic and non-genetic fatherhood.

I am also interested in estrangement, where relationships between family members have broken down.

What does your average day involve?

I don’t really have an average day at work. One day I might be trying to recruit families for a study, which can sometimes be quite glamorous. I recently found myself at ‘Family Week’ in Provincetown, Cape Cod, where over 500 families headed by gay and lesbian parents had come together for a week-long holiday.

On a more typical day, I might be doing data entry and basic project management tasks – which essentially means emailing, database work, and drinking lots of tea.

Other days I might be working on an analysis for a paper – either doing some statistics or reading through streams of interview transcripts. If it is a Friday, our research centre stops for coffee at 11, which is a lovely time to catch up with colleagues and eat a slice or two of cake.

Why is your work important? 

The Centre for Family Research produces research that is used by legislators and policy makers all over the world. Families continue to change and there are many new and emerging family forms about which we know relatively little.

We provide policy makers with evidence that can be helpful when debating a number of questions. For example, do children have a right to be told that they were conceived using donated sperm or eggs? How do families created by surrogacy, and the surrogates and their families, fare over time? Do children growing up in a family without a mother differ from children who grow up with a mother and a father, and if so, in what kind of ways?

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What do you hope the impact of your work will be?

The families with which I work are typically in a minority. The children I talk to may have been conceived using a sperm donor, and/or growing up in families headed by one mum, two mums, two dads, etc. These are the families who do not commonly feature in children’s story books, and the children in these families often feel that their families are invisible. Our research gives these families a voice, and it is this aspect of my work that I am most passionate about.

More broadly, I hope that the work I do will have a positive impact on the kinds of conversations that we have about family as a society. There is a lot to gain from moving beyond assumptions and studying families as they actually are.

How did you come to be working on this in this field?

I knew that I wanted to study Psychology before I really knew what it was. I have always been interested in people and in relationships. My interest in family relationships in particular is no doubt driven by own experiences and family history. Trying to figure out what matters for relationships and what makes families work is something that I think I will always find interesting.

How has Wellcome funding helped you/your research/your career? 

I am very fortunate to be in the middle of a five-year postdoctoral position. The learning curve has been steep, and the lessons that I am learning will no doubt be of great value throughout my career. I suspect that I will never again have this time or freedom to pursue my research interests, so I appreciate that it is a luxury.

What’s the most frequently asked question about your work?

No one question comes to mind, but I do often end up having very personal conversations with people I have only just met. There was the immigration officer in Brisbane who told me how he and his wife had been trying to have a child for over ten years without any luck; the Cambridge Professor who expressed regret that his main contact with his grandchildren who lived far away was through Skype; and then there was the stranger who told me that he had only learnt of his adoption when he was 12 and how that had come as a big shock. There really is no telling how the conversation will go!

Which question about your work do you most dread – and why?

Again there is no one question. There is without a doubt a contentious political and religious element to the work that I do, so discussions can sometimes turn fiery and personal. These days I generally try to speak less and listen more.

Tell us something about you that might surprise us…

I spend a great deal of time writing papers for scientific journals and doing statistical analyses, but was never particularly interested in maths or science at school. I wouldn’t have dreamt for a moment that I would do the job that I have now. I also love nothing more than to binge-watch really bad quality reality TV.

What keeps you awake at night? 

I sleep like a log – it’s getting out of bed that’s the problem.

What’s the best piece of advice you’ve been given?

enjoy yourselfAs a teenager I remember feeling particularly anxious about one of my A-level exams. On the day of the exam, my dad said to me – “You’ve done all of the work, so just go out there and enjoy yourself.” At the time I thought he was a bit mad, but as I get older, it’s a mindset that I think is very important. Work hard, give it your best shot, and have fun.

The chain reaction question, set by previous spotlit researcher Dr Lindsay Hall is this: What keeps you sane?

I do half an hour of iyengar yoga practice before work, which helps keep me calm, healthy and strong. And I’m also lucky to have thoughtful, considerate and supportive colleagues who I can turn to for help and encouragement.

You can find out more about Dr Lucy Blake’s research by following her on Twitter and by reading her papers ‘Daddy ran out of tadpoles’: how parents tell their children that they are donor conceived, and what their 7-year-olds understand and Parent psychological adjustment, donor conception and disclosure: a follow-up over 10 years.

Image credit: Dr Lucy Blake,  “My two dads” by J L T on Flickr – CC-BY-SA

Image of the Week: Lung Cancer Cells

14 Nov, 2014

B0006883 Lung cancer cells

This Image of the Week was written by Alice Sheehan.

This month is lung cancer awareness month, which aims to raise the profile of one of the world’s biggest cancer killers.

Cancer is a condition where cells in a part of the body grow and reproduce uncontrollably. Cancer cells invade healthy tissue disrupting their functions or killing them and can for example limit an organs blood supply. Cancer can occur due to a combination of different factors; however some types which have been linked to lifestyle, such as kidney and liver cancers, are becoming more common in some populations.

Our image of the week is of a lung cancer cell in the latter stages of cell division. During cell division a single cell duplicates its genetic information and then splits to form two separate cells. In the image, the two ‘daughter cells’ have nearly separated completely from each other, with only a small bridge of cytoplasm connecting them. This image was produced by Anne Weston in the London Research Institute at Cancer Research UK. Anne created this image using scanning electron microscopy, which bounces electrons off the surface of the cells to provide information on their structure. This information was then used to create a greyscale replica of the cells which was coloured digitally at a later date.

According to statistics from Cancer Research UK, smoking causes over 80% of all lung cancer cases in the UK. Although the number of people smoking has decreased, lung cancer is the second most common type of cancer diagnosed in the UK and forms just over 13% of the nation’s cancer cases.

Image Credit: Anne Weston, LRI, CRUK/Wellcome Images

Wellcome Images is one of the world’s richest and most unusual collections, with themes ranging from medical and social history to contemporary healthcare and biomedical science. Over 100,000 high resolution images from our historical collections are now free to use under the Creative Commons-Attribution only (CC-BY) licence.

