Chronic obstructive pulmonary disease (COPD) is a common lung condition most often caused by smoking. Many patients suffer from repeated flare-ups of COPD caused by chest infections. These infections are commonly caused by viruses and are important to treat and ideally prevent. Infections contribute to worsening symptoms of the disease and there is insufficient information about susceptibility to viruses to prevent chest infections or hospital admissions from happening. This study will investigate the environmental factors such as pollution and temperature on viruses circulating in the community on every day symptoms and likelihood of catching infections in COPD. Nationally this will be studied using large central databases and then more detailed study will be done at an individual patient level. This information will be of benefit to both patients and health care providers by helping to improve the organisation of health care resources, particularly in the winter and highlight times when patients should be aware of increased symptoms and viral infections. With the future development of new antiviral treatments for COPD infections this information will also help provide information as to when these drugs should be given to maximal effect.

We aim to know how to better control malaria in one of the most disadvantaged populations of the world. There is very little medical research conducted in Mauritania, in the north western part of sub-Saharan Africa, but the information we have indicates that malaria is a problem throughout the south of the country where most of the population live - most of the north of the country is Saharan desert. However, the disease could probably be effectively controlled and possibly even eliminated in the long-term with appropriate efforts. In countries immediately to the south, particularly in The Gambia and Senegal, recent scale up of interventions has coincided with a significant decline in malaria. Although control in Mauritania may have lagged behind it is in a situation with only a short season of mosquito transmission where the parasites might be eliminated given the right approach. The investigating team at the London School of Hygiene and Tropical Medicine and the National Institute of Public Health Research in Mauritania are planning to use state of the art genomics and cell culture methods along with collaborators at Harvard University and the Wellcome Trust Sanger Institute in the UK as well as in neighbouring Senegal, to understand the parasite populations and how they adapt to antimalarial drugs and invade red cells in a population where most people have little immunity to the infection. This understanding may help target interventions to particular parts of Mauritania and also help in the design of a vaccine that could induce immunity against the stage of the parasite that invades red cells.

Over 10.000 different virus species have the capacity to infect humans. Although the majority of these are silently circulating in wild animals, climate change and human induced land use change are breaking down the geographical barriers. This creates novel opportunities for wildlife carrying those viruses to encounter other animals and humans, and opportunity to share viruses, these are called zoonotic spillover events. Tackling this issue of global environmental changes and disease outbreaks requires a one health approach, linking human health, animal health and environmental health. The drivers of zoonoses are complex and multifaceted, and understanding their interaction requires a holistic approach. This can be realised through fostering a culture of collaboration, multi-, trans-, and inter-disciplinary work that provides integrated solutions that put an environmental approach at its core. This project specifically, will employ a combination of quantitative and qualitative methods. A review of the literature will be performed to collate evidence and possible alternate sources of data. Similarly, a review will be conducted to map and identify innovative methodological tools and techniques across a range of disciplines and research areas. Furthermore, this research will make use of cutting-edge statistical techniques, analyse vast datasets encompassing climate data, land use patterns from satellite data and biodiversity metrics. Through sophisticated spatial modelling we will be able to delve deep into the intricate relationships between these factors which will be critical to understand what drives zoonotic spillover, and additionally, identify and predict global hotspots/areas that are potential geographic points of origin. Through this, a body of evidence will be amassed that provides an understanding what drives zoonotic disease spillover and identifies vulnerable regions globally. Translating this evidence into evidence-based policy will be crucial to developing solutions in terms of prevention and breaking the chain of transmission (UN report) to reduce the risks from emerging or re-emerging zoonotic diseases. To this aim, some work will be undertaken at the WHO Pandemic Hub in Berlin this collaboration and others within the CDT and with other partners will foster the research excellence and impact. The work at the WHO Pandemic Hub will be to develop user interfaces and develop climate-resilient outbreak management recommendations and participate in strategic planning efforts. Not only specialized and technical skills but also general professional competencies are indispensable and will be developed throughout the duration of the CDT. While specialized skills (like spatial modelling, mathematics and statistics) empower to delve deep into academic domains, the fusion of these abilities with general professional skills (such as science communication, collaboration, leadership and project management) is pivotal. Expertise gains significance when coupled with the capability to translate complex research into policies that are comprehensible to policymakers and the general population. All these objectives are strongly in line with the vision, strategy and delivery plans of the UK Research and Innovation and respective councils (MRC, BBRSRC and MRC), specifically relating to the tackling infections theme. Finally, embracing interdisciplinarity, especially in fields like one health, acknowledges the interconnectedness of human, animal, and environmental health. Advocating for innovative and integrated solutions will bridge gaps between disciplines and craft effective strategies to mitigate the risks associated with zoonotic diseases, ensuring a more resilient and healthier global community.

In the last few years there have been many changes in the way that critical care is provided in the UK. This has included substantial investment to increase the number of intensive and high dependency beds. The proposed research will use the example of these changes to examine the relationship between how health care is organised, who gets health care and the outcomes of health care. With respect to critical care, the research aims to identify organisational factors that are associated with better outcomes for patients. More generally, the research aims to improve the design of studies that look at the impact of organisational factors in other parts of the health service.