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Background: In the UK, four babies are born deaf each day. Children with hearing loss not only have delayed speech and language development, but also have lower educational achievements compared with children who have normal hearing. A cochlear implant is a device that can restore a sensation of hearing to children who are born or become deaf. All newborns are now tested for a hearing loss. Subsequently, children who are suitable for a cochlear implant can be identified in the first few days or months of life. Overall, speech understanding in children improves after cochlear implantation. However, some children's speech and language abilities are much worse than we would otherwise expect and we don't fully understand why this happens. The current tests for assessing levels of hearing and speech understanding are unreliable in very young children. Since children that are born deaf often receive their cochlear implants within the first year or two of life, years can often pass before parents and healthcare professionals become aware of poor speech and language skills. Currently, it is extremely difficult to distinguish between very young children with cochlear implants who are performing well and those who are performing not so well. We want to understand why some children can hear well with a cochlear implant and others cannot. We would also like to predict and identify at the earliest possible stage those children with a cochlear implant who have poor speech understanding. Aims of this research: At the Nottingham Hearing Biomedical Research Centre, we propose to use a non-invasive brain scanning method called functional near-infrared spectroscopy, or fNIRS for short, to measure brain activity in deaf children before and immediately after they receive a cochlear implant. We want to know if this brain scanning technique can be used to test how well a child can hear and understand speech instead of having to rely on existing hearing tests that are only suitable for older children. Although we have considered other methods for measuring brain activity, they are either not safe for use in patients with a cochlear implant or are associated with potential harmful effects. fNIRS is completely safe for children both before and after cochlear implantation and does not have any side effects or risks to health. Expected benefits of this research: If we are able to assess how well a child can hear using fNIRS, clinical professionals could measure speech abilities in much younger children than is presently possible. Subsequently, we will be able to identify and treat children who are not hearing so well at the earliest age. In so doing, we will identify those children with a cochlear implant who struggle with their hearing and need extra speech and language support. At present, without any idea of the abilities of our very young children with cochlear implants, valuable NHS resources for speech and language support are provided to every single child, so that some children may receive more support than they require, whilst others receive too little. fNIRS may help us to tailor and more appropriately direct speech and language support to those children who need it the most. We would also be able to give parents a more accurate explanation of how likely their child is to improve with their cochlear implant. Cochlear implants also need to be 'fine tuned' or programmed regularly so that they provide the best possible level of hearing to meet the needs of an individual. fNIRS has the potential to guide and improve this programming process. This is because it may be able to inform us on how well speech and sound is understood by the brain, years before a child is old enough to tell us, and enable us to make the appropriate adjustments to their cochlear implant. We believe that fNIRS has the potential to allow every child with a cochlear implant to have the best possible treatment that is tailored to their individual needs.

The problem of efficient radiotherapy planning and resource management In oncology departments, In terms of both manpower and the availability of equipment, has been recognised as a key to their smooth running. The various activities, starting from patient referral through to the delivery of the appropriate treatment, form a complex system, for which generating a high quality planning and scheduling solution is a challenging real-world problem that significantly impacts on healthcare staff and patients.This ambitious research proposal concerns both the generation of possible radiotherapy treatments, for patients and the scheduling of resources. This is a joint research proposal between two research groups from the University of Nottingham and Coventry University with expertise from differing but complementary disciplines. Two large hospitals, Nottingham City Hospital and the UHCW NHS Trust in Coventry, which are both providing radiotherapy treatment to a large population throughout their respective regions, are acting as collaborators on the project. They will provide real-world data and expertise in the domain of radiotherapy treatment. The proposed research requires a multidisciplinary effort, aiming at combining different operational research and artificial intelligence disciplines within a complex real-world medical environment.A successful outcome to the proposed research would significantly improve the efficiency and the quality of radiotherapy treatment in the UK. It could lead to a reduction of waiting time and waiting lists for treatments, a reduction of stress levels in patients and improved consistency in terms of dose delivery. Most Important of all, it has a definite potential to increase the survival rate of cancer patients