Getting Strategic about School Governance

13 Nov, 2014

FP0000141FD01 Children, at primary school

This weekend the Wellcome Trust and the National Governors’ Association launch a new Framework for Governance as part of their work to improve science education. Wellcome Trust Education advisor Sir John Holman and Nancy Wilkinson from the Education and Learning Team share the findings from the pilot study that led to the new framework, and discuss the importance of good governance in schools…

Look at any schools’ mission statement and you will likely see inspiring statements about helping pupils feel confident, secure and ready to take their place in modern society. Yet when you look at how schools measure their success, it is mostly in terms of exam league tables and Ofsted judgements, the two remorseless drivers of schools’ behaviour. And that is hardly surprising, when a headteacher’s job is on the line every time the exam results are published, or when Ofsted comes to call.

Beset by regulations, targets and with Ofsted looming over all, it can be hard for headteachers to step back and think about what really matters – nurturing pupils who are not only getting good exam grades, but who are resilient, engaged with their subjects and have high aspirations for the future. This is where governors can play an important role. School governors need to help the school take a strategic view of what really matters, to help the headteacher to see the wood, as well as the trees.

A Framework for Governance

With all this in mind, the Wellcome Trust got together with governors, headteachers, the National Governors’ Association (NGA), Ofsted and others, and drafted a strategic framework for governance (which we originally called a ‘Recommended Code of Governance’) to help governors take a strategic view of what matters in their school. The most innovative part, which we call ‘Element C’ gives ideas for high-level school performance indicators. These measure all the things that matter to the school, going beyond exam results and asking questions about whether pupils are resilient, whether they enjoy coming to school and whether there are plenty of opportunities to experience success through extra-curricular activities.

After several rounds of review, we published a pilot version of the framework, which we tried out with governors in 21 schools for two years from November 2012. The 21 pilot schools were spread across England, and included primary, secondary and special schools.

What did we learn?

FP0000142F02 Child, at secondary schoolSchool governors liked the simple and concise style of the framework that made it easy to understand. Despite this, most schools told us that they needed more support and training in using it and many schools struggled with how to get started. This was especially true of Element C: although governors accepted the importance of wider outcomes, they found it hard to see how they would measure things like pupils’ future aspirations or their wellbeing and resilience. They also expressed concerns about whether concentrating on these priorities/outcomes would be ‘what Ofsted is looking for’ – confirming what a powerful driver of schools’ behaviour the inspectorate is.

Another thing we learnt from the pilot was the importance of good leadership in school governing bodies. During the pilot, four of the 21 schools dropped out, and this was usually because the person who had originally volunteered to take part had moved on. If a school wants to improve its governance, it is essential to have an ongoing champion – usually the chair of governors – who is able to take the lead.

What happens next?

We learnt a lot from this pilot, and using the feedback from participants, we’ve worked with the NGA to produce a revised Framework for Governance. We’ve worked particularly hard on improving the section that helps schools understand the importance of the suggested high-level performance indicators, and offered more guidance on how these can be measured. For example, there are suggestions for how ‘wellbeing and resilience’ can be measured through pupil and parent surveys and by analysing data on absence and behaviour. The NGA will be running a training programme to support schools in using the new Framework for Governance, which will be launched at the NGA’s Annual Conference in Birmingham on 15th November 2014.

In their hearts, headteachers know that there is more to education than exam results alone, important though these are. But in their heads, they know that their future depends on the next crop of results. Governors need to help headteachers think strategically about what really matters in their school, and we believe our new Framework for Governance, developed with the NGA and supported by their training, is a powerful tool for doing so.

You will be able to access the revised Framework for Governance soon on the NGA and Wellcome Trust websitesPlease let us know if you would like to receive an email alerting you to its publication by sending an email to education@wellcome.ac.uk with the subject “Framework for Governance”. The Wellcome Trust is committed to a continuing programme for improving school governance. Alongside the work described here, we are also developing Questions for Governors to help governors ask the right questions about the quality of science and mathematics in their school.

Image credits: Fiona Pragoff/Wellcome Images

What the Wellcome Trust is doing to tackle Ebola

12 Nov, 2014

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Although the number of headlines about Ebola may have declined in the past week, the number of infections continues to rise in West Africa. Kate Arkless Gray looks at the progress of the epidemic, and how different departments at Wellcome Trust have come together to share expertise and help to tackle this unprecedented outbreak…

“We are not close to seeing the beginning of the end of the epidemic,” says Wellcome Trust Director Jeremy Farrar, writing in The Guardian recently, but there is hope that we “may have reached the end of the beginning”.

At the Wellcome Trust our focus is on helping tackle the crisis in the worst affected areas in West Africa, and supporting research into techniques, treatments, and vaccinations that could help stop the spread of this deadly virus.

Map_of_West_AFricaThe first official cases of Ebola, in what has now become an epidemic in West Africa, were confirmed in Guinea and then Liberia in March 2014. Despite obvious concern that the virus had surfaced in a number of humans, no-one was prepared for the scale of this outbreak.

With the number of cases – and countries affected – increasing, we realised that the Wellcome Trust was well placed to help. We worked to highlight the voices of infectious disease specialists with experiences of other outbreaks – with Jeremy Farrar joining Prof David Heymann, head of the Chatham House Centre on Global Health Security, and Prof Peter Piot, director of the London School of Hygiene and Tropical Medicine in the Wall Street Journal, to call for Africans to be given access to experimental Ebola medication. In August the World Health Organisation (WHO), having already declared Ebola an international health emergency, agreed that due to the scale of the outbreak, it was indeed ethical to use experimental drugs in West Africa.

Since then the confirmed death toll from Ebola has increase to almost 5,000 (at the start of November), although the true number is likely to be much higher, and we have committed approximately £10 million to fund vital research. This funding has helped enable unparalleled international collaboration across public, private, and not-for-profit sectors to tackle this public health emergency.

There is no simple solution to the Ebola crisis. That’s why we are supporting research into vaccines, treatments, public health and social science. We are also looking at the ethics of conducting research during an epidemic and ensuring that treatments are developed rapidly, in an ethically and scientifically sound manner. There are many pieces to this jigsaw and we are lucky to have experts from a range of disciplines – from infectious disease to medical ethics – at the Wellcome Trust.

Although systematic infection control and isolation practices will remain a key method of disease control, it’s clear given the scale of this epidemic, that we need to consider how other options, such as vaccines to prevent infection, may also impact the spread of the disease.

Through our fast-tracked Ebola funding scheme we have already funded researchers at Oxford University to conduct a vaccine safety trial to evaluate the GSK-NIH Ebola vaccine in human volunteers. Healthy volunteers in Oxford and Mali are currently being given the vaccine, which is based on a type of chimpanzee cold virus, called chimp adenovirus type 3 (ChAd3). Alongside this we are also funding an international consortium, overseen by the WHO, to conduct trials of the Canadian VSV Ebola vaccine in Europe and Africa.

C0105595 Dr Felicity Hartnell. Ebola vaccine trial

Developing vaccines to protect front-line health workers and others at high risk from Ebola infection is a priority, but treatments may also play an important part in getting the outbreak under control. While effective therapies are unlikely to directly reduce transmission, they would encourage people who are infected or exposed to seek treatment, which is critical to containment. Treatment, of course, also has immense humanitarian value.

The Wellcome Trust has therefore funded a clinical trials platform in West Africa to fast-track tests of candidate treatments at existing Ebola centres. Dr Peter Horby of the Centre for Tropical Medicine and Global Health at the University of Oxford will lead an international team of partners, including the WHO and Médecins Sans Frontières (MSF), working on the platform, which will allow the rapid evaluation of potential treatments. Candidate treatments will be prioritised based on factors such as which is likely to work best, the availability of the intervention, the ability to safely administer the intervention in treatment centre settings, and the capacity for manufacture to a useful scale. We have also pledged to support research into convalescent serum, a possible treatment option using antibodies from the blood of people who have survived Ebola.

“It is a huge challenge to carry out clinical trials under such difficult conditions, but ultimately this is the only way we will ever find out whether any new Ebola treatments actually work,” says Farrar.

R2HC_logo_HighResThe Trust is also supporting public health and humanitarian research into the outbreak, and we will be announcing projects we are co-funding via the Research for Health in Humanitarian Crises (R2HC) scheme in the next few days.

The current outbreak of Ebola is now bigger than all the previous outbreaks combined, and with cases in urban, as well as rural areas, it is putting an incredible strain on already fragile health systems. We have therefore made funding available to support UK researchers who want to volunteer to travel to West Africa to undertake work related to the current Ebola outbreak.

Ultimately, we must also do what we can to help Africa develop and strengthen its own research capacity. Which is why the Trust is supporting the African-led development of internationally competitive researchers working across sub-Saharan Africa with the DELTAS scheme. This scheme is aimed at developing the infrastructure and capacity to enable African research excellence in the long-term.

Gradually the pieces are starting to come together, and Farrar is cautiously optimistic that recent developments, research, funding commitments and global collaboration will create a turning point in the Ebola outbreak – but only if we all keep to our promises and keep pushing for progress.

The Wellcome Trust mission to “improve human and animal health” has rarely felt more vital. We will continue to monitor the ongoing situation and evaluate grant applications that we receive. We look forward to working with other global partners make a real difference.

UPDATE (18/11/14):

This week we announced five projects that we are funding via the R2HC scheme, in collaboration with the Department for International Development (DFID) and ELRHA (Enhancing Learning and Research for Humanitarian Assistance). £1.34 million has been released for the projects that include a portable diagnostic tool for Ebola, mapping and modelling the spread of Ebola, and looking at training for health workers that could help them communicate health messages effectively and improve infection prevention and control.

In addition, the UK Collaborative on Development Sciences (UKCDS), has developed a database to collect information on all current academic research relevant to Ebola that they been informed about. The aim is to reduce the risk of duplication of research and enable research funders across the globe to better align their activities to achieve the biggest impact. Details of how to share information to be included in the database can be found on their website.

To find out more about the Wellcome Trust’s Ebola rapid-response research fund visit our Ebola funding page. We have created several Q&As to answer some of the most frequently asked questions on Ebola and promote #FactsNotFear. You can also keep up to date on our Ebola funding announcements via our news pages.

Image Credits: Ebola virus particles – NIAID via Flickr – CC-BY; Map of West Africa – By Mondo Magic (Own work) [Public domain], via Wikimedia Commons; Vaccine Trial, via Wellcome Images

Wellcome Trust Research Round-up: 10.11.14

10 Nov, 2014

Our fortnightly round-up of research news from the Wellcome Trust community…

Researchers re-construct the early stages of embryo development

Scientists supported by the Wellcome Trust have assembled mouse embryonic stem cells that behave like an embryo during the early stages of development. The way that cells divide and differentiate when an embryo develops is distinctive, and until now, has not possible to recreate by assembling stem cells in labs. The researchers, based at Cambridge University, suggest that the key factor is bringing together a critical number of cells, which in this case was 300. You can watch the process in action in this video:

At first cells in an embryo look identical and often form a ball. The group of cells then becomes asymmetrical as cells ‘specialise’ into different types, forming an axis which provides an initial structure for the embryo to develop along. In animal embryos, this stage is followed by a process known as gastrulation, where (using the initial axis as a reference) the head and the tail, and the front and the back are defined.

This research, published in the journal Development, reports a way to coax cells to create an axis and undergo movements and organisations that mimic the process of gastrulation. The researchers were also able to generate the early stages of a spinal cord, which they showed forms as part of the process of gastrulation.

Professor Alfonso Martinez-Arias from the Department of Genetics at the University of Cambridge, who led the research, says: “Axis formation and gastrulation are the two central processes that initiate the development of an organism and are inextricably associated with the embryo. We have managed to recreate this for the first time in the lab.”

Homelessness and health report

homeless signThe health consequences of homelessness are far reaching and in order to reduce the negative impact they have, we need to target groups at high risk of homelessness, according to a report led by Wellcome Trust Senior Research Fellow Professor Seena Fazel. The paper, the first of a two-part series published in The Lancet, reviews the extent of homelessness in the EU and USA, the impact it has on individual health and healthcare systems, as well as recommendations for improving the situation.