One in three people in the UK population will develop cancer during their life time. The incidence of cancer continues to increase world-wide and healthcare providers are facing increasing challenges in the management of this expanding group of patients. However, new imaging technologies allow detection of tumours at earlier stages and now more cancer patients than ever can be successfully treated by surgery. Tissue conserving surgery is an advanced surgical procedure that tries to only remove cancerous tissue and leave healthy tissue in place. In skin conserving surgery (also known as Mohs micrographic surgery), one layer after another of tissue is cut away and examined under the microscope to make sure that all the cancer is out. This process is stopped when only healthy tissue is left. Successful removal of all cancer cells is the key to achieving lower rates of the cancer returning. There is always a balance to be struck between making sure that all the cancer is removed and preserving as much healthy tissue as possible in order to reduce scarring and disfigurement. The real challenge however is to know where the cancer starts and ends when looking at it during an operation so that the surgeon knows when to stop cutting. Although Mohs surgery provides the highest cure rates for basal cell carcinoma, the most common type of cancer in humans with ~60,000 new patients each year in the UK, it takes around 1-2 hours per layer to prepare and diagnose under the microscope. The high costs and the need for highly specialized surgeons, has limited the availability of Mohs surgery in the UK and led to "post-code" treatment variability. Compared to Mohs surgery, breast conserving surgery (more than 10,000 procedures per year) is considerably more complex and for practical reasons, the traditional methods of diagnosis by preparing thin tissue specimens cannot be performed during surgery. As a consequence, in England more than 2,000 patients per year require a second operation, usually complete removal of the breast. Recently, my research group has developed a new method to diagnose cancer cells in tissue layers removed during surgery. The main advantage of this technique is that the time consuming steps of tissue fixation, staining, and sectioning are eliminated. This new diagnosis method uses a combination of two techniques called auto-fluorescence imaging and Raman scattering, that can measure the molecular composition of tissue and provide objective diagnosis of cancer. However, this breakthrough is just the beginning and further work is required to take these successes forward and improve patient care. In the short and medium term, I will focus on reducing the diagnosis time for skin cancers to only a few minutes by developing a method to measure Raman spectra from eighteen regions of the tissue simultaneously. In collaboration with cancer surgeons, we will expand this new technology to diagnosis of other cancers, such as breast and lung. This will be achieved by optimizing the auto-fluorescence imaging and Raman scattering to take into consideration the chemical make up of these tissues. In the longer term, I plan to develop novel hand-held medical devices based on multimodal spectral imaging that could be used by the surgeons to diagnose the tissues directly on the body and remove tissue only if cancerous cells are detected. These methods for tumour diagnosis can revolutionise the surgical treatment of cancers, by providing a fast and objective way for surgeons to make sure that all cancer cells have been removed whilst at the same time preserving as much healthy tissue as possible. To achieve these ambitious objectives I will work in close partnership with other scientists, engineers, doctors, surgeons and industry. Such collaborations will ensure that cutting-edge science and engineering is exploited to develop leading healthcare technologies for the benefit of patients.

Incremental Sheet Forming (ISF) is a flexible, cost effective, energy and resource efficient process. It only requires a simple tool to deform the sheet material incrementally by moving the tool along a predefined tool path created directly from the CAD model of a product. Without using moulds, dies or heavy-duty forming machines, it is flexible to manufacture small-batch or customised sheet products with complex geometries. However, existing ISF processes cannot manufacture hard-to-form materials, such as high strength aluminium, magnesium and titanium alloys, because these materials have limited ductility at room temperature. This EPSRC follow-on project aims to build on the initial success of an EPSRC Adventurous Manufacturing grant (EP/T005254/1) in developing a rotational vibration assisted incremental sheet forming (RV-ISF) process to manufacture hard-to-form materials for industrial applications. The RV-ISF process is centred on a novel ISF tooling to generate low frequency and high amplitude vibration in ISF processing, which produces localised heating and material softening therefore improve the material ductility without the need of additional heating or extra energy input. By developing and implementing the novel tooling, RV-ISF experimental testing of a well-known hard-to-form material has demonstrated a 300% increase in forming depth, more than 70% reduction of average grain size through microstructure refinement, 20% improvement in average hardness and up to 37% reduction of average surface roughness. To capitalise the promising findings from the EPSRC Adventurous Manufacturing grant (EP/T005254/1), this follow-on project assembles a multidisciplinary team with expertise in flexible sheet forming, material science and plasticity, advanced manufacturing technologies, novel tooling and bespoke machine systems. The aim is to develop an in-depth understanding of the material deformation mechanisms under RV-ISF processing conditions and to use this new knowledge to expand the material types and products that can be successfully manufactured using this innovative process. In working with the project partners, the follow-on project aims to deliver a range of demonstrable products and to engage in dissemination activities for a swift translation of the developed flexible, cost effective and sustainable forming process into UK's medical, automotive, aerospace and nuclear industries.