The paper reported that there are 400,000 homeless people in Europe and 600,000 in the USA on any given night. In addition homelessness was found to affect a wide range of health problems, far beyond drug and alcohol related problems, which are traditionally targeted when improving the health of homeless people. For example, the homeless are 20 times more likely to develop tuberculosis than in the average person and seven times more likely to develop mental health issues such as depression.

Homelessness also was reported to put a large financial strain on healthcare systems, as homeless people were found to be four times more likely to use acute health services such as accident and emergency than their non-homeless peers. The paper reports that the health problems caused by homelessness cost the NHS an estimated £85 million each year.

Whilst the report recommended developing national targets to improve the health of homeless people, it also called for healthcare professionals to lobby policymakers to reduce homelessness via more affordable housing and more employment opportunities for low-skilled workers.

When it comes to sickle cell genetics, East and West aren’t too different

B0000521 SEM sickled and other red blood cellsA collaboration between Tanzanian researchers and the Wellcome Trust Sanger Institute has combined local genomics research with large-scale genome-wide association studies to shed light on genetic variations leading to sickle cell anaemia in East African populations. Although sickle cell anaemia is most common in Africa, most genetic studies are of African-Caribbean and African-American populations in the UK and the US respectively.

In African-American populations, genetic variations exist that reduce the ability to produce foetal haemoglobin by up to 50%. This study investigated the genomes of 1,213 individuals in Tanzania to confirm whether or not the same variations are present in an East African population, and to identify possible new ones.

The research found genetic variations near the genes BCL11A and HBS1L-MYB in the Tanzanian population with sickle cell anaemia, which have also been found in African-American populations. However variations in HBB, which are associated with the disease in African-American populations, were not found to be significant in East African populations. There were also other genetic associations which weren’t confirmed when compared to UK populations, so will need to be investigated further using larger populations.

“By carrying out a large-scale genome-wide association study we have, for the first time, been able to identify powerfully the prevalence of genetic variants involved in sickle cell anaemia in the Tanzanian population and how that compares with other populations,” says Siana Nkya Mtatiro, co-first author of the paper from Muhimbili University of Health and Allied Sciences. “We have also identified suggestive additional variants, which can now be studied further by the research community in the search for interventions for sickle cell anaemia in patients in Africa and worldwide.”

In other news…

Unravelling Eve, a Wellcome Trust Small Arts Award funded film won a Highly Commended award at the Scottish Mental Health Arts and Film festival, where it was screened on the 17th of October. A version of the story has also aired on BBC Radio 4.

Wellcome Trust supported researcher Professor David Molyneux was made Honorary International Fellow of the American Society for Tropical Medicine and Hygiene.

Image Credits: 19th Jan: Shelter - Helen Taylor on Flickr – CC-BY-NC 2.0 and SEM sickled and other red blood cells -EM Unit, UCL Medical School, Royal Free Campus’, Wellcome Images.

Image of the Week: Sample of an Unknown Soldier

7 Nov, 2014
Source:  Wellcome Trust Sanger Institute

Source: Wellcome Trust Sanger Institute

This week’s image tells us a story about remembrance. It’s a story that reminds us of the millions of soldiers who lost their lives during World War I, not at the hands of guns or grenades, but from infectious disease. It’s also a story that demonstrates the impact of people from the past on our health today. In this case, this impact comes from a 1915 tissue sample containing Shigella flexneri, the bacterium which causes dysentery .

Scientists at the Wellcome Trust Sanger Institute wanted to understand how dysentery has evolved over the years, in order to help them combat the disease in developing countries. In these areas it has become increasingly resistant to antibiotics and kills hundreds of thousands of children under five each year.

To understand how Shigella flexneri has changed, researchers analysed the genome of the 1915 sample of Shigella flexneri and compared it to genomes from modern samples. Analysis of the 1915 sample identified areas of the genome that have evolved over nearly 100 years to evade modern antimicrobial treatments. The research also revealed areas of the genome showing resistance to penicillin before it was in widespread use – suggesting inbuilt resistance to the drug.

With this year marking the centenary of WWI, researchers decided to try to identify the soldier that the original sample came from, so they could recognise the contribution he had made to their research. They started out with a clue: the sample’s strain name – Cable. Using Public Health England’s records and the National Archives, Dr Alison Mather from the Sanger Institute was able to track down the hospital where the sample was likely taken. After sifting through the records of a provincial French hospital, Dr Mather eventually found an entry for a Private Ernest Cable of the Second Battalion of the East Surrey Regiment. It recorded his death from dysentery on March 13 1915.

“So many of the samples we work with in bacterial genomics have stories that we’ll never know,” says Dr Mather. “Finding Ernest and learning his story was a chance to commemorate those who fought in World War I, and to highlight the burden of infectious disease during this time.”

The image above is taken from a short film produced by the Wellcome Trust Sanger Institute that explains this research and the story of finding Private Cable. 

The research papers based on this sample are available in The Lancet and can be accessed online here: Bacillary dysentery from World War 1 and NCTC1, the first bacterial isolate in the National Collection and The extant World War 1 dysentery bacillus NCTC1: a genomic analysis.

Researcher Spotlight: Dr Lindsay Hall

3 Nov, 2014

Dr Lindsay HallDr Lindsay Hall wants to understand what’s going on in your guts. She’s a senior lecturer in gastrointestinal science at the University of East Anglia and holds a Wellcome Trust New Investigator grant. By understanding the communities of bacteria in the gut – especially how they develop in early life – she hopes it will be possible to develop therapies to help people with diseases caused by a disturbed balance of gut bacteria…

What are you working on?

We are working on the bacterial communities that inhabit the gut, termed the microbiota.

We are specifically focused on early life and how these beneficial bacteria such as bifidobacteria are able to colonise and subsequently protect us from pathogens. We’re also examining how early-life antibiotic administration disturbs these communities, and characterising new species/strains that could be used to ‘boost’ our microbiota after disturbances caused by antibiotics.

We’re also looking at how probiotics modulate the very early life microbiota in preterm infants and correlate this back to health.

What does your average day involve?

It’s normally very varied – each day is quite different from the next.

B0008091 Streaking bacteria on an agar plateAlthough I don’t normally do all these things in one day, this is normally what I get up to in the week: catching up on emails (so many emails!), discussing projects with everyone in the lab, meetings (science, admin, teaching), committee work, teaching/lecturing (undergraduate medical students), planning studies/projects and normally I have grants I need to work on, reading science journals, giving talks for both science and lay audiences…

I might get in to have a quick look at people’s agar plates or maybe show a technique, but I’m normally too busy to really get my hands dirty. I’m hoping that once the group is really settled and running I’ll get back in, but there is just so much to do when setting up the lab and group!

Why is your work important?

It’s important as our microbiota are critical for our health, including immune development and resistance to pathogens.

Disturbances in our microbiota can lead to a whole host of diseases and increase our susceptibility to infection. We start to ‘collect’ our microbiota straight after birth. During this time our beneficial bacterial communities are very fragile and can easily be disturbed, so we think its super important to understand what’s going on right at the start so we can have an impact on both short- and longer-term health

What do you hope the impact of your work will be?

We hope that by really getting to grips with the mechanisms of early-life microbiota colonisation and interactions with the host (in this case, us!) we can develop beneficial bacterial or ‘probiotic’ therapies. These could then be used to supplement or treat infants that may have a disturbed microbiota or disease/infections, so we can promote lifelong health.

So, rather big(!) goals, but we like to think big and we always think about the way our projects in the lab can impact people in the longer term.

lindsay hallHow did you come to be working on this topic/in this field?

Actually through a great collaboration during my postdoc in Ireland (University College Cork). I had a very strong focus on immunology and host responses with respect to chronic intestinal inflammation and one of the microbiology groups within the department, led by Prof Douwe van Sinderen, had some really interesting data on a microbiota member, called Bifidobacterium breve. They wanted to look further into how specific surface molecules could interact with the host. So we did, and we got a really nice story from the collaboration.

I also had a strong microbiology-host response background from my PhD but with a focus on pathogens, so I took all the bits I really enjoyed from my PhD, my postdoc, collaborations, and I read (a lot of!) papers. I decided this would be a great area to work in as the potential for impact and discovering lots of new and exciting things was high.

How has Wellcome funding helped you/your research/your career?

I was actually a Wellcome PhD student at the Sanger Institute and that gave me the environment and support to really start asking independent questions at a fairly early stage in my science career, and also the facilities to do some really interesting studies and answer some important questions.

When I moved back to the UK after my postdoc to start my first independent position at the University of East Anglia, I immediately thought of the Trust for funding to really get my independent career up and running. I was very lucky to be awarded a prestigious New Investigator award that has provided me with the funds to start building a world-class team and lab environment to answer questions surrounding the early life microbiota and health.

What’s the most frequently asked question about your work?

How far away are we from developing new therapies?

Which question about your work do you most dread – and why?

The same as above!

As early life microbiota disturbances have been linked to lots of diseases – including asthma, eczema, inflammatory bowel disease, autoimmune diseases, infections – we know how important therapies could be. We want to get there as soon as possible, but there is still so much to understand and develop.

Tell us something about you that might surprise us…

sprowstonladiesI play Sunday league football for one of the local ladies 11-a-side teams, Sprowston Ladies in Norwich.

What keeps you awake at night?

What I need to do in work the next day and making sure everyone’s projects in the lab are interesting/exciting and will produce some nice insights – which is incredibly important for their career development.

What’s the best piece of advice you’ve been given?

Focus” – although being a new principal investigator this is sometimes difficult as there is so much to find out!

Our chain reaction question, set by previous spot lit researcher Dr Kenneth Baillie, is: “What should scientists do more of?”

Engage with the public about their research! Let’s get everyone as excited about our research as we are!

You can find out more about Dr Lindsay Hall and her research group on her University of East Anglia research page and read more about the research she carries out on the Institute of Food Research’s Gut Health and Food Safety Programme blog

Image credits: Streaking bacteria on an agar plate – Pablo Rojas, Wellcome Images, Sprowston Ladies in Norwich, supplied by Dr Lindsay Hall,

Image of the week: ‘ferning’ saliva

31 Oct, 2014

B0008610 Human saliva displaying ferning

The beautiful branching structure of these crystal formations may remind you of minature ferns. If so, you aren’t alone – our image this week depicts of a phenomenon known as “ferning”!  What you are looking at here is a microscope image of human saliva.

The ferning pattern of crystallization is used to identify when a woman is at their most fertile period in the menstrual cycle. The oestrogen spike during a woman’s most fertile period causes salt crystals to form in her saliva, creating this pattern when magnified.

Although studies suggest that the reliability of this as a measure of ovulation is relatively weak, research  has begun to investigate specific substances found in saliva during ovulation, creating potential for a non-invasive diagnostic marker for ovulation. Knowing when ovulation occurs is important in IVF and other fertility treatments, but the best methods currently involve taking blood or ultrasounds.

Saliva ferning has also been investigated as a way of diagnosing a condition called Sjögren’s Syndrome (SS). SS is an autoimmune disease in which tear and salivary glands are attacked by white blood cells. A ferning pattern in tears or saliva may be an indicator of damage to the glands producing them.

Image credit: Anne Weston, LRI, CRUK, Wellcome Images

Wellcome Images is one of the world’s richest and most unusual collections, with themes ranging from medical and social history to contemporary healthcare and biomedical science. Over 100,000 high resolution images from our historical collections are now free to use under the Creative Commons-Attribution only (CC-BY) licence.

Facts Not Fear: Will we find a cure?

30 Oct, 2014

B0009935 Ebola virus structure, illustration

In the last of our “Facts Not Fear” Ebola Q&A posts we focus on the research being done to find effective vaccines and treatments for Ebola. The Wellcome Trust has partnered with a number of organisations to fund vaccine safety trials, research potential therapies, and we initiated a fast-tracked funding scheme for public health research in this area.

This post aims to help answer some of the frequently asked questions about the work being done, and how long it might take to move from positive research results to delivery of vaccinations or treatments to those who need them most.

Who is most at risk of contracting Ebola?

Currently front-line workers in the West African countries affected by Ebola – for example those treating or caring for patients, burial workers, cleaners – are most at risk of contracting Ebola. Next most at risk are other people in these affected countries who have close contact with patients. The risk to the general population in places like the UK is very limited.

Is there a cure for Ebola?

At the moment there is no cure for Ebola. The treatment that is currently available includes supportive care such as fluid management, antipyretics (medication that reduces fever), analgesics (painkillers) and anti-emetics (drugs against vomiting and nausea)

What’s the difference between a vaccination and a therapy/treatment?

Vaccines aim to provide protection to healthy people at risk of contracting the disease, whereas therapies aim to treat those who have already contracted the disease.

We heard about experimental treatments like ZMapp – what are they and why are we not using them on more people?

ZMapp is an investigational drug that comprises three antibodies that target a surface protein of the Ebola virus. There is some evidence that the drug can be effective in animal models, however, there is no clear evidence that the treatment works in humans. Although ZMapp was used compassionately in a few sick healthcare workers, it has not yet been tested in any clinical trials to determine its true effectiveness.

Before potential treatments can be rolled out to everyone they need to be adequately tested for their safety and efficacy. This requires safety trials in healthy volunteers first, followed by efficacy trials in volunteers with Ebola disease. There are some potential drugs that have already been tested in humans for other diseases but have not been tried till now to see if they work against Ebola. Such drugs can go straight into efficacy trials.

In order to do these trials you need sufficient doses, and currently ZMapp doses have been depleted. As ZMapp is made in tobacco plants the whole process can take as long as six months to grow. Researchers are working hard to scale up production and to investigate alternative quicker non-plant mechanisms to make the drug, but this is not a simple task. There are supplies of other candidate drugs which may be deployed.

We hear that lots of research is being funded – when will we get results/a treatment that we can use?

The scientific community is working hard with the pharmaceutical industry, governments, civil society, philanthropic foundations and the WHO to fast-track research into potential treatments and vaccines.

Currently vaccine safety trials are being conducted in healthy volunteers in Europe, USA and Africa. If there are no safety issues the next step will be to carry out trials to test their efficacy in at risk volunteers in the affected countries. There is hope that these could start as early as December 2014, but even then clear results may not be available for several months.

It is really important that we move fast, but we also have to move safely. We also have to accept the reality that new drugs and vaccines will need to be tested in the three most affected countries, but their health resources are stretched to the limit and beyond, so it is not going to be easy for trials to be conducted against this background.

 

Read our previous “Facts not Fear” posts to find out why this outbreak has been so hard to control and what needs to be done to stop the spread of Ebola. Visit the Wellcome Trust news pages to find out what the Trust has been doing to help fund Ebola research.

Image: Ebola virus structure, illustration Credit: Maurizio De Angelis, Wellcome Images

Facts not Fear: How do we get the Ebola outbreak under control?

29 Oct, 2014

 

B0009934 Ebola virus structure, illustration

In the second of our “Facts not Fear” posts we ask the experts at the Wellcome Trust about the way the current Ebola outbreak is affecting people and explore some of the options for getting the epidemic under control.

What effect is the Ebola outbreak having on West Africa?

It is having a devastating impact on the whole of the region, and it’s not limited to those infected with Ebola. Malaria will be worse this year, childbirth facilities and schools are closed, and vaccinations of children are not happening in West Africa as well as they would normally. Economies just starting to recover have been dealt a cruel blow with long term consequences and trust will have been eroded between communities and authorities.

These issues are concerning, but we have to have a calm, sensible approach and not panic. We can deal with these issues as long as we retain a sense of proportion and work together. Outside of Liberia, Guinea and Sierra Leone, the spread of Ebola has so far been contained. But we must act now. We have been too slow. The longer we allow this epidemic to continue the harder it will be to eventually control, more lives will be lost, more children left as orphans, the costs will grow and we run the risk of the disease becoming endemic or spreading beyond the region.

What steps have been taken to keep the neighbouring countries safe? Are they prepared to deal with isolated incidents?

They have been preparing for this now for some time. Nigeria was able to control it very efficiently, and Ebola is not present in Nigeria today. The same in Senegal, but all the countries in the region have fragile health systems, and all remain at risk until we bring the epidemic to a complete end.

Preparation across the whole of West Africa is critical, but the best way of protecting it is to focus on the three countries affected, and bring the epidemic to an end in those countries. That will help them, the region and the rest of the world.

Is closing borders an effective way of stopping the spread of Ebola?

Closing borders is not a practical way to control the epidemic. In today’s modern world transport and movement of people and goods occurs at an ever-increasing rate. Few countries are self-sufficient or could manage with closed borders for even a few weeks.

Travel bans are not necessary from an epidemiological perspective and could make matters worse, they will lead to food shortages and block critical aid reaching the affected people, will instill even greater fear that could lead to uncontrolled migration and further spread of the disease.

What about screening at airports? Is that an efficient way to stop Ebola and other infectious diseases spreading?

Every infection is different and for some infections fevers are a good marker of whether someone might be infectious, but for many infectious diseases you can pass it on to someone else before you have a temperature.  With Ebola you are very unlikely to be able to pass the infection on before you have symptoms.

Screening at airports upon entry to a country is not very efficient. It may identify a small number of people and it will increase awareness – making people think twice before they fly if they have a fever – and allow information to be passed on to people (for instance access to clinical care, what to do if they develop a fever, etc) but it won’t solve the problem in itself.

Most people with a fever will not have Ebola and most fevers are minor and cause absolutely no problems. Introducing routine blanket screening for fevers across all airports in the world will increase the level of public fear while only identifying a very small number of cases if any. Screening for a fever at departure from the region and advising home monitoring for fever over the next three weeks does make sense.

What’s the mortality rate for Ebola in this outbreak?

In the current outbreak it is estimated that 70% of those infected by Ebola will die. That is 7 in every 10 people.

Would access to better healthcare reduce the death rate from Ebola in West Africa?

There is no doubt that the current death rate could be lower if the level of healthcare that we are lucky enough to have in developed countries was available.

The death rate in the UK would be significantly lower than it is in West Africa, but Ebola is an incredibly nasty infection and even in London or New York or Geneva, the death rate would still be high just because of how terrible the infection can be. We don’t have a specific treatment for it at the moment, but research is being done to develop one.  Although we don’t have a ‘drug for Ebola’ very good clinical care will reduce the death rate.

In the UK we are lucky to live in a country where healthcare is available and provided free through the NHS. If you compare our situation to the events in West Africa, the fragile nature of their health systems is one of the major contributing reasons for the epidemic.

How close are we to an effective pharmaceutical tool to fight Ebola?

We’re getting much closer, but we don’t know in fact whether ZMAPP works or how effective it might be, although initial reports look encouraging. Convalescent serum (using antibodies from the blood of people who’ve survived Ebola) might offer the best potential treatment for Ebola in the short term that could be scaled up if proven effective.

We need to collaborate, share all information and move quickly on this and other potential treatments, do research to make sure they’re safe, and we need to learn which ones are really effective.

Does the military have a role to play in stemming this outbreak of Ebola – or will their presence just create more fear about it?

It’s a very delicate balance, but when you start to plan logistics, particularly the organisation of getting large amounts of supplies to an area quickly, building hospitals and clinics, delivering aid or vaccines to remote areas when roads are washed away by the rainy season, there comes a point when the essential logistical support needed can only be provided by the military.

What we mustn’t have is military-style responses in terms of guns on the streets. Violence and coercion are not the way to deliver healthcare, but the military could be incredibly helpful in this epidemic to support the critical work done by organisations like MSF, Oxfam, Save the Children and the very brave healthcare workers who are on the front line.

Can we get this outbreak under control?

Yes. If the global community comes together and implements all of the various things we have all committed to; e.g. massive increase in clinical facilities, public health, diagnostics, drugs and vaccines, then this epidemic can be brought under control.

However we do need to bring all of that together in a coordinated way with clear leadership, and for the international community to live up to the promises that have been made. And we need to do that quickly. If we don’t do that, then the epidemic will continue to increase, it could become endemic, and it could spread beyond the three countries currently affected.

What are the key priorities for getting this Ebola outbreak under control?

The international community needs to work together. We need to call upon our governments to work in partnership with the affected countries and mobilise as many resources as possible to provide support. This could include support for public health workers to take leave and volunteer in the affected areas.

Infrastructure is needed on the ground in the affected countries – from beds and protective equipment to soap, chlorine, clean water, and electric generators. Increasing public health infection control measures is key to bringing the outbreak under control, but given the scale of the current outbreak, developing effective vaccines and drugs may also now be essential. Developing a treatment option for those who do get infected will hopefully save lives and will also help increase public trust and may encourage people to seek medical help earlier. This would have a major impact on the epidemic. There will inevitably be future Ebola epidemics and we need to be better prepared for those events.

Is there anything that individuals can do to help?

Yes, there is a huge amount of things we can all do, for example supporting what MSF, Oxfam, Save the Children and others are doing in West Africa, all of that is an enormous help and it’s a fantastic thing to do. The Disasters Emergency Committee launched an Ebola crisis appeal today to raise money to help get this outbreak under control. The UK Government will match the first £5 million donated.

But there are also other ways the situation can be helped – for example encouraging politicians and your MPs to appreciate how serious the situation is. We should also all be responsible about the way we discuss Ebola as a society. For example, there is no need for schools to ban students who have been in a completely different and unaffected part of Africa.

You can read our previous “Facts not Fear” post to find out why this outbreak has been so hard to control. Visit the Wellcome Trust news pages to find out what the Trust has been doing to help fund Ebola research.

Image: Ebola virus structure, illustration Credit: Maurizio De Angelis, Wellcome Images

An INDEPTH Look at Mortality Data

29 Oct, 2014

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The INDEPTH network has today released a massive amount of information about cause of death from countries in Africa and Asia. Up until now such information was patchy, limited to single sites and often the underlying data were not available for investigation by other scientists. The head of Population Health at the Wellcome Trust, Jimmy Whitworth, explains why this release is so important and how it will change the way we approach research and policy on child death in low- and middle- income countries.

It is astonishing to find that in the 21st century there are still multitudes of people whose entire lives go officially unnoticed.

In sub-Saharan Africa, it is only in South Africa that there is comprehensive recording of births and deaths. Elsewhere on the continent populations are just estimates based on censuses that happen about every ten years.

Amongst other things, this situation is unsatisfactory for planners and policy makers. It is also a problem for those tasked with organising health systems and services, and those trying to report on the numbers (let alone the causes) of diseases and deaths. As a result most health reports from low- and middle-income countries are based on modelling projections rather than actual events.

One solution to this problem has been to set up long-term Demographic and Health Surveillance Sites (DHSS) where the whole population of a defined area can be observed. Typically survey teams will move from house to house once, or more often, each year recording births, marriages, migration, deaths and collecting health information from the inhabitants.

Indonesia VA pixellated

Dozens of these DHSS exist around the world and they are an invaluable source of information for national policy makers and planners. The value and validity of the information generated can be strengthened by collecting data to a common standard across many sites and comparing and contrasting the findings. For over a decade the Wellcome Trust has supported INDEPTH, a network of DHSS with a secretariat based in Ghana, which has recorded and analysed  cause of death data from sites across Africa and Asia.

Much of this work has been based on the development of computer-based methods to capture and combine information from different reporting systems at individual sites. Data covers a range of common causes of death such as malaria, HIV/AIDS, maternal deaths, communicable disease, and external causes such as accidental death, suicide and murder. One of the important datasets looks at childhood mortality, capturing information on over 28,000 child deaths.

The results show a wide range of infant and child mortality rates across the sites and also show a variety of patterns of causes of deaths. There are some key conclusions that can be drawn from the results.

Malaria is still a major cause of death for children in most of sub-Saharan Africa, especially in West Africa. HIV is a major cause of death of children in South Africa, while external causes, mostly drownings, are common in Bangladesh.

Some countries have several sites reporting in this study, and they often show varied patterns, demonstrating that the findings from one DHSS cannot necessarily be taken as representative of a whole country.

The causes of death were ascribed following a standardised set of questions administered by trained staff to close relatives of the deceased child. This technique, called ‘verbal autopsy’, has been shown to be reliable for identifying many broad causes of death, but it does have its limitations – reflected in the large proportion of ‘indeterminate’ deaths reported at some sites.

In line with Wellcome Trust policy, all of the information, including the individual data records, is being made openly accessible to anybody wishing to study the datasets further. This vast repository of rich information will be invaluable to population scientists, health planners and policy makers, especially those in low- and middle-income countries.

We would like to extend our congratulations to INDEPTH and the scientists at the individual sites are on their tremendous achievements so far.

You can find out more about INDEPTH in this press release and access all the available data via the INDEPTH iShare project website. The journal Global Health Action has just published a special issue which looks at the INDEPTH findings in more detail.

Image credit: INDEPTH network/Peter Byass

 

 

 

Ebola: Facts Not Fear

28 Oct, 2014

B0009931 Ebola virus structure, illustration

The latest WHO figures put the current death toll of the on-going Ebola outbreak at almost 5000, with over 10,000 cases reported in eight countries, mainly those in West Africa.

In a series of three posts this week we will be answering some of the most important and frequently asked questions on Ebola. Experts at the Wellcome Trust, including our director, infectious disease specialist Dr Jeremy Farrar, head of population health Dr Jimmy Whitworth, and international activities advisor Dr Marta Tufet, will help to provide answers.

There has been heightened media attention devoted to the Ebola outbreak in recent weeks, and many people are concerned about the epidemic. We would like to concentrate on facts, not fear, by sharing information from people working to help bring this epidemic under control.

In this first post, we look at the current situation and explore why this outbreak is worse than previous ones. Tomorrow we will look at the effects of the outbreak and what needs to be done to get the situation under control, and on Thursday we’ll focus on the research currently underway to help find a vaccine or treatment for the disease. We hope that you will find the Q&A format and the information of use.

Is Ebola really the deadliest disease known?

Ebola is certainly up there amongst the deadliest diseases, with up to 7 in 10 people who get infected dying. But other diseases, such as rabies, are almost 100% fatal and so even deadlier.

Is it true that Ebola is more infectious than AIDS (as US Senator Rand Paul claimed)?

Ebola is more infectious than HIV/AIDS, mainly because it can be spread by more routes. Any secretions from a person infected with Ebola, alive or dead, can be infectious. This is unlike HIV/AIDS, which can only be spread by sexual contact, infected needles or blood products, or from a mother to an infant.

How late in the stage of having Ebola do you become contagious? From the moment you catch it or only in the very late stages? 

Ebola only becomes contagious once a person develops signs of illness, such as fever, muscle aches and sore throat. This normally doesn’t occur until several days after a person has become infected. This allows time for health authorities to find people incubating the disease and isolate them.

People who might have been exposed to a person with Ebola should report to the health authorities as soon as possible, and immediately if they develop any signs of infection.

What level of contact do you have to have with the bodily fluids of an infected person in order to contract it? In short: how vigorously would I have to wash up my cups if someone who has Ebola came to tea?

Nobody with any signs of Ebola is going to be well enough to come for tea with you. If they are infected but still incubating the disease, with no signs of illness, they will not be contagious. So a quick rinse with hot water and washing up liquid will be fine.

Is there a danger of getting infected by pets? (In light of the Spanish nurse’s dog that got put down) 

Pet animals are a minimal hazard. There is no reason to believe that they spread Ebola. Even the pets of infected people can be managed by giving them a wash and putting them in quarantine for 21 days just to be on the safe side.

Why is this Ebola outbreak so much worse than previous outbreaks?

This outbreak is bigger than all other outbreaks put together. Transmission of this infection in major cities is what’s different compared to previous epidemics. It’s in urban areas as well as rural areas, and that’s what’s allowed the disease to spread more widely. The concentration of infected people living in very big urban centres is a key reason this epidemic has been so hard to control.

In addition, weak health systems are more likely to blame than unprecedented virulence or a different form of transmission. Two of the countries involved have been weakened by prior years of war.

Why is Ebola so hard to control? 

An outbreak of Ebola is not hard to control if it is caught early. If cases are detected, diagnosed and managed correctly, and contacts are identified and isolated, then it can be quickly controlled. In urban, crowded areas where people are more mobile and have a larger number of contacts this becomes much more challenging.

In Senegal and Nigeria, authorities acted quickly and decisively to the first cases detected and managed to control the spread of Ebola very rapidly. This is what would happen in the UK if any cases were to occur, as our public health services are alert and prepared. It is only once an outbreak has been allowed to spiral out of control and many cases are occurring in several different places that it becomes hard to control.

In addition, there are currently no drugs or vaccines on the market that are effective to treat Ebola, although these are in development.

Should we be worried about the way that this outbreak of Ebola is progressing?

We should be concerned about the situation in West Africa – the impact Ebola is having on the health of the people and on their societies. This is where all our focus must be.

The current risks to Europe are minimal, and if the international community, including ourselves, all act on the commitments we have made, this epidemic can be brought under control.

Do you think that this particular strain of Ebola has mutated to be more infectious than previous outbreaks?

There’s no evidence that this virus is mutating at a faster rate than previous epidemics. But this particular virus does get to higher levels in the body than we’ve seen previously, and that may contribute to how infectious it is.

Will the Ebola virus mutate so it can spread via air?

The way the virus is spreading is consistent with what we’ve seen in all previous 25 outbreaks, only transmitting through blood and bodily secretions. There is no precedent for a virus changing its mode of transmission so drastically. Other viruses such as HIV – which transmit in similar ways, have passed through millions of humans, and are known to mutate more than Ebola – have not become airborne.

The chances of Ebola becoming airborne are extremely small. It’s important that we retain a sense of proportion and not exaggerate the risks for it changing and becoming airborne – there is already enough fear and misinformation surrounding this epidemic.

Rather than causing people to panic, we need to focus our efforts on trying to stop this outbreak before Ebola establishes itself in West African countries.

You can find out more about the Wellcome Trust funding for Ebola research on our website.

Image Credit: Ebola virus structure, visualisatoin – Maurizio De Angelis, Wellcome Images

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